Welcome Home - A Podcast for Veterans, About Veterans, By Veterans
Welcome Home is a Willing Warriors and the Warrior Retreat at Bull Run project. The program highlights activities at the Warrior Retreat and issues impacting all Veterans. For questions or feedback, please email us at podcast@willingwarriors.org.
Welcome Home - A Podcast for Veterans, About Veterans, By Veterans
A Deep Dive into Veteran Suicide and Overdose Prevention Strategies
Join us as we uncover ground-breaking research on veteran suicide with none other than Jim Lorraine, a leading authority on this critical subject and the president and CEO of America's Warrior Partnership. Have you ever wondered about the real impact of veteran suicide on our communities and the specific strategies being utilized to address this crisis? This episode promises an enlightening exploration as Jim guides us through Operation Deep Dive's insightful research, detailing the unique data-sharing policies and how this precious data has been successfully utilized in crafting focused prevention strategies.
We are not stopping there. We switch gears to tackle the heavy subject of drug overdoses and their startling effect on veteran mortality. We delve into a candid discussion on the potential of preventive measures and the implications of using the 44-a-day mortality rate for fundraising. Not only do we explore the link between the length of service and time since discharge, but we also highlight the value of qualitative data in creating a nuanced understanding of this issue. Don't miss out as we navigate the sea of data, discussing its impact on veteran service organizations and the urgent need for funding to keep this vital research alive.
Good morning. I'm Larry Zilliox, your host Director of Culinary Services at the Warrior Retreat at Bull Run, and today I'm really excited to have as a guest Jim Lorraine. He's president and CEO of America's Warrior Partnership, which is a Georgia-based nonprofit. That is the organization that is behind the Operation Deep Dive. Research was released recently that really goes into some really groundbreaking, I think, information about veteran suicide. And so, Jim, listen, thank you for being with us today. We really appreciate it. Welcome to the podcast.
Jim Lorraine:No, thank you for having me. I appreciate it, Larry.
Larry Zilliox:For our listeners. Let me just give them a little bit of background. This Operation Deep Dive. When I saw this report, this was the first I heard about any kind of research like this being done. Again, correct me if I'm wrong, but the research itself was funded by Bristol Myers Squibb, done by the University of Alabama and Duke University. Is that right?
Jim Lorraine:That's right, that's right.
Larry Zilliox:Yeah, and what it did was it took a look at information about veteran suicide. Now, for our listeners you may hear the term a former service member used, and that's what they used in the report here, but of course we refer to everyone like that as a veteran. But they looked at the information on veteran suicide in eight states, which represented, I think, about 19% of the veteran population, and came up with some fascinating information stuff. That just totally surprised me. Jim, can you tell us a little bit about how this research got started, where this idea came from?
Jim Lorraine:Yeah, thanks, larry.
Jim Lorraine:And where it came from was we were doing America's Warrior Partnership.
Jim Lorraine:We were affiliated with nine communities throughout the United States, everything from Alaska Warrior Partnership to the Upstate Warrior Solution in Greenville, south Carolina, to the Navajo Nation of Arizona and New Mexico and Utah.
Jim Lorraine:And one of the things as we were working through what's a good suicide prevention strategy and how would we implement it, since it became such a priority for the VA under Secretary Shulkin, we said one of my board members said can we use the information that we had and we had at the time served about 50,000 veterans and we had pretty good data about them. He said can we use that data to do predictive analysis of the veterans who are most likely to take their life? And I said sure, but I mean, can you tell me what the veteran in Alaska looks like as compared to Florida who are going to take their life? I don't know what the profile is based on the community, because we knew, and I think you'd agree, that the veteran in Florida, with the population and the distribution and all the resources that are available in the Panhandle of Florida, may look different than the veteran in Virginia and likely looks different than the veteran. It's a different person that you're looking for to do suicide prevention in Alaska.
Larry Zilliox:Absolutely.
