Friday, November 13, 2009
For thousands of military veterans returning to San Diego, a new journey is beginning -- often without a safety net. Are U.S. service men and women getting the mental health care they need to return to civilian life? How much responsibility should the U.S. military have to provide ongoing support to its veterans?
ALAN RAY (Host): You’re listening to Editors Roundtable. I’m Alan Ray, in for Gloria Penner. And we’re joined at the roundtable today by Dave Rolland, the editor of San Diego CityBeat, Kent Davy, editor of the North County Times, and Hieu Tran Phan, the specialists editor for the San Diego Union-Tribune. Don’t know that you might’ve heard it earlier in the week, although I presume all of you listen to KPBS every of your waking hour, but reporter Alison St John did a story about a veterans outreach program that’s being undertaken by San Diego County. The really arresting part of the story was the disparity between the number of veterans and service providers: 18,000 veterans of Iraq and the Afghan wars registered at the VA Medical Center in La Jolla where they have 11 psychiatrists, 8 psychologists, and 7 social workers. Hieu Tran Phan, can we possibly help these people?
HIEU TRAN PHAN (Specialists Editor, San Diego Union-Tribune): Well, I think this topic actually starts all the way in the active duty military ranks and then transfers itself over to the VA. So if we look only at the Veterans Affairs system, we’re not going to be able to get to the origin of our challenges. And I think you bring up a salient point, which is both in the active duty military, as we saw at Fort Hood with the recent shootings and in the VA system, they’re both straining to try to get enough mental health care for their ranks. I would say in any objective measure that this is better than what the Vietnam War veterans went through and, in fact, many of them are leading the push to get more services, mental health and otherwise, for current veterans. That said, we still have a lot of room to improve. We can go over some of these standards and so forth. Even former Army General Eric Shinseki, the head of the VA, has acknowledged many shortcomings in his agency.
RAY: Dave Rolland, we were told by some reports that even the Fort Hood shooter, a psychiatrist, had tried to get out of the Army and was told he couldn’t leave because the Army didn’t have enough psychiatrists already.
DAVE ROLLAND (Editor, San Diego CityBeat): Well, yeah, and that’s the big issue. I mean, the organization, the Iraq and Afghanistan Veterans group, has come out with several reports and one of them really hits home on mental health issues. And the interesting thing to me is—and, well, they do say what you’re saying, is that the VA is going to be – is already and going to be increasingly overwhelmed by mental illness rather than physical industry – injuries. It – The interesting thing for me is I’m actually working on a feature story right now that has nothing to do with the military or veterans but it has to do with mental health. I’m focusing on a man who has multiple diagnoses. He’s got head trauma, he’s got schizophrenia, and he’s got a history of alcoholism. That’s a multiple diagnoses problem that really requires specialized care. Now we have a situation in the military where a lot – the military medicine, you know, on site triage, has gotten so much more effective, so much better, that you have all – thousands and thousands upon thousands of people who, you know, in past wars, would have died right on the battlefield or soon after. Now these people are surviving but they’re surviving with serious trauma, with serious head injuries. And the way traumatic brain injury interacts with post traumatic stress disorder is kind of a whole new ballgame, and I don’t – I fear that we are not prepared to deal with it.
RAY: You’re listening to Editors Roundtable on KPBS. 1-888-895-5727 if you’d like to join the conversation, and we would be pleased if you did, 1-888-895-KPBS. Kent Davy, does the military now look more kindly on people who have emotional psychiatric problems than it did say, even in the Gulf War or, certainly, in Vietnam?
KENT DAVY (Editor, North County Times): I think they do. I’m not sure that it’s any more effective, though. I have a friend who has a son that was in Iraq. He had a head trauma, had post traumatic stress disorder. He has received a fair amount of services but trying to help him move through but it really isn’t going to be anywhere close to enough, would be my guess, just watching on the outside.
RAY: So we…
RAY: I’m sorry. Go ahead.
DAVY: You know, you’ve got a nation that is willing to send people off to war but, frankly, when they come back has historically not done all that much for them except for the GI Bill after World War II. You’ve got, in this country, some experts say, 260,000 homeless veterans, 26,000 here in this state. And we don’t do all that much to try and take care of this problem and find services. Many of these men, or some portion of these men, have mental health issues, certainly all sorts of jobless issues, and there are programs around. Interfaith Community Services runs a great program but it’s only got 104 beds.
