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Veterans and Suicide, Part 2

vet“Wait, what?” — is one thing that you’re apt to exclaim, when you can’t believe what you just heard. For instance, on being told that it could take nearly two years for the VA to make a decision about treating her physical disability or psychological problem, a veteran might say, “Wait, what?” — and then probably a whole lot of rougher words.

Coming “back to the world,” a male veteran might learn that he is an expectant father, when that is a biological impossibility. A veteran of either sex might return to find that the promised sweetheart gave up on waiting, and hooked up with his or her best friend. Anybody can come back and face the grim reality that their step-parent got tired of storing their few possessions, and pitched everything — music, high school yearbooks, civilian clothes — in the dumpster.

Although the government is very optimistic about “transferable skills,” anecdotal evidence to the contrary seems to pop up all over the place. We previously mentioned Matt Farwell, whose 4.5 years of military service “provided plenty of skills with no legal application in the civilian world.”

Even with an eminently useful specialty, the returning vet may find protectionist policies that require training as if from the very beginning, in order to be certified. And whether veteran or not, many people these days have learned that a minimum-wage job does not provide a living wage.

The “Wait, what?” reaction kicks in frequently for returning veterans who discover a series of unpleasant surprises in a place that is not the America to which they dreamed of returning. Meanwhile, during all this turmoil, something else might be going on, as Richard R. Troxell of House the Homeless suggests:

It is during that first year after discharge that the demons flood their minds and they relive over and over and over again the most horrific and unimaginable events of their lives.

Huge disconnect

If that isn’t enough to handle already, what if the person has a medical condition or an emotional breakdown? After initial contact with the VA system, the average wait, to resolve a first-time claim, is between 316 and 327 days. The latest figures finger Reno, NV, as the worst place, with an average time gap of 681 days. New York, at 642 days, is not far behind.

Normally, the things that tie a person to the world and prevent suicide are few and simple. A person wants to have the sense of belonging, and as if life has some purpose, or at the very least, to feel useful somehow. And the average person who isn’t a veteran probably avoids death and pain.

Now, the veteran. The average military member has formed very close ties to other members of the unit, especially in combat. Back in the USA, that sense of belonging is gone. Faced by unemployment or underemployment, especially if unable to find a place to live, a person is likely to feel useless. Live or die, it makes no difference to the world. And having gained a tolerance for pain and a close acquaintance with death, a person might lose inhibitions about those conditions. In a mental state like this, suicide looks like a viable alternative.

The real costs of war

Some are discarded and forgotten; some are simply beyond the point of being able to accept even the most generous and well-meaning help. Either way, veterans who take their own lives make up a big portion of the real cost of war, and it’s difficult to get a clear perception of just how many such lost souls there are. Turn the clock back five years, to a news item about the same bureaucrat who said “Suicide occurs just like cancer occurs”:

William Feeley, the Veterans Health Administration’s deputy undersecretary for health for operations and management, said in an April 9 deposition that VA did not have a metric to track suicides or attempts. He added that he could not recall a time since he took office in February 2006 when VA had conducted a quarterly review of suicides or attempts…

The VA started to focus on suicide prevention in 2007, but only through connection with its own hospitals and clinics. Statistics were not a huge concern. In 2010, VA Secretary Eric Shinseki asked for cooperation from the governors of every state in getting suicide data on veterans outside the Veterans Administration health care system. Problems with access to data contained in the National Death Index needed straightening out. VA records needed to be melded with those of the Department of Defense, and there were yet more numbers to obtain from the Veterans Crisis Line and Suicide Behavior Reports. The project is underway, but as we will see next time, the system hasn’t caught up yet.

(To be continued…)

Reactions?

Source: “Back in the World — Homeless Veterans,” HouseTheHomeless.org, 05/14/13
Source: “Over 600,000 veterans caught in messy bureaucracy awaiting pending claims,” NYDailyNews.com, 05/07/13
Source: “VA Official Says veterans’ suicides not reflection of agency negligence,” GovExec.com, 05/05/08
Source: “Department of Veterans Affairs Mental Health Services Suicide Prevention Program,” VA.cov, 2012
Image by weStreet (Werner Schutz).