Jim Lorraine:And so what we found was at the time there was a national suicide strategy that didn't have state-level specific strategies, and there's a lot of governor's challenges going on right now to do that. But what we were seeing was it was a lot of copy and paste from the national strategy to the local strategy, without a real recognition that your community looks different. So the whole purpose of Operation Deep Dive is to develop a tool that can allow local communities and states to develop specific prevention strategies based on the population of veterans and their families that live there and the resources that are available, the culture a lot of factors that went into it that go into who's the veteran most at risk for taking their life. So that's how we started down the road for Operation Deep Dive.
Larry Zilliox:So eight states. Data came from eight states. How did you decide on these specific states? I noticed that Georgia wasn't one of them, which is where you're based, and I'm just curious as to who made the decision about which states to pull data from.
Jim Lorraine:Yeah, well, I will tell you that the original when we went into the study, our original focus was to go to the counties where we had programs, the county corners and medical examiners, and pull the medical records of those who were identified as suicide and then do our own research as to whether they were served in the military or not. Well, thankfully, a couple of counties said don't work with us, you'll have to make the Panhandle of Florida as an example. Represented six counties and the counties said don't deal with us, you'll have to make an agreement with all six. We give all of our data to the state, just go to the state. And so the first two states that we went to that we had been working with were Minnesota and Florida. Well, minnesota and Florida both had data sharing policies around the research that they would share the names, addresses, social security numbers and then the details of the death. And so that changed the direction of the study at that point, because what was happening was and I'll use Florida as an example we received in one email or not one email, but one in one data transfer. We received five years worth of everyone who died in the state of Florida, with all their demographic information.
Jim Lorraine:At the same time, I had been talking to the Department of Defense about what we were trying to do and I knew that the root data on military service was available to DoD because, as a retiree, I could go into my record and pull up just about everything. It was in everything about my military history and so I said, well, if I can do it, why can't we get access to it? So the state shared all the death data of everyone who died in the state. At the same time, we had established a data sharing agreement with the Department of Defense and the process was we would send all the names and social security numbers, gender and dates of birth to Department of Defense and then DoD would come back and say here's everyone on your list who served in the military and with 165 data points around their military service. So every time you went to get a new ID card or anything changed on your record that was annotated.
Jim Lorraine:So I knew, the day you came in the military, whether there was a mixture of active guard and reserve, time served, promotion schedules, demotions, units of assignment, locations of assignment and, really importantly, the characterization of discharge, why you were discharged or why you left the military and then when you match those together, you not only know.
Jim Lorraine:Now I could compare military to non-military within a state, I can compare ages, I could compare genders, I could compare, I could look at what was unique in what did the veteran who died prematurely in the Panhandle of Florida look like as compared to the former service member who died prematurely in Miami? And compare those to the rural area and be able to say, hey, there's a difference. Not only is there a difference from state to state, there's a difference within the states, there's a difference between urban and rural, and the whole goal was again to be able to identify the veteran who had the highest likelihood of taking their life in the community. And then what you do is you do outreach and engagement to them before the crisis occurred and prevent them from taking their own life, if that makes sense.
Larry Zilliox:Yeah, it makes perfect sense. In fact, it's kind of the opposite of what I thought was going on, which was coroner data and death data. The death certificate that's used nationwide does have a field for veteran to indicate veteran, and I thought that that was just a collection of those records based on that particular death certificate or death information being identified through that check that this individual died was a veteran and that the death was ruled a suicide. Which brings me it may be an explanation for the discrepancy between what operation deep dive found, which was approximately 24 former service members or veterans commit suicide each day, where the VA says their number is 16.8 or 17 a day, and I'm wondering where do you think that discrepancy lies? Is it the manner in which they're identifying veterans who commit suicide by just using the check, or is it your approach, much more detailed, and really it sounds like it's the way to go?
Jim Lorraine:I think I don't think anybody's wrong, I just want to. I think that when you look at it's, one death is too many and so, whether it's one or whether it's 24 or 17, we have to do something differently. And the reason, I think, for the disparity was we looked at former service members and the reason why we did that was I didn't, I don't know, we don't have the data from the VA to know who's in the, who's a veteran and who's not. But what we had information from DOD was I knew those who had served in the National Guard which aren't considered federalized. They're not all considered federalized, as you know, so they may not be considered by the VA as veterans. But I also knew. I also knew the guardsman who had done active duty and who had had a deployment of greater than 180 days and all the criteria for that. And I knew the reservists who had been federalized. Above and above, until we had true VA data, we couldn't say there were a veteran. So let's just talk about there's a couple of things. Number one when we went to the states and we went to the Department of Defense and they came back and they said, hey, these who served in the, these are who served in the military and these who didn't serve.
