They gave - now you can, too

By Leanne Rousseau, MD and

Claudia Miewald, APRN

This Veterans Day weekend, the members of the Region I Mental Health Board of Directors would like to call attention to the plight of veterans suffering from mental health issues and to urge support from our community to support the local veterans clinic.  We are also encouraging legislation and action at the federal level to support veterans' mental health services. 

The scope of this problem is mind-boggling.  Veterans returning to Idaho are returning to a state designated by the federal Substance Abuse and Mental Health Services Administration (SAMSHA) as having one of the highest rates of serious mental illness in the country (5.8% of the population) and a mental illness rate of 22.5%, also one of the highest in the country. The suicide rate in Idaho is nearly 20 per 100,000, nearly double the national rate. Nationwide, of the 30,000 suicides annually, 20% are veterans and approximately 18 veterans a day die at their own hand.  These are appalling statistics. 

Conversely there is a severe shortage of psychiatrists and primary care physicians, the typical medical providers for patients afflicted with mental and behavioral disorders.  Idaho is 49^th out of the 50 states for physicians per capita.

The stigma associated with mental illness far too often deters people from seeking help.  Mental illness is a physical illness with physical manifestations.  It can also cause functional impairment and can complicate or even be causal in other medical illnesses. Despite its seriousness, funding for identification, prevention and treatment is often lacking. 

Incredibly, funding for veterans' services is scant.  For instance, Tricare, the major carrier for US military medical services, reimburses less than $15 per hour for intensive outpatient services for veterans at one of our local facilities or about the price of a well-rounded lunch at a local sandwich shop and less than either Medicare or Medicaid reimbursement .

Our local veterans clinic, which is only three years old, is struggling to keep up with the demand, but they suffer from the same shortages in staff and funding as other services with the added pressure of greater demand.  Patients discharged from the state hospital or trying to access care at the local facility can wait months for an appointment. Currently there are about 3,700  veterans accessing care with many more acutely traumatized veterans expected to return by the end of the year.    Nearly 100 percent of  returning veterans are expected to need or at least benefit from behavioral or mental health services after their experiences serving in our country’s defense. The local  health community is aware that it takes sometimes several months for veterans to get an appointment at the local clinic, and longer for psychiatric services.  The clinic’s service area extends from western Montana, north to the Canadian border, south to Grangeville and over to the Spokane Valley.  Contracting with local providers for help is complicated by the abysmal reimbursement and the lack of providers.

Prevention and intervention does help.  A US Air Force study shows that education and training in suicide prevention, intervention and treatment, and protective safety nets resulted in a 33% reduction in suicide deaths, 51% reduction in homicides, 18% reduction in accidental deaths, 54% reduction in serious family violence and a 30% reduction in moderate family violence. 

As concerned citizens, we can educate ourselves about mental illness and suicide prevention. Our local NAMI chapter is an excellent source of information and education as is their national website (www.nami.org). We can support suicide prevention education and mental health awareness in our schools, churches, workplaces and other community outreach programs.  Training programs such as Mental Health First Aid  and QPR which stands for Question, Persuade, Refer are directed at helping citizens, law enforcement and professionals understand how to identify and assist someone in crisis. Region I has a crisis line we can access for people in trouble.

We can lobby our state and federal legislators for funding for mental illness treatment and lobby for improved funding for veterans' mental health services. Supporting facilities and programs that reach out to and treat people with mental illness without the pain and expense of law enforcement involvement would ensure that precious state, county and local dollars are spent wisely.  We can also lobby legislators to fund medical provider education opportunities such as the WWAMI program which sends local students to medical school at University of Washington, and loan repayment incentives to bring providers back to our state.

Finally, we can connect with each other.  As Paul Quinett, a professor at University of Washington Medical School and CEO of QPR Institute points out, “The person most likely to prevent you from dying by suicide is someone you already know.  When we solve the problems people kill themselves to solve the reasons for suicide disappear.  Thus, compassionate crisis intervention, problem resolution and competent treatment will save lives.”

Leanne Rousseau, MD and

Claudia Miewald, APRN

for the Region I mental health board of directors