For every soldier killed in combat, 25 veterans are dying by suicide. It's time to broaden efforts against PTSD.
By Robert Morgenthau
Wall Street Journal
During the Civil War, they called it "soldier's heart." In World War I, doctors called it "shell shock." In World War II, the war I served in, we called it "battle fatigue." Now we know it as post-traumatic stress disorder, or PTSD. The name may have changed, but one thing is clear: It is reaching epidemic proportions among our soldiers and veterans.
According to a Veterans Administration report released this March, current or former military personnel represent an estimated 20% of all known suicides in the United States—that's more than 7,000 veterans and service members each year. For every soldier killed in combat, 25 veterans are dying by suicide.
Peter Wielunski was one of those veterans. His story is tragically typical of what is happening at VA facilities across the country. In May, the 63-year-old Vietnam veteran hanged himself with a cord from a window shade in front of the doors of the psychology department of the VA New York Harbor Healthcare System's St. Albans Community Living Center in Queens, N.Y.
According to VA documents I obtained from the Wielunski family, on his admission to St. Albans a year earlier, the psychiatric inpatient consultation noted that he had PTSD and a history of suicidal thoughts in relation to his deployment in Vietnam. The referral notes from his prior treatment at the Manhattan VA Hospital reported him "as being at chronic elevated risk."
On Nov. 22, 2011, Wielunski told another patient at St. Albans that he wanted to kill himself. The comment was reported to the staff. He was placed on watch and received a psychiatric evaluation. The next day, the watch was lifted. The evaluation concluded that he was "considered minimal risk."
Less than two months later, Wielunski screamed at several St. Albans staff that he was going to kill himself. Again he was put on watch, and again within days the watch was released when psychiatric assessments concluded that he was at "minimal risk."
On May 20, Peter Wielunski went missing from his ward. He was found just before midnight with a curtain cord wrapped around his neck, his body cold to the touch.
Incredibly, medical reports show that during Wielunski's year at St. Albans he received no continuing course of psychiatric treatment for his PTSD and suicidal tendencies. The VA has issued no public statements concerning his death or any investigation into the treatment he received. Nor has the VA announced any changes in procedure to prevent a similar tragedy at its other hospitals and clinics across the country. The public should be asking, how many more Peter Wielunskis are out there?
His death raises questions of whether the VA has the resources and know-how to deal with veterans who have suicidal tendencies. The VA's own Performance and Accountability assessment reported that in the first seven months of 2011 alone, there were more than 5,500 rescues of actively suicidal veterans through the VA's Veterans Crisis Line. Yet the number of suicides keeps climbing.
Veterans returning from the Iraq and Afghanistan conflicts are particularly at risk. A report commissioned by the Department of Defense and released earlier this year by the Institute of Medicine called PTSD "one of the signature injuries of the U.S. engagements in Iraq and Afghanistan." The report estimated that 13% to 20% of veterans of Iraq or Afghanistan have, or may develop, PTSD. That's 338,000 to 520,000 men and women. And the report cautions that these figures actually may be an underestimation.
The VA has taken admirable steps to care for veterans suffering from PTSD. It has increased its mental-health budget 39% since 2009—to $6.2 billion from $4.5 billion—and has increased its mental-health staff 41% since 2007. But it is still unable to provide timely care to every veteran seeking treatment or to reach out to many of those who are most at risk.
According to the Institute of Medicine report: "Of the U.S. service members and veterans who served in Iraq and Afghanistan and have screened positive for PTSD, only slightly more than half of those have received treatment."
And many veterans have to wait far too long to receive the care they need. In May of last year, a panel of the U.S. Court of Appeals for the Ninth Circuit determined that delay in providing PTSD treatment to veterans violated their rights to receive care for harm and injuries they sustained in the service of our country.
Just this April, the Office of Inspector General released a report showing that the VA was not meeting its own policies for providing patients timely access to mental-health services. Fewer than half of the veterans applying to the VA for mental-health services received a full mental-health evaluation within the 14-day window mandated by VA policy. The rest had to wait on average 50 days. As the Ninth Circuit panel observed, delays in treatment "may make the difference between life and death."
The VA has announced that it will hire an additional 1,600 mental-health clinicians. This is a welcome initiative, but the VA is having trouble filling even existing psychiatric positions. The Inspector General's review noted that VA staff report that their "greatest challenge has been to hire and retain psychiatrists."
Public-private partnerships with hospitals and universities should be expanded to meet this challenge. If the government dedicated even a small portion—perhaps 5%—of its nearly $6 billion budget for veterans' mental-health care to the formation of such partnerships, it could make hundreds of millions of dollars' worth of care available to veterans who might otherwise not seek or receive it.
By tapping the resources of private-sector hospitals and universities, the VA would leverage its investment by making use of private infrastructure and trained mental-health clinicians already in place. Importantly, this would also open up treatment avenues to veterans—many of whom work as police officers, firefighters and other first responders—who fear the stigma of seeking treatment in a government facility. With the VA's own reports indicating that fewer than one in three veterans dying by suicide had made contact with the VA in the prior year, it is critical that such concerns not prevent veterans from seeking treatment.
Continuing to allow large numbers of veterans with PTSD to go untreated is not an option. The effects are socially and economically disastrous. Moreover, we have a clear moral duty to our fighting men and women to ensure that they get care for the injuries they sustained while serving our nation. Peter Wielunski's death should not be in vain.
Mr. Morgenthau, Manhattan district attorney from 1975 to 2009, is of counsel with the law firm of Wachtell, Lipton, Rosen & Katz.