The call came in at 3:30 p.m.
“I just want you to know that I’m about to check out,” the caller said. “There’s a train track nearby. I can just sit myself down there and do it.”
Social worker Tonnia Hinshaw had picked up the phone in the suicide-prevention office of the veterans hospital in North Chicago. She recognized the man’s voice, which was slurred from alcohol. A 62-year-old Vietnam veteran, he had called before and told her about his struggles with post-traumatic stress disorder.
Now, he broke into tears as he explained that he had lost his apartment, become homeless and, on this afternoon, been drinking for several hours.
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Do you have any weapons? Hinshaw asked, as she quietly alerted a co-worker to call the police.
The goal was to evaluate the man’s risk and to keep him on the phone. For 90 minutes, Hinshaw talked to the veteran about his life and his family. Again and again, she attempted to coax him into telling her where he was. But the veteran would only say that he was staying at a hotel near the railroad tracks. He had been looking at photos from the war.
Then, as suddenly as the call had come in, it ended. The veteran announced he was done talking and hung up. Hinshaw called him back repeatedly, but the phone just rang and rang.
Several hours later, police found the man, unharmed, in a local hotel and took him to the hospital. After a stay in an inpatient unit and months of intensive therapy, the veteran has since reconnected with his family and found an apartment. He sometimes stops by Hinshaw’s office to say hello.
Today, Hinshaw sees the man as proof that people in crisis can be pulled back from the brink.
“If they are calling me,” she says. “They are reachable.”
‘Nothing has helped’
The U.S. Department of Veterans Affairs estimates that an average of 22 veterans commit suicide every day. That estimate includes all veterans, young and old, male and female, from conflicts past and present. And the problem seems to be getting worse. According to a 2015 study using data from 23 states, the veteran suicide rate increased by about 25 percent from 2000 to 2010.
Under mounting pressure to address what many called an epidemic, the VA named its first director of suicide prevention in 2007 and launched an aggressive campaign. A national veterans crisis line (800-273-TALK) was created, and a suicide-prevention coordinator was placed in each of the VA’s hospitals and larger outpatient clinics.
But critics contend those efforts proved inadequate — suicides among young male veterans in VA care increased — and a scandal over treatment delays erupted in 2014. This year, President Barack Obama signed into law another round of suicide-prevention reforms at the VA. Reaching struggling veterans is critical because, research shows, those who connect with care are less likely to commit suicide.
Now, Hinshaw is part of a team of three social workers who are working on the front lines at the Lovell Federal Health Care Center in North Chicago.
Their mission requires compassion and speed.
If someone threatens to harm themselves during a phone call to Lovell’s scheduling office, an operator rings a bell to alert nearby co-workers. Hinshaw or one of the other social workers, notified via cellphone, will sprint across the sprawling, 107-acre campus to take the call.
The first priority, always, is to determine the level of danger. Is the person thinking of suicide? If so, do they have a plan? Do they have the means?
Then, their job is to connect, to make sure the person knows someone cares and, importantly, to keep them on the phone.
“A lot of times, we’ll be speaking to people who are not in immediate crisis but who are struggling,” said Stephanie Handcock, a member of Lovell’s prevention team. “They feel like they’ve tried everything and nothing has helped.”
In those cases, the social workers become expediters, cutting through red tape and connecting people to services.
Other times, the need for help is more urgent.
When a counselor phoned a veteran on a recent morning to follow up on how he was feeling, the veteran said he was sitting with his gun. “If you send the police out here,” he warned, according to a transcript of the call, “I’m going to end up on the news.”
The counselor launched what’s known as an emergency rescue, and police officers were able to safely take the man to the hospital.
“People say, ‘I could never do your job,’” Hinshaw said. “And there are times it can be depressing.”
In November, a veteran fatally shot himself in a Lovell parking lot.
Those losses can be devastating. But Hinshaw and her team work with the hope of reaching others.
It can feel incredibly rewarding to help someone in desperate need and then watch as they regain their grasp on life.
“When you see that much change,” Hinshaw said, “the job is not characterized by sadness, but joy.”
‘Did we do enough?’
At 8 a.m. on a recent Wednesday, a dozen clinicians sat around a conference table to review the cases of 68 patients at Lovell deemed to be a high risk for suicide.
