Combat to Community:
Needs & Resources for Post-911 Veterans and their Families Presented by Swords to Plowshares, Iraq Veteran Project Updated: July 2008
Overview What am I going to learn?
• The conditions of the Global War on Terrorism (GWOT) • Risk factors for substance abuse and homelessness • Protective steps that can minimize risk factors • Resources for veterans and their families
The Global War on Terror
Operation Iraqi Freedom (OIF) Operation Enduring Freedom (OEF)
Where is the Global War on Terrorism?
Demographic Overview Who are OEF/OIF veterans? • Approx. 1.7 million personnel have been deployed to the Global War on Terror • 34% of those fighting in the GWOT have been deployed multiple times1 • 28% of OIF/OEF troops and veterans are National Guard and Reservists1 • 892,848 GWOT veterans are currently separated from the military AND eligible for VA services3
POPULATION: Regular Forces What are concerns among those who served under active duty?
Regular Forces: • 46.6% of regular forces are under 25 years old4 • New homeless veterans who were in regular forces are very young • Many entered as teenagers and left home for the first time • Upon returning home, family is not available or available for short time • May return to an already unstable environment with added stress of combat
POPULATION: National Guard What are concerns among those who served as National Guard or Reservists? National Guard: •
Older cohort of veterans with little connection to military communities or Veterans Affairs
•
The average age of Reservists/Guard GWOT veteran is 36.2 years old5
•
Many Guard and Reservists are forced to leave jobs
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The National Guard is being transformed into an “Operational Force” which is frequently deployed overseas, whereas before they were primarily involved in domestic/state issues9
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They are half as likely to file VA claims as their regular forces counterparts and twice as likely to have their VA disability claim denied5
POPULATION: Women Military What are concerns amongst women military and veterans? Women: •
There are between 155,000-180,000 women who have served in OIF/OEF6
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As of April 2008, there were 101,577 female GWOT veterans5
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71% of women veterans served after Vietnam7
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There are 420,045 female veterans from all eras7
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More women engaging in combat roles in Iraq
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Women are 2 to 4 times more likely than non-veteran women to be homeless8
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Preliminary research shows that women have much higher exposure to traumatic experiences
Common Problems Amongst Combat Veterans What are major issues that occur for combat veterans? • Major Depression • Alcohol Abuse – Often used as effort to sleep
• Narcotic addiction – Often beginning with pain medication for injuries
• • • • • •
Military Sexual Trauma Suicide Job loss Family dissolution Homelessness Violence towards self and others • Incarceration
Homelessness Is homelessness an issue amongst OEF/OIF veterans? •
Yes. Recent vets are at significant risk for becoming homeless and staying homeless sooner than veterans from previous conflicts
•
After Vietnam, veterans became homeless 9-12 years after experiencing combat
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OIF/OEF veterans are increasingly seeking assistance from homeless services at the VA
Substance Abuse Is substance abuse an issue amongst OEF/OIF veterans? • Yes. Recent vets, particularly those with untreated mental health conditions are at highest risk of self-medication • In 2008, 15,653 OIF/OEF veterans were treated for substance abuse3 • The VA is the world’s largest provider of substance abuse services10
The Conditions of OIF/OEF What are some of the risk factors associated with OIF/OEF? •
Repeated urban combat. OIF/OEF veterans are repeatedly deployed to intense 360 degree fire.
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Injury and Diminished function
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Unemployment and Financial Difficulty
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Disrupted family life
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Limited access to support services
Risk Factor #1: Repeated Deployment to Urban Combat Repeated Deployments • Troops experience 360 degree fire with little or no time to recuperate
“No safe place, No safe role”
• 34% of troops have been deployed for OIF/OEF more than once1 • For every death on the battlefield, there are 7 wounded. When including “non-combat” injuries, the ratio jumps to 15 to 111 •
According to a recent RAND study about 320,000 may have experienced a Traumatic Brain Injury during deployment12
An additional set of unique stressors stems from the fact that much of the conflict in Iraq, particularly since the end of formal combat operations, has involved guerilla warfare and terrorist actions from ambiguous and unknown civilian threats. In this context, there is no safe place and no safe role.
Risk Factor #2: Injury and Diminished Function Physical and Psychological Wounds •
Many veterans are returning with multiple physical and mental injuries.
