It’s been widely accepted that the Department of Defense was not prepared for what would come after major combat operations were over in Iraq, which contributed to the protracted insurgency that developed in the ensuing security vacuum. The same seemed to be true at home: both DoD and VA were not prepared for the influx of troops that came home with severe physical wounds or what came to be known as the “signature wounds” of these conflicts, TBI and PTSD. Brian was injured fairly early in the Iraq war, and that early cohort of wounded warriors was heavily affected by gaps in systems of care, leading to a proliferation of many of the problems we experienced personally: poor care, lengthy and confusing MEB/PEB processes, inadequate case management, unemployment, poor support pursuing higher education, lack of support networks, trouble identifying resources, and more. For some, these barriers proved insurmountable, leading to homelessness, suicide, family dissolution, and other crises.
A series of investigations, commissions, and task forces produced reports identifying a plethora of problems and offering myriad solutions. Among these were the President’s Commission on Care for America’s Returning Wounded Warriors (commonly known as the Dole-Shalala Commission),1 numerous Government Accountability Office (GAO) reports including one on “Challenges Encountered by Injured Servicemembers during Their Recovery Process,”2 the well-known and often cited RAND Invisible Wounds of War report,3 an Army Medicine TBI Task Force Report,4 one from the Defense Health Board on mental health,5 and many more. Advocates also pressured members of Congress to do more; over time, this led to significant changes. For example, the 2008 National Defense Authorization Act contained a number of provisions to improve care for wounded warriors and veterans,6 and the Post-9/11 GI Bill dramatically increased education benefits for today’s veterans. In addition, a vast number of nonprofit organizations have stepped up to help fill remaining gaps. Those who come home today are far more likely to find proper care and services. That does not, however, mean that the system is perfect or that no work remains to be done.
At events around the country, people regularly ask me, “What can I do?” Sometimes, these are wounded warriors or families still struggling to find the support they need. Often, the question comes from civilians who want to help, but don’t know how. Below, I offer some suggestions. Note that these are highly personal—I urge you to use them only as a starting point. Many organizations are local, state, or regional. There are variations in purpose or direction that may be a better fit for you than for me (for example, I’m not drawn to faith-based groups but that may be right for you). I can’t claim to know about all good programs. And it’s always a good idea to do your own due diligence—a nonprofit I mention or ignore now may have changed focus or leadership, for better or for worse, by the time you read this.
The most important message I would offer to anyone struggling is Don’t give up. There is compelling evidence that treatment works for mental health issues, but that doesn’t mean the first counselor you try will be the right one for you. You may not want to be medicated—if not, try a psychologist, social worker, or group therapy. Or yoga, or kickboxing, or volunteering. Don’t isolate, stagnate, or quit. If you bought toothpaste and didn’t like the flavor, would you swear off brushing your teeth forever? No, you’d pick a new variety. Apply that same principle to picking a mental health provider or an organization to volunteer with: if the first one doesn’t work out, try another until you find a good fit.
SERVICE MEMBERS, VETERANS, AND WOUNDED WARRIORS
Veterans in crisis can call the crisis line at 800-273-TALK (8255) twenty-four hours a day. They also have online chat sessions and more. Memorize the number and share it.
Department of Defense (DoD)
Compared to when Brian and I were on active duty, DoD has a huge number of new or dramatically expanded resources.
• Military OneSource (www.militaryonesource.mil) offers everything from financial counseling to disaster resources to non-medical counseling.
• inTransition (www.health.mil/intransition/) provides coaches to maintain continuity of mental health care and more during times of transition.
• The Real Warriors campaign (http://www.realwarriors.net) is a multimedia public awareness effort to encourage troops (as well as vets and family members) to seek help.
• The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (http://www.dcoe.health.mil) offers a tremendous number of resources on those issues.
• The Sexual Assault Prevention and Response website (http://www.sapr.mil) has lots of data for those hoping to learn more about MST, as well as links to resources for those personally affected.
Department of Veterans Affairs (VA)
You earned your benefits—use them. VA (http://www.va.gov) is a somewhat complicated beast: it’s important to remember that VA is comprised of three entities—the Veterans Health Administration (VHA), Veterans Benefits Administration (VBA), and National Cemetery Administration (NCA)—and they’re fairly disconnected. You may qualify for health care even if you don’t qualify for disability (for instance, medical and mental health care for conditions related to military sexual trauma is provided to veterans regardless of type of discharge or benefit claim status). So you may have to spend some time figuring out what you need and how to get it. Get signed up and learn what you qualify for.
Veterans’ health care may have a bad reputation in many quarters, but that’s outdated: independent researchers have found that VHA patients receive higher-quality care on many measures.7 There are also options: innovative developments like a smartphone app for PTSD and remote “telehealth” counseling sessions. Vet Centers (http://www.vetcenter.va.gov) may meet your needs for non-medical counseling better than a traditional VA Medical Center—they’re usually smaller, there’s very little paperwork, and the care can seem more personal. Note that while VHA generally cannot help active duty personnel, there are exceptions for those who have sustained certain types of serious injuries (such as spinal cord), and Vet Centers are also authorized to help AD troops in some cases.
