The Veterans Affairs Department is ratcheting up efforts to address the high rate of suicide among veterans, bringing in mental health experts, advocates and affected families to formulate an "action plan" in the coming months to reduce these preventable deaths.

VA Under Secretary for Health Dr. David Shulkin said Tuesday that suicide reduction is one of his top priorities, and he called on experts to help the department establish prevention initiatives aimed at getting veterans into treatment.

"This is really one of our top priority issues for VA," Shulkin said. "Seeing the number of suicides that occur every day is simply not acceptable."

The VA hosted a Veterans Suicide Summit in Washington, D.C., on Tuesday to jump-start the effort, drawing behavioral health providers, veterans service organizations, Defense Department personnel and veterans who have attempted suicide, as well as parents of troops who have died.

VA Secretary Bob McDonald and members of Congress also took part.

"In recent years, the suicide rate has risen steadily for the general population, but not veterans in the VA system. For veterans in our care, rates have remained stable, maybe even declined slightly, which tells us that treatment works," McDonald said.

The VA estimated in 2012 that 22 veterans die each day by suicide, but the number is an extrapolation derived from 1999-2011 data from 21 states, and both the VA and advocacy groups say it should be interpreted with caution.

Given that at least four states with large veterans populations were not included in the calculations — California, Texas, Arizona and North Carolina — the numbers could be higher.

So one of the first orders of business for the new initiative is to obtain concrete data on the extent of the suicide epidemic among veterans, VA officials said.

VA has been working with states and the Centers for Disease Control and Prevention to get the information since it released its 2012 Veterans Suicide Data Report; a more definitive report is expected by June.

"This data is going to help inform all of what we do after that," said Caitlin Thompson, Veterans Health Administration national mental health director. "The information is going to help us focus our efforts."

The summit provided opportunity for speakers to offer recommendations for improving suicide prevention efforts. Many offered a laundry list, from better organization and improved data to elevating the VA's suicide prevention office to a more prominent position within the department.

For many, appointing a single agency to lead the effort was a top concern.

Iraq and Afghanistan Veterans of America research director Jackie Maffucci said that with so many organizations working on the problem, it "needs a champion."

"We need a convening authority. We need someone to organize all of this energy, all of this momentum into something more organized and much more effective," Maffucci said.

The parents of Army National Guard veteran Daniel Somers and Marine veteran Clay Hunt, who died by suicide in 2013 and 2011 after long, frustrating efforts to receive medical care at the VA, have long lobbied the system for change.

Taking the podium Tuesday, they pressed for changes to privacy laws to allow doctors to alert a family member if their veteran is suicidal, stronger disciplinary rules for poorly performing VA employees, and improved transition from the military to the Veterans Health Administration.

"It took six weeks to turn our son from a civilian into a soldier. It should have taken them at least six weeks to transition him back," Jean Somers said.

The new initiatives were made possible largely through the Clay Hunt Suicide Prevention for American Veterans Act, but VA has stepped up efforts in the past decade to address the the issue.

Its suicide hotline, the Veterans Crisis Line (800-273-8255, Press 1), has had more than 2 million callers since it was established in 2007, with nearly a quarter of those calls — 490,000 — coming in last year.

It is funding a massive research study at 30 facilities across its system to determine whether the drug lithium can prevent suicide.

And it has hired more than 9,000 mental health clinicians — psychiatrists, psychologists, social workers and therapists — since 2009.

But for some, the slow pace of progress has been discouraging. Andrea Sawyer, who has cared for her husband, Loyd, and fought to keep him alive since he returned home from Iraq in 2007 with severe post-traumatic stress disorder, said it was ironic that the forum took place on Groundhog Day, a reference to the movie.

"Right? It's like watching the same thing over and over again. How many conferences do we need to hold on this? We are literally studying veterans to death. I'm tired of hearing the same thing and not moving forward," Sawyer said.

Some communities that have been overlooked at previous forums were given the opportunity to participate. Former Sen. Elizabeth Dole spoke of her concerns for the caregivers of disabled veterans who may be at risk for suicide and Rand Corp. senior behavioral scientist Rajeev Ramchand addressed the large number of veterans who do not have access to VA care because they received bad-conduct discharges, many for conduct possibly linked to post-traumatic stress disorder or traumatic brain injury.

"If you want to get serious about veterans suicide, you need to be serious about addressing the number of suicides among those with bad paper," Ramchand said.

VA Under Secretary for Health David Shulkin

Photo Credit: Mike Morones/Staff

Shulkin said VA plans to be more aggressive in ensuring that all eligible veterans are enrolled in VA care, since 70 percent of veterans who die by suicide are not under VA care.

He promised to "do more" and said he is action-, not talk-, oriented.

"We are going to be sitting down and going through the ideas we've heard here, we are going to go through the more than 90,000 tweets we received [about the conference] and we're going to come up with a plan. And we're not going to stop until we can figure out how to do more."

Patricia Kime is a senior writer covering military and veterans health care, medicine and personnel issues.

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