Peer support key to helping returning vets overcome mental health problems

by Andy Marso, KHI News Service

Topeka — Sitting in a Junction City coffee shop with his laptop and a pile of textbooks splayed on a table, Will Stucker looks like any other college student, if a bit older than average.

But Stucker, 38, has taken a different path to college than most of his classmates at Emporia State University.

His path took him to South Korea and Kuwait, then to a tank rolling toward Baghdad, then to an armored Humvee on the streets of a small town in Iraq where insurgents repeatedly tried to kill him — and two of them almost succeeded. Then, finally, to a Department of Veterans Affairs hospital in Topeka, where counselors helped him work through the post-traumatic stress disorder (PTSD) he came home with.

Stucker is working toward a master’s degree in clinical psychology so that he can help other veterans overcome PTSD.

“The doctors have a lot of experience, but — this is just my experience working with mental health providers — they don’t understand the patients and what they’ve gone through,” Stucker said. “It’s hard to talk to someone about combat that’s never experienced combat and expect them to understand what’s going on.”

Need is great
About one-third of the 2.6 million veterans returning from Iraq and Afghanistan have been diagnosed with mental illnesses like PTSD, anxiety and depression. If you or anyone you know has gone through any form of mental or psychiatric disorders and live in Tennessee, you can look into something like veterans mental health disability lawyer Tennessee to help get you the benefits you need if you were a veteran disabled by mental illness while in the service.

The VA Eastern Kansas Health Care System, which includes the Topeka hospital where Stucker was treated, is seeing more patients for PTSD every year: up from 1,297 in 2011 to 2,216 in 2014. The costs of PTSD treatment there this year exceeded $28 million.

Stucker praises the specialized mental health unit at Topeka’s Colmery-O’Neil VA Medical Center, but not all veterans have easy access to that kind of facility, and there is widespread agreement that the VA system nationwide needs more psychiatrists and more innovative outpatient therapies. Veterans also seem to agree that one of the things that can most benefit them is talking with other veterans.

“Peer groups need to start,” said Anthony Webster, a U.S. Army veteran who served multiple tours in Iraq and Afghanistan and now works with Topeka resident Melissa Jarboe’s Military Veteran Project. “There needs to be some kind of veterans network with some guidance from doctors. There are guys that have the same issues. Some guys are more successful than others, and they can help with that.”

A VA mental health reform bill aimed at filling some of those gaps passed the U.S. House unanimously but has been blocked in the Senate by Tom Coburn, a Republican from Oklahoma.

The Clay Hunt SAV Act, named for a Marine who committed suicide in 2011, would create a peer support and community outreach pilot program and an interactive website to help veterans find those resources in their area. It also would offer student loan repayment to psychiatrists who choose to work at the VA and require annual evaluations of suicide prevention programs within the VA and the U.S. Department of Defense to determine their effectiveness.

Coburn, a retired physician who has earned the nickname “Dr. No” for his stances against federal spending, reportedly balked at the bill’s $22 million price tag.

Coburn is slated to leave the Senate at the end of the year, and the bill’s supporters say they will bring it back next year when he is gone.

But Iraq and Afghanistan Veterans of America criticized the senator in a recent press release that called the delay deadly, given that an average of 22 veterans take their lives each day.

“You’ve got guys who have gone out on multiple deployments since Desert Shield that are done; they are just wiped,” Webster said. “They’ve done multiple back-to-back deployments and now they’re coming home and being brought back into civilization. They’ve got a ton of issues they don’t know how to deal with.”

Horrors of war
Stucker, 38, had more military preparation and experience than many of those he served with in Iraq.

He joined the U.S. Army out of high school in 1995, then served peacetime deployments in Kuwait and South Korea, where he was stationed close enough to the demilitarized zone that he could “throw a stone and hit it.”

He was on a monthlong exercise on Sept. 11, 2001, when some of the South Koreans he was working with told him that “New York got blown up.”

By the spring of 2003, Stucker was back in Kuwait, but this time gearing up for an invasion of Iraq. A tank commander, he was part of the “tip of the spear” that drove straight into Baghdad with little trouble.

“There was pockets of resistance, but it wasn’t the Battle of the Bulge,” Stucker said. “There was no huge onslaught of soldiers.”

He and his colleagues later found out many Iraqi soldiers had smuggled themselves out of Baghdad in garbage trucks.

Stucker was deployed for a year while a country in chaos tried to find its footing with its former leaders deposed, scattered and on the run.

He returned to Fort Riley in February 2004, but within a month his unit had orders to head back to Iraq.

According to the National Council on Disability, soldiers should get twice the time at home between deployments as the time they spend deployed to minimize PTSD. In Stucker’s case, that would have been two years.

“We had eight months,” he said.

In Kansas

The Veterans Subcommittee of the Governor’s Behavioral Health Services Planning Council has made the following recommendations for state-level reform of veterans mental health:

• Identify veterans in need of care by including a question about military service on mental health and substance abuse screening and intake forms, and store that information in state databases.

