New smartphone apps may help veterans with PTSD, many of whom have traditionally been unreachable.
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 (PTSD) 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.
Unfortunately, Hunt’s tragic death was anything but rare. The extent of the epidemic of veteran suicides became public in 2013, when the Department of Veterans Affairs (VA) released a troubling report. For the first time, the research included veterans who had not sought VA healthcare services before dying by their own hand. Results showed that 22 veterans, young and old, kill themselves every day – a suicide every 65 minutes.
The report prompted the VA to add 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.
But 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 very nature of PTSD can make getting help problematic.
Up to 18 percent of veterans who served in Iraq and Afghanistan suffer from the condition, 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 now 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.”
Hunt’s suicide inspired Jake Wood, a Marine who served in both Iraq and Afghanistan with Hunt, to create POS REP, a free iPhone app (an Android version is in the works) designed to help veterans who are experiencing emotional distress or who need help adjusting to civilian life.
Wood had fought beside Hunt. And at his friend’s memorial service, Wood learned that, although Hunt had felt isolated, it turned out that three other veterans who had served with Hunt lived within 15 miles from him. An app that could have connected these men might have provided the lifesaving support Hunt needed, Wood reasoned. Determined to help prevent the loss of other veterans to suicide, Wood and his business partner, Will McNulty, developed POS REP.
The app, which currently focuses on the Los Angeles area, networks verified veterans with their peers and locates nearby resources. Although not officially connected to the VA, the POS REP will eventually include GPS-linked maps and directions to VA services, including health clinics and job fairs.
Bryan is planning to analyze how veterans use the app over the next year. The goal? To see if the results can help spot those at risk for suicide who need help.
“Right now we actually don’t know much about warning signs for suicide in the same way we know about warning signs for other health conditions, like a stroke or a heart attack. This makes it very difficult to educate the public and develop intervention programs,” he says. “POS REP could be used to track health-related behaviors over time that could serve as indicators for mental health status and suicide risk.”
The VA is also actively developing apps to help veterans. Julia Hoffman, PsyD, the VA's National Director of Mobile Health, worked with veterans diagnosed with PTSD to learn what would be most helpful for them. The result was the PTSD Coach, a free app for both Apple and Android devices. For veterans in treatment already, the app can help them cope with stress between doctor or therapist visits. For untreated veterans, the app provides tools for managing stress and helps them understand their symptoms and how PTSD treatment can help.
“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.
While apps designed to help veterans coping with PTSD may not prevent all suicides, they are quickly being adopted. Hoffman emphasizes that the applications are meant to be a supplement, not a replacement, for mental health treatment. And she’s hopeful that mobile apps can help overcome the social stigma associated with seeking help for PTSD, since veterans can use them anonymously.
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.”
February 24, 2020
Christopher Nystuen, MD, MBA