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The RAND study estimates 300,000 veterans who have returned from Iraq and Afghanistan are currently suffering from PTSD or Depression12
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Roughly 50% who need treatment for depression, PTSD and/or TBI seek it, and only slightly more than half who receive treatment get, “minimally adequate care”12
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VA has confirmed 18 suicides per day15 among the entire veteran population and 1000 suicide attempts per month among all veterans seen at VA medical facilities16
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Launched in July 2007, the VA suicide hotline received 43,294 phone calls during its first six months of operation.14
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2,947 sexual assaults were reported by service members in 200613
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1,400 sexual assaults were investigated in 2006– this includes incidents dating back to 200413
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Only 26% of the reported sexual assaults resulted in disciplinary action13
What have our returning troops experienced? Received small-arms fire – 94%
Know someone who was seriously injured or killed – 86% Saw dead or seriously injured Americans – 68%
Handled or uncovered human remains - 51% Shot at or directed fire at the enemy – 77% Responsible for the death of an enemy combatant – 48% Responsible for the death of a noncombatant – 28% Source: New England Journal of Medicine, July 2004(23)
Risk Factor #3: Unemployment and Finances •
Younger veterans express difficulty transferring their military skills to the civilian work force
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A recent study for the VA found that 18% of veterans, recently separated from service, are unemployed, and of those employed 25% earn less that $21,840 a year17
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1 in 4 military families have outstanding loans from predatory lenders that carry interest rates of 400% or higher18
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Guard/Reserve troops find their former jobs no longer exists, or their employers have folded, down-sized, merged, or relocated
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Financial difficulties put tremendous strain on families and can jeopardize security clearances and military careers
Risk Factor #4: Disrupted Family Life •
There are 37 million dependants of veterans of 7 all eras in the U.S.
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Roughly half of the military have spouses and dependant family members4
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700,000 children have had at least one parent deployed19
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PTSD has a debilitating effect on veterans ability to maintain employment and family relationships.
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50-60% of spouses of brain injured patients reported having depression20
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Drastic increase in the rate of child abuse 21 and neglect amongst military since 2002
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Limited resources for spouses, children, and parents.
Risk Factor #5: Barriers to Support Services •
• • • •
Combat veterans are at high risk for PTSD and other mental health problems, but are often unlikely to report them. Those with a mental health condition were twice as likely to report concern about stigmatization should they report their problems. Discharge Status. Veterans with other than honorable discharges may be barred from receiving health and compensation benefits through VA. Nearly 2 million veterans are uninsured– 2/3 of which are employed.22 Lack of legal assistance in processing and applying for disability benefits.
65
I would be seen as weak. My unit leadership might treat me differently.
63 59
Members of my unit might have less confidence in me. It would harm my career.
50 0
10
20
30
40
50
60
70
80
90
100
Percent agree or strongly agree
Source: New England Journal of Medicine, July 2004 (23)
The Conditions of OIF/OEF What are the protective factors associated with OIF/OEF vets?
• Access to supportive services • Employment and training success • Continuity of tours of duty • DOD housing and rehabilitation
Resources: Department of Veterans Affairs
The Department of Veterans Affairs
Veteran’s Health Administration
Veterans Benefits Administration
Eligibility: • Generally, veterans must have an honorable discharge, have served 24 continuous months, demonstrate financial need, and/or have a service connected disability. • OIF/OEF veterans are eligible for 5 years of free health care and may be eligible for 90 days of dental care after separation. • Vets must apply separately to the VHA and the VBA. – Veterans must apply for healthcare through the VHA. – Veterans must then complete a separate claim for disability compensation payments through the VBA.
Resources: VA Outreach • VA established Seamless Transition specifically for OIF/OEF veterans • www.seamlesstransition.va.gov • More resources need to be directed toward post-deployment adjustment • Bureaucratic obstacles and delays serve to discourage veterans from seeking out care
Resources: Vet Centers • Designed to serve combat veterans, their surviving family members, and victims of military sexual trauma (MST) • Provide individual and group readjustment counseling • Provide marital and family counseling with veteran as a conduit for care
Limitations on availability of VA Care and Benefits Vet Centers According to a review for the House Committee on Veterans Affairs:24 • Vet Centers do not have the capacity to meet the current increase in OIF/OEF veterans • Due to increased demand Vet Centers are reducing rather than expanding family services
VA Disability Claims: • • • • •
The backlog of disability claims has risen to 600,000 claims In 2006, the VA reported receiving 806,382 disability claims7 As of April 2008, 287,790 GWOT Veterans have filed a disability claim5 AVERAGE WAIT TIME: 183 days for an initial decision7 Time frame for a claim decision, including appeals can exceed 10 years
Vocational Rehabilitation: • • •
Securing appropriate services and benefits can be a challenge Services vary widely Approval for certain vocational education or training program requests can be difficult
Contact Us Swords to Plowshares, Iraq Veteran Project
1060 Howard Street San Francisco, CA 94103 Ph: 415-252-4788
Thank you The California Endowment The Iraq and Afghanistan Deployment Impact Fund Jeffery Johnson, the Coordinator of the Wisconsin Department of Veterans Affairs Mission: Welcome Home program Eric Proescher, Psy.D., clinical psychologist at the Jesse Brown VAMC, Chicago
Sources 1. Department of Defense; Defense Manpower Data Center. (2008). CTS Deployment File Baseline Report: Contingency Tracking System (CTS) Deployment File for Operations Enduring Freedom & Iraqi Freedom As of: October 31, 2007. Obtained by Veterans for Common Sense using the Freedom of Information Act.
