Criminal Justice Forum

By PATRICIA COHEN


CANANDAIGUA, N.Y. — Nancy Nosewicz was busy fielding calls at the new national veterans hot line on a recent afternoon when someone from theDepartment of Veterans AffairsinTopeka,Kan., phoned. He had a 55-
year-old Army veteran from the Northwest on the line who had called to complain about his benefits, but now the guy, drunk and crying, was talking about not wanting to live. Could Ms. Nosewicz pick up? In a slurred voice, heavy from weeping, the veteran, named Robert,  told her that he was homeless and wanted to “just lay down in the river and never get up.”
Ms. Nosewicz, a social worker, listened. Then in a voice firm and comforting like a big sister, she said: “We don’t want you to either.  Today we’re not thinking about the alcohol or the housing, Robert.  Today it’s about keeping you safe.”
She gave an assistant Robert’s phone number to find his address and alert local police to stand by. The chain of care resembled a relay race, with one runner trying not let go of the baton until the next runner had it in hand.
The veterans hot line is part of a specialized effort by the Department of Veterans Affairs to reduce suicide by enabling counselors, for the first time, to instantly check a veteran’s medical  records and then combine emergency response with local follow-up  services. It comes after years of criticism that the department has  
been neglecting tens of thousands of wounded service men and women who have returned from war zones inIraq andAfghanistan.
On Monday, a class action suit brought by veterans groups opened in San Francisco charging a “systemwide breakdown,” citing long delays in receiving disability benefits and flaws in the way discharged soldiers at risk for suicide had been treated. Kerri J. Childress, a department spokeswoman, said Monday that there were an average of 18 suicides a day amongAmerica’s 25 million veterans and that more than a fifth were  
committed by men and women being treated by Veterans Affairs.
Up and running since August, the hot line tries to respond to at least some of those in crisis. Over eight months, it has received more than 37,200 calls and made more than 720 rescues — sending out, from a narrow office here in upstate New York, emergency responders all over the country to find someone on a bridge, with a gun in his hand, with a stomach full of pills.
Paul Sullivan, the director of Veterans for Common Sense, one of the groups involved in the lawsuit, said of the department: “I’m pleased they’re responding. However, much more needs to be done so vets aren’t turned away from health care and don’t have to wait for benefits.”
Mr. Sullivan says suicidal patients have not been able to get care promptly; he cited the case of Jonathan Schulze, who was turned away twice from a Veterans Affairs hospital before he killed himself in  
January 2007.
“More than 600,000 veterans are waiting, on average, more than six months for disability benefits,” said Mr. Sullivan, who worked at the department monitoring benefits.
Experts agree that veterans are more likely, perhaps twice as much, to commit suicide as people who have never served in the military.  Meanwhile, a study released last week by the RAND Corporation estimates that roughly one in five veterans of IraqandAfghanistanhas symptoms of post-traumatic stress disorder, which heightens the risk of suicide.
Yet whatever larger failings may exist, the staff of social workers, addiction specialists and nurses who keep the hot line running — 24 hours a day, seven days a week — can count at least some victories by the end of each shift.
Unique about this hot line, said Janet Kemp, the national suicide prevention coordinator with the department, is that now the counselors have medical information at their fingertips, which they use to connect vets with counseling near their homes. The model evolved from a new research program on suicide prevention paid for by the department.
“For years people thought that asking questions about suicide put the thought in people’s mind, but now we know that’s not true,” said Dr. Kemp, who travels throughout the country training V.A. staff.
The department is spending about $3 million to start and operate the hot line during its first year, said a spokesman, Daniel Ryan, and another $2.9 million on a mental health research center at the sprawling red-brick V.A. Medical Center in Canandaigua. Referring to the hot line’s relay model, Kerry Knox, the director of the new research center, said, “You don’t want them to fall through the cracks.” With Robert, for example — whose last name was not provided for confidentiality — Ms. Nosewicz gradually nudged him to agree to be  
taken to a hospital and to give his name and Social Security number so she could check his file and put him in contact with the department’s suicide prevention coordinator in his area.
Meanwhile, Denise Slocum, a health assistant, relayed questions from the local police dispatcher. “The police are asking if you’re near an elementary school,” asked Ms. Nosewicz, who then nodded her head at  
Ms. Slocum.
“No, no, no — no handcuffs,” Ms. Nosewicz reassured Robert. “You’re going to go to the hospital.”
“Do you have a tissue to blow your nose? Then use your sleeve.”“When they come in, you put them on the phone with me, and I’ll tell them to treat you with respect.” Twenty minutes later, Ms. Slocum called the police again to confirm that Robert had been taken to a hospital. Ms. Nosewicz alerted the prevention coordinator. One is at each of the department’s 156 health centers.
Robert’s name was added to a board near the doorway so that the staff could follow up to ensure a local counselor actually met with him. Of course, sometimes a crack is unavoidable. “He’s going to do it. He’s really going to do it,” said Terri Rose, a counselor who was working the noon-to-midnight shift. She was wiping  
her red-rimmed eyes. A caller fromTexas, who said he was 65 and a helicopter gunner in Vietnam, said he had a suicide pact with his friend, but the friend had gone off and killed himself. Now he, too, was ready to die, saying he had even found a coffin for $150, said Ms.  Rose, who is an Air Force veteran herself. The veteran hung up and had stopped answering her calls.
Sometimes veterans have a lot of trouble asking for help, said Jacalyn O’Loughlin, a counselor. “They keep saying, ‘I’m sorry, I’m sorry, I’m sorry,’ ” Ms. O’Loughlin said. “Especially marines. They feel they’re weak if they reach out.”
Mr. Ryan said about half the calls to the hot line — 1-800-273-TALK  (8255) — were from veterans, split fairly evenly betweenVietnam and Iraq. Family members and friends also frequently call. About 30 percent of the veterans are women.
A couple of months ago, Ms. O’Loughlin said, a distraught woman called from Oregon who was driving to the woods and then threatened to “walk and walk and walk and never come back.” Ms. O’Loughlin rang the tiny  
silver bell on her desk to signal the health technician. The health tech checked the area code and phoned the closest Veterans Affairs health center.
“And lo and behold, that suicide prevention coordinator knew her just by her first name,” Ms. O’Loughlin said. The tech called the police and the coordinator called the woman’s husband, getting the car’s make and model. Ms. O’Loughlin kept her on the line; when she hung up, Ms. O’Loughlin called her back. “This went on for hours,” she said. “I could hear her getting out of the car. I could hear the rustling from the leaves.”
Meanwhile, the police and her husband were driving up and down roads.  They spotted the car, dashed through the trees and found her. She had a bottle of pills in her hand but had not yet swallowed them.
Sometimes, the victories are smaller but no less satisfying. That morning, Ms. Nosewicz spoke to a veteran whose house was destroyed by Hurricane Katrina; he had been relocated to a different state.
“He called crying because he can’t find a job, saying ‘my teeth are so rotten and my mouth stinks,’ ” Ms. Nosewicz said.
Dental referrals are not exactly part of the job description, but Ms. Nosewicz tried dental schools in his area until she found a school to do the work. “He was crying on the phone,” she recalled, “and said,  "Thanks so much. Thanks so much.’ ”
All in all not a bad day’s work, Ms. Nosewicz said, as she got ready to leave. “Three rescues, four consults and one set of teeth.”
An earlier version of this article referred incorrectly to the Department of Veterans Affairs, known as the V.A., by its former name,  the Veterans Administration.