The Truth About Veteran Support Systems and How to Fix Them

[00:00:00] So we've talked to Zach, Sam, and Joe about what it's like to be a veteran in crisis. We've heard from Lindsay that there actually are ways to help people out before they get to that point. Interventions that can work. But how do we take this and scale it and provide access in a way that actually makes a meaningful dent in the problem? Well, for that, we are going to have our fifth and final part of this series talking to another Lindsay, actually.

[00:00:29] If you or someone you know is in crisis, please reach out to the National Suicide Crisis Hotline at 988. With that, let's get to Lindsay. Lindsay, good afternoon and welcome to the podcast. How are you doing today? I'm good. Thank you for having me. Pleasure. Could you please introduce yourself in your own words to the audience? Oh, okay. So I'm Lindsay Teacach and I am the Mental and Brain Health Services Director here at Wounded Warrior Project.

[00:00:56] I come to you from Pittsburgh, Pennsylvania. I've been with Wounded Warrior Project about 12 years now. And then prior to that, I worked for local government just overseeing mental health and case management services in the behavioral health network. Cool. So we've been having a bunch of conversations this month with veterans and clinicians discussing the, you know, very interesting topic of veteran suicide.

[00:01:23] You know, there's a number that gets thrown around a lot in the media that, you know, 22 veterans a day end up killing themselves. People have disputed that number, but it speaks to a broader crisis. Just how big is the issue of suicide in the veteran community? Yeah. Good question. So I think even if you look right outside the veteran community, because I think that's important to notate as well. This is an epidemic.

[00:01:50] This is one of the leading causes of death in the United States, you know, outside of veteran community. You look at within the veteran community, this is the second leading cause of death for veterans under the age of 45. To your point, the number disputes between 17 to 22. But both of those numbers are extreme. Still bad. Right. Extreme.

[00:02:12] When you compare the veteran population to the civilian population, veterans that are 72 percent higher suicide rate than their civilian counterparts. Women veterans are at 101 percent higher rate than their civilian counterparts. This is it's an epidemic, you know, quite frankly. I think that it's important to note, though, people think this is a mental health issue. It's a mental health issue within the veteran community. It is not. Suicide is a human issue.

[00:02:41] It has many factors that contribute it outside of just the mental health world. So how do you differentiate between a human issue and a medical issue? Because medical issue is how I would have described it as a lay person. So what is that human dynamic? Yeah. If you look at what are some of the biggest risk factors to somebody who's having suicidal thoughts and to why people ultimately complete suicide,

[00:03:08] it is not just because of, you know, PTSD and mental health. Some of the leading causes of how somebody gets there or why they're getting there is financial distress, relationship distress, chronic pain, sleep disturbances. And so it's so important that when we talk about suicide, we really look at it for all the potential risk factors that are within it. And they're not just specifically medical conditions, mental health conditions.

[00:03:37] These are human issues. These are, you know, issues that span across physical health and wellness, financial health and wellness. Connection is a huge piece of that. And so that's why it went to worry project. And if you look at the organizations we partner with, the VA, all of that, the approach has to do that as well. You cannot just approach this from the medical model. You really have to approach it from this community-based model of all the different risk factors. And then how can we impact that? Yeah.

[00:04:07] So are there risk factors that are unique to the veteran community that make suicide more prevalent? Or I guess I can ask this even first. Based on the data, is suicide actually more prevalent in the veteran community when you control for things like age, demographic, socioeconomic status, all the other things that can contribute? Yeah.

[00:04:55] You know what you're doing. You know what your job is. You have people around you that are like-minded, that are in similar positions, and that you can relate to. And then that stops. And then you go home. And a lot of veterans then lose that sense of purpose, that sense of mission. They're trying to figure out so many different things at the same time. What's my new job going to be? Sometimes you're going home into maybe relationship issues.

[00:05:20] It's not uncommon for somebody to seek enlisting into the military because of something that might be going on within their childhood or their home life or things like that. And so that's definitely something that's unique to that type of population of that transition period and finding, again, that sense of purpose, that connection, and then all of a sudden it's stopping.

[00:05:44] And that's why that transition period is so important, those first two years when somebody transitions, because that's when they're at a much higher risk of suicidal thoughts. Gotcha. Gotcha. So what gaps exist in how veterans seek treatment for issues or what gaps exist in how veterans seek out help for the issues that could lead to wanting to commit suicide?

