US congressional hearings expose stonewalling on veteran suicide data

By Naomi Spencer

9 May 2008

The House Veterans Committee on Tuesday revisited the issue of military suicides in light of a pending lawsuit against the Department of Veterans Affairs by veterans’ rights groups. Following the court-ordered release of internal emails regarding staggering veteran suicide rates, Department of Veterans Affairs officials were accused of “criminal negligence.”

At the same time, a new estimate indicates that veteran suicide deaths could exceed combat fatalities for Iraq and Afghanistan forces.

The hearing, called “The truth about veteran suicides,” centered on emails released last month by the federal District Court of Northern California. The emails showed that there were an average of 12,000 annual suicide attempts by veterans within the VA system. The emails also revealed that the VA was aware of an estimated suicide rate of 6,570 per year across the veteran population. With regard to both figures, the emails made clear that top officials did not want the information to be made public.

The lawsuit (Veterans for Common Sense et al. v. Peake et al.), brought last June by veterans groups Veterans for Common Sense and Veterans United for Truth, is seeking to force a restructuring of the veterans’ medical system to better handle the growing numbers of seriously injured and mentally traumatized veterans. Of particular concern to the groups are the hundreds of thousands of returning Iraq and Afghanistan veterans suffering from post-traumatic stress disorder (PTSD) and traumatic brain injuries (TBI), who are at the greatest risk for suicide.

In November 2007, CBS News independently arrived at an estimate of 6,256 veteran suicides in 2005—a figure that top VA officials vociferously denied at the time. At a December hearing before the Veterans Committee, VA Mental Health Director Iraq Katz said the CBS figure “is not, in fact, an accurate reflection of the rates of suicide.” Katz testified that “from the beginning of the war [in 2001] through the end of 2005 there were 144 known suicides among these new veterans.”

Just days after the December hearing, however, Katz confirmed in an email exchange with VA Undersecretary Michael Kussman that veterans were committing suicide at an average rate of 18 per day, in line with the CBS figures reports, adding, “VA’s own data demonstrate 4-5 suicides per day among those who receive care from us.”

On February 13, Katz sent an email to the department’s communications officer with the subject line “Not for the CBS News Interview Request.” Katz wrote: “Shh! Our suicide prevention coordinators are identifying about 1,000 suicide attempts per month among the veterans we see in our medical facilities. Is this something we should (carefully) address ourselves in some sort of release before someone stumbles on it?”

In testimony Tuesday, VA Secretary James Peake and Katz denied a deliberate attempt to stonewall the data, and portrayed the department as fastidious in its tracking of mentally traumatized and suicidal veterans. Peake told the panel that the “VA has long subjected its own data, that of the Department of Defense, and data from nationally accepted statistical sources to careful and painstaking analysis to obtain the truth about veterans’ suicide.”

Referring to the February 13 email, Peake suggested Katz did not want to release the figures out of concern that they were not complete and could be manipulated. “The number of [suicide] attempts referenced was based on only three months worth of data, too short a time period to determine if it was reliable,” he said. Katz’s “Shh!” was simply poor style, Peake suggested. “We’re as far from hiding information from the public as anyone I know.”

Significantly, however, rather than questioning the accuracy of the figure of 12,000 annual suicide attempts, in his testimony Peake suggested it might be conservative. “I can appreciate that the number of 1,000 suicide attempts a month might be shocking,” he said, “but in a system as large as ours ... and consistent with the literature, we might well expect a larger number of attempts than that.”

Democrats on the panel called for Katz’s firing, a suggestion Peake rejected. Committee Chair Bob Filner, a California Democrat, said Peake’s testimony revealed “a culture of bureaucracy.” “This is a matter of life and death, and I think there was criminal negligence in the way this was handled.” Filner told Peake, “The pattern is deny, deny, deny. Then when facts seemingly come up to disagree with the denial, you cover up, cover up, cover up.”

Arizona Democrat Harry Mitchell said that the VA refused to provide him specific information on what resources the department had devoted to suicide prevention for four months. Indicative of stonewalling, the VA then told the congressman to file a Freedom of Information Act request. Mitchell threatened Peake with a congressional subpoena if the VA did not provide the data by May 9.

The Democrats are anxious to turn the debacle to their favor without questioning the source of soaring suicides and mental trauma—the brutal occupations of Iraq and Afghanistan, the funding for which congressional Democrats have continuously approved.

The most damning testimony came from Ronald Maris, the director of the Suicide Center at the University of South Carolina. Maris served as an expert for the veterans’ groups at the trial last month. He told the congressional committee that the VA stonewalled the plaintiffs over documents related to suicide attempts. “I was given only 170 of the estimated 15,000 incident briefs and none of the root cause analyses,” he said.

Maris also related that during a deposition, William Feeley, the VA’s Health Care Operations deputy undersecretary, admitted that he had not read “from cover to cover” the VA’s mental health program. When asked whether there were methods for tracking troops who may be at risk for suicide, Feeley responded, “I’m not sure, sorry.” He also told the court, “Suicide rates are not a metric we are measuring.”

At one point, Feeley declared, “Suicide occurs like cancer occurs.” Maris commented during his testimony Tuesday, “We all have to die, but no one needs to suicide. The VA seems to think that a certain number of vet suicide deaths are inevitable and that there is not much we can do about them.”

According to Maris, VA documents turned over to the court state that “90.9 percent of the VA facilities do not have suicide case managers.” While there are “suicide coordinators” in all of the VA’s 154 medical centers, Maris said, there are none at all in their 875 community-based outpatient clinics, most of which do not have psychiatrists on staff.

The much-touted suicide prevention hotline established by the VA, Maris said, was utilized by less than 1 percent of those veterans who committed suicides, according to documents reviewed by the court.

Pointing out the inadequacy of the VA’s suicide screening, Maris noted that the process involves asking only two questions of veterans: “Have you felt depressed or hopeless in the last two weeks?” and “Have you thought about hurting or harming yourself in the last two weeks?” If the veteran answers “no” to the second question, Maris said, then no further screening is conducted. “Asking one or two suicide questions, which could easily be denied, misunderstood, misrepresented, etc., is not a suicide screen up to the standard of care. Probably self-destruction is undercounted by the VA with such perfunctory screens.”

Maris also noted that although the VA measures suicide risk factors such as depression, drug dependency, and feelings of hopelessness, the VA relies entirely on self-reporting. “Since hopelessness and depression are key suicide risk factors, they should be measured systematically, not by subjective self-reporting,” he said. “Some vets may not even know if they are depressed, hopeless, or suicidal.”

Separately this week, the National Institute of Mental Health director, Thomas Insel, told reporters during a meeting of the American Psychiatric Association Monday that “suicides and psychiatric mortality ... could trump combat deaths” from the two wars. Insel said he based the opinion on a study published last month by the RAND Corporation think tank, which said that some 300,000 new veterans suffer from PTSD, and that 320,000 have sustained a traumatic brain injury. The study found that only half of these soldiers sought treatment for their injuries.