RAY: 1-888-895-5727, 1-888-895-KPBS. Please do join us on Editors Roundtable. I’m Alan Ray, in for Gloria Penner. Dave Rolland, 27%, by some estimates, of the 18,000 veterans of Iraq and Afghanistan who are registered at La Jolla have PTSD. And if we have 27 psychiatrists (sic) and 7 social workers, is it possible those people can – could, with the help of the military, even turn to private providers to get some help?
ROLLAND: I honestly don’t know the answer to that question. I have heard that there have been – people have been – We did a story this week on bureaucratic problems, red tape, paperwork problems with certain people trying to get benefits and my associate editor, Kelly Davis, who did that story, told me last night in an e-mail, we were talking this over, and she said that was – that came up in her conversation. I don’t think it had got included in her story but she said that came up where one of the people she talked to was trying to get help from a private, you know, in private practice but it was very difficult to get the government to give them the go ahead to do that.
PHAN: I want to stress I’m getting the feeling from our talk that this is a hopeless situation and it’s not entirely hopeless. There are actually many, many groups trying to step up to help the VA and the active duty military. UCSD does tons of research along with biomedical institutes here to help on traumatic brain injuries, on PTSD. The Pentagon has created two new offices that have shown a lot of results at Camp Pendleton, at Miramar and at local Navy bases in terms of dealing with suicide, in terms of trying to deal with domestic violence, alcohol problems. And even with PTSD, with the short staffing that we have for mental health care, the VA system has now figured out ways to deal with the American Psychological Association. The psychiatric associations and so forth offer free healthcare to people who either, one, can’t get in quickly enough through the military system or, two, don’t want to go to a military system because they feel it may hurt their career, there may be a stigma being seen as weak or so forth. So there are lots of grassroots efforts out there and there are a lot of charities like the American Combat Veterans of War and so forth that are trying to give whatever help they can provide. I do want to go back and say that this is not just an Iraq and Afghanistan war problem. Many Vietnam War, World War II veterans are, through flashbacks and through listening to and seeing images of war in the Middle East right now, are having their own triggered memories on PTSD and are seeking help for that as well. That’s a huge portion of the healthcare need that we’re seeing right now through the VA system.
RAY: The question was raised, and I want to, again, ask if you are a veteran or if you know somebody who is, if you know a homeless veteran or somebody who came back from Iraq or Afghanistan and needs help, give us a call. 1-888-895-5727, 1-888-895-KPBS. The question was raised a little bit earlier, or the issue, of homeless veterans. We have some thousands of them in San Diego. Are they a cause for concern on the streets to people other than themselves?
DAVY: Well, I think that – I think they ought to be a cause for everyone’s concern, that we have homeless, period. Homeless veterans, I don’t know that as a class that they are any more dangerous to the average pedestrian walking down the street than anybody else. But certainly we – it seems to me that we ought to be engaged in trying to find ways to get people off the street, to get them into safe housing and take care of these people.
PHAN: I should mention that Veterans Village of San Diego has given an estimate there are about 4,000 to 5,000 homeless veterans in our county, and as part of a national push, Shinseki has been trying to get 130,000 veterans off the streets in six years. That’s a highly ambitious goal by any standard from all independent surveys. But at least they’re trying to make a dent in the problem.
RAY: Dave, I’m wondering, do you see the situation markedly improving if we get a change? We were talking about healthcare reform earlier, do you think getting some change in healthcare might help approach this problem with the veterans?
ROLLAND: Well, it will only get better if you, you know, if you push more resources to the problem. I mean, if you get more psychiatrists into the system, you get better access, you improve your recordkeeping system. What I’m hearing is that the VA’s records system is severely outdated. It’s all based on paper, still people are pushing papers and you have to, especially if you’re a veteran, a homeless veteran, somebody down on your luck, it’s harder to keep track, or chaperone your paperwork as the veterans groups call it. You have to be so diligent about that. If you lose your – I think the document that we wrote about this week was a DD-214 or something like that…
ROLLAND: …where if you don’t have that, you’re, you know, you’re out of luck when it seems like in this day and age with electronic recordkeeping that they could do a much better job of helping people. You just have to have the political will to do some of these things and you have to just get after it.
