After coming home from Iraq, Ray Rivas’ life had become a grind of rehab and chronic pain from a brain injury. On that morning in July 2009, he told his wife he hadn’t slept the night before — the headaches that had plagued him since a mortar shell exploded near him three years earlier often robbed him of sleep.
But Colleen Rivas said her husband was in good spirits as he drove away from their New Braunfels home.
“He left with a doughnut in his hand and a smile on his face,” she said.
Instead of going to his vocational rehab session at Easter Seals in San Antonio, the 53-year-old Army Reserve lieutenant colonel drove to Brooke Army Medical Center and overdosed on sleeping pills in a parking lot. A suicide note was found with his body.
“I was totally caught off guard,” Colleen Rivas said. “Three years later, I’m still shocked at what he did.”
A drumbeat of media attention has accompanied the toll of active-duty suicides, along with a stack of official reports with titles like “Losing the Battle: The Challenge of Military Suicide” and growing alarm from the Department of Defense and Congress. Military suicides jumped about 50 percent between 2001 and 2008 and reached new highs this year: The 26 suicides in July more than doubled the Army’s total from the previous month. The Marines already have equaled their suicide total for all of 2011.
But veterans such as Rivas, who die after leaving the military, are not included in the death count of America’s wars. And no one — including the Department of Veterans Affairs — seems to know how many Iraq and Afghanistan veterans are killing themselves after they are out of the service.
An American-Statesman investigation into the deaths of 266 Texans who served during the Iraq or Afghanistan wars show that 45 committed suicide, making it the fourth-leading cause of death behind illness, accidents and drug-related deaths. That percentage is more than four times higher than the general population: Suicide accounted for 3.6 percent of all Texas deaths over the same period, compared with 16.9 percent of the veterans the newspaper studied.
More than half of the veterans committed suicide before their 30th birthdays. The youngest was 22; Rivas was the oldest at 53. All but one of the 45 confirmed suicide victims were men.
It’s likely that the elevated numbers are at least partially explained by differences between the veterans and the general public. The veterans were predominantly male — men are much more likely to die by suicide than women — and all of them were VA patients who had been declared disabled to some degree (the disability could be as serious as cancer or as minor as skin rashes).
National suicide rates have remained relatively constant for decades, said Peter Gutierrez, co-director of the Military Suicide Research Consortium in Denver, which was created through a Department of Defense grant to support suicide research.
The VA estimates that an average of 18 veterans per day commit suicide, or 1 out of 5 suicides in the U.S. But that’s just a guess based on incomplete data, said Jan Kemp, who heads the VA’s suicide prevention programs. “To be honest, we don’t know how many veterans are dying by suicide,” Kemp said. “It’s too many, and we have to do whatever we can to stop it.”
The numbers have been an issue at the VA since 2008, when a CBS News investigation revealed an “alarming” rate of suicide among veterans and a failure by the VA to gather the nationwide data needed to track the deaths. Six months later, the U.S. House Committee on Veterans’ Affairs blasted the agency for “denying” and “underplaying” suicides after emails surfaced that showed VA officials sought to keep the numbers of suicides and suicide attempts — the latter totaling 950 per month among VA patients — from public view.
In August, President Barack Obama issued an executive order with a list of suicide prevention and mental health requirements for the VA — some of which the agency had already begun. Obama ordered the VA to fill staff vacancies, reduce wait times and launch a national campaign to educate veterans about mental health services.
Kemp said the VA has devoted substantial resources to preventing suicides in recent years, adding a national crisis hotline and hundreds of additional mental health professionals as it pushes its suicide prevention budget from $73 million this year to an estimated $83 million in 2013.
But researchers have long known that deterring suicide is easier said than done. It requires being able to predict suicidal behavior in individuals, a feat that “is not possible at the present time, even among high-risk groups of patients,” according to Dr. Leo Sher, associate clinical professor of psychiatry at Columbia University.
“I’ve often asked… why do we know so much about suicides but so little about how to prevent them?” said VA Secretary Eric Shinseki at a 2010 conference on suicide prevention in Washington.
