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Oklahoma suicide rates high among young veterans

June 6, 2018

CRESCENT, Okla. (AP) — Hours before dawn on a March morning in 2015, Josh Holley woke to his worried mother knocking on his bedroom door.

Your brother’s downstairs in the bathroom, she told him. He’s sick, and he’s yelling.

When Josh found his younger brother, Jeffrey, a U.S. Army veteran who had been discharged for medical reasons four months earlier, Jeffrey told him not to worry, he only had a stomachache. Josh asked if he needed anything. Jeffrey said he didn’t, so Josh turned to walk back upstairs. But before he could leave, Jeffrey said something that caught Josh by surprise.

“I love you,” Jeffrey said. The comment struck Josh as strange. It wasn’t the way Jeffrey usually talked. But Josh didn’t think much of it.

“I love you too, bro,” he answered. “Try and get some sleep.”

Josh went back to bed. An hour later, he woke again to his mother pounding on his door. He opened the door to find her in tears.

I just heard a gunshot, she told him. Tell me where your brother is.

The two searched the house and the front yard, but didn’t find him. Finally, Josh ran into the backyard. Immediately, he spotted the old wooden shed at the edge of the yard. The door was standing open.

“I knew in my heart he was in there. I prayed that he wasn’t, but I knew,” Josh said. “I opened it, and we found him. He’d shot himself in the head.”

Jeffrey Holley was one of 159 military veterans who took their own lives in Oklahoma in 2015, according to figures from the Oklahoma Department of Mental Health and Substance Abuse Services. Only 21 at the time of his death, he is a part of a pattern that has troubled mental health providers, veterans advocates and policymakers: young Oklahoma military veterans dying by suicide in alarmingly high numbers.

Across all age groups, Oklahoma’s military veterans die by suicide at a higher rate than do veterans nationwide, according to a U.S. Department of Veterans Affairs report released in September. But among veterans age 18-34, Oklahoma had the highest rate of suicide in the nation, the report shows.

The report is based on veteran suicides reported in 2014 and population estimates from the U.S. Census Bureau’s 2014 American Community Survey.

According to the report, 149 veterans died by suicide in Oklahoma in 2014, or 53.8 veteran suicides per 100,000 veterans. The national rate of veteran suicides is 38.4 per 100,000 veterans.

Among veterans age 18-34, the state saw 33 suicides in 2014. That total gives the state a suicide rate of 122.3 per 100,000 veterans in that age bracket, far outpacing the national rate of 70.4 per 100,000 veterans.

Regardless of their ages, Oklahoma’s veterans are far more likely to die by suicide than nonveterans. From 2005 to 2012, the state’s veteran suicide rate was 39.2 per 100,000, compared with 18.2 per 100,000 among nonveterans, according to a report from the Oklahoma Department of Health.

The number of Oklahoma veterans who die by suicide each year has grown in recent years, climbing from 110 in 2005 to 159 in 2015 — a 44.5 percent increase, according to figures from the Oklahoma Department of Mental Health and Substance Abuse Services.

Advocates point to a number of factors they say are to blame for the state’s high rate of young veteran suicides, including a high rate of substance abuse, ready access to firearms and problems young veterans face managing the transition from the military to civilian life.

But more than any other single factor, advocates point to a lack of available treatment for mental health and addiction issues as a key driver of the rate of suicides among Oklahoma veterans, the Oklahoman reported .

Jeffrey Holley served as an artillery crew member stationed at Fort Wainwright, just outside of Fairbanks, Alaska. Before he joined the Army, Jeffrey had smoked marijuana, but he’d never done any harder drugs, his brother said.

But that changed after Jeffrey enlisted, Josh said. Like many military service members, Jeffrey began smoking synthetic marijuana, or K2, thinking it wouldn’t show up on the Army’s mandatory drug screenings. But the chemical makeup of K2 often varies from one batch to the next, and its effects can be difficult to predict.

In 2012, Jeffrey came home from Alaska on leave. During a night of partying with old friends, Jeffrey smoked K2 and took an entire box of cold medicine, his brother said. He came home the following morning complaining of a stomachache. That evening, his mother found him lying unconscious on the bathroom floor.

Jeffrey was in the hospital for the next two weeks after the overdose. Although he survived, the incident left him with lasting medical issues. After about a month at home, Jeffrey returned to Alaska. But the Army gave him a medical discharge, and he returned to Oklahoma in November 2014.

