Lost Among Us: New veterans programs aim to reach homeless and mentally ill

Veteran Michael Delich gets a new haircut during the 14th Annual Stand Down Against Homelessness on Thursday at Armory Park in North Charleston. 1.3 million veterans nationwide received specialized mental health care from the VA in fiscal 2012.

It is a mighty goal — to end veteran homelessness by 2016. Sounds a bit lofty even. But the U.S. Department of Veterans Affairs has been putting its money where its PR is.

Hawes honored for mental health work

Staff writer Jennifer Berry Hawes has been awarded the National Alliance on Mental Illnesses’ NAMI S.C. Reporter of the Year 2013 award for her work covering the challenges facing people with mental illnesses.

She will speak at the Charleston area chapter’s Nov. 11 meeting.

The VA, including its growing medical center in downtown Charleston, has been hiring throngs of new staff and funding comprehensive new programs to combat homelessness and its life-consuming triumvirate with mental illness and substance abuse.

Do you need help?

Veterans struggling with mental health issues can call the Veterans Crisis Line at 1-800-273-8255 or go to VeteransCrisisLine.net.

Those with housing problems can call the U.S. Department of Veterans Affairs’ toll-free National Call Center for Homeless Veterans at 1-877-424-3838 (1-877-4AID-VET). The VA also has launched a new hotline — 1-855-VA-WOMEN — to answer questions about resources available to women veterans.

For instance, the VA’s fiscal 2014 budget includes $1.4 billion (up $41 million from 2013) to end veteran homelessness, and $7 billion (up $469 million from 2013) to expand mental health care.

By the numbers

39%

Increase in U.S. Department of Veterans Affairs mental health care budget since 2009.

21,000

The VA’s total mental health workforce nationwide.

1.3 million

Veterans nationwide who received specialized mental health care from the VA in fiscal 2012.

927,052

Veterans who received specialized mental health care from the VA in fiscal 2006.

45%

Homeless veterans nationwide suffering from mental illness.

70%

Homeless veterans nationwide suffering from substance abuse.

2015

Year the VA aims to eliminate veteran homelessness.

That makes the VA a rarity among today’s public mental health systems.

The influx of resources comes as state and local mental health agencies have weathered shrinking budgets and staffs compared to a decade ago, despite soaring needs.

With roughly 21,000 mental health staff, the VA has become the nation’s largest single mental health provider.

Its mental health services have grown substantially since President Barack Obama and the VA secretary set the goal of eliminating veteran homelessness, followed last year by the president signing an executive order mandating better mental health care for veterans.

Two demons set critical traps that can cause homelessness.

Of homeless veterans assessed for critical housing needs at the local Ralph H. Johnson VA Medical Center, more than half suffered mental health problems. Two-thirds grappled with substance abuse.

One in three suffered both.

To address that reality, the local VA medical center has more than doubled its mental health staff over the past several years. Veterans now can get more help with everything from severe mental illness to homelessness to primary care — all under one roof in downtown Charleston’s medical hub.

“You can’t do that anywhere else,” said Dr. Hugh Myrick, associate chief of staff for its mental health service line.

‘It’s over with’


That triumvirate of mental illness, drug abuse and homelessness ruled many of Marvin T. Williams’ 58 years of life. Williams found himself in its clutches following his Army service during Vietnam’s closing days. He returned home to face what he expected to be a long and promising life. Instead, he wound up homeless in Brooklyn, N.Y. In time he returned to his hometown of Walterboro and met his nemesis, crack cocaine.

Depression’s dark waves would roll in, melding with his drug use, drowning him.

“It was just a sense of hopelessness. You don’t care about anybody else, and nobody else cares about you,” he recalled.

He wound up at Crisis Ministries, where a VA worker showed up and explained all that the local medical center could offer.

Since then, Williams has received PTSD treatment for a horrific car wreck he witnessed involving his family members and a logging truck. He gets help with the nightmares and the images of the bodies he loaded up from the Hanoi airport back in his Army days. He gets care for his depression. He completed substance-abuse treatment. He has people to talk to, including a counselor he adores and fellow veterans who have been clean longer, struggled harder, and whose advice he trusts. “I have gotten good services from the VA,” he said. “I wouldn’t go anywhere else.”

Clean for four years, enjoying life as a grandfather, he lives in rental housing and gets care for diabetes.

“Thank God it’s over with,” Williams said. “I’ve put it behind me.”

Bonds of trust


Unlike some hospitals, the local VA’s hallways fill with the shouts of grizzled old guys greeting long-time buddies and young comrades new to the veterans’ fold.

It’s not a fancy place, but there is an undeniable camaraderie inside its doors. Combat photographer Stacy Pearsall’s black and white portraits of veterans hang thick down a main corridor, adding grit and elegance to the unique connectedness shared here.

