Taking Calls From Veterans on the Brink of Suicide

– Though suicides among active-duty service members are carefully tracked — they hit a one-month record, 32, in June — no reliable data exists for suicides by veterans –

By James Dao in the NYT

CANANDAIGUA, N.Y. — Melanie Poorman swiveled in her chair and punched a button on the phone. The caller, an Iraq war veteran in his 30s, had recently broken up with his girlfriend and was watching a movie, “Body of War,” that was triggering bad memories. He started to cry.

And he had a 12-gauge shotgun nearby. Could someone please come and take it away, he asked.

Ms. Poorman, 54, gently coaxed the man into unloading the weapon. As a co-worker called the police, she stayed on the line, talking to him about his girlfriend, his work, the war. Suddenly, there were sirens. “I unloaded the gun!” she heard him shout. And then he hung up. (He was taken to a hospital, she learned later.)

Ms. Poorman sat back and took a deep breath. “That was an easy one,” she said. The hard ones are “angry, angry, angry — they have intent, they have a plan, and they have no desire for help,” she said. But they call anyway.

“I think contact is important, even at the end of life,” she said.

It was just an average night at the Department of Veterans Affairs suicide prevention hot line in central New York. Over here, Rebecca talked to a drunken man who was seeing people he had killed. Over there, Katie was on the line with a bipolar man having nightmares. Across the room, Virginia tried to calm a man who had refused to take his medication and was threatening to run headlong into traffic.

This is the front line of the government’s expanding efforts to deter suicide among veterans.

Though suicides among active-duty service members are carefully tracked — they hit a one-month record, 32, in June — no reliable data exists for suicides by veterans.

But estimates, while not universally accepted, seem alarming. According to the Centers for Disease Control and Prevention, veterans account for about one in five of the more than 30,000 suicides committed in the United States each year.

Under growing pressure from veterans groups and Congress, the Veterans Affairs Department in recent years has hired more than 5,000 therapists and counselors and established a system of suicide prevention coordinators at more than 150 medical centers.

It also opened a research center here in Canandaigua associated with the University of Rochester, which already had one of the nation’s largest programs for the study of suicide.

But the hot line has become the most visible facet of the government’s efforts to prevent suicide among veterans, providing tangible examples of both successes and shortcomings in the campaign.

To critics, including some veterans advocates, the hot line is a necessary but last-ditch approach, a tourniquet for people with dire psychological wounds. Until the department develops more effective long-term programs to treat and prevent suicidal behavior, the numbers will continue to rise, they say.

“A veteran would have to have reached the point of actually considering suicide to actually call the suicide hot line,” a veteran, Melvin Citron, testified before a House Veterans’ Affairs subcommittee in a hearing on suicide this month. “I would submit that by then, for some, it could have been prevented.”

But the department and its supporters say the hot line is much more than a Band-Aid. For many veterans, it has become a gateway into government services. About a third of callers are not in the veterans health system, so workers on the prevention hot line can steer them to programs they may not have known about.

The hot line is also clearly saving some people, if only for a day. In the 2007 fiscal year, when it opened, the center handled about 9,380 calls. Last year the number jumped more than tenfold, to nearly 119,000.

On a typical day, responders handle 250 to 300 calls from across the country and overseas. Not all are veterans, but the responders take all calls.

No one knows what ultimately happens to the callers, a vast majority of whom are men. Some probably overcome their impulse, but many eventually call back making new threats. And a few undoubtedly kill themselves.

One measure of effectiveness is known as a rescue: when emergency service workers are able to rush people threatening or actually trying to commit suicide to a hospital. The hot line has chalked up 10,000 rescues since 2007.

Benjamin Rowe, 24, had one such rescue a few weeks ago. A caller said he had tied a noose around his neck and was going to hang himself from a ceiling fan.

Mr. Rowe called the police, but before they arrived, the man, still holding the phone, stepped off his chair. Mr. Rowe could hear him gasping for air.

But the rope broke and the man fell to the floor, softly crying for help as the police finally knocked down the door.

“I couldn’t disconnect, I had to listen,” Mr. Rowe said. “Everyone who works here has had several calls like that.”

Janet Kemp, the department’s national mental health director for suicide prevention, said she was initially skeptical about the hot line. “I didn’t think soldiers would call,” she said. “But I was wrong. It’s kind of blown me away.”

The hot line is run in conjunction with the nation’s largest network of crisis call centers, the National Suicide Prevention Lifeline. Veterans who call 1-800-273-TALK (8255) are prompted to press 1 and are then connected to a bank of about 15 phones in a red-brick building at the Canandaigua veterans medical center.

Recently, the center also began conducting online chats with suicidal veterans, as well as handling calls from homeless veterans seeking emergency housing.

Just about all of the 124 people on staff have degrees or experience in counseling, social work or therapy. Only about a third are veterans themselves, which has prompted criticism from some veterans groups.

Caitlin Thompson, the clinical care coordinator, said a vast majority of veterans simply wanted an empathetic ear. “The very act of picking up the phone is an attempt to reach out one last time,” she said. “It’s that ambivalence that we are trying to jump on.”

Throughout the evening, Kevin Prenatt hovered near the responders, a clipboard in hand. His job was to hunt through databases and phone records for the addresses of callers who refused to give locations. Luck and hunches are sometimes his only tools.

In April, he was able to locate a man who had slit both wrists in a public park simply because the responder could hear a train in the background. As luck would have it, the town had just one park near the tracks.

“I know the residual effects of suicide,” said Mr. Prenatt, a 52-year-old Navy veteran whose older brother killed himself at the age of 26. “It changed my mother forever.”

He was soon hovering near Michelle Edwards as she talked to a despondent National Guard soldier who had just broken up with her boyfriend, was drinking heavily and had a 9-millimeter pistol nearby.

Ms. Edwards firmly tried to persuade the woman’s mother to take her to a hospital. When that failed, she called the police.

“I lived all this stuff,” Ms. Edwards said after hanging up. Her father, she said, was a veteran who returned from Vietnam with serious physical and psychological injuries. But he became a social worker and threw his energy into helping others. She learned from him, she says, to love counseling.

Within minutes, her phone rang again. She had forgotten to press a button that bounces calls to other lines — a system designed to give responders time to decompress before taking another call.

She answered, and a moment later, her voice lowered into an earthy calm.

“Slow down, sir,” she said. “You say you’re seeing people with guns?”