Jim Lorraine:What we found was that the states, and most actually the counties, whoever was filling out the death certificate and filling out that information they were doing it based on the opinion either of the family member or of a friend for most of the cases. And what we found was that the states, where whoever was filling out the documents at the local level, weren't annotating it correctly and they were, which meant I had served in the military, but on my record I never was marked as having served. And, by the way, not all states collected in the same way. There was one state that the checkbox was did the service? Did the decedent serve in the army? And that was the question about military service. That's since been changed in that state, but the point was it wasn't accurately done and there was no corroborating information from the government to match that. So what we found was that 18% of the decedents in the eight states that we studied had served in the military but were not counted on their death certificate as having served. So that's an 18% difference there. That's a high. That's 7% of the yeah, 7% of the time. We found that people who had never served in the military, their death records were marked as having served, and so that's the net error is 25%, and so there's a right off the top. There's 25% that are different.
Jim Lorraine:We looked at veteran's deaths differently than the veteran did, than the VA did. We looked at it from the perspective of if you served your nation, whether you were in the Guard, reserve or active duty, okay, we counted you. The VA doesn't do it that way. The other piece was we looked at, and when we talked about the 24, that was just suicide. We went beyond, and when I say just suicide, that was suicide. That could have been by firearm, overdose, suffocation or strangulation, et cetera.
Jim Lorraine:By any means, that was categorized by the coroner as suicide. What we found when we looked at the data, though, was that the vast majority of veterans, in almost all the states, died by overdose, but they weren't classified as suicide, and so we used a term called self-injury mortality, and self-injury mortality is it's a self-harm behavior that you wanna get ahead of, and so we rolled that in. We included that in the study because we felt it was important to not just conspiring ourselves to the category of suicide, because there's a lot of documentation, and in our conversations with corners and medical examiners. They were really open. They said if there's an overdose and we can err on the side of an accident or undetermined, rather than classifying it as suicide, we will Because of the impact, especially in rural communities, the impact on the family, the stigma, the financial impact, et cetera.
Larry Zilliox:So I guess my question surrounding the self-injury mortality issue, which adds 20 more deaths per day, raising the total to 44 per day, is that, when it comes to drug overdoses, how is the data determined as to whether that drug overdose was accidental or intentional? Because so much fentanyl is in drugs today? 44% of the drugs that the DA confiscates and tests contain lethal amounts of fentanyl. The military itself acknowledges that last year 80% of the soldiers who died by drug overdose, their drugs contained. Their system contained fentanyl. So I understand that there are other ways, in that some deaths might not be counted, but I'm just not sure how you determine what's intentional and what's accidental, or I would say almost a homicide by some idiot drug dealer who doesn't know how to cut their drugs with fentanyl. But it's certainly not the user's fault.
Jim Lorraine:No, well, illicit use of drugs is kind of you know, addictions are terrible things and I think I don't think the user is fully to blame. But I would say what we did was to get to your question of how do you differentiate between accidental versus intentional. There's a category and a code that the coroner's put on that piece that, depending on if it's illicit drugs, if it was like if somebody had a diabetes and they died because of an insulin error, that would be categorized as a separate code, which we didn't count. We only counted the codes that were either criminal or illicit drug use or non-prescribed drugs. To your point about the fentanyl and you hit it right about when you said about homicide there's three states that we studied of the eight that classified fentanyl deaths as homicides because it drove a criminal investigation, vice, accidents, suicide or undetermined, and so, unless you were looking for it, you couldn't find it. It was buried in another category. That's why what we did was we pulled the categories out and the codes of the type of overdose out to get to it.