2. DoD Definition of Combat Operations for Title 10 Service Members. Prepared by: OSD Personnel and Readiness, Military Personnel Policy, Compensation, March 2007. 703-695-9363. 3. Veterans Health Administration, Office of Public Health and Environmental Hazards. ―Analysis of VA Health Care Utilization Among US Global War on Terrorism (GWOT) Veterans: Operation Enduring Freedom Operation Iraqi Freedom,‖ PowerPoint Presentation. May 2008. Obtained by Veterans for Common Sense using the Freedom of Information Act. 4. Department of Defense. 2005 Demographics Report. Office of the Deputy Secretary of Defense (Military Community and Family Policy) 5. Veterans Benefits Administration. ―VA Benefits Activity Veterans Deployed to the Global War On Terror,‖ April 16, 2008. Obtained by Veterans for Common Sense using the Freedom of Information Act. 6. PBS. ―More Women Soldiers Dying in Iraq.‖ News Hour with Jim Lehrer. December 18, 2006. *several news reports account for range in numbers 7. Department of Veterans’ Affairs. ―Performance and Accountability Report.‖ November 15, 2007. <http://www.va.gov/budget/report/2007/index.htm> Accessed 19 June 2008 8. Overrepresentation of Women Veteran Among Homeless Women, G. Gamache, R. Rosenheck , R. Tessler. J. Amer. Public Health, July 2003, Vol. 93 No. 7. <http://www.ajph.org/cgi/reprint/93/7/1132> Accessed 19 June 2008 9. Punaro, Arnold L., et al. Commission on the National Guard and Reserves. Transforming the National Guard and Reserves into a 21st-Century Operational Force. Washington DC, 2008. <http://www.cngr.gov/Final%20Report/CNGR_final%20report%20with%20cover.pdf>. Accessed 23 Jun 2008 10. Dept. of Veterans Affairs. ―Practice Matters.‖ February 2001. 11. Stiglitz, Joseph E., and Linda J. Bilmes. The Three Trillion Dollar War: the True Cost of the Iraq War. New York: W.W. Norton & Company, 2008. Also see DoD website for casualty statistics: http://siadapp.dmdc.osd.mil/personnel/CASUALTY/castop.htm 12. Tanielian, Terri, Lisa H. Jaycox,Eds., Invisible Wounds: Mental Health and Cognitive Care Needs of America's Returning Veterans. Rand Corporation Center for Military Health Policy Research. Santa Monica Calif.: RAND Corporation, 2008. Accessed 19 June 2008 < <http://www.rand.org/pubs/research_briefs/RB9336/>
Sources (con’t) 13. Department of Defense. ―Annual Report on Military Services Sexual Assault for CY 2006.‖ March 15, 2007. 14. Peake, James. "Opposing View: VA is Reaching Out." USA Today 23 May 2008. <http://blogs.usatoday.com/oped/2008/05/opposing-viewv.html>. Accessed 19 June 2008 15. Katz, Ira R. Email to Kussman, Michael J, M.D. 15 Dec. 2007. http://www.cbsnews.com/htdocs/pdf/VA_email_121507.pdf. Accessed 19 June 2008 16. Katz, Ira R. Email to Chasen, Ev. 13 Feb. 2008 http://www.cbsnews.com/htdocs/pdf/VA_email_021308.pdf Accessed 19 June 2008 17. Abt Associates Inc. Employment Histories Report: Final Compilation Report. Washington DC: U.S. Department of Veterans Affairs, 2007. <http://www1.va.gov/vetdata/docs/Abt_Emplymnt_Histories_FINAL_COMPILATION_REPORT_Sept28.pdf>. Accessed 19 June 2008 18. Henriques, Diana B. ―Lenders at the Gate; Debtors in the Barracks.‖ New York Times, December 7, 2004. <http://query.nytimes.com/gst/fullpage.html?res=9D06EFDB1531F934A35751C1A9629C8B63&sec=&spon=&partner=permalink&exprod=per malink> 19 June 2008 19. Presidential Task Force on Military Deployment Services for Youth, Families and Service Members, The Psychological Needs of U.S. Military Service Members and Their Families: A Preliminary Report, American Psychological Association, February 2007.
20. U.S. Medicine Institute for Health Studies. ―TBI: Fitting the Pieces Together.‖ Roundtable Discussion Executive Summary. Washington D.C., September 21, 2007. 21. Rentz, Danielle. (2007) ―Stress of Deployment Increases Risk of Child Abuse, Neglect in Military Families.‖ US Fed News Service, Including US State News. Washington DC. 22. Himmelstein., et al. ―Lack of Health Coverage Among US Veterans From 1987 to 2004.‖ December 2007. <http://www.pnhp.org/veterans_study/APHA_Veterans_galley.pdf> Accessed: 4 December 2007. 23. Hoge, CW., et al. ―Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care.‖ The New England Journal of Medicine. Vol. 351, No.1., July 1, 2004. 24. U.S. House of Representatives, Committee on Veterans Affairs—Democratic Staff. ―Review of Capacity of Department of Veterans Affairs Readjustment Counseling Service Vet Centers.‖ Prepared for Representative Michael H. Michaud, October 2006.