[00:06:14] Yeah. I think that when we talk about gaps, we also need to talk about the individuality of it, right? There's a lot of gaps within our systems, which is why it's so important that we all work together. There's not one entity that can tackle this alone. It's not going to live within the healthcare systems or the veteran service organizations or just within their homes. We all have to work together because we all fill one of those gaps. But it really is so individualized.

[00:06:42] A gap for somebody, you know, in the middle of a really rural area is going to look very different than a gap for somebody that maybe is in, you know, right next to a VA center or something like that. But what we see as themes is one of the largest gaps, right, being access to care. And what I mean by access to care is timely care, quality care, and the right level of care.

[00:07:06] You may hear of, oh, no, I could get an appointment with, you know, my therapist, but it's five months away. Or the wait list to get into an intensive outpatient unit is three months, so I'm going to connect with a peer in between. Or my closest, you know, organic support is three hours away from me and I don't have the best internet connection. Right. These are all the things that we hear around access to care.

[00:07:35] Sometimes it's financial, you know, the cost of giving, you know, not having the financial means to have a vehicle to get to your appointment or to pay for, you know, a taxi service, Uber service, whatever it might be. And so it's really important when we're looking at gaps that we do, again, take that individualized approach. We can paint it with that broad brush and say, hey, access to care is a really big one and that quality care, that timely care.

[00:08:02] But the gaps can be so different for each person coming in, which is, again, why it's like we take a very individualized approach at Wounded Warrior Project and why we work so closely with these other folks to make sure that we address those individual gaps. Does getting someone help typically look like getting them in front of a therapist or their care provider? Because those seem like medical interventions.

[00:08:26] Are there other non-medical interventions that folks can try to access prior to getting to the point of needing, you know, full-blown medical care? Absolutely. Absolutely. You know, I'm right. I love a good therapist. I think everybody could use a therapist at some point in their life. But sometimes that's not enough.

[00:08:47] Sometimes people are actively involved in their treatment and they're still having thoughts like this because their finances are, you know, they're struggling or they're having marital issues. Sometimes it's just pure connection of what they mean. And so, yes, I think that clinical interventions, to your point, things like, you know, medication, if that's appropriate, or clinical appointments with a therapist or a psychologist are really important.

[00:09:15] But as important are those non-clinical options. Having connection is going to be one of the largest protective factors that you can have to combat suicide. Having a good support system, whether that's within your own home or it's in a peer support group or your colleagues at work, that is as important. Good physical health and wellness, right?

[00:09:40] If we look at what are the protective factors for somebody's overall well-being that we know, without a doubt, evidence-based, that are going to help contribute to reducing suicide or even ending suicide. It's good physical health and wellness. You have groups that really focus on that in the VSO space. Good financial health and wellness. You know, good mental health and wellness. And connection.

[00:10:06] Those four pieces are really going to help you because what I can't do is I can't guarantee you a life without trauma. I can't guarantee you a life without sorrow. But how you can respond to it and the resiliency you have by beefing up those protective factors are absolutely going to be super important and then helping us to reduce then those risk factors with that as well. How are these risk factors identified for a patient?

[00:10:35] Is there like a data set that, you know, has been collected that looks at what leads up to a suicide attempt by a veteran? So I think it's important to differentiate of what a risk factor is versus what are signs that somebody might be contemplating suicide. So risk factors are really, you know, honestly, the opposite of protective factors, right?

[00:10:56] Somebody with chronic pain, somebody who has PTSD, somebody who has sleep issues, somebody who's experienced military sexual trauma, somebody who's in financial distress. Those are somebody who would be considered a higher risk for contemplating or completing suicide. Signs that somebody might be doing that are things that are outside of their norm.

[00:11:21] Things like giving possessions away, isolating, you know, participating in behavior, risky behaviors that they never participated in. And increasing substance use, you know, substance abuse, mood swings, things like that. And again, it's important that it's, you know, these are outside of their normal behaviors.

[00:11:44] If you have somebody who's, you know, has always been kind of chronically introverted, things like that, that isolation may not look the same for somebody who all of a sudden, you know, was a very social person and then cuts the world off. And so those are some signs that somebody might be contemplating it versus, you know, what is a risk factor. Gotcha. Is there a way to look at a veteran and assess what their likely risk factors are statistically?