Jim Lorraine:Is this something that's preventable? Because, again, our approach is America's Warrior Partnership is. Is this preventable? Yes, it is. So how do we identify the veteran at greatest risk for a preventable death, and that's why we just didn't want to constrain ourselves to suicide. Suicide is, yeah, we need to work on it, but, boy, overdose, we need to get out. When I testified to Congress, I said there's a tsunami coming and it's overdose and it's not classified as suicide. So we need to look broadly and say are we going to, are we going to get on top of this, or are we going to wait for it to roll us over?
Larry Zilliox:And we know for a fact that there's a combination of things that affect the veteran and cause them to self-medicate, whether it's the PTS, whether it's TBI, and so when they start to go down that road, very often they end up at a point where, by no fault of their own, they're overdosing because of the fentanyl. So anything can be done upfront to help them with the underlying issues so they don't need to self-medicate and not get on that road to an overdose. I think is important, very important. My only concern, my only concern, is that I have seen some organizations that are using this 44 a day number almost for fundraising purposes, and I know, and so that drives me a little nutty, but that's my only concern with it.
Jim Lorraine:Yeah, I agree with you 100% and I think I do think that the engagement whether it's, you know, whether it's for overdose or whether it's for firearm what we've been advocating for is, yes, safe storage is important for drugs and for firearms. And what are we doing about drugs? And my point is we just can't be myopic and say, okay, I'm going to focus on one method of death. I need to look broadly and say how do we engage it across the board? But to your point about the fundraising, I agree, I've been on the other end where I've said what do you mean? I've heard people use it. They don't realize that I'm in the room or that we even did the study and I'll say, no, no, that's not what the study says. Oh yeah, it is. No, it isn't, I did it.
Larry Zilliox:Oh, my goodness.
Jim Lorraine:And I'll say no. No, you're mischaracterizing what was written, so I don't know how you get ahead of it other than just buy or beware. Don't or beware.
Larry Zilliox:Yeah, well, yes, and I think the way to do it is to talk about it and to get the information out there and say, ok, this is what we're looking at 17 to 24 a day by identifiable corner, identifiable suicide. It's a terrible tragedy. There's also the possibility of these other deaths that are happening because of a combination of events that are leading our veterans to self-medicate, and with a terrible, tragic end as well. Some of the results of the study were just jumped out at me and just were startling. The one, the number one thing that I saw that I just was so surprised is that the Coast Guard for veteran, a former Coast Guard were most likely to die from suicide in the data set that you sampled, and I just couldn't believe it.
Jim Lorraine:We're capital. When we looked at it now and we put it in the methodology that, when you look at the states, so the eight states, there was only one state that was landlocked and that was Montana. When you look at the other states, I thought we were skewed. And I talked to all the state directors of veteran services and they said no, no, you're not. Like Massachusetts said. No, you're not skewed, it's not.
Jim Lorraine:They said you're absolutely right, we see it very heavily amongst our Coast Guard veterans. What they described to me was here you have uniform service members who have a law enforcement arm. They're always engaged and then this is one of the things they said 50% of the time they're successful at saving the life and some of the times they're not, and when they're not, they're the ones you have to stay behind and make sure everything is together. And I thought, having been in the military, I thought that is nothing like, or maybe not as much as my experience has been. So that was one of the things. I don't know. If you noticed the demotions, that may have surprised you 56%.
Larry Zilliox:Yeah, you have a greater 50% Go ahead. Yeah, no that, and the in the military less than three years, mm-hmm.
Jim Lorraine:So what we saw was it sort of went along with the demotion, the military service and the demotion the lesser the military service, especially in younger vets. So the normal contract right now is about, or has been about, four years, and when you see veterans who are or service members getting out a length of service of three years or two years, but they're honorably discharged, you sort of scratch your head and say, okay, why did they leave? Why did they leave early? There had to be something that was there.
Larry Zilliox:I almost think too, is that what we tend to forget is that there are many people that enter the military to escape situations in their life that they've grown up with and they have problems when they come in, and I think that it takes some time in the military for those problems to fade and that if it's a combination of disciplinary action but maybe not adjusting to military service the way they should and then all their own baggage that they bring in, I could see where, in that timeframe of three years or less, would be a period of probably the most turmoil for some of these young soldiers. That would make them more inclined to take their own life.
