Community Services Provide Safety Net for Returning Veterans (Part 2)

By Rebecca A. Clay

A Critical Safety Net

The military system has plenty of help to offer veterans who experience problems with mental health, substance abuse, or the transition to civilian life.

In addition to rigorous predeployment screening to identify those with pre-existing mental health problems, the U.S. Department of Defense (DoD) screens personnel once a year during active duty, at discharge, and again 3 to 6 months later. The goal? To catch problems early.

Veterans who need mental health or substance abuse treatment then receive care at the Veterans Health Administration (see Veterans Resources). Medical facilities there offer care for mental health and substance abuse issues as well as care for specialized PTSD problems. In addition, care is available through a network of private providers participating in the DoD's TriCare program.

More informal assistance is available through the 207 Veterans Centers around the country, where veterans offer peers both readjustment counseling and help accessing other programs.

Community mental health and substance abuse treatment providers can supplement this care by serving as a critical "safety net," explained Mr. Steinberg.

To play that role effectively, community providers need to become knowledgeable about the resources available to returning veterans and the rules for using them.

They need to know that veterans aren't automatically eligible for VA care, for instance. "In general, the veteran must take the first step and apply for the benefit," explained Gary M. Baker, M.A., Director of the VA's Health Eligibility Center.

"With the active cooperation of all of society, the road home for our veterans can be further improved and the journey home can be made easier."

—H. Westley Clark, M.D., J.D., M.P.H.   
CSAT Director   

Iraq and Afghanistan combat veterans—including active-duty military with honorable discharges, reservists who completed their tours, and National Guard members activated for Federal duty—have certain privileges. There's a special rule that gives them priority access and no-cost care of combat-related problems for the 2 years following their discharge. The only catch? They must register in the VA system within 2 years of discharge or risk losing access to VA care later on. This 2-year "window" is covered through the military treatment facilities and TriCare, along with the VA. More information on this topic is available on the DoD and VA Web sites.

In addition to screening veterans and referring them to DoD or VA facilities for care, community providers also need to be ready to provide services themselves. That's because some veterans return to geographically isolated communities where VA services aren't available. Others aren't eligible for services even if they are available. Stigma, denial, or anger at the military keep others away. And symptoms of PTSD may not show up until long after the war is over.

Community providers should routinely ask clients—both men and women—whether they've served in the military or experienced trauma. They should also assess them for PTSD, other mental disorders, and substance abuse. "If you don't ask," said Dr. Clark, "they're not going to tell."

And not asking could prove fatal, warned Col. Jonathan W. Coffin, Ph.D., staff psychologist for the Vermont National Guard and Outpatient Director at the Howard Center. "I guarantee that every one of you will have the opportunity to save a veteran's life," he said.

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A Warm Welcome Home

Veterans aren't the only ones local providers and the community as a whole can help: Families of active-duty service members and veterans may also need support.

That's a message Susan A. Storti, Ph.D., R.N., Director of the CSAT-funded Addiction Technology Transfer Center of New England, has taken to heart.

When her fiancé was deployed with the Rhode Island National Guard, she jumped into action. She assessed the needs of soldiers, veterans, and their families; identified available resources; and helped create a "Rhode Island Blueprint" to fill the gaps.

Now the entire community is involved in welcoming veterans home and supporting families while they're gone. Experts train community providers in such areas as traumatic brain injury. Support groups give families tips on stress management and opportunities to vent. Researchers are studying ways of enhancing resilience in children. Even the local theater company has gotten into the act, with a play drawing on the words of soldiers, journalists, and others who have been to Iraq.

Simply welcoming veterans home can help, said Major Gen. Arthur T. Dean (Ret.), Chairman and Chief Executive Officer of Community Anti-Drug Coalitions of America.

"The way many of my contemporaries were received when they came back from Vietnam set them up for failure," he said. "We can all participate in welcoming and embracing today's troops as they return home."

Dr. Clark agreed. "With the active cooperation of all of society," he said, "the road home for our veterans can be further improved and the journey home can be made easier."

Electronic files of the presentations from the conference are available online at the SAMHSA Web site, www.samhsa.gov/conference/va_conference.

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