PROVINCETOWN — When Marine Corps veteran Craig Butilier was stationed on Okinawa in 2004, he told a recent meeting of the VFW here, “there were eight suicides in my unit.”
That story reported by Butilier, who is the commander of Provincetown’s Veterans of Foreign Wars Post 3152, reflects a crisis affecting the military across the U.S. A surge in deaths has led the military to identify “veteran suicide as its highest clinical priority,” Tori DeAngelis wrote in a 2022 article for the American Psychological Association. The Dept. of Defense, the Veterans Administration (VA), nonprofit organizations, and individual clinicians have increasingly been working together to reach veterans and current service members at risk of suicide.
Yet the experience of veterans on Cape Cod “does not map onto the national numbers,” said Dr. Monty Vanbeber, a family physician in Hyannis affiliated with the VA. The VA reports that the suicide rate in Massachusetts “was significantly lower than the national veteran suicide rate, and it was not significantly different from the national general population suicide rate.” On the Outer Cape, there have been no documented veteran suicides at all since the early 1990s. Sources at three veterans support facilities in Hyannis attribute the lower suicide rate to the strength of the Cape’s veterans community.
Across the country, however, the statistics are grim.
A 2021 Brown University study found that 30,177 active-duty and veteran military had died by suicide since Sept. 11, 2001, compared to 7,057 killed in combat. More than 22,000 of the deaths were of veterans.
Explanations for the high number of suicides include the increase in traumatic brain injuries, medical advances that prevent deaths on the battlefield, and the intensification of what Hyannis psychologist Duke Ellis refers to as “moral injury.” While those factors are certainly at play, a close look at the numbers complicates the story.
The Office of Veterans Affairs recently released its annual National Veteran Suicide Prevention Report for 2022 with national and state-by-state data. In 2020, the most recent year for which there are data, 58 veterans died by suicide in Massachusetts. Of that number, 29 were over age 55, and 10 were over 75. Those deaths, then, included veterans who served from Vietnam to the first Gulf War. And the Brown University study noted that more veterans who did not serve in combat died by suicide than combat veterans.
Moreover, the number of suicides between 2001 and 2021 may be underreported. As Thomas Steele, a 24-year Army veteran and Provincetown VFW member said at the recent meeting, before 1995 admitting to personal problems while in the service “was the kiss of death.” Marine Corps veteran Andy Fingado added, “It still is.”
Long-standing institutional pressure against service members seeking help for psychological and emotional problems has meant that those needing help have not asked for it. Fingado commented that “the higher you go up in rank in the military, the harder it is to ask for help.”
Those pressures are reinforced by military regulations. According to NBC News, under current regulations, “suicide attempts are still punishable in the military.” The regulations make it difficult for those charged with reporting service members’ suicide attempts or deaths to report them fully — to protect survivors from punishment and, in the case of death, to protect the family’s death benefits, which may be denied in cases of suicide.
Consequently, there may be more deaths by suicide by active duty and veteran service members than we will ever know.
At the Cape Cod Vet Center in Hyannis, the emphasis is on human connection. “We do suicide prevention through wellness,” said Jocelyn Howard, a psychiatrist at the center, through programs such as Project Healing Waters, which “guides veterans in need to recovery through fly fishing, mentoring, and friendship,” according to its website.
Programs like Together With Veterans, an initiative funded by the VA Office of Rural Health, are designed to give “the nation’s service members as many options for healthy living as possible,” DeAngelis wrote. She quoted psychologist Nate Mohatt: “It’s a whole community, population health approach to reducing suicide rates.”
Statistics provided by Barnstable County show 153 veterans living in Provincetown: six who served between World War II and Korea, 25 in Korea, 43 in Vietnam, 24 between Vietnam and the first Gulf War, and 25 in Afghanistan and Iraq. The Cape Cod Vet Center sends a clinician to provide counseling services monthly at the Veterans Memorial Community Center at 2 Mayflower St.; the state sends an adviser, retired Air Force veteran Shawney Carroll, to provide guidance on veterans benefits every month.
The non-VA-affiliated Veterans Outreach Center in Hyannis recently extended food pantry and transportation services for veterans on the Outer Cape and is in the process of establishing a satellite office here.
On Jan. 17, 2023, the VA announced in a press release that “veterans in acute suicidal crisis will be able to go to any VA or non-VA health care facility for emergency health care at no cost.” That would include Outer Cape Health Services and the new Cape Cod Healthcare urgent care facility in Orleans. The program may draw in some of the 52 percent of veterans here who have no relationship with the VA at all.
Military and VA initiatives to prevent suicide would be strengthened even further with two major policy changes: suspending regulations that penalize at-risk service members in crisis, and, in times of war, treating deaths by suicide among those on active duty as casualties of war and among veterans in times of peace as service-related deaths.
Those changes would reflect the message of the monument, created by the Cape Cod Veterans for Peace chapter on the village green in Hyannis, that honors military members who have died by suicide. Called “The Hidden Wounds Memorial,” the monument honors deaths by suicide as casualties of war.
