Cutting veterans’ suicide prevention in the name of efficiency is a fatal mistake

Earlier this month, in alignment with directives from President Trump’s Department of Government Efficiency, Secretary Doug Collins announced his intention to eliminate over 70,000 positions from the Department of Veterans Affairs. For emphasis, he pointedly added, “So get used to it.”

Collins quickly signaled what he plans to cut. During a speech for the American Legion, he criticized the billions spent on suicide prevention efforts, noting that the yearly veteran suicide number — roughly 6,500 — has barely changed. In a follow-up interview, Collins repeated his indictment of VA suicide prevention, and declared that the “programs and operations have serious vulnerabilities for fraud, waste and abuse.”

Collins has a willing partner in Rep. Mike Bost (R-Ill.), chairman of the House Veterans Affairs Committee. In a recent blistering letter to the VA, Bost wrote, “It is unfathomable that the mental health budget has increased by billions of dollars each fiscal year, yet the suicide rate, tragically, has not budged.”

Bost’s and Collins’s framing of these topline statistics flagrantly disregards how VA’s suicide prevention efforts have effectively and efficiently produced life-saving advances.

Between 2008 and 2022 (the last year for which complete data is available), the number of U.S. suicide deaths rose 36 percent — a rate three times faster than population growth. In stark contrast, during this same period, the number of veteran suicide deaths diminished by 2 percent.

Even accounting for the shrinkage in the veteran population, the VA fared better in addressing suicide risk than the general healthcare system did for civilians.

What about their contentions of overfunding and waste? The Veterans Crisis Line accounts for more than half of the VA’s suicide prevention expenses. Since the 24-hour line launched in 2007, staffing has expanded exponentially to meet growing demand. The Crisis Line has initiated more than 351,000 emergency dispatches — 100 per day — each one a potentially life-saving rescue intervention. It has connected over 1.6 million veterans to local VA “suicide prevention coordinators” for follow-up care. The Crisis Line annually handles more than a million calls, texts and chats, with an average wait time of nine seconds.

Most significantly, the last two years have seen a 25 percent reduction in suicide deaths among those who had contacted the Veterans Crisis Line in the last month. How could slashing personnel and slowing these urgent responses possibly be wise?

The remainder of the budget provides for suicide prevention coordinators at each of the VA’s 170 medical centers, who provide enhanced care for veterans identified as at high risk for suicide. They collaborate with VA providers to monitor suicide risk screening, mental health appointments, follow-ups after missed appointments, safety planning and medical record flagging.

The need for suicide prevention coordinators has grown substantially over the last 17 years, paralleling the doubling of veterans seeking VA mental health care. Their careful attention to veterans using VA services is one plausible explanation for why suicide rates for veterans receiving only VA care are 50 percent lower than for those who exclusively use the government’s community care program. As the Congressional Research Service has noted, “Outside the VA, the use of suicide prevention coordinators has not been widely adopted.”

Does Collins want to purge the suicide prevention coordinator system that supports veterans during their most vulnerable moments?

With 73 percent of veteran suicides involving firearms, the VA adopted Trump’s 2020 roadmap for veteran suicide prevention with a focus on “lethal means safety.” The VA formed a groundbreaking partnership with the National Shooting Sports Foundation that seeks to create more time and distance between at-risk veterans and access to their firearms. These innovations far exceed efforts elsewhere.

The VA also runs national social media campaigns, distributes lockboxes, consults with firearm retailers and range owners and staffs suicide prevention booths and trainings at major industry events, including the National Shooting Sports Foundation’s annual SHOT Show, Business Expo and Leadership Summit. Should these critical priorities be jettisoned, too?

The VA’s leveraging of predictive analytics to identify and provide enhanced care to veterans at highest risk for suicide is better than analogous programs. This cutting-edge approach allows the VA to proactively assist susceptible veterans before crises occur — including many without recent suicidal thoughts. Veterans in this program are less likely to discontinue mental health treatment (thereby reducing long-term risk), and have fewer mental health admissions, emergency department visits and suicide attempts.

The VA further leads in suicide prevention innovation through its Mission Daybreak grand challenge, which engages thousands of veterans, researchers, technologists, advocates, clinicians and health experts to develop forward-thinking solutions for preventing veteran suicide. Should the VA stop innovating?

Two comprehensive analyses extolled the VA’s suicide prevention framework as more robust and methodologically sound than any other. The VA has successfully developed, integrated and standardized multi-level, evidence-based prevention protocols across its entire system — a significant achievement that other healthcare organizations and government agencies have failed to replicate. The VA’s approach demonstrates superior adherence to scientific principles, consistently applying standardized interventions across diverse settings while maintaining quality control throughout its nationwide system.

If Collins wants to identify an aspect of veteran suicide prevention with questionable returns, he might consider the Staff Sergeant Parker Gordon Fox Suicide Prevention Grant program for community-based agencies. This program adds $53 million yearly to the budget and has shown no demonstrable impact on reducing suicide risk factors. Yet, paradoxically, this is precisely the aspect of the VA’s program that Collins and Bost seem inclined to expand.

By any measure, the VA’s suicide prevention efforts represent an effective and economical use of taxpayer money, especially given the escalating demand for mental health care and crisis services. Its funding should be increased, not shredded.

But should the VA suicide prevention budget fall victim to Collins’s chainsaw, he should be prepared to answer grieving families and buddies who will ask whether the cost-cutting was worth the lives lost.

Russell B. Lemle, Ph.D. is a senior policy analyst at the Veterans Healthcare Policy Institute.

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