Although the VA screens its patients for depression and post-traumatic stress disorder annually for the first five years after discharge, “there isn’t some magic test we can give people that says, ‘This person is 90 percent likely to die by suicide in the next week,’ ” Gutierrez said.
With thousands of service members expected to leave active duty as the Afghanistan war winds down, Gutierrez worries that the number of suicides will increase.
“My fear is that we’re seeing the start of a surge in terms of the size of the problem,” he said. “I hope I’m wrong, but I don’t think I am.”
A ‘happy-go-lucky’ guy
In towns like Killeen and Copperas Cove that sprawl beyond the environs of Fort Hood — the military’s busiest deployment hub — the names of veterans who die by their own hand are quietly added, month after month, to the dreary coda of a decade of war.
John Guinn, a Copperas Cove justice of the peace since 1981, has seen generations of soldiers pass through Coryell County after serving in Vietnam, the Gulf War and now Afghanistan and Iraq. He also has seen plenty of suicides. In his county, suicide accounted for 25 percent of deaths in the 20-to-34 age group between 2003 and 2007, compared with 12 percent statewide, according to statistics from the Texas Department of State Health Services.
Nobody keeps track of how many of those are veterans. “We really don’t have any statistics,” Guinn said.
But he has walked into enough grieving households of veterans to see certain similarities. They seldom leave a note. Alcohol is often involved, as is PTSD. And almost without exception, their families never saw it coming, Guinn said.
Wendell Bigham, a 28-year-old who had deployed to Iraq and Afghanistan with the Missouri National Guard, fit that pattern. His family said he gave no warning before he hanged himself in a tree outside his Killeen home last October.
“That doesn’t seem like something he would ever do,” said Tanya Koerner, his ex-wife. “He was always a very happy-go-lucky kind of guy.”
Tall and handsome, Bigham fathered three children by three different women. After leaving the Army, he worked for a while as groundskeeper at Fort Hood and struggled.
Tori Felt, the mother of his youngest child, Isabelle, said a back injury he received in Iraq made it hard for Bigham to work. They had to move in with another family when their electricity was cut off. He applied for disability from the VA; it wasn’t approved until after his funeral.
Bigham also was diagnosed with PTSD. He felt guilty, Felt said, about a friend who died when the truck in which he was riding was hit by a roadside bomb; Bigham was supposed to be in the same truck but had changed vehicles. He wanted one-on-one counseling at the VA, but “the wait time was always like a month, and the only way they could take him sooner was if he called every day to ask if somebody had canceled,” Felt said. He had been drinking with friends the night he killed himself.
Isabelle is now 4 years old. “He was so happy to have her. One of his biggest regrets was not being around to raise his other kids,” Felt said.
She paused. “When I die and see Wendell, I’m going to kill him all over again. Not for what he did to me — I’m a grown-up; I can handle it. But for what he did to her.”
’Too much damage’
Back in New Braunfels, Colleen Rivas describes her late husband’s life as a series of adventures anchored by his family. Ray Rivas joined the Marine Corps for two years right out of high school, then worked on offshore oil rigs in places such as Africa and the Netherlands before enrolling at the University of Houston.
After earning a science degree, he stayed for his master’s — and met Colleen, then a 19-year-old undergrad whose roommate was dating one of Rivas’ friends. On a double date at an Italian restaurant near campus, Rivas regaled Colleen with his seemingly inexhaustible array of jokes and stories of his travels.
Rivas, then 26, told his friend after the date, “That’s the woman I’m going to marry.”
They married the day after she graduated and moved from city to city as he worked a series of jobs, eventually becoming a civilian engineer at Fort Sam Houston in San Antonio. By then, they had a son and two daughters, whom Colleen cared for while Rivas worked and pursued his other love: being a soldier.
