March 11, 2007
IS STATE VA SYSTEM UP TO THE TASK?
By Abram Katz, Register Science Editor
Tom hadn’t seen the most horrible sights in Iraq and Afghanistan, but dead comrades and other disturbing images and memories convinced him he needed help.
But although the Department of Veterans Affairs is supposed to provide psychological care for returning servicemen and women, securing it at the West Haven VA medical center was not easy.
Now Tom (who asked that his real name not be used) worries about what will happen when hundreds of troops in the Connecticut National Guard’s 102nd Infantry Division, 1st battalion, return home next month.
Some veterans and state and federal officials are skeptical of the VA’s ability to provide prompt and easily accessible mental health care.
"They’ll need help," Tom said of the 102nd. He doesn’t think many veterans will receive it.
Instead, officials are counting on a state program that started training private mental health clinicians last week on the unique traumas that veterans are apt to bring home.
No matter what programs are in place when the 102nd finishes demobilizing at Fort Drum, N.Y., caregivers know the return will be rocky.
"We’re going to have some troubles," said Laurie Harkness, social worker and director of the Errera Community Care Center at the West Haven VA.
"Seven hundred soldiers are coming home in April, and if they showed up at the VA we’d be overwhelmed," Harkness said. "Services are so fractured. We want them to get in. Helping people with readjustment is very important," said Harkness, who has worked for many years with veterans with post-traumatic stress disorder and other problems.
"We have no idea what we’re going to see," she said.
Others are downright doubtful of the VA.
"I’m confident that people who work there want to help," said Linda Schwartz, a Vietnam veteran and commissioner of the state Department of Veterans Affairs.
"But the red tape and the circuitous way you get into the system is a problem," she said.
"If you don’t have PTSD, getting into the VA system will give it to you," Schwartz said. "If you don’t have an advocate it’s like a labyrinth. The VA is sometimes impossible to understand."
Connecticut is spending $1.3 million to establish a statewide network of private psychiatrists, psychologists, social workers and other specialists to meet the immediate needs of veterans and their families.
The Military Support Program is apparently the first of its kind to offer mental health resources and will be operated by the state Department of Mental Health and Addiction Services.
State Rep. Patricia Dillon, D-New Haven, proposed the legislation to create the program long before recent revelations of poor conditions at Walter Reed Army Medical Center led to doubts about how the government treats military patients.
But Harkness and Schwartz both said they are counting on the program to ease veterans of the wars in Afghanistan and Iraq back into peaceful civilian life.
More than 150 trauma experts met with the state, Harkness and another PTSD specialist from the West Haven VA last week at Connecticut Valley Hospital for training to treat newly returned soldiers and their families.
Help for the soldier and his or her family is just a local phone call away.
Since its inception in 1776, the battalion has fought with distinction at Saratoga, Gettysburg, the Marne, Normandy and Guadalcanal. The 102nd can now add OIF and OEF to the list.
All veterans emerge from patrols, ambushes, roadside bombs and firefights drenched in adrenaline — jumpy, easily startled and on guard.
However, some men and women who endure the particularly horrific sights, sounds and smells of combat may have symptoms of post-traumatic stress disorder that will not go away.
The soldiers in Iraq and Afghanistan also face an array of new difficulties, Harkness said.
Many young veterans lived with their parents. They left home as teenagers and are returning as battle-hardened adults.
Well-meaning parents may not be aware of the transformation. They may ask their sons and daughters about their experiences in combat, perhaps the one subject the veterans least want to discuss, Harkness said.
The soldiers may escape by leaving home but becoming homeless. "That is going to be a big problem," she said.
Vietnam veterans started to become homeless seven to eight years after they returned to the United States, she said. Now, veterans start appearing on the streets within two to three months.
When married men and women come home, they may find that their spouses assumed many of their old duties. They no longer fit in. Friction can result.
Depression, irritability, social withdrawal, distraction and other symptoms of PTSD aggravate an already difficult time.
Some soldiers will come home knowing that they are going to be redeployed.
"We don’t want to tear down their defenses or make them ‘too relaxed,’" Harkness said.
The Military Support Program was developed to offer quick help to veterans and their families in all parts of the state, said Wayne F. Dailey, spokesman for the state Department of Mental Health and Addiction Services.
"Some soldiers may need long-term support, which they would receive through the VA. Connecticut feels a special obligation to support its troops and help service members and their families to address transition issues," he said.
"We hope to make services available quickly, in case there are waiting lists in other programs," Dailey said.
"From speaking to the military and their families and the VA, it seemed like an opportune time to augment existing resources," he said.
The mental health department will pay for the clinicians, and services will be provided at no charge. "We wanted to make sure we had a clear plan for how to bring clinical assets to bear statewide," Dailey said.
The VA’s West Haven hospital continues to be a national center for PTSD research and treatment and has kept a core group of researchers.
But VA doctors must receive clearance from VA headquarters in Washington before commenting on PTSD.
When asked whether the West Haven VA could accommodate returning Connecticut veterans, Dr. John H. Krystal, who heads the clinical neuroscience division at the VA Connecticut Healthcare System in West Haven, said, "I am not an expert on the VA’s national capacity to treat veterans."
Krystal said that in general, PTSD experienced by soldiers returning from Iraq is similar to PTSD reported by soldiers when they returned from prior U.S. wars.
While Vietnam veterans sometimes reported discomfort related to reminders of the jungle, such as the smell of freshly cut grass, veterans of Iraq have their own unique reminders, he said.
It is not clear whether a higher percentage of Iraq and Afghanistan veterans have PTSD than veterans of Vietnam, he said.
"We know that a certain percentage of soldiers are developing PTSD as a result of their experiences in Iraq or Afghanistan. However, we are now assessing returning soldiers for PTSD much more carefully than we did following their return from Vietnam. The good news is that we are in a much better position to treat PTSD in returning soldiers in the current war," Krystal said.
Tom was almost killed when an improvised explosive device destroyed the Humvee he was in. The insurgent triggered the bomb a fraction of a second too soon, and it blew the engine out of the vehicle. An instant later and Tom and the driver would have absorbed the blast.
Tom said he dragged dead Americans out of a ditch, but did not experience the worst violence. Even so, he felt he needed some help.
Tom finally went to the West Haven VA to fill out forms and make an appointment. He was immediately told to report to the seventh floor — the psychiatric ward — Tom said.
He was puzzled because he hadn’t seen so much as a triage nurse and had not had a chance to tell anyone why he was at the facility off Campbell Avenue.
Tom was asked to undergo a psychiatric screening and he consented. "I was told someone would call me," he said.
Two weeks later a doctor called and offered to write Tom a prescription, he said.
Tom had not been examined or diagnosed. "I asked him, a prescription for what? I was never told I had anything."
Tom, a sergeant in the Army Reserves, said he declined the pills. Two more weeks elapsed, and then a counselor called and said, "I heard you refused medication," he said.
By now, a month had passed and Tom had been labeled a noncompliant patient.
He eventually was offered counseling, but counselors leave at 4:30 p.m. sharp. "What is someone who’s working supposed to do?" Tom asked.
Tom said he reluctantly agreed to an early-morning meeting and said the counselor arrived 15 minutes late. That left too little time to accomplish anything, Tom said.
He never went back. Summer and fall had given way to winter when he received a letter from the West Haven VA: It was "closing the case."
"That sounds very familiar to me," Schwartz said. "Ask him to call me."