• Consider the high veteran suicide rate when the Suicide Prevention Subcommittee makes its recommendations.

• Develop an online clearinghouse of resources available in Kansas for veterans seeking help.

• Identify military culture training programs and encourage mental health providers to have at least one veteran or at least one person who has completed the training on staff.

When his unit returned to Iraq, things had changed. It was still chaotic, but now the U.S. military’s role was to occupy and police, rather than facilitate the overthrow of Saddam Hussein. Stucker’s years of tank commander training were set aside.

“We drove our tanks to our FOB (forward operating base) and then parked them and didn’t touch them again,” he said.

He became a tank commander in a Humvee, leading patrols in Yusufiya, about 20 miles south of Baghdad. Stucker said they were generally “presence patrols,” similar to cops on the beat.

“We were there letting them know we were there,” he said. “If we saw something happening, we needed to intervene, stop it. We would get attacked, but the only time we attacked was when we had to go find someone.”

Stucker became intimately acquainted with the insurgents’ main weapon: the improvised explosive device (IED).

“They were really slick; they had a system,” he said. “Overnight they would go out and cut a chunk of the curb out, and then the next night they would go back and replace it with an IED stuffed into a curb and we’d drive by and detonate it.”

Sometimes insurgents would kill donkeys or camels, hide explosives in the bodies and set them on the street to blend in with other roadkill. Other times they used human bodies.

“We called it a dead-man switch,” Stucker said. “They would kill an Iraqi, put him on the ground, and our job was to investigate. So we grab him and pull him over, and the IED would blow up in our face. So we stopped. We would make the family go and get the body.”

He once saw a couple of heavily armored Bradley Fighting Vehicles blown up by mortar rounds buried in the road.

Stucker survived several IED blasts in his armored Humvee, but every patrol brought the possibility of death.

While he was on patrol in May 2005, two men in a car with a trunk full of explosives pulled into the road in front of his 5-ton Humvee. The car did not explode, but Stucker’s Humvee flipped as it drove over the vehicle.

Stucker broke three vertebrae in the crash and still suffers chronic back pain.

The injuries he suffered in the crash ended the war for Stucker. But his fight to reintegrate into civilian life was about to begin.

Hard homecoming
Stucker’s father and grandfather both served in the Army, but he said he found it hard to talk with them about his deployment.

“I did a little bit, but I was in a bad place when I got out,” he said.

He said the PTSD treatment at Colmery-O’Neil was very helpful, even though demand for the services sometimes meant he had to make appointments with his doctor weeks in advance. When he felt like he was in crisis and needed to come to the hospital on an emergency basis, he could.

“I’ve had to do that a couple times, and they’ve always been very professional, very nice to me,” Stucker said.

He’s not sure the general public understands the scope of the mental health crisis confronting the embattled VA health care system.

“All these guys that are injured like that, it isn’t like putting a Band-Aid on something,” Stucker said. “It’s a very intensive process. With what they’re dealing with, I think they’re doing a good job.”

Other veterans, like Webster of Topeka, seek treatment outside the VA system.

Webster said he found his best treatment option at the Elk Institute, a Florida-based nonprofit run by psychotherapist Carrie Elk, who provides free services to military veterans.

“She says, ‘I’ll never understand, because I’ve never served, but I’m willing to listen and help in whatever way I can,’” he said. “She’s not sitting there telling me she understands, she knows what I’m feeling, because you can’t.”

Webster also endorsed programs that Jarboe’s foundation runs that take veterans with PTSD out of the hospital to do things like ride horses, rather than “sitting in a room in a group with somebody mitigating and writing down stuff.”

“Getting a veteran out of an environment, taking him somewhere else where he can be outside, or whatever, helps,” Webster said. “Because a lot of guys come home and they lock themselves in their room and draw away from society, which creates more problems.”

Webster said it’s important for the VA staff to “look outside their system” and partner with carefully vetted organizations like Jarboe’s.

Jarboe said the Military Veteran Project has helped a Marine veteran who locked himself in his house for 10 months because that was the only place he felt safe and others who have instinctively tried to strangle their wives when awakened.

“We train these guys and gals to go to war, but we don’t train them how to come home and rehabilitate and reintegrate into society,” she said.

Jarboe said she believes PTSD is the result of not only what veterans have seen in combat but also the stress their bodies endure. The combination takes time and patience to overcome. Things like lights, noises, crowds and fast movements can be triggers for reactions that even friends and family members might not understand.

“These men and women were taught how to kill,” Jarboe said. “They’ve killed. They’ve seen people be killed. It’s a whole other world. They need to decompress.”

Stucker still goes to the VA regularly and has come a long way in the decompression process. He’s married and completed a bachelor’s degree in family studies at Manhattan Christian College. He considered attending Kansas State University, but thought the private school just south of campus with an enrollment of less than 400 students would be a better fit.