[00:12:14] Yes. So screening is really important. Screening is something I think that as a collective, we need to get better at, right? How do we get ahead of this? It's, it's really crucial to, to really start to develop and better, you know, improve our programs before a crisis happens. There are a lot of suicide prevention programs that are geared towards when a crisis happens. And screening is going to be key in getting to that, you know, preventative piece.

[00:12:42] So, for example, at Wounded Warrior Project, we do what's called the Columbia Suicidality Severity Scale. That helps us see where this person is at at that moment in time when it comes to risk. We also collect a ton of data. And so does the VA and other entities around those, those risk factors that I talked about earlier.

[00:13:01] If we know that we have somebody that experienced military sexual trauma, maybe is a female veteran, that they have, you know, recently went through a divorce or something like that. These are all risk factors that we can screen and that we can say, hey, data has told us that this person is going to be higher risk.

[00:13:20] Now, how do we then screen them to, to see exactly where they're at and then connect them to the appropriate resources and supports to meet their need at that moment? Gotcha. So is the goal to get like a, some sort of personalized level of care for someone who might be in a crisis or ideally even before they get to a crisis? Or is there like a generic list of best practices that everyone goes through? No, there's no, right? There's no magic list. There's no generic list.

[00:13:50] If this was easy, right, we, we wouldn't, we wouldn't be here. But yeah. And, and I think, you know, I'd like to tell you if you don't mind a little bit about our, our triage program, Windward Warrior Project, because, because that's what that does. So anybody coming into Wounded Warrior Project, when you come into our financial health programs, our physical health programs, or our mental health programs, you get screened for your suicide risk that through that Columbia suicidality severity scale. We then also collect a ton of data.

[00:14:16] And through triage, we do this kind of psychosocial screening to figure everything out about that individual. We want to know what treatment have you tried that maybe worked or didn't work? What's going on in your current home situation that you might need additional supports? It would be very rare that you might have a veteran in the home who's really struggling with suicidal thoughts and that not be impacting the other people in the home.

[00:14:42] So we want to make sure that we're going to have supports for the spouse, the children, whoever else is in that home, so that everybody can be at their best. But we do a real 360 to see what's going to make sense for this person. If you're somebody who's really into your physical health and wellness, us incorporating into that into your treatment plan is going to be helpful.

[00:15:31] Me, right? We're going to have to make sure that we're going to have a better time to appropriate, timely, and individualized program after that. And again, I really like Wounded Warrior Project and who we've decided to partner with because we can do that. We can do that with clinical. We can do that with non-clinical. And again, make that individualized for the whole house. Now, is this screening, you mentioned this screening goes for anyone who interacts with Wounded Warrior Project, regardless of why they reached out to interact with Wounded Warrior Project. Is that correct?

[00:15:57] So it's anybody who interacts through our programs that we know are risk factors. So our financial health and wellness programs, because we know that's a big risk factor. Our physical health and wellness, because we know sleep and pain are large risk factors. And our mental health programs. Our larger goal is to have it completely across the organization. But we're really excited to have implemented in those three programs over the past year.

[00:16:21] And this is like a physical questionnaire that somebody fills out or online, they type in their responses to a series of questions, that type of deal? So when you come in, you get a human that talks to you. And that human is going to ask you those questions. And, you know, an example question might be on there is, have you considered or thought, have you had suicidal thoughts? Have you considered suicide in the past three months?

[00:16:45] One of the questions that we ask on our survey, in addition to that, because we also surveyed Wounded Warrior Project, we asked them, have you had suicidal thoughts in the past 12 months? We found out that one in four of our Wounded Warrior Project warriors have had that. So we ask that question, and then depending on their answers, we'll depend on if there's another question and then how we, you know, what we connect you with. So I'm just thinking about, you know, veteran community. You know, we all had periodic health assessments. You had pre-deployment health surveys, post-deployment health surveys.

[00:17:15] And we all lied on all of them all the time as a matter of course. That's why we all have clean medical records, which is why getting VA disability is such a pain in the ass later. Sure. So, I mean, I'm just assuming being somewhat cynical and knowing myself and the rest of the community. Yeah, you put that in front of me. I'm lying through my teeth. Who the fuck are you? I just signed up here for some financial stuff. Like, why are you in my business? So I guess is how is that addressed at all?