A 29-year-old who slit his wrists had been attending therapy and doing much better.
A 47-year-old who attempted to jump off a building had stopped showing up at appointments.
A 20-something who tried to overdose had been buoyed by the news of his wife’s pregnancy.
For every case, the social workers confer with doctors, nurses and family members. At the Wednesday morning meeting, the panel of clinicians reviews the cases that, after three months, are considered for removal from the high-risk list.
Some patients eventually stabilize. Others refuse treatment and drift away. For a few, the danger could shadow them through their lives. And some, no doubt, take their lives.
“At the end of the day,” said Kristina Lecce, a social worker on the prevention team, “we have to question: ‘Did we do enough?’”
In Forreston, Ill., Mike Bowman and his wife, Kim, will always wonder.
Their son, Timothy, 23, shot himself in the head in 2005, soon after returning from Iraq. After their son’s death, the Bowmans became advocates. They testified before Congress and they sat for a dozen interviews with journalists.
Today, they believe their efforts helped improve the VA’s prevention programs.
“We did make a difference,” said Mike Bowman, 56.
But the loss, he said, never goes away.
“Every suicide destroys a family,” he said. “If anybody wants to come live with us for a week, they’ll see that we’re 10 years down the road and our family is still reeling.”
Researchers are still attempting to tease out the factors that make veterans vulnerable to self-harm. Recent studies have shown that veterans – especially women and young men – have a higher risk for suicide than nonveterans, and that the danger is highest in the first three years after leaving the military.
But, surprisingly, that higher risk does not seem to correlate with deployment to a war zone. After controlling for age, sex and other factors, a 2015 study of 1.3 million veterans showed that those who deployed had a lower risk of suicide than those who did not.
“Everyone’s intuition was the ‘war is hell’ theory,” said Michael Schoenbaum, a National Institute of Mental Health epidemiologist who studies military and veteran suicide. “That theory is too simple.”
Some speculate that the wars in Iraq and Afghanistan might have attracted people who were more prone to impulsive behavior, more financially vulnerable or those with traumatic childhood experiences – all factors that, military service aside, could put them at greater risk.
As researchers attempt to untangle the complex factors at play, the VA has pointed to one encouraging sign in the statistics: Veterans who seek care at the VA seem less likely to commit suicide.
“When they get into treatment, they feel better,” said Caitlin Thompson, deputy director for suicide prevention at the VA. “These initiatives that we have put out since 2007, something is working, even though we have so much work to do.”
‘Backed into a corner’
Advocates say more must be done.
“It takes a lot of courage to come forward and say, ‘Hey, I’m hurting and I need help.’ If someone is able to do that, they should immediately be connected to high-quality care,” said Jacqueline Maffucci, research director at Iraq and Afghanistan Veterans of America. “They shouldn’t be fighting a system.”
At 11:30 p.m. on a Friday night in June, a 61-year-old Vietnam-era veteran from Chicago’s suburbs called the national crisis line.
He was struggling to care for his elderly parents and feeling overwhelmed. “You feel backed into a corner,” said the veteran, who asked not to be named because of the stigma around suicide. “Your head gets filled with stuff and you feel like you’re going to explode, like you’re going to hurt yourself or someone else.”
During his service in the early 1970s, he was sexual assaulted by another service member, he said. After his discharge, he couldn’t control his anger, struggled with relationships, became addicted to alcohol and was eventually diagnosed with PTSD.
Recently, he found himself thinking of suicide, but he worried about his parents: “When they wake up in the morning and I’m not here, who is going to take care of them?”
After his call to the national crisis line, he heard from a VA social worker and, within a few days, he was sitting with her in a bright meeting room at Lovell. “I’m really glad you came in today,” she said.
White-haired and weary, the veteran said he felt nervous on the VA’s huge campus, with its labyrinth of halls and stairwells. “I hear doors closing behind me,” he said. “A little voice in my head says, ‘Oh maybe they’re going to admit you. I’m going to be locked in here.’”
The social worker gently explained that no one would force him to do anything. And as they talked more, the veteran seemed to relax. He spoke about family pressures and health problems.
At the end of the meeting, he reached out his hand and said he was glad that he had come.
“I got to talk,” he said. “And I got to have someone listen.”