She’d tried suicide once before. This time, she meant it.

It had been nearly 16 years since her first attempt. She was in the Coast Guard then, the first year of a two-year stint. She felt isolated, and the pressures of her job overwhelmed her. But after downing a bottle of aspirin, she panicked and walked to a nearby hospital.

In the intervening years, she’d been diagnosed with depression and PTSD. She’d been in treatment and on medication: Prozac, Zoloft, Wellbutrin, others. Still, she struggled.

“In 2004, they told me, ‘You’re intractable,’ that I should consider institutionalization or conservator-ship,” said the veteran who requested anonymity. “I said, ‘If that’s what’s ahead of me, I can’t do this anymore.’”

Her then-husband was out of town. She dumped 240 50 mg tablets of Trazodone, a sleep inducing anti-depressant, into a blender, mixed in some water and drank it.

“I put a note on the bedroom door warning whoever found it what they would find when they opened the door,” she said. “That there was going to be a dead body.”

She was ready to become one more number in the tally of suicides among female veterans, a tally that is far outpacing suicides among nonveteran women.

Results of a massive study issued Aug. 4 by the U.S. Department of Veterans Affairs show that the rate of suicide among female veterans is several times higher than that of women in the general population.

But her name was not among the suicide count.

She survived. She had ingested so much of the drug that it paralyzed her. It also caused her to vomit much of what she’d taken. Though she didn’t die, she was incapacitated for days. The experience, she said, cured her of any further attempts.

“My mind was fully functional while my body was shutting down,” she said. “It was terrifying. I decided to take suicide off my list.”

For the past four years she has worked with other survivors of suicide attempts and those dealing with severe trauma. Currently, she is part of the mental health support staff at the VA Medical Center in Loma Linda.

Sex assaults linked

She and others say that the high rate of suicide among female veterans and the high number of sexual assault reports in the same population go hand in hand.

“Military sexual trauma plays a big part,” she said, when it comes to reasons female veterans report for considering or attempting suicide. “We’re talking rape. It’s so close to 100 percent.”

Often, she said, it is coupled with sexual trauma experienced before entering the military. In her own case, she said, she was sexually abused as a child and a teenager. While she said she endured crude jokes and innuendo during her time in the service, she was never assaulted. Several years after swallowing the aspirin, she was diagnosed with PTSD and clinical depression.

Floyd “Shad” Meshad, has been working with veterans for more than 40 years. The president of the Los Angeles-based National Veterans Foundation, he too sees the connection between sexual assault and suicide among female veterans he counsels.

“Last year there were 26,000 cases of sex abuse cases in the military,” Meshad said, citing a figure from a 2013 Rand survey. “When you consider the number of women in the military, that seems outrageous. It seems to be at an epidemic level.”

The new VA study looked at 55 million veteran records from 1979-2014.

The findings are presented in such a way that it makes it difficult to compare data with a report released last year showing women veteran suicide rates were as much as 12 times greater as their nonveteran counterparts. The highest rates were among the 18-29 age group.

The Aug. 4 report presents charts comparing veteran and civilian women rates as recent as 2014, but no raw numbers are included, making it difficult to assess actual percentages. The new report states that overall, veteran women are 2.4 times more likely to commit suicide than civilian women. No numbers are provided to support that figure.

The earlier study, which covered the period from 2000 to 2010, showed women veterans were at six times the risk for suicide. Between 2001 and 2014, suicide among women veterans not using the VA’s health care system doubled.

While the new study did look at the relationship between suicide and mental illness — depression, schizophrenia, PTSD, substance abuse and other anxieties — it did not look at sexual trauma as a factor.

Federal effort

In July, President Barack Obama signed the Female Veterans Suicide Prevention bill, calling on the VA to identify the most effective suicide prevention programs.

Some female veterans view the new law as more of a publicity stunt than real policy change.

“The act is a great gesture,” said Amber, a Navy veteran from Los Angeles who has attempted suicide twice. She requested that her last name not be used. “But it’s like someone split your skin open, and they are trying to heal it with a Band-Aid and forgo the irrigation and stitches.”

That kind of disappointment and distrust often extends to the VA, Meshad said. Women veterans see the institution as the same kind of male-dominated environment where they were traumatized.

“They don’t feel comfortable, with the trauma they’ve experienced, to share that with the VA,” he said. “This happened in a male’s world. The VA is majority men.”

