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VA Adopts New Programs For Mental Health Care

U.S. Department of Veterans Affairs

Michael Fellman says a chance passerby — or, perhaps, divine intervention — kept him alive when the symptoms of post-traumatic stress disorder became overwhelming.

Fellman, a combat veteran of the Iraq War who spoke Friday at a U.S. Department of Veterans Affairs summit in Topeka about mental health care, said he had planned to die on July 31, 2015.

About a month earlier he had gone to the Colmery-O’Neil VA Medical Center in Topeka and was prescribed medication for his condition. But he didn’t realize the medication would take time to work and stopped taking it when he didn’t see improvement after a week.

Fellman’s symptoms soon escalated to the point that even a trip to the grocery store became overwhelming.

“I was tired of the nightmares, tired of the anxiety, tired of the hypervigilance, tired of the depression,” he said.

Fellman said he drove to Lake Shawnee, in east Topeka, and wrote some notes while sitting in his car. No one had gone by for some time, he said, so he stepped out of the car and raised his gun to his head.

It was then that someone happened to walk by and ask if he was OK.

He said he was. The person walked on. But that split second was enough to disrupt his plan.

“That fraction of a second, when I put my pistol down, gave me a chance to think,” he said.

The interruption led Fellman to seek treatment. But the VA hopes to flag other veterans in need of mental health care before they experience a similar crisis and reduce the odds they will get so close to death.

Changes in care

The VA is developing a program called Reach Vet, which will identify veterans who may be at an increased risk of suicide based on any mental health diagnoses and other information that might suggest a mental health need, such as seeking treatment for insomnia, said Stephanie Davis, suicide prevention coordinator for VA Health of Eastern Kansas.

People who receive psychiatric care early tend to have better health outcomes, she said.

“We can provide advance care to people maybe even before they know they’re struggling,” she said.

In 2014, veterans died by suicide at a rate that was 21 percent higher than the general population, Davis said. In Kansas, those who died were more likely to be white males who were younger than 30 or older than 65, she said.

Brian Stephens, group practice manager for VA Health of Eastern Kansas, said the VA medical centers in Topeka and Leavenworth have implemented same-day access for people thought to be at risk for suicide, though people requesting mental health care without an urgent need may have to wait until the next day to be seen.

The two medical centers also are working to integrate their primary care and mental health care providers, Stephens said. If veterans don’t have to come back for follow-up appointments to meet with a mental health provider, he said, they are more likely to start treatment, less likely to harm themselves and generally more satisfied with their care.

The psychiatrists and psychologists know about the change, but the medical centers still are working out how to manage the new workflow, Stephens said. Ideally, they will reach some veterans who may not realize their symptoms come from a mental health problem or who wouldn’t seek care for it because it hasn’t reached a crisis level, he said.

“If we don’t capitalize on that right there in the beginning, we miss that opportunity,” he said. “Most times, asking for help is the hardest thing to do.”

Recognizing warning signs

If VA employees detect someone is at an increased risk of suicide, they can set up mental health appointments and develop a safety plan for that veteran, Davis said.

While some people think about suicide for a long time, the decision to act on those thoughts typically is impulsive, meaning even the brief delay to remove a trigger lock could give the person time to reconsider, she said.

“If we can just interrupt somebody for five minutes, we can save a life,” she said.

Some people have gotten creative, such as one veteran who froze the key to his gun safe into an ice cube so he would have to thaw it before he could harm himself, Davis said.

The safety plans also ask the veterans to recognize warning signs that their mental health may be deteriorating, such as isolating themselves or abusing alcohol or drugs, Davis said, and to come up with coping strategies and safe distractions.

For example, one veteran found that he felt better after doing some people-watching, so he would go and buy a movie ticket — not to watch the movie, but to sit outside a comedy and see the smiling people come out, she said.

While there is no cure for post-traumatic stress disorder or most mental health conditions, people can learn to cope and substantially improve their quality of life with treatment, Davis said.

In Fellman’s case, it took about five months of inpatient treatment through the VA to process his experiences and learn to cope with them. While he said the treatment at times was frustrating, he now feels better equipped to deal with symptoms as they come up. He also is using his experiences to encourage other soldiers who are struggling to seek help.

“I have this giant toolbox and all of these tools have been given to me,” he said.

Megan Hart is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team. You can reach her on Twitter @meganhartMC

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