Combating Threats to Veterans’ Mental Health Care Through Strategic Partnership … Conference... · 2017-06-03 · Combating Threats to Veterans’ Mental Health Care Through Strategic

Combating Threats to Veterans’ Mental Health Care Through Strategic Partnership

FROM VIETNAM TO TODAY: WHAT DECADES OF COMMUNITY-BASED SERVICE HAVE SHOWN US

May 19, 2017

© Swords to Plowshares 2016

Strengthening Care through Partnership

• Identifying & working toward common goals:

Providing the necessary comprehensive support

services to veterans in need

Establishing trust and rapport with veterans in need


An Overview of Services

Supportive Housing

Programs

Employment &

Job Training

Health &

Social

Services

Policy and Community Education

Legal Services

Supportive Services for Veteran Families


Our Mission

War causes wounds and suffering that last beyond the battlefield. Swords to Plowshares’

mission is to heal the wounds of war, to restore dignity, hope, and self-sufficiency to all

veterans in need, and to prevent and end homelessness and poverty among veterans.

War causes wounds and suffering

that last beyond the battlefield.

Swords to Plowshares’ mission is to

heal the wounds of war, to restore

dignity, hope, and self-sufficiency

to all veterans in need, and to

prevent and end homelessness and

poverty among veterans.


Swords to Plowshares’ Impact


Understanding Psychological

Needs of Veterans: A Critical

View of the Vietnam Generation


Vietnam: Legacy of Neglect

• Programs and services for veterans were woefully inadequate.

• Lack of federal support: Not given same care as WWII.

• Lack of support from WWII veteran service organizations.

• Vietnam veterans were not seen as deserving as prior era.

• Vietnam veterans were the most neglected generation of veterans.

• The Poverty Draft

• Decade of Neglect

• Health & Economic Consequences


The Legacy of Neglect

Social isolation

Divorce

Community neglect

Unemployment

Homelessness

Mental illness

Physical disabilities


The Veteran Service

Organization Movement


The Iron Triangle

VA

CONGRESS

VSOs


1974-1984: The Decade of Neglect

• 1974 – Swords to Plowshares founded

• 1976 – Expansion of services: military discharge upgrades, targeting

incarcerated veterans, providing employment, training and

educational assistance.

• 1977 – Community-based organizations gain legitimacy through VA

support



• 1978 – Swords to Plowshares becomes the first organization in

32 years certified by VA to represent veterans.

• 1979 – Swords’ won one of the first PTSD cases in the country.

• 1980 – PTSD was finally recognized. Prior to this it was called

“Post-Vietnam Syndrome & was not a compensable disorder.

• 1980 – Community-based organizations serving veterans expand



• 1982 – The Vietnam Veterans Memorial completed

• 1984 – Swords’ attorneys helped develop the Agent

Orange Self-Help Guide and served on the National

Agent Orange Settlement Advisory Board.


1985-1994: America is Awakened

• 1985 – “Welcome Home” parades begin 10 years after the end of the

Vietnam War.

• 1988: VA Completed the National Vietnam Veterans Readjustment

Study: prevalence of post-traumatic stress disorder (PTSD) and other

psychological problems in readjusting to civilian life among Vietnam

veterans.

• 1990s – Stand Downs began taking place throughout California.

• 1990 – Establishment of the National Coalition for Homeless Veterans.


1995 -2004: Heightened Awareness

• 1995 – California Association of Veteran Service

Agencies is established by Swords and partners.

• 1996 – The Gulf War Self-Help Guide is established by

veteran advocates.

• 1996 – Congress establishes the Commission on

Servicemembers and Veterans Transition Assistance.

• 1997 – Veteran Advocates expose military records that

prove the military’s knowledge of depleted uranium.


2005 – Today

• Homeless veterans are truly welcomed by the VA.

• VA’s 5-year plan to end veteran homelessness

• The creation of the HUD VASH program

• The creation of the SSVF program

• Two distinct veteran populations:

1. Aging Vietnam Veterans

2. Current-era Veterans


Ages

20-349%

Ages 35-5427%

Ages 55+64%

Aging Vietnam Veterans

• Aged beyond chronological age.

• Pre-disposed for a variety of health issues impacted by

their military service related injuries.

• Life-limiting illness, frailty or disability associated with

chronic disease, aging or injury.

• Veterans aged 55+ represent

66% (13.9 million) of the

veteran population in the U.S.

22% are over 75 years old.


Aging Veterans - PTSD

POST-TRAUMATIC STRESS DISORDER (PTSD) is associated

with high rates of morbidity and mortality among veterans.

Many older veterans find they have PTSD symptoms even

50 or more years after their wartime experience and

PTSD symptoms can worsen later in life.

Vietnam veterans: up to 30% lifetime prevalence of combat-

related PTSD.

World War II and Korean veterans: PTSD prevalence

remained as high as 12% even 45 years after combat.


Post 9/11 Veterans – Mental Health Needs

• Complex mental health needs: trauma, (Military Sexual Trauma & combat-related), experienced Traumatic Brain Injuries, physical injuries, and more.

