Finding New Ways to Serve Military, Families

civilan man with shadow of soldier in combat dressThe U.S. military and organizations that offer mental health care to veterans have made tremendous strides over the years in how they recognize and treat mental stress during times of war.

During the American Civil War, for instance, the term "soldier's heart" was used to describe a combat stress reaction, or CSR, and focused on treatments that would place less physical stress on the heart, such as improving one's posture and wearing loose-fitting clothing around the waist.

By World War I, the term "shell shock" was being used to describe a CSR, although it was believed to be the result of a physical injury to the nerves that happened when a soldier was exposed to heavy bombardment. In World War II, more progress had been made: The general principles of psychiatry were being followed by the U.S. military, although terms like "exhaustion" that focused on physical symptoms were still being regularly used to describe CSRs.

Times have changed. Today, every branch of the U.S. military recognizes the critical importance of mental health and strives to offer appropriate care for soldiers, both in the U.S. and those who are deployed. Additionally, mental health services for veterans and their families, such as those offered through organizations and agencies like the Department of Veterans Affairs — from family counseling to inpatient treatment to education programs and beyond — can be accessed at sites across the nation.

As impressive as this care system is, in recent years it has become critically overloaded with soldiers returning from countries like Iraq and Afghanistan, and has not had enough resources, funding or personnel to adequately support these service members and their families. Contributing to this overload is the fact that nearly a third of deployed soldiers returning home now find themselves in need of some type of mental health care, a much larger number than in past conflicts.

Focus and change. In 2007, much public attention was drawn to the issue of health and mental health care of the military as a result of several published news reports. At the time, many organizations working with veterans and their families had already recognized areas in need of improvement and had begun addressing them, developing new ways to improve access to and delivery of mental health services. This increased attention served as a catalyst for change, and many groups increased funding for mental health services and research, amounting to hundreds of millions of dollars.

As Veterans Day 2009 approaches, the NASW News interviewed representatives from the Mental Health Division of the Department of Veterans Affairs to find out more about new programs and initiatives that have happened in the past two years, as well as looked at ways NASW members are helping bring about positive change.

Homeless programs strengthened. On any given night, there are approximately 131,000 homeless veterans across the nation, and the VA's commitment to end homelessness among veterans gains strength daily. To meet that goal, the VA has made unprecedented strides to create opportunities to bring together veterans in need of assistance with the wide range of services and treatment VA provides directly, as well as those services offered in partnership with others.

Since 2007, the VA has been strengthening existing programs — from outreach to transitional housing to permanent housing and prevention services — and adopting new ones designed to deal with homelessness.

The U.S. Department of Housing and Urban Development works with the Veterans Affairs Supportive Housing initiative on the HUD-VASH program, which offers housing choice vouchers to veterans who are homeless along with VA-provided case management and clinical services, says Lisa Pape, the VA's director of residential rehabilitation and treatment services.

"Vouchers are allocated to the local public housing authority by HUD while VA provides the case management services to support the veteran and his or her family in permanent housing," she says.

HUD awarded funding for approximately 10,000 HUD-VASH vouchers in May 2008. According to Pape, this program has been particularly effective for homeless women with children, a group that traditionally has received less attention than others.

Justice-involved initiatives. VA medical centers often operate in conjunction with community partners in the justice system such as police departments, public defenders and probation officers. New programs for veterans with mental health issues who have had contact with this system (referred to as "justice-involved" veterans) have been established, including a new Veterans Court program. This program assists veterans who are in the court system so they do not end up incarcerated unnecessarily.

"Social workers have been integral to this and our other justice-involved programs," says Antonette Zeiss, deputy chief of mental health services for the VA. "They do a number of things, such as work with the courts, train police in how to deal with individuals who have mental illness and do outreach to vets who may be at risk."

Substance abuse program. Substance abuse has been a challenge for many veterans. To assist those dealing with these issues, a substance abuse specialist has been placed in residential rehab treatment programs. Veterans participate in rehabilitation and treatment in these programs for an average of 120 days and address substance abuse issues, post-traumatic stress disorder or serious mental illness, homelessness and other psychosocial issues.

"This is another compartment of care the VA offers -- it is longer-term care, but (enrollees) are still free to come and go, to visit their families, and yet still have the security and supports of this program," Pape says. "Many returning vets need this type of care. It is for those who are too ill to be in outpatient care, yet are able to be outside of the intense environment of a locked, inpatient unit."

Suicide prevention hotline. The VA's suicide prevention program and hotline, 1-800-273-TALK, has served as a valuable resource since 2007, staffed primarily by social workers. Recently, new capabilities have been built into the system to make it both more accessible and more effective.

"Now, if a veteran calls in and gives us permission, we can look up his or her medical history online during the call," Zeiss says. "Having this information allows us to offer better care and help save lives."

In the summer, an online chat feature as well as e-mail and text messaging capabilities were added to the suicide prevention hotline program. Now veterans can use these lines of communication to contact hotline staff, who then can start a dialogue. Although the goal is usually to get the veteran to call in by phone, having these additional communication tools allows veterans who might not have called in to take that first step toward getting the help they need.

Access for all. In September 2008, an important handbook was developed for VA medical centers, establishing minimum clinical requirements for mental health services nationally.

"This is a groundbreaking policy," Pape says. "It defines what programs are and delineates services that must be available and delivered to veterans and their families when clinically appropriate."

When fully implemented, these requirements will complete the patient care recommendations of the VA's mental health strategic plan and its vision of a system providing ready access to comprehensive, evidence-based care. Overall, VA medical facilities are expected to implement these requirements by the end of fiscal year 2009. What this means to patients and their families is a shift in the type and focus of care they may receive.

"It is based on the recovery model of care," Zeiss says. "We are partnering with patients to help them meet their personal goals, as well as deal with their mental illness. The goal is to work in partnership with veterans."

Pape notes that approximately 7,600 social workers are working in hospitals and community-based outpatient clinics across the VA system, comprising a key and critical component in the care delivery system.

"They bring unique characteristics and strengths to the table and are champions of many of our programs," she says. "It is a beautiful fit."

'Give an Hour.' Recently, NASW asked its members to volunteer with the Give an Hour program, a grassroots organization that provides a network of licensed mental health professionals to offer mental health services to military personnel and their families. Mental health professionals who join the Give an Hour network volunteer one hour of their time every week to provide the services for free.

"So far, 1,900 social workers have participated in Give an Hour," says NASW project manager and lobbyist Elizabeth Franklin. "Since July 2007, Give an Hour has recruited 4,200 professionals who have donated 14,556 hours in mental health services."

NASW members are helping in other ways. In New York, there is a significant military population and therefore the New York state chapter of NASW has recently begun its New York State Veterans Mental Health Training Initiative, funded through a grant by the state legislature.

This initiative is a comprehensive, statewide training program to prepare New York's mental health workforce to identify and address military-specific issues.

LeslieBeth "LB" Wish is an NASW member who serves as co-director of The Counseling Network for the Special Operations Warrior Foundation in Tampa, Fla., which offers free counseling for grief, post-traumatic stress and family and children needs for military families and veterans. Wish has noticed improvements in the way care has been delivered in the past two years.

"I think there is more awareness now of PTSD and more of an appreciation as to how difficult it is," she says. "I also believe overall life issues are being met in a more timely way and this is helping. ... Are there improvements? Yes. Are more needed? Yes. But, in general, veterans and their families are getting seen in a more timely fashion. There is a greater sense that they are being heard."