Mental Health Summit

Remarks by VA Secretary Denis McDonough:

Thank you, Shannon, for that kind introduction. Good morning, everyone. Thanks to all of our faith-based and community partners for being here today for this important event. Most importantly, thank you for your partnership and leadership in helping prevent Veteran suicide. Because there is nothing more important than saving Veterans’ lives, together.

I’ll start with a story. For 30 years, a Veteran—I’ll call him Steve—struggled with complications stemming from PTSD related to his military service. Thirty years. He tried VA years ago, but he didn’t have a positive experience. So Steve tried a number of different providers over the years, different medications, and different extended hospital stays. But one fateful day, in a moment of crisis, Steve’s minister encouraged him to give VA another chance. And what happened next changed everything. His VA doctor listened. The doctor began to build a bond of trust. And Steve opened up. He accepted help. For the next six months, Steve worked through an innovative care program. He received evidence-based suicide prevention therapy—therapy tailored to his personal needs—all via telehealth and in the comfort of his own home.

A few weeks ago, Steve sent a note to his local VA leadership. Here’s some of what Steve wrote.

“For the first time in over 30 years, my suicidal thoughts have totally decreased. After wishing to be dead for so long, I never thought my life could be lived without those thoughts. It’s been two months now, and I can’t believe how free I feel.

I use the skills I learned every day. And it feels good. No … it feels awesome.”

Now, let me stop there for a second. Veterans were trained to put a mission or others before themselves. That can sometimes make it harder for them to accept or ask for help. We need to reach Vets like Steve and bring them into our care, because Vets in VA care do better. And that’s where you can really make a difference. It’s one thing for a Veteran to hear about VA services from us. It’s an entirely different thing for them to hear about VA services from you. Because you are the people in Veterans’ lives and communities every day. You pray with them, break bread with them, work with them, and spend time with them. You are the people they know and love. You are the people they trust. So, a recommendation from you can go a long way toward convincing a skeptical Veteran to give VA a try. And doing that, well, it can change their life. I’ll come back to this later. But please, check in with the Veterans in your life who may be going through a rough time. Visit VA.gov/REACH for resources, today. Everyone can be part of the solution and help save Veterans’ lives. Every interaction a Vet has with clergy, friends, family, strangers, or loved ones has the potential to save a life.

Let me continue. Steve closed his letter by saying,

“I’m sending this letter because I need [you] to know that [you’re] making a difference. Keep up the phenomenal job. Thank you for your dedication to Veterans. And for saving my life.”

Now, there’s so much to take away from that. What strikes me most is that Steve is trusting VA again and getting the care he earned, all because he connected with a faith leader he trusted.

And his story shows the impact VA providers and our partners—folks like all of you—are having in communities and neighborhoods around the country. Serving Veterans. Saving lives. It is a testament—pun intended—to the amazing colleagues and partners I am blessed to work with at VA. I have the privilege of seeing your inspiring work every single day.

I especially appreciate any opportunity I get to work with and hear from VA’s incredible chaplains. Spiritual care offers concrete health benefits—research shows that VA patients who have chaplains or faith leaders involved in their health care leave the hospital sooner and better manage their pain and stress. So VA chaplains are key members of our interdisciplinary care teams—on-call around-the-clock, 365 days a year. They participate in medical rounds and patient care conferences. They provide meaningful spiritual care interventions. They offer interdisciplinary education for other providers. They are often the first person a Vet is comfortable talking to about mental health challenges or concerns. And they build trust, and offer the light of hope, to Vets in their darkest moments. Chaplains and faith leaders are invaluable to everything we do here at VA, offering wisdom and spiritual support to providers, Veterans, and their families.

Now, not too long ago, Veterans like Steve might not have felt so comfortable talking to VA because of stigma, discomfort, and fear. And at VA, we haven’t always gotten it right for Veterans of color, LGBTQ+ Veterans, and other underserved populations who may have tried VA in the past but didn’t feel welcomed, didn’t feel heard, didn’t feel seen. And maybe the same is true for Veterans who felt they couldn’t or shouldn’t talk about their faith at VA, either. Well, they can. And they should. And because we haven’t gotten it right, too many of our Veterans don’t come to VA for the care, benefits, and services they’ve earned, and so richly deserve.

But what VA is doing differently—what we didn’t do well for so long—is pairing Veteran-centric care with new innovations in suicide prevention. Listening to the Veterans we serve. Building trust. It’s so simple, yet so powerful. And that right there—trust—that’s exactly what our partnership is all about. You’ve earned the trust of Vets in the community. And that kind of trust can make all the difference in the world. With your help, we’re fighting to remove the stigma of mental health, the stigma of talking about suicide, and the stigma that keeps Veterans from reaching out for help. We’re fighting to counter the narrative that a Veteran who needs help is a victim or is broken. Too often, that narrative threatens to degrade our Veterans, perhaps make them feel like their value and human dignity is diminished because of these challenges. But let me be clear: it’s the narrative, not the Veteran, that’s broken.