Meshad thinks separate facilities for women are warranted, much like the women’s clinic that will soon open as part of the Loma Linda VA. It was that same kind of distrust of the VA that led Meshad to create the Vet Center Outreach Program in 1979. There are more than 300 vet centers scattered across the country.

At the Veterans Center in Corona, director Crystal Presbury counsels both men and women veterans. She said she hasn’t lost any women clients to suicide, but the trauma she sees sometimes involves past suicide attempts and, more frequently, thoughts of suicide. She said sexual trauma is almost always a factor.

“Military sexual assault and childhood sexual assault are the No. 1 things,” Presbury said, referring to the issues her clients struggle with. The women she deals with frequently are survivors of sexual trauma when they enlist and, she said, “they get revictimized when they’re in the military.”

An 11-year veteran of the Marine Corps, Presbury said she did not experience any sexual assault during her career. She knew fellow Marines who did. Having a female drill instructor during boot camp helped, she said.

“The Army drill instructors are men,” she said. Based on her client’s stories, she said, “there’s a lot of sexual assault that occurs in boot camp.”

Part of boot camp training is cutting new recruits off from the rest of the world so that they learn to rely on one another and form stronger bonds.

“In boot camp, you don’t have any ID, you don’t have a phone, you have nothing,” she said.

She said isolating women that way, with a male superior, is asking for trouble.

“It took me awhile to get my head around that,” she said. “It breaks my heart.”

Meshad said until structural changes are made in the military, he doesn’t see much opportunity for significant progress.

“There’s been a lot of talk but nothing’s changed so far,” Meshad said. “It seems out of control.

“I think we really need to have a commission on the readjustment of veterans and, in particular, women’s sexual harassment,” he added. “We need a commission to make changes or it’s not going to happen.”

Betrayal

Dr. Marion Sherman is director of mental health at the VA Medical Center in Loma Linda. She said sexual assault is prevalent among the women patients she sees.

“I’m struck by the number of women who say they were pressed to have sex,” Sherman said. “It gets very hard to untangle.”

Much of it is dealing with issues of betrayal. They went to serve their country, she said, did what they were asked to do but were violated. They feel betrayed by their comrades and commanders. They tell her they’re mad at their country, yet they love that country.

“If you (add) in there some traumatic brain injury and PTSD, you can see why people say, ‘I’m just going to have a drink because nothing can help me,’” she said. “And it’s not true because we have effective treatment.”

Because the Inland Empire is one of five high-risk regions for veterans making the transition from military to civilian life, the Loma Linda VA is a pilot site for the recently passed Clay Hunt Act. The act is designed to address the military suicide rate by connecting more veterans to VA services through outreach and collaboration with other mental health services in the area.

“We have lots of folks that come out (of military service) with lots of symptoms,” Sherman said. “Part of what the Clay Hunt mandate is, is to reach out to those veterans that have symptoms.”

Loma Linda is making other efforts as well, she said.

“We’ve created a suicide elimination team,” she said. “I believe it’s unique to Loma Linda. “We look at every (suicide related) situation and we meet with any of the clinicians involved. The clinicians can be devastated by this. We analyze it and we come up with lessons learned.”

Mental health practitioners also are integrating with primary care teams and other hospital agencies, such as the police, to more quickly identify patients who may need help. The medical center will soon open a women’s clinic, and Sherman said there will be a mental health team on each wing of the hospital.

But the Loma Linda mental health worker who survived her suicide attempt said even more needs to be done. She said there is a menu of different group therapy programs, but they are dominated by male patients, who make up 90 of those served by the hospital. There are only two groups that are exclusively for women, she said.

“A woman can’t go into a group where there are nine males and she’s the only female,” she said. “We need to provide more women-oriented sessions.”

She also thinks more peer support staff, like herself, are needed.

“We talk to them in ways clinicians haven’t before, and we speak from experience,” she said. “We’ve been there. We’ve had the commander’s boots at eye-level while we were doing push-ups. When we say something works, they believe us. It’s lived experience. That’s what reaches them.”

Kaitlyn Landgraf of the Mercury News contributed to this story

RESOURCES FOR VETERANS

There are three VA Medical Centers in Southern California:

Los Angeles

11301 Wilshire Blvd.

310-478-3711

Long Beach

5901 East 7th St.

888-769-8387

Loma Linda

11201 Benton St.

800-741-8387

VA Suicide Crisis Line: 800-273-8255 (press 1) or text 838255