After he came home, family members tried to talk to Jeffrey about his drug use. Once, they staged an intervention. None of it did any good, Josh said. Jeffrey insisted he could quit anytime he wanted.

“He didn’t think he had a problem,” he said. “That was the problem.”

But drugs weren’t the only problem. After he came back to Oklahoma, Jeffrey had a hard time finding work. He talked about looking for a job as an oil-field worker or trying to re-enlist in the Army. But mostly, he seemed unsure of what he wanted to do with his life.

Looking back on it, Josh can point to signs that his brother may have been depressed. He’d always had lots of friends and enjoyed spending time with them, Josh said. But after he was discharged from the Army, he became withdrawn and spent most of his time at home. At the time, though, the warning signs were difficult to see.

The first year after a service member leaves the military is often a vulnerable time, said Juanita Celie, suicide prevention coordinator at the Oklahoma City VA Medical Center. Some veterans find the transition from military culture to civilian life difficult to manage, she said. Others feel they’ve lost their identities when they leave the military.

Veterans who have had to leave the military because of factors like physical conditions or mental health disorders often have an especially difficult time handling the transition, Celie said. In most cases, those veterans had planned to stay in the military, she said, and the circumstances of their discharges often leave them without any sense of closure.

Then there are more practical concerns. Some veterans have a hard time finding jobs, Celie said. Others can’t find opportunities to do the same kind of work they were trained to do in the military, and still others can’t work at all for physical or emotional reasons. Those factors can lead to financial stress and a loss of self-worth, she said.

“I think that can be very debilitating for them,” she said.

Another factor that experts say likely contributes to veteran suicides is the trauma that often comes with military service. Between 11 and 20 percent of all veterans who served in Iraq or Afghanistan experience post-traumatic stress disorder in any given year, according to the U.S. Department of Veterans Affairs.

A number of factors increase the likelihood that service members will experience PTSD or another mental illness, the department reports, including being put at risk of death or injury, seeing others killed or killing someone themselves. For many troops, being away from home for an extended period causes family problems, which can exacerbate the stress.

Another contributing factor is military sexual trauma. According to VA reports, one in four female veterans and one in 100 male veterans in the VA health care system told screeners they’d experienced sexual trauma while serving in the military. A VA study published in December 2015 suggests veterans who experienced sexual trauma during their time in service are at increased risk of suicide.

Those factors come on top of Oklahoma’s already-high baseline rate for trauma, said Terri White, the state’s mental health commissioner. The state scores high in a number of categories that lead to childhood trauma, including childhood neglect, domestic violence, having a parent who is incarcerated and having a parent with an untreated mental illness or addiction, White said.

Added to those struggles is the lack of adequate mental health care in the state. Oklahoma posts some of the nation’s highest suicide rates among veterans and nonveterans alike, and mental health providers estimate that they’re only able to serve about one out of every three people who need help. That lack of access to treatment is one of the key drivers of the state’s high rate of suicides, White said.

During the 2013-2014 fiscal year, the state’s mental health department received $500,000 in state funds for suicide prevention. The appropriation marked the state’s first investment in suicide prevention, and White said the department used that funding for evidence-based suicide prevention programs.

But until April, when lawmakers approved an $11 million increase in the department’s budget for next year, the department had seen its state budget slashed $52.6 million, and it has lost another $80.4 million in federal matching funds. Those cuts forced the department to cut back on its mental health treatment services, White said.

For people who are suicidal, those services could mean the difference between life and death, White said. When people with mental health disorders receive treatment, they generally go on to live full, productive lives, she said, and in almost all cases, when a suicidal person receives treatment, that person never goes on to be suicidal again. But when treatment isn’t available, she said, people with mental health disorders often end up in the criminal justice system or dying by suicide.

Another factor that could contribute to the state’s veteran suicide rate is the high rate of gun ownership, said Jessica Hawkins, the state mental health department’s senior director of prevention services. According to the VA report, 63.8 percent of Oklahoma veterans who died by suicide did so using a firearm. Nationally, the rate of veteran suicide by firearm is 50.2 percent.

In some populations, suicide is an impulsive act, Hawkins said. So easy access to a firearm, medication or anything else that could be used in suicide could turn a sudden impulse into a fatal decision.

In those cases, it’s important for mental health workers, health care professionals and family members of those who are at risk of suicide to minimize those people’s access to things like firearms and medication, Hawkins said.