Jim Lorraine:No, I would agree, and that's where I think that we need to. And in working with the Department of Defense, we've talked through about how do we structure a good transition. And when you look at someone who either is encouraged to get out of the military or whenever the reason is that they're encouraged to get out early, and you look at TAPs or TAP, the Transition Assistance Program, most of the time they're not going through it. Their time in the military has been truncated and it's time to get out. And then when you look at it, when we look at that, we say okay, are we doing the best thing for these folks who are at greatest risk? And that sort of goes to our next phase.
Jim Lorraine:We're working with the Council on Criminal Justice to move forward and look at how do we? What's the connection between justice involvement, both while they're in the military and then post-military, and their causes of death? And, larry, if you don't mind, we've been talking a lot about the quantitative side of the study. We have a qualitative side of the study, which is so. We have a, and your listeners can go out to our website. We have a qualitative piece where what we do is we interview the friends, families and coworkers of decedents who've died from premature non-natural causes. It doesn't have to be classified as suicide. It could be classified as an accident or a determined but is attributed to self-harm.
Jim Lorraine:And what our team does is that they interview three to four close friends and close people who can talk about the last year of the veteran's life. What was their past history? Where did they go? What did they do? What's their history? What was unique to them? And it has been an eye-opening validation and stuff. It's information you can't get quantitatively by big data sets. It's really the personal side. One of the things that we notice is what was the veteran's impression of themselves and their military service as compared to what the reality of their military service was, and sometimes there's a disconnect. So we're always looking at participants who. So the criteria is the decedent has to have died prematurely from non-natural causes within the last two years. And then the family. We talk to them and then we get connected to a friend and then our biggest, just recently, we have seven people that have come in and said I wanna talk about my friend before they died, about what was happening before they died, and that brings up a whole different picture.
Larry Zilliox:And what patterns are you seeing there? Are you seeing any kind of pattern?
Jim Lorraine:You know it's so early, we're not really seeing. One thing that I'll bring up, and the reason why we went down the road is criminal justice development Sure, one way or another, whether it's a DUI or something, and but much more to be done. And again, our partners at Duke. They're the best at doing this work. We do the interviews. Our folks who are veterans do the interviews. They understand what's being said in the context and then we turn to our friends at our partners at Duke to interpret it and look at it, and what we look to do is to merge the quantitative and the qualitative together to get them to paint a really good picture of okay, where, how should I, what should I be looking for two years before somebody's really trying, thinking about taking their life?
Larry Zilliox:So what's the funding look like? Is Bristol-Mayer-Squibb still on board, or do you need more funding?
Jim Lorraine:We, so we do need more funding. So Bristol-Mayer-Squibb is no longer on board. The grant cycle ran out and and unfortunately for our space, the veteran space Bristol-Mayer-Squibb moved to a different population and they were. They were great. But we do have other funding to continuous, but not to elevate us to the level of because, again, we're looking beyond just now, we're looking beyond just non-natural deaths, we're also looking at natural deaths, and so what that brings with it is, as an example, why do veterans die from heart disease at a younger, higher rate than non-veterans?
Jim Lorraine:Why do veterans die from certain cancers, et cetera, et cetera, which are related to the PAK Jack at a younger, higher rate, or why do they even have them in the first place and then to go back into to correlate their military service to the causes of their death? So it's, the study has grown much more than just it started out as suicide, then it went to premature, non-natural death and now it's premature death because of the robustness of the data we have.
Larry Zilliox:Sure, and then I'm sure you can tie things to career fields, to length of service, to deployments. There's got to be all sorts of data points that are really, I think would be really helpful. But it seems like the DOD or the VA would have that information and are they willing to share it?