Rivas had joined the Army Reserves in Houston and was called to active duty frequently, going to Bosnia, Egypt and Korea. His first combat mission was a 2003 deployment to Afghanistan, where he suffered a severe concussion when his vehicle rolled over during a clash with the Taliban. His wife said he’d suffered concussions before; a car once hit him as he rode his bike and split his helmet.
He also came back with PTSD, she said, but got counseling through the VA and went right back to work. After a year, he seemed to be his old self again.
His unit was sent to Iraq in 2006, Colleen said, and he was on a base in Tallil when a mortar exploded nearby. Other soldiers found him stumbling around and took him to a hospital. Neurological tests later revealed the brain injury.
“He gets beat up, then they send him back to me and I put him back together, then he goes back out,” Colleen said. “But this last time, I couldn’t put him back together. There was too much damage.”
’A different person’
The VA’s own numbers on suicides, culled from patient records, paint an incomplete picture because only about half the soldiers who served in the recent conflicts have received VA health services. And although the Department of Defense maintains a database of active service members who attempt suicide or show other warning signs, the VA does not.
“We don’t have anything comparable to that (database) for veterans,” Gutierrez said, “because they’re not a captive audience. If they don’t want to tell the VA where they are, they don’t have to.”
They also don’t have to tell the VA about previous psychiatric problems, and the VA can’t check because it does not have access yet to the military’s database, said Kemp.
Chance Cody Hausinger, 23, might have slipped through that gap. He had enlisted in the Marines after high school and served three tours in Iraq as a radio operator. Six months after his discharge, he committed suicide in his Clear Lake apartment.
His mother, Chris Gerstenberger, said that he was already “a different person” when he came home on leave. “If you walked down the street with him, he’d be nervous, looking behind him,” she said.
During the last year of his enlistment, he was in an accident in Iraq. His parents never learned the details, but at some point, he sliced his arm with a knife and was put under psychiatric care at Camp Pendleton outside San Diego. His mother said the Marines gave them no information about their son’s condition, even after Hausinger’s father flew to California to see him. Hausinger spent the last months of his service cutting grass and doing odd jobs on the base.
He came home in early 2007. “He got his own apartment; he got a great job with his uncle. He didn’t talk anything about Iraq,” his mother said. When he went to the VA for a physical exam, “nothing whatsoever was mentioned about anything psychological. I’m a nurse, so I asked. No medication.”
Kemp said the VA is building a joint suicide database with the Defense Department so they can share information. The database, which she said should be operational by the end of the year, will allow the VA to get the Social Security numbers for everyone who has served in the military and begin comparing them to death records — and hopefully learn the scope of the suicide problem for the first time.
The challenge is identifying veterans such as Rivas who show few, if any, of the usual warning signs.
Colleen Rivas said her husband came home unable to walk straight, to drive, to dress himself. A scan showed diminished activity in the frontal lobe of his brain, she said. When he went for walks, she would write his phone number and his address on his hand.
Brooke Army Medical Center, where Rivas lived in a guest house for nearly two years after returning, was just beginning to figure out how to treat traumatic brain injuries, she said. After doing what they could, they shuttled Rivas several times a week to HealthSouth Rehabilitation Institute of San Antonio.
“He made huge strides,” she said. “Anything that they could do, they did.”
Over time, the career engineer was able to do simple math and read again. Colleen taught him to drive in a high school parking lot. He didn’t talk about Iraq. And he was never free from the headaches.
“You could see the pain etched in his eyes, and there was nothing you could do,” his wife said.
During his rehab, he and Colleen heard a news report about the soaring number of suicides in the military. She said she asked him if he had suicidal thoughts.
“I’d never do anything like that to you and the kids,” he’d told her. Good, she replied, because I could never forgive you.
In a phone interview, Kemp quickly listed the things the VA has done in the past few years to reduce suicides. It has added about 200 employees to its suicide prevention staff in the past three years and has been training employees — from administrators down to van drivers — to recognize warning signs and encourage veterans to seek help. It launched a Veterans Crisis Line in 2007 that has received more than 655,000 calls from veterans, active-duty service members, family and friends. (Marines have their own crisis line.)