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Veterans and Suicide

H StreetIn The New York Times earlier this month, Tara Parker-Pope summarized the data on suicide in America, as compiled by the Centers for Disease Control, and also sought confirmation from an expert that the number of people taking their own lives is vastly underreported.

What we do know is that “More people now die of suicide than in car accidents.” The first question that comes to mind is, how can statisticians treat those categories as separate? Surely, a proportion of auto accident fatalities are deliberate and successful attempts at self-extinction. There must be an overlap.

Anyway, the suicide rate has risen most among the “baby boomer” generation. A CDC official theorized, “There may be something about that group, and how they think about life issues and their life choices…”

Interestingly, the demographic includes Vietnam veterans and the widows and bereaved girlfriends of Vietnam casualties. Maybe that is the “something” that makes a difference. And the most popular means of suicide, overall, is by gunshot. Active duty military personnel and veterans of all ages are more likely to have access to, and knowledge of, firearms than the general population. Just sayin’.

Speaking of bureaucrats, remember when William Feeley, who was at the time an undersecretary at the Veterans Administration, said:

Suicide occurs just like cancer occurs.

But negligence on the part of the bureaucracy? Never happens, according to him. Still, two veterans’ groups sued the VA, claiming that the Mental Health Strategic Plan, supposedly adopted in 2004, was never implemented. The VA failed to follow through on providing immediate help for vets with PTSD and/or suicide risk. Shockingly, the Justice Department ruled there is “no such expectation” of a suicide prevention program or anything like it.

In the same year, journalist Joshua E. S. Phillips recalled what the National Vietnam Veterans Readjustment Study had found out about post-traumatic stress disorder. The inner conflicts and moral and spiritual trauma experienced by veterans is perhaps worst among those who took part in “abusive violence” — defined as “torturing, wounding, or killing hostages or POWs.” The psychological consequences can be more serious than those resulting from combat violence.

Phillips wrote that informational piece as background for an American RadioWorks project he collaborated on with Michael Montgomery, titled “What Killed Sergeant Gray.” The 23-year-old had been in Iraq for a year, and apparently wanted to return there. But for some reason, he was found dead in the barracks and the event was declared by the Army to be accidental; it happened because the young man was trying to get high off some toxic chemical.

Maybe so. But it is known that Adam Gray had things on his mind. He and a small group of soldiers had opened fire on an Iraqi family, killing one parent and a little girl, to make sure they were not planting any bombs. He had also participated in detainee abuse. So who knows. One thing is for sure, there are an awful lot of equally troubling individual histories.

Around the same time, there was plenty of public attention for the story of James Blake Miller, the so-called “Marlboro Marine,” made world-famous by the photojournalism of Luis Sinco. Miller’s troubled and problematic road back to some semblance of normalcy put a human face on the abstraction of PTSD for many Americans who had previously ignored the problem.

In other news, Bob Ireland, mental health policy program director for the Department of Defense, reassured the public:

… [F]or the person who’s suffering, if they’re coming to the edge of suicide […] they always have a choice to engage in what the real issues are or not. And the support for them is there…

Meanwhile, increasing numbers of vets found that, actually, support was not there. The Veterans for Common Sense and Veterans United for Truth didn’t give up. In 2011, reporter Jason Leopold tells us, the Ninth Circuit Court of Appeals declared that:

… [Y]ears of ‘unchecked incompetence’ at the Department of Veterans Affairs (VA) was directly responsible for an epidemic of suicides and lengthy delays in processing disability benefits for war veterans who suffer from post-traumatic stress disorder (PTSD)… Internal VA memos that surfaced during the trial showed VA officials were aware of and attempted to cover-up the fact that 18 veterans per day took their own lives and more than 1,000 veterans had attempted suicide per month…

Two years ago, the federal government settled a wrongful death lawsuit with the family of an Iraq war veteran who hung himself in his parents’ basement in June 2005 after being turned away by doctors at a VA hospital in Massachusetts where he sought help for PTSD.

