Returning Troops Face Multiple Challenges
Many of those returning from overseas will undoubtedly face challenges, including physical and mental health problems, as they re-enter civilian life.
Jeremy Williams, a behavioral health program coordinator with the Mental Health America of Greater Houston (MHA Houston), advocates for the rights of military servicemen and women who are now returning from Iraq and Afghanistan. Williams, a retired Marine who was wounded in the line of duty, has been honored by the Horatio Alger Association of Distinguished Americans as a National Military Scholar and awarded the Distinguished Citizen Award by the Marine Corps League for his service to veterans.
Williams explains what resources are available to wounded warriors as well as the challenges troops face as they return from abroad. He stressed that the situation of American veterans is “just as important of a social issue as obesity, cancer and racism.”
What resources does the Mental Health America of Greater Houston offer to veterans?
Jeremy Williams: In 2009, MHA Houston was tasked by then Houston Mayor Bill White and Harris County Commissioner Ed Emmet to address the gaps in veterans’ mental health services in the Greater Houston Area. MHA in collaboration with over 70 federal, state, and local agencies to formulate an action plan and implement recommendations within the community to improve the care of Houston’s population of returning OEF/OIF veterans. Since early 2010 some of these facets within the Veterans Behavioral Health Initiative included the following elements: Implementing a suicide prevention campaign, and assisting in the implementation of a Veterans Court, to divert veterans with a criminal charge in lieu of treatment for their service related mental health concerns. Other resources include MHA’s Information and referral line and our pro bono counseling service to those who qualify. MHA has also distributed countless amounts of our resource guides through out the veterans’ community via the Houston VA Medical Center.
What kind of training does the Mental Health America of Greater Houston offer to government and non-government organizations?
Jeremy Williams: Expanding trauma training for non-military, behavioral health care service providers through our conference title “From Combat to the Community; Addressing the Behavioral Health needs of Returning Veterans and their Families.” This conference was the result of a partnership between the Michael E. DeBakey VA Medical Center, the Menninger Clinic, MHA Houston, and the University of St. Thomas. This resulted in the training of more then 200 private providers who service returning veterans. Some of the topics presented at this training were; military cultural awareness and terminology, Post Traumatic Stress Disorder (PTSD) and moderate Traumatic Brain Injuries (mTBI), depression in veterans, the deployment cycle and its impact on families, Substance Abuse in returning veterans and suicide awareness.
MHA has worked closely with the Houston Police Department’s Mental Health Unit to Develop, implement and deliver a specialized crisis intervention and critical incident response training for law enforcement officers to help them appropriately address and identify the behavioral health issues of returning Operation Enduring Freedom and Operation Iraqi Freedom veterans. Over the past year this collaboration has trained over 800 police officers and deputies in the Houston and Harris County. This training focuses upon the deployment related issues facing veterans in the community and how they can better approach a veteran in crisis and lessen what can many time be a high risk situation.
In addition to professional education, MHA in collaboration with the Lone Star Veterans Association and the Michael E. DeBakey VA Medical Center provided a professional certification to certify peer support specialists within the VA medical system in Houston and to operate within the Harris County Veterans’ Court. The premise behind the peer support is to show a returning veteran that they are not along in the recovery process as it pertains to PTSD and reintegration within the community. The training we conducted trained 30 new peer mentors to facilitate services in the newly established community infrastructure.
This week President Obama laid out a plan for withdrawing troops from Afghanistan. What are some of the challenges troops face when returning home?
Jeremy Williams: Among the obstacles and challenges faced by returning service members and veterans are transition stress, Post Traumatic Stress Disorder (PTSD), mild and moderate Traumatic Brain Injuries (mTBI), employment and education barriers and the stress associated with family reintegration. Life after combat service complicates many aspects of the warriors’ life. PTSD and TBI has become the single most relevant obstacle to transitioning into life after combat and into the community. PTSD is often the most debilitating factor regarding readjustment due to the fact that a significant amount of returning warriors are not diagnosed and treated for it prior to discharge, this results in the warrior isolating from families and family. Other challenges warrior’s face upon return is the social stigma surrounding warriors after return form combat, this stigma presents itself in a variety of ways; such as: lack of social support in the workplace, in the colleges and universities, a lack of understanding by perspective employers, and even medical professionals. Divorce and the dissolution of intimate relationships are another area of impact for returning veterans and warriors. The divorce rate among veterans and warriors is 50%; more then double the rate of their civilian counterparts. In a New York Times article released in 2005 “Research shows that about 20 per cent of marriages fall apart within two years when one spouse has been sent off to war.”