“Most veterans have that bond,” Williams said. “Even if you don’t like each other, you are still the Army, Navy, Air Force, Marines. It’s unique.”

Yet veterans with mental health problems have not always sought help here. Many struggled to overcome stigma surrounding mental illness, despite the traumas of mind and body that many have suffered.

Nobody who ever wore a military uniform wants to look “weak.” Or worry how that image might play out career-wise.

Perhaps that perception is changing.

Over the past two years, the local VA has served nearly 2,000 more veterans with mental health problems — up from about 12,000 to 14,000.

Or maybe the boost is due to improved access to care.

With new resources, the VA has built a tier of programs to ensure veterans’ access to mental health care, housing and substance abuse treatment.

Those services are all available today all under one roof, the bustling Ralph H. Johnson VA Medical Center.

Veterans don’t have to go to a separate mental health clinic or psychiatrist’s office, where the purpose of their visits are more obvious. At the VA, they enter the same doors as a someone with heart trouble or bad eyesight en route to care.

“There’s less stigma associated,” said Dr. Elizabeth Call, who manages the medical center’s program that offers primary and mental health care to homeless veterans.

And it’s designed to be easy.

Homeless veterans can arrive at a walk-in clinic without so much as an appointment or VA benefits in place.

If they can show basic eligibility, they are supposed to be able to access care quickly, from admission to one of its inpatient psychiatric beds to enrollment in substance-abuse treatment to housing to simply finding a quiet place to talk with a peer counselor.

And if veterans have other medical needs, the rest of the hospital is down the hall or up an elevator. “We’re all just 10 steps away,” Call said.

The goal: Don’t let them leave without addressing their problems.

Help made easy


The emphasis is partly why Call, board certified in psychiatry and internal medicine, switched from MUSC, where funding was a problem, to the VA, where it hasn’t been. She now heads the new Homeless Veterans Patient Aligned Team, which launched in July.

Already, nearly 100 men and women have come through it.

“It has grown much quicker than we thought,” Call said.

Many of those clients arrive at walk-in clinics held on weekday mornings.

That’s what Gerald Montgomery did on Oct. 2.

An articulate and friendly 48-year-old, he had been sleeping on the streets after losing his job. When he walked into the VA with nothing but his Social Security number, he was able to verify his eligibility immediately.

Then he was sent down a hall to the homeless veterans project. That night, the VA set him up in transitional housing.

By Oct. 3 he had a place to live and a plan for treatment.

“There were so many opportunities in one spot,” Montgomery said. “I figured I would have to wait a few months, there are so many homeless veterans out there.”

Last year the local VA assessed 545 veterans like Montgomery and moved 447 into transitional housing. On average, 78 percent of them wound up in stable, permanent housing such as renting an apartment or house or reconnecting with family, said Erin Smith, supervisor of a program that helps veterans find transitional housing.

That long-term solution to homelessness remains the ultimate goal.

“This is not a place people stay forever,” Myrick said of the medical center. Plus, when he leaves the hospital each day, Myrick passes construction crews at work on its new $9.9 million PTSD/Mental Health Research Building. The expansion will give the medical center its first research laboratory facilities and expand space for research involving multiple mental health areas.

The building should open next year.


Driving force


What is driving this emphasis on homeless and mentally ill veterans?

Statistics played a big role, namely a few that rolled around Washington, D.C., creating very large waves:

A study found that 22 veterans commit suicide each day. A count in January 2012 found 62,619 homeless veterans — a drop from previous years.

More than 2 million military men and women have been deployed to Iraq or Afghanistan since September 2001. At least one in five suffers from PTSD, stress disorders or major depression upon returning to the U.S., according to the RAND Center for Military Health Policy Research.

Then there are the growing ranks of female veterans. They are the fastest-growing subset of homeless veterans.

And one in five suffers PTSD related to “military sexual trauma,” which includes sexual harassment and rape, according to VA statistics.

In response, Obama issued an executive order in 2012 to improve access to mental health care for veterans, service members and their families.

It required, among other things, the VA hire 1,600 mental health professionals nationwide.

Already, the local hospital’s mental health staff has grown from 160 to at least 260 out of 2,000 total employees.

Next challenge: Spreading the news. It’s tough to reach folks living on the streets, mired in untreated mental illnesses or drug addiction.

At a recent summit of Lowcountry mental health workers, Myrick stood before his audience and highlighted the VA’s offerings.

When they broke into small groups, Dr. Julian Libet, associate director of the local mental health service line, asked his table: How much do you know about the VA’s mental health programs?

Most gave their knowledge three out of five stars — if that.

“It indicates we have work to do getting the word out,” Libet said.

Otherwise, despite the resources, despite the new programs, homeless and mentally ill veterans will remain lost among us.

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