Smartphone Apps Help Vets in Crisis

New algorithms and smartphone apps may help veterans who are at risk of suicide, many of whom have traditionally been unreachable. Here's what you should know.

Clay Hunt was a U.S. Marine who saw combat in both Iraq and Afghanistan. Yet when he returned to civilian life in Houston, he faced his most difficult battle — one he would ultimately lose.

In March 2011, struggling with post-traumatic stress disorder from his war experiences, the lonely, depressed veteran could no longer bear his feelings of isolation. Hunt ended his emotional pain by committing suicide.

Smartphone technology designed specifically for troubled veterans could have helped.

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Unfortunately, Hunt’s tragic death was anything but rare. In 2019, the most recent year of data available from the Department of Veterans Affairs (VA), 6,261 veterans in the United States died by suicide — on average, 17 veterans each day. Veterans are twice as likely as non-veterans to take their own lives. Veterans ages 18 to 34 are almost three times as likely. The numbers were slightly down from the year earlier, but we do not yet know what happened in 2020 and 2021, when so many lives were disrupted by lockdowns and COVID-19.

After a troubling report in 2013 revealed an epidemic, the VA added comprehensive suicide prevention initiatives, including a toll-free veterans crisis line, trained suicide prevention coordinators at all VA Medical Centers and large outpatient facilities, and improvements in case management and reporting of vets in crisis.

Flagging people at risk

These strategies don’t necessarily reach troubled veterans who are unable or unwilling to make an appointment with a doctor or call a counselor. The VA is also using computer algorithms to analyze patient records and flag veterans who may be at risk of suicide. It produces a composite suicide risk score for each person, integrating 16 factors, which might be a job loss or arthritis and using statins. For some, it’s a big surprise when they hear that they’ve been flagged by a machine.

Doctors are getting a lesson in how to how to assess risk. “You end up with a lot of older men who are really struggling with medical problems,” said Dr. Marianne S. Goodman, a psychiatrist at the Veterans Integrated Service Network in the Bronx and a clinical professor of medicine at the Icahn School of Medicine at Mount Sinai. “They’re quietly miserable, in pain, often alone, with financial problems, and you don’t see them because they’re not coming in.”

Mobile apps to help PTSD

Some 16  percent of veterans who served in Iraq and Afghanistan suffer from PTSD, which is strongly linked to suicide risk and marked by depression, anxiety, relationship problems, drug and alcohol abuse, and feelings of hopelessness and emotional numbing. PTSD is also characterized by extreme avoidance of experiences that elicit symptoms.

Visiting a veterans’ facility, talk therapy, even minor interactions with uniformed service members, may cause significant stress. To avoid stress, a veteran may be less likely to seek treatment through traditional channels. Plus, as the blockbuster film American Sniper demonstrates, war veterans have an added adjustment of transitioning to civilian life.

Mobile apps can put help directly into a veteran’s hands. They’re an immediate way for vets to find information on PSTD and other problems, locate VA centers and additional resources and, perhaps most importantly, connect with other veterans to share support and experiences. And they can do it anonymously.

“The use of technology will be essential for reaching out to younger veterans in particular,” says clinical psychologist Craig Bryan, executive director of the National Center for Veterans Studies at the University of Utah. “Many veterans with mental health conditions do not want to visit a mental health clinic and are therefore ‘unknown’ to the healthcare system.”

“However, many (or most) of them have smartphones and access to other forms of technology that could be used as a platform for interventions. We could therefore use apps to reach veterans who would have traditionally been unreachable.”

Some of the options for vets

• PTSD Coach provides information about PTSD and a self-assessment tool. ​
• Objective Zero anonymously connects service members and veterans dealing with mental health issues to supportive volunteers over voice, video, or text messaging. The app can steer users to other resources as well. ​​
• Rallypoint is a social network made by and for service members and veterans that can help them find jobs, mentors, and people with shared interests.

Julia Hoffman, PsyD, the VA's National Director of Mobile Health, worked with veterans diagnosed with PTSD to develop PTSD Coach, a free app for both Apple and Android devices.

“Most people who carry smartphones have them within reach and on all the time. The goal of the app is to take education, skills training, and support to veterans wherever they are, whenever they need it. Plus, veterans who are concerned about stigma can use the tool in complete anonymity,” Hoffman wrote for the VA’s “Vantage Point” blog.

The hope is that that mobile apps might help enough to nudge someone in pain to look for more mental health support or treatment.

The National Center for Veterans Studies’ Bryan agrees.

“Waiting for veterans to go to traditional healthcare settings is unlikely to succeed; we must reach out to veterans where they are and take the services to them,” he says. “Suicide is not just a military problem; it is a societal problem. And it is our collective responsibility to confront it together.”

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