A report this month from the Iraq and Afghanistan Veterans of America and the Rand Corporation pointed to staggering numbers of unemployment of veterans and mental health barriers. Why are veterans experiencing unemployment at such high rates?
Jeremy Williams: There are multiple reasons for the high unemployment rate in returning veterans; among these factors is the difficulty translating years of military experience into terms of civilian equivalent. The lack of translation and transferability into the civilian sector leads to entry-level positions and lower wages. In reference to the 2011 IAVA report on employment and education veterans experience a $10,000 a year deficit in earnings compared to their nonveteran peers because of the aforementioned cause. In addition to the pay differential, the wars in Iraq and Afghanistan rely heavily upon the service of national guardsman and reservists and as a result these service members experience loss of employment or reduced wages when they return to their communities. The unemployment stress is another contributing external stressor that often exacerbates the warriors’ preexisting conditions such as PTSD, anxiety and/or depression.
Can you explain the kinds of barriers to mental health care?
Jeremy Williams: Barriers to care of a variety of reasons. The primary barrier is an access to adequate care. Navigating the bureaucracy associated with care in the current system is frustrating and exhausting to veterans. The time associated with registering and maintaining continuity of treatment is usually in the timeframe of months and sometime even years to receive benefits. In the event that a veteran receives a diagnosis of PTSD the turnaround from time to filing an initial claim to receiving compensation is anywhere from six months to a year, in the event that an appeal is filed the time involved if often longer than twelve to eighteen months. This barrier affects the access to care for mental health conditions in many circumstances. Other barriers associated with receiving care are the distance to the provider(s), the stigma surrounding treatment for mental illness often prevents warriors from receiving therapy because of the mentality that warriors are strong mentally and emotionally, and the presence of weakness implies that warriors are incapable of performing their duties. The stigma surrounding PTSD specifically impacts not only the warrior but also the warrior’s families and friends. One such barrier that prevents warriors from receiving care is the view that; no one understands them and looks at them as just a diagnosis, not as a person. Medication and its effects are also another barrier to care, many of the veterans that I worked with prior to coming to MHA Houston indicated that the psychotropic medication prescribed caused the experience of feeling “doped up” and they began to feel like “zombies,” they indicated that they didn’t feel normal and didn’t want to return because of the medication. All of these barriers are being addressed in the Veterans Behavioral Health Initiative, I have said to many of my fellow warriors and their families that “It’s okay to say that you are not okay.” Attacking these barriers and helping remove the stigma surrounding mental and behavioral health care is the one thing that MHA Houston is diligently working towards.
Why should the average American, who is perhaps more detached from the issue of veterans' welfare, be concerned about the status of veterans?
Jeremy Williams: I believe that after military service, veterans’ posses a unique skill set that can benefit society. These are largely contributed to their time in military service. After military service when warriors are sent home they come home to the communities not to federal agencies. American’s are impacted in a variety of ways when we as a country send our citizens to fight America’s enemies. The fact that warriors come home to the community and become a part of that immediate environment impact the lives of every American that crosses their path. The reason American’s should be concerned is a matter of basic humanity and dignity. If we are willing to send our nation’s sons and daughters into harms way to fight a ruthless enemy, we as American’s have a solemn responsibility to care for those who born the burden of war. The matters that effect America such as homelessness, unemployment, increased crime rates, drug addiction, and suicide are a result of a lack of public awareness. The war is only removed until the warrior comes home into the community, then and only then can Americans show support in a variety of ways, through community collaboration welcome the warriors home, provide a network of care within the immediate community, establish a network of employers that will help in mentoring and hiring. The plight of the American veteran is just as important of a social issue as obesity, cancer and racism. The care of Americas’ warrior class often defines the character of a nation. It’s a national duty to acknowledge and care for our newest generation of warriors.