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BLOG #10: What Congress is Learning About Mental Health and Suicides

Congress, the VA, and DoD are waking up to the inextricable links among mental health, suicide, brain injury, and effective diagnoses and treatments. Passage in both the Senate and House of S.785 (awaiting Presidential signature) the Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019 continues an unending series of statements about the national need to do more to arrest the Suicide Epidemic among veterans and citizens.
For over twelve years DoD has tried to provide “solutions aimed at helping individuals build resiliency to help strengthen their life-coping skills.” Service-wide “Stand Downs” for over a decade have talked about the complexity of the problem. Suicide is understood to be “caused” by everything from relationship and financial problems, lack of resiliency, depression, disaffection, hopelessness, lack of support, a broad array of mental health issues, and lack of training on the part of everyone. A bumper sticker for suicide prevention stand downs that this author has attended could be “If you see something, say something.”
Numerous Suicide Prevention Conferences, programs, Bills, studies, Reports and collaborative efforts have consumed tens of millions of dollars. And yet the suicide rate is climbing. The Wall Street Journal reports that “Senior Army leaders — who say they have seen about a 30% jump in active-duty suicides so far this year — said they are looking at shortening combat deployments. . . . there has been up to a 20% jump in overall military suicides this year.”
One of the sad statistics of accounting for suicide is to ask the Question: “How many more Suicide Prevention Programs do we have to have before we change the way we conceive of the problem?” The Joint Chiefs of Staff, the highest ranking officers in DoD, have had over two dozen members come and go, all wanting answers to Questions about “What is to be Done?” Forests of tress have been sacrificed for printing Reports with arguments for and against improving any number of organizational relationships; with recommending more training; with removing the stigma of mental health problems; with budgets for more mental health workers in DoD and VA; and with millions more dollars allocated for research and better data collection.
Regarding Suicide Prevention, S.785 is explicit in calling for, among many provisions: Expanded Health Care and Transition Assistance to Veterans; grants for more services; designation of “buddy check” week by the VA; post-traumatic growth partnerships; progress reports on meeting goals and management objectives of past Suicide Prevention programs; and, importantly, expansion of complementary and integrative health services to veterans. Among those services is Hyperbaric Oxygen Therapy (HBOT), animal therapy, agri-therapy, outdoor sports therapy, yoga, meditation, acupuncture, and chiropractic care.
Reps. Andy Biggs (R-AZ) [H.R.4370] and Greg Murphy, MD (R-NC) [H.R.8306] have introduced Bills calling explicitly for the VA to furnish HBOT to a veteran with a traumatic brain injury or post traumatic stress disorder. Each understands a fundamental fact: an untreated brain injury carries with it a higher likelihood of suicidal ideation, whether from initial brain damage or from the impact of drugs prescribed by the VA that emphatically warn against ideation of suicide in males between the ages of 17 and 25. Literally billions of drugs are dispensed to brain wounded service members who may or may not have been properly diagnosed for brain injuries that naturally lead, when untreated, to mental health and behavioral issues.
The suicide epidemic is real and growing. Emergency measures to provide HBOT to brain injured service members and veterans can be invoked immediately, all the while conducting independent research free of the taint of pre-conceived conclusions about how HBOT does not work. HBOT Naysayers oppose the use of HBOT despite a mountain of peer-reviewed data and clinical evidence about positive effects of HBOT on symptoms and neurocognitive improvements. An unbiased and accurate reading of the scientific literature demands that patients be provided information about and access to HBOT for their brain injuries. To repeat: untreated brain injuries lead to deterioration in quality of life, and can lead to suicide. Data show that HBOT virtually eliminates suicidal ideation, and allows patients to get off most of their drugs.
As Drs Xavier Figueroa, PhD and James Wright, MD have written: “There is sufficient evidence for the safety and preliminary efficacy data from clinical studies to support the use of HBOT in mTBI/PPCS [mild TBI and Persistent Post Concussive Syndrome]. The reported positive outcomes and the durability of those outcomes has been demonstrated at 6 months post HBOT treatment. Given the current policy by Tricare and the VA to allow physicians to prescribe drugs or therapies in an off-label manner for mTBI/PPCS management and reimburse for the treatment, it is past time that HBOT be given the same opportunity. This is now an issue of policy modification and reimbursement, not an issue of scientific proof or preliminary clinical efficacy.” Figueroa, XA, PhD and James K. Wright, MD (Col Ret), USAF Hyperbaric Oxygen: B-Level Evidence in Mild Traumatic Brain Injury Clinical Trials. Neurology® 2016, 87:1400–6
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