As the Taliban swept across Afghanistan and seized Kabul in August, anguished U.S. veterans reached out to the Department of Veterans Affairs' crisis hotline, sending double the number of texts and 40% more chat messages than had been received during the same period a year earlier.
Concern ran high that the stress of watching the blitz would result in a rise in suicides among Afghanstan veterans who lost friends or whose lives were forever altered by their military service.
But early data from that time frame on suicides indicates those fears may not have come to pass. In fact, incidents of suicide appear to have fallen.
According to the VA and Department of Defense, 376 service members and veterans treated in the VA health system took their own lives in the third quarter of 2021, down nearly 20% from the same time frame in 2020.
Most significantly, suicides among active-duty personnel in July, August and September fell by 38% from the previous quarter, 70 suicides compared with 112.
Overall, suicides among veterans in the VA health system were down by 23% for the year -- 213 deaths in 2021 compared with 277 in 2020.
Only the National Guard and reserve components experienced increases, with six more deaths each for a combined total of 93, during the third quarter of 2021, according to the Defense Suicide Prevention Office's third-quarter report.
Experts at both departments caution against using the initial raw numbers, which the VA issued by request of Military.com and the Defense Department published in late December, to draw conclusions about suicide trends. They say rates, which are calculated using the number of deaths compared with population size, provide a more accurate reflection of the issue within both communities.
But those rates won't be published until September 2022 for the DoD and 2023 for the VA.
Still, without seeing the rates, Rand Corp. epidemiologist Rajeev Ramchand said he wouldn't be surprised if there was a decline in military suicides for the period given the rapid response of the community during and after the withdrawal.
Ramchand explained that the initial narrative was one of concern that Afghanistan veterans would have mental health crises or question the worth of their military service as the Taliban regained power after 20 years.
But veterans "quickly transitioned to concern for our Afghan allies," and that may have played a role in reducing suicides, Ramchand said.
"There's an interpersonal theory of suicide that says a person may feel like they don't belong, that they're a burden and have an ability to inflict self-harm," he said. "So, if you're helping people, you don't feel like a burden, right? You're actually in the game and helping people, so I do think that that shift potentially was a really positive one."
Suicides have risen steadily in the U.S. military over the past nine years after a one-year drop in 2013, when the Department of Defense and military branches moved to respond to the growing crisis, which took the lives of a record-high 483 service members in 2012.
In 2020, 580 personnel died by suicide, a 15% increase from 2019 that department officials said reflected a relatively flat course, statistically, when considering the margin of error in calculating and comparing rates.
In the veteran population, suicides also had been on the rise since the start of the Global War on Terror, with more than 22,261 veterans taking their lives since Sept. 11, 2001, according to the Costs of War Project at Brown University.
But in 2019, the number of veterans who died by suicide dropped considerably -- by 399 veterans, a 7.2% decrease in the suicide mortality rate when adjusted by age and gender and a larger drop than observed in the civilian U.S. population in the same year of 2.1%.
Both the VA and DoD have undertaken initiatives to address suicide among service members and veterans. In addition to answering calls, texts and chats on the crisis line and referring veterans for services, both departments include universal screening programs during medical visits and increasing access to services for at-risk patients.
The VA also unveiled new plans in November on suicide prevention, focusing on firearm and drug prescription safety, expanded mental health services and education of emergency room personnel to recognize and address at-risk patients, as well as follow up with them.
The VA has launched a lethal means safety initiative, emphasizing safe storage of firearms and reduced access to prescriptions for at-risk veterans -- medications that could be used in a suicide attempt. Roughly 68% of veteran suicides in 2019 resulted from a self-inflicted gun injury; within the DoD, 64% of suicides in 2020 involved a firearm.
Matthew Miller, the VA's national director of suicide prevention, said the VA's "Keep It Secure" advertisements have garnered more than a billion views, airing during sports events on television and on the internet. He said the VA's emergency room education initiatives reduced suicidal behavior by 45% in a research study conducted on veterans in 2018.
"It's usually not one thing in terms of [the] cause [of suicide], and it's not going to be one thing in terms of prevention," Miller said in an interview with Military.com. "It's going to be a combination of things going to require collective engagement and all of us working together."
In the past year, the DoD also instituted training for younger enlisted service members on resiliency and coping strategies, in addition to expanding services to the National Guard and military family members, according to Karin Orvis, director of the Defense Suicide Prevention Office.
"Suicide is preventable," Orvis said during a press conference in September on the DoD's 2020 suicide report. "We will not relent in our efforts. We owe this to our service members and families defending our nation."
Despite the effort and outreach, however, some inexplicably continue to take their own lives.
Navy Master Chief Special Warfare Operator (SEAL) Doug McNutt died Sept. 12, roughly a month after the fall of Kabul and despite seeming, at least to his brother Brad McNutt, that he was on an upswing.
After retiring from the service, McNutt became reclusive, rarely venturing outside or reaching out to others.
But friends, team members and family reached out to him and, for a while, he "made peace" with "the stuff he was carrying inside" from multiple deployments to Iraq and Afghanistan, Brad McNutt said.
He even attended therapy at a VA facility 90 minutes away. But when his counselor left, Doug discontinued the treatment, according to his brother.
Still, his death shocked everyone, Brad McNutt said.
"I think the death of the soldiers in the last days of Afghanistan possibly added to his burden. It was so widely publicized that it couldn't be avoided. ... I think it was very painful for Doug," Brad McNutt said.
In a letter Doug McNutt left, he said he would like to see the "exit strategy for soldiers becoming just as advanced as the entry strategy."
"Incurring physical, mental and spiritual trauma is a price we all accept as SEALS. ... The [exit strategy] needs to be as advanced as the equipment, weapons, vehicles, and special tactics that are used for missions," he wrote.
Congress in December moved to strengthen the DoD's suicide prevention programs by directing the department to establish independent suicide prevention and response review committees at military installations this year.
The fiscal 2021 defense policy law also contains a provision that would give service members faster access to mental health evaluations and treatment by giving them the option of self-referral and requiring commanders to ensure that they get help.
The VA also rolled out an effort late last year to reduce veteran homelessness because, according to Miller, the highest period of risk for suicide tends to be the 30- to 60-day window preceding homelessness."
The DoD will not publish its calculated suicide rates for 2021 until September, and the VA will not publish its official record for 2021 until 2023, when it can include data for all veterans, obtained through the states and the Centers for Disease Control and Prevention.
But Ramchand says he hopes the drop at the VA seen in 2019, the statistical leveling at the DoD in 2020 and the declines in the third quarter of 2021 demonstrate that things are going in the right direction.
"The decrease is something to celebrate. The issue is, if next year it continues to decrease, that's what we want. If it stays the same, that's still not bad. If it increases and doesn't increase to what it was in 2018, that's another step forward," Ramchand said. "It might not look like a trend, but it could still mean that some things have been effective."
The Veterans Crisis Line can be reached 24 hours a day, 7 days a week by calling 1-800-273-8255 and pressing 1, or by texting 838-255 or engaging via the Crisis Line's website.
-- Patricia Kime can be reached at Patricia.Kime@Monster.com. Follow her on Twitter @patriciakime.