Government Relations Update

“It is a tragedy that our service members and veterans survived the battle abroad only to return home and fall to suicide,” said U.S. House Committee on Veterans’ Affairs Chair Bob Filner (D-Calif.) at a Feb. 24 hearing to explore the relationship between veteran suicide and medication.

APA was among the groups invited to participate in the hearing, which was held to address the rising number of suicides among military service members and veterans. Data suggest that the Army suicide rate is now higher than that among the general U.S. population.

APA member M. David Rudd, PhD, dean of the College of Social and Behavioral Science at the University of Utah, testified as a former military psychologist and suicide expert.

He began by recognizing the considerable confusion about medications and suicide risk since the 2004 Food and Drug Administration black-box warning label was placed on certain antidepressants being prescribed for children and adolescents. The FDA expanded this warning in 2007 to include young adults ages 18 to 24. In 2008, the FDA also issued an alert that antiepileptic drugs should include a warning label to inform patients about the risk for suicidality. Rudd, who served on the suicide classification review panel for the series of FDA studies that led to the warning label, explained that these warnings have had an impact on the mental health community and encouraged significant debate regarding treatment options for patients who are depressed and experiencing thoughts of suicide.

Rudd explained to policymakers that acute and chronic suicidality is a particularly difficult clinical problem that requires an accurate understanding of the role and effectiveness of medications and behavioral interventions.

“The reality is that the efficacy of treatment, both psychotherapy and medications, far outweighs the observed risk for suicidal thoughts and behaviors,” Rudd said. “We now know scientifically that a number of behavioral treatments help reduce the risk of death by suicide.”

However, as Rudd pointed out, behavioral treatments can require a lengthy process. In a recent review, Rudd identified common elements of effective treatments for suicidal behavior, including:

  • Using simple and understandable models that are shared with patients to help them understand why they have become suicidal and the benefits of the treatment.

  • Targeting identified skill deficits.

  • Emphasizing self-reliance, self-awareness and personal responsibility.

  • Emphasizing the importance of crisis management, removing available lethal methods and ensuring access to care during and after treatment (with written and accessible treatment plans).

  • Using compliance protocols to keep at-risk patients engaged in treatment.

“These are very simple actions that can save the lives of our veterans who are experiencing thoughts of suicide,” he said. “We owe it to our veterans to ensure that they have the mental and behavioral health care that they need and deserve.”

Other witnesses at the hearing included leaders from the Department of Veterans Affairs and the Department of Defense who testified about new and ongoing VA and DoD initiatives aimed at addressing suicide. VA efforts include the creation of a Suicide Prevention Lifeline, which has provided counseling for more than 185,000 veterans and their loved ones. The VA has also designated a suicide prevention coordinator at each VA medical center and created a Mental Health Center of Excellence, which focuses on developing and testing clinical and public health intervention standards for suicide prevention. In addition, the VA has hired more than 3,900 new mental health employees since 2005, many of whom focus their time on suicide prevention.

DoD is also engaging in a robust suicide prevention effort, including data collection and analysis to detect contributing risk factors; facilitating partnerships across DoD, federal agencies and civilian organizations; reducing stigma and increasing access to resources; and using research to close gaps and identify best practices.

To read Rudd’s testimony and learn more about this hearing, visit Exploring the Relationship Between Medication and Veteran Suicide. To learn more about APA’s policy initiatives focused on the needs of service members, veterans and their families, visit Military and Veteran Issues.

Dr. Diane L. Elmore is senior legislative and federal affairs officer in the Public Interest Government Relations Office and director of APA’s Congressional Fellowship Program. Kathleen M. Van Dyk is a graduate student intern in the office.