That one case alone drained the taxpayers of $350,000 plus litigation costs. Wouldn’t it have been more economical to just treat the guy? Now, multiply that by 18 known and admitted veteran suicides per day — all potentially courtroom fodder. And the money is the least of it. What about the lives?

The director of emergency psychiatry at one VA hospital, Dr. Marcus Nemuth, said in a deposition that:

[…] he expected a high volume of post-traumatic stress disorder cases among veterans returning from Afghanistan and Iraq.

That was more than six years ago. How come so few others, even now, have caught on to this obvious fact?

(To be continued…)

Reactions?

Source: “Suicide Rates Rise Sharply in U.S.,” The New York Times, 05/02/13
Source: “VA Official Says veterans’ suicides not reflection of agency negligence,” GovExec.com, 05/05/08
Source: “Inside the Mind of a Torturer,” PublicRadio.org, 10/18/08
Source: “What Killed Sergeant Gray,” PublicRadio.org, 01/10
Source: “Court Demands Mental Health Care Reform for Veterans,” Truth-Out.org, 05/13/11
Image by Daquella manera (Daniel Lobo).

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Back in the World — Homeless Veterans

Richard McFarthingThe expression was born in Vietnam, a surreal place so different from accustomed reality that many American military personnel spent their whole tour of duty in a state of disorientation. “The world” was anyplace that wasn’t Vietnam, and they longed to return to it, only to find, once they got back, that the USA was even more impossible to cope with.

Things haven’t changed much. Veterans are 50% more likely to experience homelessness than Americans who were not in the armed forces. They tend to stay homeless longer than non-veterans , and are more likely to develop life-threatening medical conditions. They are also more likely to die on the streets.

William Jackson, of the National Association of Black Veterans, has mentioned another facet of the overall problem that is not often called to mind — the fact that many now-homeless vets were not full-time active duty military when they went to Iraq or Afghanistan:

A lot of National Guard soldiers were sent to this war. Many of them only had income from their drill checks before they went off to war. When they come back home, they still have nothing.

What they do have, in many cases, is post-traumatic stress disorder or mental illness.

Faces of Veteran Homelessness

University of Virginia undergraduate Matt Farwell is an accomplished writer whose account of being a 27-year-old homeless vet was published by The New York Times in October of 2011. His biography and resume don’t fit anybody’s stereotypical picture of a homeless guy, and during his time on the streets he kept up a successful facade. This is, in fact, one of the problems with any kind of official census of homeless veterans. One way or another, many of them fly under or above the radar. He writes:

Four and a half years in the Army, including 16 months as an infantryman in eastern Afghanistan, provided plenty of skills with no legal application in the civilian world. It was, however, wonderful preparation for being homeless.

He had lost two close friends in Afghanistan, along with his brother, who was also in the military. A comrade who had likely saved Farwell’s life died of an overdose a year after discharge. One of his former NCOs committed “suicide by cop” after returning stateside. Farwell himself lost his balance for a while, but formed a determination to be treated by a highly regarded VA Facility in California, and received the help he needed to get back on track. He says:

Memories […] helped keep me alive and sane amid the boredom, ennui, confused terror and brief moments of adrenaline-fueled elation of combat — a euphoric sense of zen-like calm and focus that’s better than any drug I’ve ever tried or heard about — but they’ve been doing their damnedest to kill me and my friends since we got back.

The top of Matt Farwell’s Twitter page says, “Turns out I’m not dead, despite what you heard.”

For more individual stories, please consult the documentary “Street Vets,” made by Issac Goeckeritz. One of the homeless vets he interviewed, Eugene Morris, told the filmmaker:

I was severely depressed, and I tried to wreck myself. I tried suicide, and I was addicted to drugs…

Morris was one of the lucky ones, fortunate enough to find First Step House in Salt Lake City, and to find within himself the resources to make use of the opportunity.