• Nearly 60% of post-9/11 veterans seen at the VA have been diagnosed with a mental disorder, including

• 32% with PTSD

• 26% with Depressive Disorder


Critical Partnerships with VA


Housing & VA Partnerships

Addressing the mental health needs of homeless veterans

is the foundation for our partnerships with VA to house and

treat homeless veterans.

• Transitional Housing

Models

• Housing First Model

(2012)

• HUD VASH Support (2013)


Mental Health & VA Partnerships

VA Mental Health Summits

• Swords to Plowshares partners with the San Francisco VA

Medical Center to host annual Mental Health Summits.

Key takeaway: Targeting issues facing aging veterans was

a consistent theme and concern among providers.

Follow-up: Partnering to hold an Aging Veterans

Roundtable to delve deeper into the issues facing senior

veterans in the community.


Creating Legal Partnerships to Serve Veterans with Mental Health Issues

• Growth of law school veteran clinics & veterans programs within

existing legal aid programs:

• 73 veterans legal clinics nationwide

• 32 veterans legal clinics focused on discharge upgrades

According a recent VA study, at least 5 out of the top 10 problems leading to veteran homelessness, and the associated health risks,

cannot be solved without legal help.

-VA Project CHALENG Survey, 2015



Unprecedented rate of exclusion

Over 140,000 veterans who served since 2001

Over 33,000 of whom deployed to contingency operations


Expansion of administrative “OTH” DISCHARGES

Over 140,000 veterans who served since 2001

Over 33,000 of whom deployed to contingency operations


Some of our most at-risk veterans

SUICIDE RISK Veterans with bad paper are 2x more likely to commit suicide Marine Corps combat veterans who were diagnosed with PTSD

were 11x more likely to be discharged for misconduct

HOMELESSNESS Veterans with bad paper discharges are more likely to be homeless 2 out of 3 unsheltered veterans in Houston have bad paper

discharges

INCARCERATION 23% of veterans in prison are VA ineligible

One-third of veteran treatment courts require VA eligibility

R.M. Highfill-McRoy, G.E. Larson, S. Booth-Kewley, C.F. Garland, Psychiatric Diagnoses and Punishment for Misconduct: the Effects of PTSD in Combat-Deployed Marines,

BMC Psychiatry, Oct. 2010; M.A. Reger et al., Risk of Suicide Among US Military Service Members Following Operation Enduring Freedom or Operation Iraqi Freedom

Deployment and Separation from the US Military, J. Am. Med. Ass’n Psychiatry (2015). 3 Adi V. Gundlapalli et al., Military Misconduct & Homelessness Among US

Veterans Separated from Active Duty 2001-2012, 314 J. Am. Med. Ass’n 832 (Aug. 2015); Coalition for the Homeless, Houston/Harris County/Fort Bend County Point-in-

Time Enumeration 2014 Executive Summary, at 11 (2014).


Medical-Legal Partnerships

Medical-Legal Partnerships (MLPs) are an innovative, interdisciplinary model of care that recognizes that many

health problems cannot be solved without legal aid.

• To address patients’ intertwined medical-legal problems, clinicians and lawyers in MLPs work as members of the same team:

Lawyers offer legal aid onsite at healthcare facilities. They also train clinicians to spot legal issues affecting their patients’ health.

Clinicians refer their patients directly to these lawyers for help with their health-harming legal needs.

Patients get integrated medical-legal care at one site, instead of having to navigate referrals processes while suffering from ill-health.

• Swords to Plowshares MLPs


Looking Ahead:

Applying Lessons Learned to

Strengthen the Systems of Care


Preserving and Strengthening VHA

GOAL: ensure veteran-centered care is accessible and

effective for veterans who rely on it.

• Veteran health care services are best provided by an effective,

efficient VHA

• VHA provides better quality healthcare on average than

outside providers

• Veterans want more VHA care

• Reduction in VHA care services = reduction, not expansion, in

choice


VA Commission on Care

Established by law – Choice Act 2014

Scope:• Officially: nonpartisan, objective, expert review of VHA

functioning over 20-year horizon with recommendations for change

• In reality: tasked with justifying scope and mechanism for “community care” reliance. No veteran voices present, inadequate estimation of costs and veteran demand.

Outcome:• Officially: Report with 18 recommendations and President’s

response. Strong endorsement of community care reliance.• In reality: Observed push toward dismantling of VHA through

privatization. VSOs on record opposing privatization in letters and Congressional testimony.

https://commissiononcare.sites.usa.gov/


Strengthening Partnerships,

Strengthening Care


Copyright © 2017 by Swords to PlowsharesAll rights reserved, including the right of reproduction in whole or in part in any form.

Swords to Plowshares1060 Howard StreetSan Francisco, CA 94103

Michael BleckerExecutive [email protected]

Documents

Combating Threats to Veterans’ Mental Health Care Through Strategic Partnership … Conference... · 2017-06-03 · Combating Threats to Veterans’ Mental Health Care Through Strategic