Jim Lorraine:Well, the DOD is. The DOD has been a great partner with us and you brought up an interesting point. A lot you hear a lot of talk about the age group 18 to 24 and 25 to 34, et cetera. We look at that. But, more importantly, what we look at that we're the only, this is the only study that can do this is length of service and time since discharge. So I know how long somebody served. I also know how long it's been since they've been out of the military, and so did it have. Have they been out six months? Have they been out three months, three years, five years, 10 years, regardless of their age? There is some, there is some correlation there. So, regarding DOD, I think there's a lot. The other thing that we're looking at is is National Guard Reserve Service a protective factor to? Is it a protective factor for premature, non-natural death, for suicide is an example. Can I? If somebody goes from active duty into the National Guard, does it reduce their suicide rate? That's something that we're looking at it right now.
Larry Zilliox:Or does somebody, somebody go from reserve regard to active duty, then back again, then active duty, and you start to see a correlation between two active deployments and the rate goes up quite a bit. I could see it going either way.
Jim Lorraine:Yeah, yeah, and all of the, all of the possible connections that they have. Without a doubt, there's there's a lot that we can look at, but where we're trying to get to is to say again, to go back to the purpose who and why are they taking their life? Not just how they're taking their life, but who is it? To go back to how we get started. When we started to get a large amount of data, I had served in special operations command and I can I can recall being in part of a group set use data to identify where our high value targets might go, what their patterns, et cetera, would be. And I said if we can find high value targets in Iraq and Afghanistan using data, why can't I use the same method to find the veteran, to identify the veteran who's at greatest risk for taking their life and then engage with them early? That's the whole goal. That's the whole goal. It can't be a website. We've got to figure out who's at risk and how do we take care of it.
Larry Zilliox:And I think, too, what people don't understand is there's a tremendous amount of veteran service organizations out there that do amazing work, and this kind of information would be extremely valuable to them, because then they can start to create policy, create programs around what veterans in their community need specifically and to really get in front of this freight train of suicide. And I just think the work you guys are doing is just amazing.
Jim Lorraine:Well, thanks, I appreciate it and helping getting the word out is important. To answer, to read, to footstomp on a couple of things. You know, if people know of a person who died prematurely from non-natural causes within the last two years and they want to tell their story, we want to hear it. Number one, and that's our qualitative side, and you can go out to our website, www. americaswarriorpartnership. org and FIMED. The second piece is we are looking for funding to continue and to bolster the growth of the study. We've got some great partners and I'll give you an example. Like the Navy SEAL Foundation, it supports us because they want us to look in which we're gonna do, which we are doing, is isolating the Navy SEALs and looking at what's unique to them as compared to the general population, that those who never served and then those who served in the military what's unique and how do they get ahead of their crisis.
Larry Zilliox:Yeah, I think it would be very interesting to know what impact, what the data shows relating to tier one community as opposed to other, just the general rank and file of military service. But I just can see this going in a hundred different ways and it's just.
Jim Lorraine:You know we do that. This is a Larry. You're living my life right now because every new piece of data that comes in we say, oh my gosh, well we could do about X, y and Z. And yeah, we're fortunate to have this opportunity. We look forward and hope that the VA will share their data. We haven't gotten data sharing from the VA yet, but if you just think about it, I have military service and I have debt. And if I had, and then now we're gonna have justice involvement in financial history. Now I overlay that with the VA history. Now I've really narrowed my site picture on who do I engage with? That take greatest risk.
Larry Zilliox:Yeah, yeah, well, listen, thanks so much for taking time to speak with us today. This is such an important topic and you guys are doing really great work. We really appreciate it. And again, is where you go for more information. The webpage is set up. It's easy to use. There's tons of information on there. If you do know a former service member of Veteran who unfortunately took their life within the last two years, and please reach out to them and tell them all about that Veteran and what their life was like and what they meant to you, this is valuable information. You may not think anybody's interested, but it could be used to help other Veterans down the road. So it's important to reach out to America's Warrior Partnership and just tell the story of that Veteran. So, Jim, thank you so much for coming on with me and I appreciate it.
Jim Lorraine:You're welcome and thank you for having us.
Larry Zilliox:Yep, so for our list, no problem. Thanks for listening. If you have any comments or suggestions, you can reach us at podcast at willingwarriorsorg, and we'll have another episode next Monday at 5 am. Thanks for listening.