Young and Combat-Ready

During 2011, the overall number of homeless vets was said to drop by 7% or thereabouts, but the number of specifically Afghanistan war veterans more than doubled in that time period. Again, the Veterans Administration admitted that the number could be higher because not everyone reports in. For USA TODAY, Gregg Zoroya pointed out an attention-getting statistic concerning folks returned from Afghanistan and the other most recent war, Iraq. Around 70% have had combat exposure, as compared to somewhere around 20% to 30% amongst the total number of homeless veterans.

Psychologically, that can make a big difference. Even if it can be shown that the total number of homeless vets has decreased, the population includes a larger proportion of unstable and volatile personalities than ever before — belonging to relatively young people — which makes it even more essential to help them reintegrate into society. Because the alternatives are not attractive.

The President and the VA

Running for reelection, Barack Obama said:

When you take off the uniform, we will serve you as well as you’ve served us, because no one who fights for this country should have to fight for a job or a roof over their head or the care that they need when they come home.

Sounds good. Maybe there will come a day when vets no longer have to file class-action lawsuits against the Veterans Administration, to force the bureaucracy to stop ignoring post-traumatic stress disorder and brain trauma and the devastating long-term effects of Agent Orange.

A extraordinarily humane story by Kyle Martin for The Augusta Chronicle brought to light some of the daily struggles faced by veterans on the streets:

  • Inability to escape the summer heat, which is exacerbated by some medications.
  • The public library’s locked restrooms and habit of throwing out anyone caught asleep.
  • The extreme difficulty of getting around, and defending oneself from attack, in a wheelchair, whether manual or electric.
  • Walking or wheeling a chair to a soup kitchen can use up as many calories as the food provides.
  • Meals often contain pork or other foods that those with restricted diets can’t eat, making a wasted trip and even more depletion of bodily strength.
  •  Additional danger from attackers who want to steal pills, which veterans lucky enough to receive some kind of treatment will probably be carrying.
  • Long hold times when calling the VA hospital, using up precious phone minutes, and the difficulty of being notified about appointments without an address or phone.

One of the comments appended to Martin’s article castigated fellow veterans who have managed to get their lives back and feel free to criticize the homeless:

In combat we, I never left anyone behind but now that you are ‘back in the world’ it is ok for you to abandon your brothers in arms.

Reactions?

Source: “Veterans 50 Percent More Likely To Be Homeless, Study Shows,” The Huffington Post, 02/10/11
Source: “More Black War Veterans Ending Up Homeless,” BlackAmericaWeb.com, 11/11/10
Source: “Back Home, and Homeless,” The New York Times, 10/05/11
Source: “Unknown soldiers: Documentary follows Ogden’s homeless vets,” Standard.net, 01/30/11
Source: “Number of homeless veterans explodes,” USA TODAY, 07/26/11
Source: “Homeless in the Home of the Brave,” The Huffington Post, 09/14/12
Source: “Conditions dire for homeless veterans,” The Augusta Chronicle, 05/30/11
Image by EsotericSapience.

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Uninformed Forbes Blogger: “The Minimum Wage: More Baloney”

William Dunkleberg

William Dunkelburg, contributor to the Forbes magazine and author of The Minimum Wage: More Baloney, is a special kind of elitist. He is out of step with the times, economists, the Small Business Administration, and the special symbiotic relationship between employers and employees.

He starts off by reflecting upon the small business majority (SBM): “Scientific opinion polls show small business strongly supports raising the minimum wage.” Rather than realizing that countless minimum wage myths been debunked and abandoned as so much “baloney,” he clings to sophomoric perspectives and attacks poll methodologies while ignoring common sense.

For example, on the Small Business Administration website, we found a report by Amy Knaup, “Survival and Longevity in the Business Employment and Dynamics Data Base,” that determined that by the end of the fourth year, 64% of all new business startups fail. The report goes on to announce that by the end of the fifth year, a 90% failure rate occurs.