[00:17:43] Or is that a persistent problem that you've you've seen come up? You know, I can't say that nobody's ever going to lie to us. You know, right. And you're correct, especially if somebody is reaching out for financial health and wellness. We might get that question of like, why are you asking me this? I get mad every time I call the VA and I get that thing at the end of the phone call. Like, oh, if you're having suicidal thoughts, like call this number. It's like it's white noise at this point. Right. So that's why it's really important that we have the other questions that we have on that.

[00:18:11] And that, you know, full kind of assessment is there. It might be somebody's baseline, sadly, that they're saying, you know, I have these thoughts. That doesn't mean that they're okay. Right. We're looking at, again, at that point when we're at the screening, we want to know how can we boost these protective factors and how can we reduce these risk factors?

[00:18:34] So even if they're answering that, nope, I'm clean, I'm good, I'm not having that, we're still watching and collecting like, okay, this person is saying that. But then they've also shared this, this, this, this, and this. The fact that they're coming to us for financial help tells us that's already a risk factor. The fact that they're a veteran tells us that they're also at an increase at risk. So how can we ensure that we are providing this, again, well-rounded support?

[00:18:59] To your point, if somebody's coming to us for financial health and wellness, that might not be the best time to intervene a mental health therapist. Maybe if I can't pay my mortgage, that's what I'm focused on at that moment. I don't, I don't want an appointment a week from now to talk to the therapist. I need to be able to pay my mortgage, right? I have a family. I have, you know, kids, whatever it might be. So it's important for us that we stay then close connected. We already know this person has a risk factor because they're involved in this program.

[00:19:29] Regardless of what they've told us on that, that information is great. It helps us identify higher risk. But either way, we're involved. Either way, we're looking at that. And again, we're building that relationship and that connection to, you know, get you to a point of what you're willing to do at that time. If you're only focused on financial health and you're not going to see a therapist, okay, maybe that's not what you need at that time. How can we intervene right now? Because good financial health is a protective factor. That's great if that's what you're willing to participate in.

[00:19:58] And then we follow up and our team's pretty good at kind of sniffing stuff out. But yeah, I can't guarantee that we're going to get an honest answer every time. Do you think having a person actually ask the questions? Now, let me check this. Are they asking these questions in person or over the phone or a web call? Could be both. Could be either. It depends on how the person gets to it, right? Some of our stuff is in person. Some of it is virtual. Gotcha.

[00:20:25] Does asking the questions with a human doing the asking versus having them fill out a questionnaire, have you seen that or do you have any sense of how that impacts responsiveness? Are they more likely to be honest with the person or are they more likely to be closed off than a stranger is asking them questions? You know, I don't know the answer to that. I could tell you that we don't have anybody fill out questionnaires with this. Every time we ask it, it's a person, you know, asking you that other than our larger survey. But depending on how you answer that, it will trigger a person to then contact you.

[00:20:56] What do I know? I know the human connection is really important. I know that if somebody is working with us to begin with, that there's at least a level of motivation there for us to work with them in other areas. But what's important, to your point, is that we're working with people at a place where they're ready and what they're capable and willing to do at that point.

[00:21:22] If we try to force ourselves onto, you know, somebody that's not going to be helpful and that can turn them away. Access to care, right, has it has different levels to it. It's not great if somebody calls and we say, hey, we can't get to you for three months. It's also not great if somebody calls and then we are forcing a level of interaction that is going to shut them down. And so we do have humans in Revolve to, you know, gauge that. I don't know if, you know, if AI eventually or things like that. That's just not our approach at this point. Gotcha.

[00:21:53] How much of this is, you know, a system not being responsive enough to the needs of veterans at scale? And how much of this is veterans not taking the initiative to advocate for themselves or be honest when they're in trouble? You know, I can't answer that. What I can say is this. I can only go by what I know and what I see.

[00:22:21] What I know is that there are gaps in our system of care. There are gaps in Wounded Warrior Project system of care. There are gaps in the VA system of care. There are gaps in other DSO system of care. Again, it's so important that we all work together because nobody's going to be able to do this alone. That's just the truth. I also know that humans in general and in particular individuals dealing with PTSD, that that could be a disease of avoidance.

