On February 12th, President Obama signed into action the Clay Hunt Suicide Prevention for American Veterans (SAV) Act. This piece of legislation was developed by Iraq and Afghanistan Veterans of America (IAVA) due to the alarmingly high rate of suicide among veterans. The Clay Hunt SAV Act is a multifaceted policy aimed at improving mental health services provided to veterans and active duty members in order to reduce the current rates of suicide.
This piece of legislation was named in honor of Clay Hunt, a Marine veteran who died by suicide in March 2011. According to the IAVA,
“Clay enlisted in the Marine Corps in May 2005 and deployed to Anbar Province, near Fallujah, in January 2007. Clay was shot in the wrist by a sniper’s bullet that barely missed his head, earning him a Purple Heart. Clay recuperated at Twenty Nine Palms, CA and then graduated from the Marine Corps Scout Sniper School in March 2008. Clay redeployed to southern Afghanistan a few weeks later. His unit returned in late October of 2008 and he was honorably discharged from the Marines in April 2009.
Clay initially received a 30% disability rating from the VA, but Clay submitted an appeal after struggling with maintaining a full-time job due to his PTSD. However, his appeal was met with significant bureaucratic barriers, including the VA losing his file. Clay constantly voiced concerns about the care he was receiving, both in terms of the challenges he faced with scheduling appointments as well as the treatment he received, which consisted solely of medication. After moving back to Houston to be closer to his family, Clay had to wait months to see a psychiatrist at the Houston VA medical center. Two weeks later, Clay took his own life. Five weeks after his death, and 18 months after filing an appeal with the VA for his PTSD rating, Clay’s appeal finally went through. The VA rated his PTSD 100 percent.”
Veterans are at risk for mental illnesses like post-traumatic stress disorder (PTSD), anxiety, depression and substance use disorders, particularly alcohol abuse (Hoge et al., 2004; Seal et al., 2009). While the prevalence of PTSD in a community sample was found to be approximately 9%, the prevalence of PTSD among veterans is approximately 16-21% (Breslau, 1998; Hoge, Terhakopian, Castro, Messer & Engel, 2007; Seal et al., 2009).
The suicide rate among active service members in 2012 was 22.7%, an increase from 2011 and 2010 (Department of Defense, 2013). However, this statistic does not include veterans who are no longer serving. Further, veterans who served in Iraq or Afghanistan are 35% more likely to commit suicide than other veterans (Sargent, 2009).
According to the Veterans Health Administration (VHA), rates of suicide are almost twice as high among VHA users with a mental health diagnosis (Kemp, 2014). However, after the VA began an intensive effort to track and reduce rates of suicide in 2007 and 2008, the rates of suicide among VHA users decreased in 2009 and 2010 (while the rates of suicide among non-VHA users increased) (Kemp, 2014).
Therefore, suicide risk assessments could improve mental health services for veterans and greatly reduce the risk of suicide by early identification. Additionally, psychoeducational prevention programs for all VHA users, not only those with a mental health diagnosis, would be a more inclusive approach, considering the rate for suicide among VHA users without a mental health diagnosis was still 25 per 100,000 in 2011 (Kemp, 2014).
The IAVA published a policy agenda in 2014, which reviews their suggestions for reducing rates of suicide among veterans:
1. Involve the American public by launching a national awareness campaign and reducing the stigma associated with mental illness or seeking mental health care.
2. Improve access to timely mental health care by extending access to mental health care beyond 5 years and ensuring that service members who are discharged due to a personality disorder or disciplinary problems are not the result of mental health injuries.
3. Ensure the healthcare system can meet the demand of today’s veterans by providing incentives to mental health providers to address the national shortage of mental health professionals, expanding TRICARE benefits and accurately adjusting Medicare reimbursement rates with rising healthcare costs.
4. Improve the quality of care provided to veterans by investing in research to identify best practices in mental health care and suicide prevention as well as developing a nationally recognized certification program that would train mental health professionals in military culture and the unique challenges faced by service members, veterans and their families..
5. Proactively identify and support service members and veterans in crisis by training VA primary care providers and their staff in the assessment of suicide risk as well as improve communication across VA departments regarding a veterans or service member in crisis.
6. Ensure service members and veterans are not lost in the system by improving joint efforts between the Department of Defense, VA, state and local mental health providers as well as follow-up with veterans that call the Veterans Crisis Line.
Now that President Obama has officially signed the Clay Hunt SAV Act, we are eager to see which IAVA policies the White House decides to implement. Hopefully this new policy will be effective in reducing suicide rates as well as improving the mental health and quality of life among American veterans and their families.
Breslau, J., Lane, M., Sampson, N., & Kessler, R. C. (2008). Mental disorders and subsequent educational attainment in a US national sample. Journal of psychiatric research, 42(9), 708-716.
Department of Defense. (2013). Suicide Event Annual Report, 2012. Retrieved from http://t2health.dcoe.mil/sites/default/files/dodser_ar2012_20140306_0.pdf
Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. I., & Koffman, R. L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 351(1), 13-22.
Hoge, C., Terhakopian, A., Castro, C., Messer, S., & Engel, C. (2007). Association of posttraumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq war veterans. American Journal of Psychiatry, 164(1), 150-153.
Kemp, J.E. (2014). Suicide Rates in VHA Patients through 2011 with Comparisons with Other Americans and other Veterans through 2010. Veterans Health Administration. Retrieved from http://www.mentalhealth.va.gov/docs/Suicide_Data_Report_Update_January_2014.pdf
Sargent, W. M. (2009). Helping Veterans Transition into Academic Life through the Creation of a University Veteran Support Group: So We Can Better Serve Those Who Served Us. Institute of Education Sciences. Retrieved from http://eric.ed.gov/?id=ED505889
Seal, K. H., Metzler, T. J., Gima, K. S., Bertenthal, D., Maguen, S., & Marmar, C. R. (2009). Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002–2008. American Journal of Public Health, 99(9), 1651.