There are other social factors that can leave younger veterans feeling isolated and more likely to take their own lives, said retired Oklahoma Air National Guard Maj. Gen. Rita Aragon. When veterans leave active service, they’re also leaving an institution that provides support for its members, Aragon said. The military instills in its troops that they have a responsibility to take care of themselves, and individual service members tend to look out for one another, she said.

Often, veterans don’t find anything in civilian life to play that role, Aragon said. That’s particularly true of younger veterans, who don’t join organizations like Veterans of Foreign Wars and the American Legion in the same numbers as previous generations of veterans. That lack of connection leaves many young veterans without anyone who can understand their experiences, she said.

Aragon, who served as Oklahoma Secretary of Veterans Affairs from 2011 to 2015, said those who seek to solve the problem of veteran suicides have much to learn from the way individual military service members look out for one another in combat.

“Your job is to take care of the guy on either side of you, bring them back alive,” Aragon said. “Well, we should be doing the same thing with suicide.”

Although Oklahoma’s suicide rate among veterans age 18-34 was higher than any other state, veterans in that age bracket died by suicide at higher rates than older veterans in every state where data was available, according to the VA report.

That high rate of suicides among younger veterans is likely an extension of the rate of suicides among active military service members, said Craig Bryan, executive director of the National Center for Veterans Studies at the University of Utah. When those service members leave the military, the same risks follow them forward into civilian life, Bryan said.

Part of that risk may come from the social nature of suicide, Bryan said. Research has shown that when a service member dies by suicide, his or her entire unit is at greater risk of suicide, he said.

“I’ve heard plenty of service members say things like, ‘Well, if that guy couldn’t handle it, there’s no hope for me,’” Bryan said.

Another factor that contributes to suicides among veterans is traumatic brain injury, Bryan said. Research suggests there’s a link between repetitive traumatic brain injury and suicide, he said. So a military service member who was exposed to several bomb blasts or other trauma could be at increased risk of suicide for the rest of his or her life.

Military service members have suffered traumatic brain injuries for centuries, but the link between such injuries and suicide seems especially pronounced among younger veterans, Bryan said. That may be because increased use of body armor and better battlefield medical care mean service members are more likely to survive the kinds of injuries that would have been deadly decades ago. While those troops may survive the immediate injuries, the longer-term effects put them at increased risk of suicide, Bryan said.

Many problems contribute to Oklahoma’s high rate of veteran suicides, and no single factor can explain the entire trend, said White, the state mental health commissioner. She compared the issue to an image on an overhead projector: One projector transparency may only show part of the image, but with two or three more laid over the top, the full picture begins to appear.

The good news, White said, is that help is available for veterans in crisis. She encourages people to call the National Suicide Prevention Lifeline for help. The hotline has special services tailored toward veterans who are at risk of suicide, she said.

April 9 would have been Jeffrey Holley’s 25th birthday. Josh and Jeffrey’s father and stepmother invited the family over and made Jeffrey’s favorite dinner — chicken-fried steak with mashed potatoes and gravy. And, like she does every year, their mother bought Jeffrey a birthday cake from a local bakery. On the cake, the words “Jeffrey — Happy 25th birthday in heaven” were spelled out in white icing.

Special days like Jeffrey’s birthday and the anniversary of his death are always difficult, Josh said. And holidays always serve as a reminder of who is missing at the dinner table. When they talk about Jeffrey, the family mostly dwells on happy memories like his days as a lineman for the Crescent High School football team or goofy things he did to get a laugh.

In the three years since his brother died, Josh has come a long way. He and his parents go to a support group, which has helped him open up about his feelings.

Josh still has bad days. Sometimes, he gets angry with Jeffrey for taking his own life. Then he gets angry with himself for feeling that way. The support group has helped him understand that those feelings are normal, he said.

Before his brother died, Josh didn’t know much about Oklahoma’s high rate of veteran suicide. He suspects most Oklahomans don’t know any more than he did. Children in school learn to say no to drugs, he said, but nobody teaches them about the state’s suicide epidemic.

Josh hopes to see people become more willing to talk about suicide. More conversations about the issue could help people spot signs that their loved ones might be at risk, he said.

Mostly, he said, he wants to see the state do a better job of preventing young veterans like his brother from taking their own lives.

“It’s rampant. It’s terrible,” Josh said. “I don’t know the answer. But soldiers deserve better.”

If you or someone you know is considering suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255. Veterans may press 1 to be directed to the Veterans Crisis Line.

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Information from: The Oklahoman, http://www.newsok.com

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