[00:22:47] And so it's not uncommon, right, if somebody doesn't raise their hand and say, I need help. That can be the nature of how PTSD, you know, manifests. That's why for us, we're coming at it from so many different directions. We're not just coming at it from the mental health. We're coming at it from connection events.

[00:23:07] We're coming at it from just building those peer groups that raising your hand for help doesn't need to look like I need to be in an, you know, inpatient setting or I need to talk to a therapist. It could just be like I need to connect with somebody and also reducing stigma and having these conversations and people seeing how, you know, big this problem is, is going to be super helpful in it as well. But it's a big effort that takes all of us to get involved.

[00:23:36] You know, veterans have to feel comfortable to talk about it. We're hoping to provide that space, stigma, other veterans talking about it. And again, you know, removing any of those gaps. So when we're talking about trying to, you know, solve a problem at scale, there's so many different factors coming into play. There's, you know, access to care. There's how the care is set up. There's resources, issues, whether it's money or personnel or whatever, different organizations.

[00:24:03] Where do you think the most room for improvement with providing care to veterans, where the most potential for improvement is? Is it doing more of what we have right now? Is it continuing to refine the system before we scale it? Is this something like, man, if we spent a hundred billion dollars or we hired these number of people or we just took this one template and gave it to everybody?

[00:24:26] Where do you think at a mass scale level there's the most potential to improve outcomes? I think for me, my answer to that would be in connection. Something that may not cost a dime and something that doesn't necessarily have to be dependent on these systems, right? These systems are important. We know they are important. Clinical care is important.

[00:24:55] If you need clinical care, it's necessary. But connection is so important. And it can be free, right? Building your support system is going to be crucial for your overall well-being. And I think that the more emphasis we put on that, helping folks to feel more comfortable to build their support system and even to look outside of the home for support,

[00:25:24] I think that there's a lot of opportunity there. For a long time, like I said, you hear suicide as a mental health issue, that this is mental health and therefore that the response to it is the medical model, is in mental health, is a therapist or it's medication. And it might be that if that's what it is for that individual. But there are other things here contributing to it.

[00:25:44] And so for me, that connection piece is really something that I don't think we emphasize as much as we need to and something that we don't capitalize on as much as we need to. I love that that's one of the largest programs at Wounded Warrior Project is focused strictly on connection and building that support program. Hmm.

[00:26:07] Well, if there's a veteran out there listening to this or a family member of a veteran and they think something might be off, they're not sure where to start. You know, where would you point somebody who's looking for a first step in getting help with whatever happens to feel not right before it gets to the point where they're looking at catastrophic solutions to problems? Yeah. Reach out. Have a conversation. Right? That is going to be so important.

[00:26:36] You can reach out to Wounded Warrior Project, right? WoundedWarriorProject.org. We have a great resource center. If we're not what you're looking for, we can connect to other things. We're part of the Veterans Wellness Alliance. That's CheckIn.org. They have a website as well. They can help veterans of all areas get connected, whether you're a caregiver, whether you're a family support member. You can come to either one. Talking with your providers, you know, if you're connected within the VA system or even outside of that is also important.

[00:27:04] But if you take anything from this, talking to somebody, right? Connecting with somebody. Again, we have 988 that's a crisis line. Our goal, though, is to get to you way before you need 988. And it's a fantastic resource at that level, but we're really trying to be proactive and get to people ahead of that. So I would say reach out, talk to somebody, let them know how you feel. There is no stigma with this. We're here to help.

[00:27:32] There are other organizations there to help as well. Nice. Well, really appreciate you taking the time to talk with us today. But while I have you here, you know, is there anything that I didn't ask you about that I should have? Oh, great question. I would say I just want to emphasize a little bit more on the family support members as well.

[00:27:51] So somebody going through this or even worse, somebody that has completed or attempted to complete suicide, they say on an average that affects 135 people in their life. So for the family support members, for the children in the home, the caregivers, this is not a burden that they need to carry. Nobody needs to walk through this alone, whether it's the veteran or the people within the home. And, you know, Wounded Warrior Project is there to help. There are other organizations there to help as well.

[00:28:20] That it's as important that they raise their hand and say, I'm not okay, too. That we understand that this is something that greatly impacts them as well. Okay. Well, Lindsay, thank you so much for joining us today. Really appreciate you taking the time. Absolutely. Thank you for having me. Thank you.