When examining these failed small business plans, House the Homeless suggests that while adequate attention may be paid to manufacturing, advertisement, transportation, warehousing, etc., when it comes to their minimum-wage workers (restaurant workers, construction laborers, janitors, day care aids, store clerks, bank tellers, fast food workers, theater attendants, farm workers, receptionists, maids, poultry processors, garage attendants, retail salespeople, car washers, manicurists, ambulance drivers, landscape workers, data entry processors, elder care aids, security guards, infant care workers, warehouse, general laborers, etc.), the businesses are setting themselves up to fail by paying less than a stabilizing wage.

They are paying less than a living wage: enough to simply pay for a basic food, clothing, and shelter. That “penny wise and pound foolish” practice destabilizes the business. Many, many small businesses see the pool of unemployed workers as an endless resource for employment. The reality is that the resulting employee turnover attacks the business’ bottom line in terms of retraining costs that are exorbitant. House the Homeless has estimated this to be in the billions of dollars. (See book:  Looking Up at the Bottom Line.)

Furthermore, by paying a stabilizing wage (a living wage), we can drastically reduce taxpayer subsidies in the form of excess food stamps, general assistance, temporary assistance to needy families, Earned Income Tax Credit (EITC), Medi-cal, etc., which can also result in billions of dollars in savings to taxpayers. (Again, see book: Looking Up at the Bottom Line: The Struggle for the Living Wage).

Mr. Dunkelburg is correct in that study after study has shown that increased wages to minimum-wage workers have been spent right back into the economy. What he does not realize is that due to businesses paying less than living wages since the 1980s, over 1,000,000 minimum-wage workers now needlessly comprise a portion of 3.5 million people experiencing homelessness in this nation. 

Upon passage of the Universal Living Wage, these American workers will instantly be empowered to return to the workforce. Additionally, they all need the same thing: affordable housing. The American housing construction industry, both locally and nationally, will leap at the opportunity to create the affordable housing that this population will again be able to afford.

Mr. Dunkelburg states that: “And geography matters, the minimum wage goes a lot further in Ohio than in New York City.” His core thought is correct but he fails to realize the broader implication and the need to create a stabilized workforce.

The United State Military has adjusted its pay system from Variable Housing Allowance (VHA) to Base Housing Allowance (BAH), recognizing that it costs different amounts to live in different areas of the country, and you must pay accordingly in order to have an economically stable workforce. Similarly, the federal government now pays “Locality Pay” to acknowledge the varying costs and the need to pay living wages, so as to stabilize the workforce across the board.

Mr. Dunkleberg then presents an elaborate (if skewed) observation that there are fewer teenage minimum-wage workers and then makes the assumption that that is due to increases in the minimum wage. The moral standard is to pay a fair wage for a fair day’s work. If the worker successfully completes the unit of work, then it does not matter if they are 17 or 71. It is, however, the prerogative of the employer who is hired, but we don’t discriminate against anyone.

In closing, Mr. Dunkelburg states, “High labor costs ultimately show up in higher prices.” He follows with, “All in all, raising the minimum wage is poor policy.”

An example of the non-inflationary relationship between wages and the cost of goods can be found in the1996 survey report entitled: “Think Again:  A Wage and Price Survey of Denver Area Fast Food Restaurants.” The survey focused on four national fast food chains: Arby’s, Burger King, McDonalds, and Taco Bell. The lowest-paid Arby’s employees were found at a franchise charging the second highest price for a meal. Conversely, a Taco Bell, while paying $1.50 per hour above other restaurants for starting wages, had the lowest food prices among the 12 other Taco Bells restaurants surveyed. Overall, the study showed that just because wages rise, there is not, and does not have to be, a corresponding increase in prices.

It would appear that the rise is more of a question of what the market will bear, not what the consumer will tolerate. This is not to say that there will not be economic pressures of an inflationary nature. However, minimum-wage workers deserve to be paid a wage that will afford them a roof over their heads other than a bridge. They are just seeking the bare minimum to afford basic food, clothing, and shelter (such as an efficiency apartment).

