Sea Changes aren’t Always Smooth, but We Should Welcome Them Anyway

The unacceptably heightened veteran suicide rate will never be solved by any one entity. If we really want to address this national tragedy, it will take a concerted effort by the megacommunity comprised of public, private, and nonprofit organizations.

Of course, the problem of veteran suicide begins long before an imminent suicidal crisis, and truly tackling this challenge will include social support networks, families, employers, and faith communities, not just health care systems. It is also essential that we remove barriers to mental health care when veterans are in immediate crisis or danger of self-harm so that crisis situations can be mitigated and stabilized.

Because we all know that access to affordable care is an ongoing challenge for U.S. citizens in need – including veterans – I was delighted last week to read that VA is now implementing the provisions of Section 201 of the Veterans Comprehensive Prevention, Access to Care, and Treatment (COMPACT) Act of 2020, which directs VA to furnish, reimburse, and pay for emergent suicide care for certain veterans, including emergency transportation. Although there are still limitations on what makes a veteran eligible for this cost-free care (for example, dishonorably discharged veterans are currently excluded), it does expand eligibility for care beyond VA’s standard requirements and sets that care at no-cost when it might otherwise incur a bill for eligible veterans.

I applaud these changes -- anything that expands care for veterans at risk for suicide is something we in the field of veteran suicide prevention should be cheering on. That said, this is not a cure-all, and the megacommunity supporting veteran wellness is still needed to fill in the gaps.

Additional details will need to be addressed before veterans and community providers will feel confident that the specific non-VA care to be provided in a given instance will be reimbursed by VA. Although the intention is wholly positive, I can still picture veterans who don’t want to access such care if they don’t have a guarantee ahead of time that it won’t result in a bill to them. Similarly, how will community mental health providers of inpatient, residential, and outpatient care know in advance that the services will be reimbursed or whether the veterans they are trying to help will meet the still complex eligibility criteria?

Our services at Stop Soldier Suicide are completely cost-free to veterans, and we provide that care to at-risk veterans regardless of discharge status, length of service, or the era in which they served. However, if we were a provider seeking reimbursement from VA, it would be useful to have a 24-hour claims adjudicator available through VA. This would allow both veterans and community providers to be assured that a given instance of care would be covered by this regulation, avoiding unwanted surprises down the road. It would be a terrible outcome for a veteran who is already in crisis to think he or she was receiving free care and then be billed for it unexpectedly after the fact.

The impacts of this legislation will need to be closely monitored by VA and other mental health advocacy groups as the processes are rolled out and implemented. If you or a loved one have recently tried to find a therapist or inpatient psychiatric care, you probably realize that our mental health care systems nationally are already not able to keep up with demand. It will be important to see whether the rollout of these new policies has the unintended consequence of making the scarcity of available mental health treatment even worse.

Further, I want to stress that it’s not enough to get someone into just any mental health treatment. The good news is that there are effective, evidence-based treatments that are specific to the prevention of suicide (e.g., Collaborative Assessment and Management of Suicidality, Brief Cognitive Behavioral Therapy for Suicide Prevention). The bad news is that access to these treatments is still very limited. Walking into an emergency department and being assessed at high risk of suicide provides no guarantee that the veteran will gain access to the timely, suicide-specific care that is needed to really make a long-term difference in the veteran’s life.

On the other hand, a positive consequence could be that hospitals and emergency departments might start asking about veteran status more routinely once they realize that the care could be reimbursable by VA. This is a change that many veteran advocates have been promoting for more than a decade because it can lead to more targeted care for veterans.

Overall, I am excited for the implementation of these new regulations and policies that were required by the COMPACT Act in 2020. Anything that expands care, support, and awareness of the needs of veterans at risk for suicide is a good thing.

That said, I also worked in government long enough to know that such change is generally slow and complex, especially when it means adjustments in the largest integrated healthcare system in the country. We will all need to work together to make these changes work for the good of veterans – and personally, I welcome that challenge.

Sonja V. Batten, Ph.D.
Vice President of Programs, Stop Soldier Suicide