The same year, the VA began placing suicide prevention coordinators at VA clinics. Gutierrez said each VA clinic now has at least one.
Two years later came an online chat service that has been used nearly 65,000 times to anonymously connect veterans and service members with counselors — “people will often reveal more things on the computer than they will on the phone,” Kemp said — followed by the November launch of a text messaging option. For veterans who live far from clinics, the VA added counseling via video conference.
The VA says those efforts have helped rescue 23,000 “actively suicidal” veterans.
Kemp said improving access to health care is the key to the VA’s strategy. To reduce long waiting times, Kemp said the VA is adding 1,600 mental health professionals to its staff this year, with a goal of getting every veteran who calls for help evaluated within 48 hours.
“There still are some waiting times,” she said, but the VA is re-evaluating its response regularly “so we don’t get caught behind like we currently have been.”
The backbone remains face-to-face care and therapy. Kemp said new patients shown to have suicide risk factors get an “enhanced package” that includes more frequent clinic visits — four within the first 30 days — and a safety plan to help them recognize when they are sliding toward danger and know what to do if it happens. Clinics require the name of a friend or family member they can call if a veteran misses an appointment.
The focus that the Defense Department and the VA are putting on suicide is unprecedented, said Gutierrez, a psychologist and college professor who has studied suicide since the early 1990s. “I have never seen this level of research funding and this level of clinical resources devoted to suicide,” he said.
The consortium he co-directs is part of the push. The Defense Department realized it didn’t have the expertise it needed in suicide prevention, he said, and reached out to the academic community. Launched in September 2010 with Defense Department money, the consortium has fast-tracked the research approval process, funding nine studies in its first 18 months, Gutierrez said.
The studies are focused on finding the best ways to assess people for suicide risk and the best ways to improve treatment. “We think that’s where we can make the biggest difference,” he said.
Earlier studies on veteran suicide reached mixed conclusions, with some concluding elevated suicide risk among veterans and others showing no connection between military service and suicide. In March, however, a VA panel reviewing the latest scientific literature found that Iraq and Afghanistan veterans “may be particularly at risk for suicide,” though it said more study is needed. The review included 2010 research at Houston’s Baylor College of Medicine, which found that having both PTSD and depression put those veterans at higher risk for suicide than either condition alone.
Colleen Rivas has no doubt that her husband’s war wounds led to his suicide.
After two years of therapy and rehab, the staff at Brooke Army told the couple that Rivas had recovered as much as he ever would. A neurologist told them that Rivas’ military career was over, and that he probably would be in an assisted living facility within five years.
Rivas was demoralized, his wife said.
She said no one prepared her and her children for the personality changes that could accompany a serious brain injury. Starting in late 2008 — two full years after he returned from Iraq — her husband started to disappear, she said. First, it was little rebellions, like refusing to do chores he’d always enjoyed, such as mowing the lawn or cleaning the pool. Then, he started swapping his subdued wardrobe for bright colors, listening to rap music (which he’d always disliked) and eating onions (which he’d disliked even more).
“There were times I would turn around… and I swear to God my husband was there, that was Ray,” she said. “But the rest of the time, he was an adolescent.”
After his death, the staff at Brooke Army assigned an advocate to help Colleen through what was to come. “They handled everything extremely well,” she said. “They took care of him, and they took care of me.”
Still, it took a long time for the guilt to start subsiding. She would wake every night around 3 or 4 a.m. What had she missed? Should she have prodded him to talk about what happened in Iraq?
“He lived a hell on earth,” she said. “He did the best that he could. I think what he did was a split-second decision.” He had called her the day he died and said he was going to see his psychologist. “I’ll see you tonight,” he’d told her.
After a prolonged fight with the VA — she had to prove that his suicide was connected to his combat wounds — she’s collecting his retirement benefits and says working part-time at a local hardware store — a job she recently quit — was crucial in helping her move on.
“I talk to him every day,” she said. “And you know what? I thank God for him every day.
“I’ve forgiven him.”