RAY: Okay, we heard General Shinseki talking about PTSD and about all kinds of emotional disconnect in veterans and even people in the active duty military. Does anybody have the sense that the military is now institutionalizing its approach to dealing with these problems? Or is it still kind of just haphazard?
PHAN: I think as – Oh, I’m sorry, Dave.
ROLLAND: Go ahead.
PHAN: I think as Kent mentioned earlier, at the higher ranks, the generals and so forth, there is a concerted effort to get the message out that we want to help you. Whether that’s really filtering all the way down to the sergeants, down to the lance corporals and to the privates is a big question right now. Do you still get promoted, do you get picked on, do you, you know, feel that you’re ostracized? I’m not sure that’s happening immediately yet.
ROLLAND: I think…
DAVY: Yeah, the…
ROLLAND: Sorry, Kent. I’m sorry, I interrupted you.
DAVY: I can’t speak on the individual enlisted man basis but I know that, for instance, the Marine Corps and the services generally are spending a fair amount of time trying to study the problem in general and try and find some strategies to both minimize it and to deal with those people who are out there. There’s a conference, I think, that’s been here every year for the last several years specifically on this topic, so it’s not like it’s completely off anybody’s radar.
ROLLAND: I was going to say, it seems to me that you need to start earlier in the soldier’s process by getting across to them if they’re going to – if they’re going into combat, it’s likely that they are not going to come out mentally unscathed. And you’ve got to – I think you have to get it into their thinking process that it can’t be a stigma; you have to be able to approach your supervisors and tell you that – tell them that you’re having trouble hacking it because what you – I think what soldiers see in war is something that human beings are probably not meant to be equipped to handle emotionally.
RAY: And this goes back to the Greeks, this goes back to Greek tragedies about war.
PHAN: Alan, I would say this too. We’re – I don’t want our listeners to think this is purely a military veteran’s problem. We can contribute to it too, as civilians which as so many military families tell our reporters and tell me that they have friends who are civilians, they have coworkers who are civilians. People need to try to encourage the veterans and service members to get help when they see signs of distress, they shouldn’t just be polite and ignore it or keep quiet about it. This seems to be the message that comes up time after time after time from suicide victims’ family members to people who are going through various emotional and the physical problems at home in terms of domestic violence or alcohol abuse or so forth. So I think there is a role for the general public to play here, too.
ROLLAND: Yeah, one thing I was going to add is that the – we still have problems in the system in terms of diagnoses of mental illness and whether you can get benefits based on those diagnoses. They are still prioritized very low, way below physical injuries, and I think there’s still a lot more to improve on in that area. It’s almost like private insurance and preexisting conditions. We hear that veterans are being told that they’re distressed, their emotional distress was a preexisting condition. Oh, it must’ve been in your childhood, that kind of thing. That – They’ve got to stop assessing those situations as narrowly as they seem to be assessing them.
RAY: You’re listening to Editors Roundtable on KPBS, 1-888-895-5727 if you’d like to join the conversation, 1-888-895-KPBS. Lauren in Mission Hills, good morning. You’re on KPBS.
LAUREN (Caller, Mission Hills): Thank you. Good morning. I’m a clinical psychologist and I just wanted an insight opinion on serving this population. I’ve seen thousands of patients in my experience and I went down to the VA in Mission Valley to see if there was anything, since I knew a psychiatrist there who encouraged me to do so, and I found that it’s research driven. No disrespect to UCSD. I’m very proud of our university and my daughter goes there and it’s a wonderful university, but I think collecting data in electronic grids with questionnaires is valuable in terms of finding out more about patterns of PTSD and head injury but I was interested as a clinician in helping people who are returning with multiple problems, emotional problems, even the repercussions of head injury and head trauma. And I think in this time now of cuts, budget cuts to MediCal when so many psychologists are finding that they can’t serve their MediCal population because they’ve recently been told that there’s no more psychotherapy or drastically reduced psychotherapy for the MediCal population, I would imagine there are many therapists like myself who’d be more than willing to help our returning veterans at this point.
