LGBTQ+ Health Program and suicide prevention

“I have been thinking a lot about suicide,” said the Veteran, not making much eye contact. Unlike in past discussions, on this day he had a plan and access to lethal means. He had dealt with distress and thoughts of suicide most of his life—a life that included hiding that he was gay and coping with childhood sexual abuse and military sexual trauma.

I was sitting at a dining room chair in the tiny, senior apartment of a Vietnam Veteran in a rural town. He was seated across from me on a recliner where he also slept, walker in front. On the recliner was a soft fleece blanket he was worrying with his fingers. Touching the blanket was one of his important grounding strategies. The Veteran was in his late 70s and was dealing with many health problems. I had been visiting him about once a month for a year in my role as home-based primary care psychologist.

Stories like this Veteran’s may not be as rare as you think. We know that LGBTQ+ Veterans face many unique health challenges, including a higher risk for mental health issues and thoughts of suicide, than their non-LGBTQ+ counterparts.

This is even more true for Veterans in rural areas, which is why VA has been making inroads to increase access for Veterans in these areas—who are unable to leave their homes—by expanding clinical telehealth and use of the Veterans Crisis Line.

For LGBTQ+ Veterans, additional barriers may still exist, like uncertainties about how sexual orientation or gender identity will be perceived by VA or how it will affect care, especially when one may have had negative experiences in the past.

Abuse by authority figures who should have been support

During our first meeting, the Veteran told me he was gay. This identity was important in so many ways, both in terms of his experiences in the military, the ways he interacted with VA, his resilience and, unfortunately, his experiences with trauma. As a child he experienced sexual abuse at the hands of authority figures who should have been supports in his life. He experienced military sexual trauma before deploying. During our conversation that day, I wished I had something about suicide prevention and LGBTQ+ Veterans from VA to give him.

Now, through the LGBTQ+ Health Program, there is an LGBTQ+ Veteran Care Coordinator at every facility to help Veterans get the care they need. VA policies require that health care is delivered in an affirming and inclusive environment and that VA employees respect a Veteran’s identity. You can visit this link to contact the LGBTQ+ VCC at your nearest facility.

The first time I met this Vietnam Veteran, I put the Veterans Crisis Line number into his phone and set it as automatic dial #1. Since I had started visiting, he had not been hospitalized for thoughts of suicide and I wondered if that day might be the day. He said, “I didn’t know if I should tell you. I wondered if you would want to just lock me up, but I figured I trust you and you’re my psychologist, so I should tell you.”

After talking through how he was feeling and what his thoughts were, we agreed on a plan that did not involve hospitalization, and his thoughts of suicide dissipated over the next several weeks.

Suicide prevention tools

This story highlights the need for improving care and support for LGBTQ+ Veterans as a critical part of VA’s suicide prevention efforts. The VA Office of Suicide Prevention and the LGBTQ+ Health Program are working together to educate Veterans on LGBTQ+ suicide prevention efforts, including:

• Acknowledging the impact of discrimination experienced by LGBTQ+ Veterans, which can be associated with increased risk of suicide and barriers to seeking care.
• Continuing to improve services and provide education to increase inclusion of LGBTQ+ Veterans.
• Supporting LGBTQ+ Veterans and service members who call the Veterans Crisis Line, which is available 24/7.
• Having a suicide prevention coordinator at every VA Medical Center to connect you with your local LGBTQ+ Veteran Care Coordinator for additional support and resources.

A few months after this visit with the Veteran, I was moving to a new position within the LGBTQ+ Health Program. He told me he was sad but happy to hear that VA had an office for LGBTQ+ Health. He asked that I remember his story and share it whenever I had the opportunity.

I contacted my old team to bring him this new flyer for LGBTQ+ suicide prevention. LGBTQ+ Veterans have faced bias and discrimination which can affect health. Because of this we may have to work a little harder to earn your trust. Everyone plays a role in suicide prevention, and as a health care institution, we need to make sure LGBTQ+ Veterans feel welcome at VA.

If you’re a Veteran in crisis or concerned about one, contact the Veterans Crisis Line to receive 24/7 confidential support. You don’t have to be enrolled in VA benefits or health care to connect. To reach responders, Dial 988 then Press 1, chat online at Veterans Crisis Line, or text 838255.