Especially for women veterans, it’s also important to go to VA for health care to send the right demand signals—if we don’t show up in sufficient numbers, they won’t be pressured to increase services specifically designed to meet our needs. Due to the growing number of women veterans and our changing needs, VA can cover care for newborns for the first seven days after birth for eligible women veterans getting VA maternity care, and has been testing child care pilot programs at several sites.
VBA can certify you for a VA-backed mortgage and clarify your educational benefits. If you have service-connected problems, fill out a disability claim—and remember, your lungs may seem fine now, but documenting exposure to burn pit smoke now may matter if you have problems down the road. If possible, submit a Fully Developed Claim electronically for faster processing.
And make sure your family knows about the burial and memorial benefits you’ve earned; NCA could be a tremendous help to them during a terrible time.
Community Resources
The National Resource Directory (www.nrd.gov) lists well over 10,000 national, state, and local resources. You can search this huge database of vetted organizations to find one that meets your needs, or find a way to get involved. See what the best fit is for you!
• Federally chartered Veterans Service Organizations (VSOs) are approved by the VA to assist veterans with filing claims—so if you are worried about getting your paperwork done right, this is a good place to start (learn more at http://www.va.gov/vso/). These include, but are not limited to, Disabled American Veterans (http://www.dav.org), Veterans of Foreign Wars (http://www.vfw.org), and the Wounded Warrior Project (http://www.woundedwarriorproject.org). They all have other missions as well.
• A suite of wellness resources—including online assessments, a library of resources, and workshops—is available at www.afterdeployment.org.
• The Mission Continues (http://missioncontinues.org) awards community service fellowships to post-9/11 veterans.
• Team Rubicon (http://teamrubiconusa.org) is made up of veterans who respond to natural disasters, using skills developed in the military to serve in a new capacity.
• Student Veterans of America (http://www.studentveterans.org) has communities on college campuses so vets going to school now have better support systems in place than when Brian and I first hit the books again.
• The Pat Tillman Foundation (http://www.pattillmanfoundation.org) offers scholarships to veterans.
• The Bob Woodruff Foundation has a public education wing (http://remind.org).
• The USO (http://www.uso.org) supports troops abroad and troops and families at home.
• Not Alone (http://www.notalone.com/site/Default.aspx) provides programs, resources, and services to warriors and families impacted by combat stress through a confidential and anonymous online community.
• Service Women’s Action Network (http://servicewomen.org) focuses primarily but not exclusively on issues that disproportionately affect women troops and veterans, such as military sexual trauma.
Family Members
Many—but not all—resources available to service members and veterans also include their families, so review the previous section. Note that although the VA generally cannot help family members, Vet Centers now offer both family counseling and bereavement counseling.
• Blue Star Families (http://www.bluestarfam.org) is an organization dedicated to supporting, connecting, and empowering military families.
• Fisher House (http://www.fisherhouse.org) provides housing for military families close to loved ones during hospitalizations.
• Tragedy Assistance Program for Survivors (http://www.taps.org) helps the families of all those who have made the ultimate sacrifice (including suicide survivors).
Civilians
Some general advice: Be thoughtful about what you say to veterans and military personnel—some like being thanked for their service, others find it discomforting.8 Remember time and place—a combat veteran newly returned from Afghanistan may not want to tell you “what it’s really like over there” at your cousin’s wedding—she may want to just relax with family and friends instead of having questions bring to mind horrible experiences. This isn’t to say you should not ask your best friend what he went through, of course. But rather than pushing them to tell you about what happened downrange, let friends or colleagues who are veterans know that you’re there and willing to listen if they want to talk. If they seem to be struggling, offer to help them find or navigate resources, which can be confusing. Or just let them know by your consistent presence that you’re still there, that you still want to hang out—and consider getting out to do something active instead of just sitting around drinking. As much as many of us enjoy doing that when we first get back, it isn’t always the best coping mechanism.
If you want to give time or money, use the NRD to search for local or national organizations that are a good fit for your values and interests. Consider using a resource like Charity Navigator9 to ensure that the one you pick is a responsible steward of your donation.
Perhaps most importantly, get involved in the national conversation and political process. The single best way you can thank a veteran for their service is by using the right to vote that military personnel were willing to die to preserve for you. Tell your representatives that you care how veterans are treated and watch how they vote on important issues.10 We as a nation elected politicians who chose to send troops off to war—now we as a nation must hold elected officials accountable for ensuring that the systems are in place to care for veterans when they get home.
1. http://militarymedicine.com/node/77
2. http://www.gao.gov/products/GAO-07-606T
3. http://www.rand.org/pubs/monographs/MG720.html
4. http://www.armymedicine.army.mil/r2d/tbitfr.html
5. http://www.health.mil/dhb/subcommittees-MHTF.cfm
6. http://www.fas.org/sgp/crs/misc/RL34371.pdf
7. http://www.rand.org/pubs/research_briefs/RB9100/index1.html
8. http://usnews.nbcnews.com/_news/2012/11/11/15079818-your-thank-you-to-veterans-is-welcomed-but-not-always-comfortably-received?lite
9. http://www.charitynavigator.org—however, note that there are concerns about how these ratings are developed; see, for example, http://articles.latimes.com/2012/apr/30/opinion/la-oe-shakely-charity-rating-Kahneman-20120430.
10. IAVA (Iraq and Afghanistan Veterans of America) does a Congressional Report Card: http://www.veteranreportcard.org.