So we’re working together alongside faith and community leaders to fix that broken narrative. In partnership with the Ad Council, we launched a national campaign called “Don’t Wait. Reach Out.” This campaign encourages Veterans to seek help for their life challenges before they reach a crisis point. Research shows that the time between suicidal ideation—thinking about taking one’s life—and the action is remarkably short. 24% take their lives within 5 minutes, 48% take their lives within 20 minutes,  and 71% take their lives within 60 minutes. Think about that. The thought, plan, and attempt of suicide can occur in 60 minutes or less nearly 75% of the time. Now, if the attempt is paired with a highly lethal means such as a firearm, it results in death 90% of the time. Here’s my point: every minute—every second—matters for a Veteran in crisis.

“Don’t Wait, Reach Out” normalizes the act of reaching out before the thought, before the boiling point, before the crisis. Every time a Vet goes to the “Don’t Wait, Reach Out” website, they can access scientifically proven, clinically validated information that can help them prepare and plan for times of crisis. As they click on the various links, Veterans can see all of the different challenges they may be facing that are related to suicide. Perhaps it’s legal problems or incarceration, a new cancer diagnosis or the death of a child, the pandemic, a strained relationship, chronic pain, substance abuse, homelessness, financial problems, job transitions, and so much more. What “Don’t Wait, Reach Out” shows is that there is no single path to suicide. And it’s not always one thing, one problem, or one challenge in life.

When people come to a boiling point, they may not have a diagnosis for PTSD or substance use disorder. In fact, over 40% of Veterans who were enrolled in VHA for health care—and died by suicide—had no mental health diagnosis. And in a recent analysis of 365 research studies over 50 years, mental health indicators were only weakly correlated with suicide or suicide attempts. So that means that any of those interconnected, unpredictable, and complicated factors I highlighted can create intense moments of crisis that can lead to utter despair, hopelessness, and suicide. There is enormous power in reaching out. There is enormous power in bringing the Veterans we serve into contact with a real person. There is enormous power in linking them up with someone who is ready and willing to help them contend with any crisis. So I’ll say it again.

Please, check in with the Veterans in your life who may be going through a rough time, and encourage them to reach out if they need help. Visit VA.gov/REACH for resources, today.

I know you’ll discuss this work in more detail throughout the course of the day, but let me quickly tell you about six of VA’s Veteran-centric, innovative solutions; inspiring work designed to save lives and get Veterans the world-class care they need, wherever and whenever they need it.

First, we are now working with more than 1,000 local community coalitions engaged in ending Veteran suicide. These coalitions—faith-based and community groups, health technology companies, universities, Veteran Service Organizations, and others—now reach more than 7.5 million Veterans. These trusted partners, like so many of you in this room, work with Veterans in their neighborhoods, in their communities, around the country. Because Veterans need and deserve suicide prevention solutions that meet them where they are, rather than expecting them to come to us.

Second, we rolled out 988 Press 1, the brand-new national suicide prevention lifeline that connects Veterans quickly and directly to the Veterans Crisis Line. Since that launch, the hotline has fielded over one million calls, texts, and messages—with an average time to answer of just under 10 seconds. And every second counts in a time of crisis, so Veterans are getting the help they need when they need it most.

Third, we’re significantly expanding VA coverage through the COMPACT Act—opening doors of emergency care for Veterans in crisis, access to any health care facility—VA or not—for free emergency mental health care for any Veteran, whether or not they are enrolled in VA care.

Fourth, we announced a final round of prizes through our Mission Daybreak challenge totaling nearly $20 million across 40 teams to build-out proven new innovative solutions in suicide prevention developed by Americans in communities across the country.

Fifth, Staff Sergeant Parker Gordon Fox Suicide Prevention Grants—an innovation advanced by several members of Congress, including your very own Senator John Boozman—are getting resources to local suicide prevention services where Veterans are, funding local innovations among people who know their Veterans best. Here in Arkansas we recently provided one of these grants to a non-profit group called Reboot Recovery. They provide faith-based outreach, education, and support for suicide prevention across the state, uniquely designed and tailored for Veterans and their families.

Sixth, and finally, we’ve brought on over 1,300 peer specialists. These peer specialists are all Veterans, trained to use their personal experiences with their own recovery to help struggling fellow-Veterans reconnect, find a sense of belonging, and access resources at VA and in their communities. Veterans helping Veterans, long after they take off the uniform. There’s nothing better than that.

Suicide is preventable. But it takes all of us, all of our collective heart and will, alongside the very best evidence-based solutions to save Veterans’ lives. And with all this work, and more, saving lives is exactly what we’re going to do, together.

In closing, I want to reflect on something President Biden often says about serving Veterans. He says: “It’s our country’s most sacred obligation is to prepare and equip the troops we send into harm’s way, and to care for them and their families when they return home.” The second part of that sacred obligation is ours to fulfill at VA. And it comes back to the promise our country makes whenever someone signs up to serve in the military. It’s a promise that’s as simple as it is fundamental. If you serve us, we’ll serve you when you come home. If you take care of us, we’ll take care of you. If you fight for us, we’ll fight for you. And in times like these—keeping that promise to Veterans has never been more important.

This is our promise, not just in September during Suicide Prevention Month. It’s our promise every single day. Like Steve wrote, thank you for your dedication to Veterans. The Veterans you help are blessed to have you. Very blessed. I look forward to continuing this important work, together. God bless you all. And God bless our Veterans, their families, caregivers, and survivors. Now let’s get to the panel discussion and your questions.