PHAN: Lauren, one way that you can help out is there – the National Psychological and Psychiatric Associations now have formal programs that you can register for and they do quite a bit of marketing to active duty service members and veterans on how you can access a local provider for counseling sessions, for medical therapy in terms of psychotherapy and so forth. And so if you just go to the websites for those organizations, it’s prominently displayed and you can volunteer that way.
RAY: Let’s stay right on the phones. Ted in Point Loma, good morning. You’re on Editors Roundtable.
TED (Caller, Point Loma): I’m just calling to ask the editors that in addition to intervention programs if it might be a good idea to have legislation that would guarantee every vet SRO, the single residency housing, which is what so many homeless vets would want if they could have it.
DAVY: Is it – Well, to guarantee every home – every veteran single resident housing strikes me as a fairly substantial big ticket item and in an era when – and it’s the same problem that you’ve got. You can spend – A dollar’s a dollar and you can spend it all the way across the board, we can spend it on healthcare in general, we can spend it on vet housing, we can spend it on psychological services, so on and so forth. There’s a point in time in which the total demand for public goods is greater than the ability to supply them.
ROLLAND: Well, I think it might be interesting if we had such a requirement that we had to take care of these people for the rest of their lives after we send them into a situation of horrible atrocities like this where they – it’s, you know, they have a high risk of losing their life, they have – they’re – almost certainty of having life altering experiences, to go out and fight what often are elective wars. If we consider the cost, you know, we talk – you know, in our last topic, we talked about the cost of healthcare, you know, whether it’s going to be a trillion dollars over the next ten years. We have just – we’re almost at a trillion dollars in terms of the cost of the wars in Afghanistan and Iraq but we don’t seem to be debating that too much. So maybe if we understood that we had to pay for these people’s healthcare and their housing for the rest of their lives, maybe we’d enter fewer wars.
RAY: You’re listening to Editors Roundtable on KPBS. Raven in Ramona, good morning. You’re on KPBS. Raven? Well, I guess not. Okay. The question apparently on the screen is the suggestion by this caller that the VA treats veterans like lab rats. Have you guys – I mean, we know we heard about research institutions, but has anybody heard that?
PHAN: Alan, I think this is painting a broad brush stroke whether it’s for the VA or for any hospital system, Scripps, Sharp or so forth. The VA has had its fair share of medical problems this year, high profile ones, the contaminated colonoscopies, the botched prostate surgeries and so forth, but in general, outside of the paperwork computer issue, the medical care in the VA is routinely ranked better than average by independent organizations, the best organizations around in terms of evaluating them. I would say that it’s a lack of resources. It’s probably, as Lauren said earlier, there is debate about whether there’s too much research versus actual clinical care, patient care. I think the distinction is on the benefit side, the part where you enroll for disability benefits and so forth, that’s the big backlog that still has to be cleared at this point.
RAY: Okay, let’s try Raven again. Do you have personal experience with the VA?
RAVEN (Caller, Ramona): Yes, I do have personal experience with the La Jolla VA. And one of my procedures was a colonoscopy. They were looking for internal bleeding, lower gastrointestinal bleeding, and in the clinic that I was in when I asked the doctor, he was a Fellow of – supposedly experienced to some degree, a few years. And when I asked him how many procedures he did, he asked why do you want to know? And I said, well, I had a uncomfortable, unfortunate experience with other procedures and I’d like to know what your experience – how much experience do you actually have. And he thought about it for a while and he said, basically, if you don’t like it here why don’t you go somewhere else. That was from this doctor that was going to provide a procedure for me. So what do you do with that? Veterans don’t come back to the hospital. They don’t come back to the VA system. One of the big reasons they’re in the streets is that they can’t see their doctor. I’m waiting three weeks now for a minor situation to see my doctor and he’s buried. He’s literally buried. And veterans don’t come back because they are not seen. The PTST (sic) veterans go to 2 North, the psych floor, and we’ll gladly get you somebody to talk to but first you have to commit yourself.
RAY: Raven, would you do me a favor, would you hold on the line. I’m going to have somebody take a telephone number where we can contact you off the air because this does sound like a story that might be worth pursuing. Okay. Thank you. You’re listening to Editors Roundtable on KPBS. I’m Alan Ray in for Gloria Penner. We’ll come back. We’re going to talk about the possibility of term limits for San Diego County Supervisors? Oh, my.