Trump Orders Expanded Mental Health Services to Curb Veteran Suicides

President Donald Trump signed an executive order Tuesday directing the Department of Veterans Affairs to boost the availability of mental health services to transitioning vets in an effort to cut the suicide rate.

At a White House signing ceremony, Trump said the order includes "concrete actions we must take to ensure every single veteran who needs mental health and suicide prevention services will receive them immediately upon the separation from military service."

"They get out of the military and have nobody to talk to, nobody to speak to. And that's been a very sad situation, but we are taking care of them," the president said.

At the Pentagon, Defense Secretary Jim Mattis praised Trump's action.

In a statement, Mattis said, "We look forward to continuing our partnership with the VA to ensure veterans who have served our country continue to receive the important mental health care and services they need and deserve."

Under the executive order, the VA will put more focus on making mental health services available to veterans for the first year after they leave the military in an effort to cut the suicide rate of about 20 daily among veterans nationwide.

Transitioning vets are considered to be at particular risk. VA and independent studies show veterans who have recently left the military are between two and three times more likely to commit suicide than active-duty service members.

In the executive order, Trump directed VA Secretary Dr. David Shulkin, and the Departments of Defense and Homeland Security, to come up with a plan for improving mental health services to transitioning vets within 90 days and to implement it within 180 days.

In a release, the VA said that it would joint with Homeland and the DoD to "develop a Joint Action Plan to ensure that the 60 percent of new veterans who currently do not qualify for enrollment in health care -- primarily due to lack of verified service connection related to the medical issue at hand -- will receive treatment and access to services for mental health care for one year following their separation from service."

Shulkin said, "As service members transition to veteran status, they face higher risk of suicide and mental health difficulties.

"During this critical phase, many transitioning service members may not qualify for enrollment in health care. The focus of this executive order is to coordinate federal assets to close that gap," he said.

A White House background statement on the order said, "Only 50 percent of returning service members who need mental health treatment seek it, and only about half of those who receive treatment receive adequate care, according to the Substance Abuse and Mental Health Services Administration."

The language of the executive order did not specifically mention whether the families of transitioning vets would also have access to mental health services through Military OneSource, but Shulkin indicated that they would be covered.

He said, "President Trump has provided clear guidance to further ensure our veterans and their families know that we are focusing on ways to improve their ability to move forward and achieve their goals in life after service."

Expanding Military OneSource

The VA said part of the plan will be to expand the DoD's Military OneSource, which offers resources to active-duty members and their families, "to include services to separating service members to one year beyond service separation."

Rosemary Williams, deputy assistant secretary of Defense for Military Community and Family Policy in the Obama administration, told Military.com that, based on her experience, the expansion of mental health services to families is crucial.

"This idea of expanding Military OneSource seemed obvious in 2016, and I'm just grateful that it will now be available so military veterans and their families can get the resources they need during a time of transition, which is never easy for anyone," she said.

Military OneSource currently gives active-duty troops and their families access to free mental health counseling both by phone and at in-person civilian providers. Veterans previously lost access to the benefit six months after leaving active duty. The executive order expands the benefit to a year.

In addition, the VA said the plan is to expand "peer community outreach and group sessions in the VA Whole Health initiative from 18 Whole Health Flagship facilities to all facilities. Whole Health includes wellness and establishing individual health goals."

The plan also would extend the DoD's "Be There Peer Support Call and Outreach Center" services to provide peer support for veterans in the year following separation from uniformed service.

A Top Priority

Shulkin has made cutting the veteran suicide rate his top clinical priority at the VA. He said the 20 veterans lost daily to suicide is "just an unacceptable number, and we are focused on doing everything we can to prevent these veterans suicides."

In a conference call with reporters, Shulkin said part of his plan would be to pre-enroll service members before they leave the military to have VA mental health services immediately available to them, if they choose to use them.

In response to the order, Louis Celli, national director of veterans affairs and rehabilitation at the American Legion, said, "Transition from the military to the civilian workforce is a challenge for any veteran.

"Essentially, transitioning veterans are looking to resolve four critical issues: where to live, what to do for employment, how to access health care, and how to find purpose in post-military life," he said in a statement.

"Some veterans have more difficulty with this than others, and we see this expansion of mental health care and suicide prevention programs to be part of an important safety net," Celli said.

However, the executive order appeared to have been rolled out in haste and caught many closely involved in veterans issues by surprise.

"I am seriously concerned by the White House's failure to provide any specific details to Congress or engage with veterans organizations in the community until the day of the executive order," said Rep. Tim Walz, D-Minnesota, the ranking member of the House Veterans Affairs Committee.

"The lack of detail raises significant concerns with regard to targeted funding, outreach, and the education of service members and veterans about the new policies," he said in a statement.

"Additionally, this executive order should not be seen as an opportunity for the administration to push even more critical veterans services and programs into the private sector," Walz said. "Outsourcing mental health services from the VA and into the community would be a catastrophic mistake."

Walz cited a Rand report titled "Ready to Serve," which he said showed that "private providers are substantially less able to provide high-quality mental health care to veterans than their VA counterparts."

In a statement, Arthur C. Evans, chief executive officer of the American Psychological Association, said the association is committed to ensuring that any mental health services provided to veterans in the private sector would meet VA standards.

"APA supports the VA in continuing to collaborate with community providers, with important requirements in place to prioritize fully resourcing VA mental health programs; ensure that VA is the coordinator of all care; and demand that outside mental health care providers meet VA's high standards in using evidence-based treatments," Evans said.

In contrast to Walz, Rep. Phil Roe, chairman of the House Veterans Affairs Committee, said the executive order will ensure service members "have the resources and support they need to successfully transition from active duty to civilian life."

"This executive order will explore new avenues to provide this critical support, and I thank President Trump for his continued commitment to the health and well-being of the men and women who serve," he said in a statement.

New Homeland Security Secretary Kirstjen Nielsen said that Homeland "is where many veterans find a second opportunity to serve their country -- nearly 28 percent of our workforce has served in the armed forces, in addition to the 49,000 active-duty members of the United States Coast Guard."

"This critically important executive order will provide our service members with the support they need as they transition to civilian life," Nielsen said.

Fulfilling Promises

At the signing ceremony, Trump also used to occasion to tout the other efforts of his administration to fulfill his promises during the presidential campaign to improve services and care at the VA.

He cited the bill he signed on greater accountability in the VA workforce to make it easier to terminate poorly performing employees.

It's "one of the things I'm most proud of," he said. "Now, when somebody doesn't do the job at the VA, we fire that person. When somebody's bad to our great veterans, even sadistically bad, we fire those people -- get them out."

He also noted the creation of a 24-hour veterans hotline, which he said was a campaign promise along with the accountability legislation. "We put a very great deal of focus on our veterans -- great, great people," he said.

On world suicide prevention day last September, Trump issued a statement saying, "Suicide is the 10th leading cause of death [in the U.S.], with one death every 12.3 minutes on average.

"We particularly commit to supporting our veterans, who will always be a top priority for my administration," he said.

"Every day, 20 veterans tragically take their own lives. More service members have died by suicide than from combat in recent years," he said.

"We must do more -- they are our heroes, and they deserve the world-class health care my administration has pledged to provide to them."

-- Amy Bushatz can be reached at amy.bushatz@military.com.

-- Richard Sisk can be reached at Richard.Sisk@Military.com.