Avoiding Homelessness for Our War Veterans
By Margaret L. Woods, President/CEO, Independence: A Family of Services.
More than a decade of war in the Middle East has pushed post-traumatic stress disorder (PTSD) to the forefront of public health concerns. The last several years have seen a dramatic increase in the number of Iraq and Afghanistan war veterans (approximately 11-20% of these veterans) seeking help for PTSD, shining a spotlight on this debilitating condition and raising critical questions about appropriate treatment options and barriers for care.
Improvements in protective gear and battlefield medicine have greatly increased survivability—but at a high price. Our service men and women are returning stateside with both physical and psychological traumas. Veterans suffering from PTSD have multiple chronic conditions; depression being the most common followed by anxiety and substance abuse or dependence.
Not only are recent veterans at higher risk of suffering from PTSD than those in the general population, they also face unique barriers to accessing adequate treatment. These include the requirement that they have either an honorable or general discharge to access Department of Veterans Affairs (VA) medical benefits, long waiting lists at VA medical centers, and the social stigma associated with mental illness within military communities.
Several factors have been shown to increase the risk of PTSD in the veteran population, including (in some studies) younger age at the time of the trauma, racial minority status, lower socioeconomic status, lower military rank, lower education, higher number of deployments, longer deployments, prior psychological problems, and lack of social support from family, friends, and community.
Veterans now account for 20% of all suicides in the U.S., with the youngest (18–24 years of age) four times more likely to commit suicide than their nonveteran counterparts of the same age. An estimated 18 to 22 veterans die from suicide each day. Some of the most effective psychotherapies are in community-based settings, such as primary care practices, behavioral health centers, substance-abuse treatment facilities, and hospital trauma centers.
A veteran with psychological problems consistent with a diagnosis of PTSD may not be able to take care of life’s basics, such as paying bills, keeping steady employment. S/He may use what money s/he has on gambling, drugs, or alcohol—avoidant coping strategies to protect himself or herself from the memories of his/her war experience.
Unfortunately, the combination of substance abuse and trauma exposure, can lead to homelessness, and once homeless, the vet may become depressed, and a cascade of psychological problems can occur. One of the major obstacles to seeking help for the mental health issues that contributes to homelessness is stigma. Issues of military identity and culture as well as fear of discrimination may stand in the way of veterans seeking available help or being receptive to outreach efforts.
We need to get veterans into a home first, to set the groundwork and build trustful relationships with service coordinators, housing specialists and provide a framework for getting the treatment and support they need. To maintain housing, they need to manage the mental health issues that contributed to homelessness or lost opportunities.
The first priority should be to secure them a place to live. Once they have a home, they will require support to help them transition into day-today living. Only then can they begin to realize what assistance they need to develop the skills and mindset required to keep their home.