Large employers may need to learn to live with a little less profit, and small employers may need to learn to grow at a much more reasonable rate, but by paying a living wage, they will have a stable workforce that may well ensure their business’ survival. At the same time, a generalized increased demand for goods, and a new reasonable profit share, will protect the business’ bottom line from being negatively affected by wage increases that afford their employees a minimal existence.

Source: “The Minimum Wage: More Baloney,” Forbes, 04/29/2013

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Heroes on the Homeless Front

Homeless man in my basementTwenty years ago, Dr. Roseanna Means looked around Boston and didn’t much care for what she saw — homeless women on the streets. She started volunteering at homeless health clinics, and in 1998 started her own nonprofit, Women of Means, which now encompasses a team of 16 volunteer doctors who collectively chalk up 10,000 professional visits per year with women experiencing homelessness.

For CBS News, Elaine Quijano learned what inspired such activism. Dr. Means told the reporter:

When I see these women, I see this could be me, it could be you, It could it could be any one of us, because there’s nobody that goes through life without having any problems. My own personal life, I’ve been through cancer, I lost a child, I’ve been through divorce, I have steel knees — I’ve been through lots of personal things in my life.

Last year, the same news agency profiled another Massachusetts medic, Dr. Jessie Gaeta of Quincy. This success story, reported by Seth Doane, merits close attention from other cities. Working in the emergency room at the Boston Medical Center made one thing very clear to Dr. Gaeta — for many homeless patients, it was a “revolving door.” She is quoted here:

It wasn’t until I had just a couple of patients housed that I saw this turnaround in their health. Basically I was seeing that if I could write a prescription for keys to an apartment that that was going to do more to improve the health of the patient sitting in front me than the prescription I can write for anything else.

In 2006, Dr. Gaeta got state funding for the program known as “Home and Healthy For Good,” which espouses the “housing first” principle, i.e., first get the person under a roof and between some walls, then bring on the counseling, substance abuse programs, and other measures (a model embraced by House the Homeless at its inception in 1989, as may be guessed from the name).

Here’s what happened in Massachusetts, and watch out, because this part will knock your socks off:

The program has helped reduce homelessness by 63 percent in Quincy and has also cut medical costs for formerly homeless people by more than two-thirds.

‘It was astonishing that a year into this project, we saw such a decrease in medical costs, that we could basically more than afford to pay for the housing,’ said Gaeta.

The “Housing First” philosophy is based on the concept of meeting people where they are, and the reason it works is because where they are is really the only place at which people can be met, no matter how fervently opponents might wish it were otherwise. We hear it again, from Ken Stevens of Waterville, Maine, who says:

My mission is meeting people at their point of need.

The North East Dream Center is where it happens, we are told by journalist Amy Calder. Volunteers pick up or drop off donations for the food warehouse. “Unemployable” people experiencing homelessness and ex-convicts are set to work making furniture and learning skills. Clothes and counseling are also available. The furniture sales help pay for gas to get more donated food so Stevens and his crew can deliver it to food pantries, soup kitchens, and senior citizens all over the surrounding area.

Now Stevens, with the help of Mid-Maine Chamber of Commerce president Kimberly N. Lindlof and other supporters, is raising money for a larger space where these activities can continue with the addition of more ambitious plans. Calder writes:

A big part of the plan is to launch a manufacturing incubator that would provide administrative support and space for 20 startup businesses, as well as jobs and training for people, including those who are ‘unemployable.’

When asked if he has formal training to run such an enterprise, Stevens answers:

Yes. I got trained by the best — God’s spirit.

Reactions?

Source: “Boston doctor’s kindness helps save homeless,” CBS News, 04/23/13
Source: “Mass. doctor’s prescription for homelessness,” CBS News, 02/23/12
Source: “From homeless and hopeless to vital link in the food pantry chain,” KJOnline.com, 03/24/13
Image by Matt Lemon.