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Talking Veterans Down From Despair

  New York Times Recognizes Canadaigua National Suicide Hotline  


Published: April 22, 2008

CANANDAIGUA, N.Y. — Nancy Nosewicz was busy fielding calls at the new national veterans’ hotline on a recent afternoon when someone from the Veterans Administration in Topeka, Kan., phoned. He had a 55-year-old Army veteran from the Northwest on the line who had called to complain about his benefits, but now the guy, drunk and crying, was talking about not wanting to live. Could Ms. Nosewicz pick up?

In a slurred voice, heavy from weeping, the vet, whose name was Robert, told her he was homeless and wanted to “just lay down in the river and never get up.”

Ms. Nosewicz, a social worker, listened, and then in a voice firm and comforting like a big sister, said, “We don’t want you to, either. Today we’re not thinking about the alcohol or the housing, Robert. Today it’s about keeping you safe.” She gave Robert’s phone number to an assistant to locate his address and alert the local police to stand by.

The chain of care resembled a relay race, with one runner trying not let go of the baton until the next runner had it in hand.

The veterans’ hotline is part of a specialized effort by the Veterans Administration to reduce suicides among veterans by enabling counselors, for the first time, to instantly check a veteran’s medical records and then combine emergency response with local follow-up services. It comes after years of criticism that the department has neglected tens of thousands of wounded service men and women who have returned from war zones in Iraq.

On Monday, a class action suit brought by veterans groups opened in San Francisco charging a “systemwide breakdown,” citing long delays in receiving disability benefits and flaws in the way discharged soldiers at risk for suicide have been treated.

Up and running since August 2007, the hotline is an attempt to respond to at least some of those in crisis. Over eight months, it has received more than 37,200 calls and made more than 720 rescues — sending out, from a narrow office here in upstate New York, emergency responders all over the country to find someone on a bridge, with a gun in his hand, with a stomach full of pills.

Paul Sullivan, the director of Veterans for Common Sense, one of the groups involved in the lawsuit, said of the Veterans Administration: “I’m pleased they’re responding. However, much more needs to be done, so vets aren’t turned away from health care and don’t have to wait for benefits.”

Mr. Sullivan said that suicidal patients have not been able to get care promptly, citing the case of Jonathan Schulze, who was turned away twice from a V.A. hospital before he killed himself in January 2007. Mr. Sullivan, who has worked at the agency monitoring benefits, said, “more than 600,000 veterans are waiting, on average, more than six months for disability benefits.”

Exact statistics on how many veterans commit suicide each year are difficult to obtain and verify. But experts agree that veterans are more likely — perhaps twice as likely — to commit suicide than people who have never served in the military.

Meanwhile, a RAND study released last week estimated that roughly one in five veterans of Iraq and Afghanistan has symptoms of post-traumatic stress disorder, which heightens the risk of suicide.

Yet whatever larger failings may exist, the staff of social workers, addiction specialists and nurses who keep the hotline running 24 hours a day, seven days a week, can count at least some victories by the end of each shift. What’s unique about this hotline, said Janet Kemp, the national suicide prevention coordinator for the Veterans Administration, is that the counselors now have medical information at their fingertips, which they use to connect vets with counseling near their homes.

The model evolved from a new research program on suicide prevention funded by the agency. “For years, people thought that asking questions about suicide put the thought in people’s mind, but now we know that’s not true,” said Dr. Kemp, who travels throughout the country training the agency’s staff.

The V.A. is spending about $3 million in the first year to start and operate the hotline, said Daniel Ryan, an agency spokesman; another $2.9 million is being spent on a mental health research center at the sprawling red-brick V.A. Medical Center in Canandaigua. Referring to the hotline’s relay model, Kerry Knox, the director of the new center, said, “You don’t want them to fall through the cracks.”

With Robert, for example —The Times has agreed to use no last names or exact locations to protect callers’ confidentiality — Ms. Nosewicz gradually nudged him to agree to be taken to a hospital, and to give her his name and social security number so she could check his file and put him in contact with the local suicide prevention coordinator

Meanwhile, Denise Slocum, a health assistant, relayed questions from the local police dispatcher. “The police are asking if you’re near an elementary school,” Ms. Nosewicz asked, and then nodded her head at Ms. Slocum.

“No, no, no — no handcuffs,” Ms. Nosewicz reassured him. “You’re going to go to the hospital.”

“Do you have a tissue to blow your nose? Then use your sleeve.”

“When they come in, you put them on the phone with me and I’ll tell them to treat you with respect.”

Twenty minutes later, Ms. Slocum called the police again to confirm Robert had been brought to a hospital., while Ms. Nosewicz alerted the local suicide prevention coordinator, one of 156 the agency employs at its health centers.

Robert’s name was added to a board near the doorway, so that the staff could follow up to ensure a local counselor actually met with him.

Of course, sometimes a crack is unavoidable.

“He’s going to do it — he’s really going to do it,” said Terri Rose, a counselor who was working the noon-to-midnight shift. She was wiping her red-rimmed eyes. A caller from Texas who said he was 65, a former helicopter gunner in Vietnam, said he had a suicide pact with his friend, but the friend had gone off and killed himself. Now he, too, was ready to die, saying he had even found a coffin for $150, said Ms. Rose, who served in the Air Force before being injured in an explosion. The veteran hung up and had stopped answering her return calls.

Sometimes veterans have a lot of trouble asking for help, said Jacalyn O’Loughlin, a counselor: “They keep saying ‘I’m sorry, I’m sorry, I’m sorry.’ Especially marines, they feel they’re weak if they reach out.”

About half the calls to the hotline — the number is (800) 273-TALK (273-8255) — are from veterans, split fairly evenly between Vietnam and Iraq, Mr. Ryan said. About 30 percent of the vets who call are women.

A couple of months ago, a distraught woman called from Oregon, Ms. O’Loughlin recalled: The woman was driving to the woods, she said, and was threatening to “walk and walk and walk and never come back.” Ms. O’Loughlin rang the tiny silver bell on her desk to signal the health technician. The health technician checked the area code and phoned the closest veterans’ health center.

“And lo and behold, that suicide prevention coordinator knew her just by her first name,” Ms. O’Loughlin said. The technician called the police, the coordinator called the woman’s husband to get the car’s make and model, and Ms. O’Loughlin kept the woman on the line for hours, she said. “I could hear her getting out of the car. I could hear the rustling from the leaves.”

Meanwhile, the police and her husband were driving up and down back roads. They spotted the car, dashed through the trees and found her. She had a bottle of pills in her hand but had not yet swallowed them.

Sometimes, the victories are smaller, but no less satisfying. That morning Ms. Nosewicz spoke to a veteran whose house was destroyed by Hurricane Katrina; he had been relocated to a different state.

“He called, crying, because he can’t find a job, saying ‘My teeth are so rotten and my mouth stinks,’ ” Ms. Nosewisz said.

Dental referrals are not exactly part of the job description, but Ms. Nosewisz tried dental schools in his area, first one and then another, until she found a school to do the work. “He was crying on the phone, and said ‘Thanks so much, thanks so much.’ ”

All in all, not a bad day’s work, she said, as she got ready to leave for the day. “Three rescues, four consults, and one set of teeth.”



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