For many of us working to curtail suicide among veterans and service members, our focus is on preventing their isolation. Because isolation, which Jules Verne rightly warned is “beyond human endurance,” is a powerful precursor to suicidal patterns.
As the U.S. Department of Veterans Affairs (VA) concludes in its summation of the research, social isolation is “arguably the strongest and most reliable predictor of suicidal ideation, (suicide) attempts, and lethal suicidal behavior.”
And it’s not only suicide that isolation foments. Compared to civilians, veterans who suffer social isolation are at an increased risk for heart disease, stroke, emergency room visits and hospitalization, according to the Center for Deployment Psychology, which is part of the government’s Uniformed Services University. The school is responsible for training military doctors and researchers.
The problem is that many already are isolated and struggling outside the VA network of services, with estimates that two-thirds of veterans who take their own lives have had no contact with the VA.
The importance of staying connected
Because so many already are isolated or on the brink of isolation, that dramatically heightens the importance of interactions with the sprawling VA network.
If they have good experiences that are effective at mapping out a care plan, veterans are more likely to stay connected. If not, if the interactions are excessively bureaucratic and result in greater obstacles, confusion and contradiction, they are more likely to detach and head into isolation – and potential self-harm.
So, from the perspective of my organization, dedicated to reducing suicide among veterans and service members, the VA’s pursuit of a modern electronic health record (EHR) system is vital for keeping warriors connected.
In a healthcare setting, greater connection translates into continuity of care . A top issue I hear from veterans is that the legacy records system at the VA is clunky and clumsy, that veterans repeatedly must provide their health histories to different clinicians, particularly if they use multiple VA medical centers, that continuity of care suffers.
Health records system needs overhaul
Just how bad the Veterans Affairs medical record keeping system was only a few short years ago is underscored by a combat medic I got to know. He was so fed up with the agency’s inability to accurately document his combat injuries and ensure continuity of care that he lugged his records in a rucksack from appointment to appointment. The VA didn’t have an effective system in place to allow a health professional at one VA center to access the entirety of his records from another center, let alone craft a get-well plan accessible by all health professionals working on his case.
My own Navy SEAL son experienced this same situation as he sought help for his “invisible wounds.” Ryan quickly became frustrated, disenfranchised and distrustful of the VA system, much of it due to the lack of continuity related to his care.
He felt no one was listening to him, a perception reinforced each time he visited the VA, where he consistently had to repeat the history of his physical and mental health challenges. He became distrustful of the VA system, which then labeled him as treatment resistant. They essentially turned on him, ironically caused by their own dysfunction and inability to maintain continuity of care, in large part because of poor record keeping and poor knowledge management of his lived distress.
Both Ryan and the combat medic died by suicide.
For VA patients, modernized electronic records keeping, including the kind that civilians now enjoy with their MyChart-type systems, sends a strong signal that health professionals care and are listening – because patients don’t have to cover the same ground with every appointment. It keeps them connected to the VA and support networks. And if they are connected, they are less likely to harm themselves.
Modernized health records system on the way
The VA is in the process of developing a new EHR system for the 170 VA medical centers and 1,193 outpatient sites across the nation that serve approximately nine million veterans. Adoption of the new system has lagged, both due to developmental problems that have since been corrected, and inadequate training of VA staff and related issues. As a result, only five of VA’s 170 medical centers currently are using the software since the effort began in 2017.
But as the VA adds more sites, and assuming the system will work as advertised, veterans no longer will need to repeat tests or repeat basic info to each provider. Clinicians will track and identify health risks earlier –before they spiral out of control. Veterans will benefit from improved strategies to address suicide risk, post-traumatic stress disorder and traumatic brain injuries. If they move from one state or region to another, their records will follow.
The hope is that it will help keep veterans from descending into isolation by fundamentally improving their overall health care experience.
“Social isolation destroys you slowly, from the inside out, which is why researchers have termed it as ‘a silent killer,’” the Uniformed Services University said about the plight of U.S. veterans.
We must defeat isolation. It will save lives.