“K-State was a little too big for me,” Stucker said. “I still have problems with large crowds. I don’t think I could handle a classroom full of like 500 students.”

‘A wound that will never heal’
There’s only one thing that still bothers Stucker about his military service: the way it ended. Though he was deemed too disabled to return to the fight, he was denied medical retirement because he was not disabled enough to qualify given his years of service.

He said Army policies have since been changed to give medical retirement to anyone injured even in their first enlistment, but a military benefits counselor told him he was one of thousands who “fell through the cracks” early in the Iraq and Afghanistan conflicts, when the U.S. Department of Defense was not prepared to process the large numbers of wounded soldiers.

Stucker said he has contacted people in the military, the VA and Congress about the issue but has only been routed elsewhere.

“I know that I’ve moved forward with everything that happened to me — my injuries, losing friends and all that, seeing the combat, the death and destruction —but the way I was kicked out of the Army is just sore for me,” he said. “It’s a wound that will never heal until they at least acknowledge it.”

Meanwhile, he will keep working toward his clinical psychology degree, so he can help show other combat veterans the path to recovery.

“I just want to help soldiers, because I didn’t have an easy time at all when I got out,” Stucker said. “Mental health was a black label when I was in the Army. Only ‘insane’ people went to behavioral health, and if you went to behavioral health your career was going to be over. Now it’s got more of a positive spin, and I want to help perpetuate that by helping soldiers get back to their jobs.”

The KHI News Service is an editorially independent initiative of the Kansas Health Institute. It is supported in part by a variety of underwriters. The News Service is committed to timely, objective and in-depth coverage of health issues and the policy-making environment. All News Service stories and photos may be republished at no cost with proper attribution, including a link back to KHI.org when a story is reposted online. More about the News Service is at khi.org/newsservice or contact 785-233-5443.
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Wounded veterans return to unprepared medical system

by Andy Marso, KHI News Service

Topeka — A sniper’s bullet tore through U.S. Army Sgt. Jamie Jarboe’s neck while he was on patrol during a tour of duty in Afghanistan in April 2011. The bullet shattered three vertebrae, severed Jarboe’s spinal cord and caused severe bleeding. It was the kind of wound that almost certainly would have been fatal in previous conflicts.

But an Army medic was at Jarboe’s side almost immediately to keep him from bleeding out, and within 17 minutes of the shooting a helicopter lifted Jarboe out of the danger zone. In less than an hour, he arrived at a state-of-the-art field hospital in Kandahar, where a medical team was waiting to stabilize him enough so that he could be evacuated from the country.

Jarboe arrived back on American soil paralyzed but alive and was able to get the best care the military had to offer at Walter Reed Army Medical Center in Washington, D.C.

But less than a year later he was dead from complications of surgery, one of several medical errors that his wife, Melissa Jarboe, documented in a self-published memoir about her husband’s last months.

“It wasn’t the sniper that shot him that killed him,” Melissa Jarboe, of Topeka, said in a recent interview.

Rather, it was a mistake made during a surgery that took place in May 2011 that eventually killed Jamie Jarboe. A surgeon in training nicked Jarboe’s esophagus. Dozens of attempts were made over the next nine months to repair the damage. But none of them worked. Jarboe died in March 2012.

Jamie Jarboe’s story illustrates a military medical system that is better than ever at saving lives on the battlefield but has not kept pace when it comes to ensuring quality of life for the severely wounded once they come home. Some veterans struggle to have a high quality of life after returning from war injured because they are denied by benefits by the VA. If this happens to you then you may want to look into getting a va lawyer to help get you the benefits you deserve.

Growing VA problems
An estimated 2.6 million American men and women served in Iraq and Afghanistan, and more than half now receive government medical care through military facilities, the U.S. Department of Veterans Affairs or TRICARE, which provides coverage for private-sector care to military members and their families.

In the last year media and congressional investigations have documented widespread problems in the VA medical system. Stories about veterans being forced to wait months for treatment and accounts of wounded veterans receiving inadequate care forced U.S. Army Gen. Eric Shinseki to resign as secretary of the department in May.

But Melissa Jarboe said overhauling the VA leadership is not enough to provide veterans the long-term support they need. Jarboe, who started a foundation called the Military Veteran Project in honor of her husband, said investments are needed in veteran-supported nonprofits and the VA health system.

Linda Bilmes, a lecturer at Harvard University’s John F. Kennedy School of Government who has studied the costs of the Iraq and Afghanistan wars, said in a phone interview that VA backlogs that led to Shinseki’s departure were the short-term consequence of failing to anticipate the influx of new patients into the veterans medical system and build the VA capabilities accordingly.

Larger consequences are on the horizon, she said, if Congress doesn’t start preparing now for the long-term medical needs of Iraq and Afghanistan veterans — whose care she estimates is likely to cost at least $1 trillion.

“The longer-term problem is we now have a large liability sitting on the books and nobody has made any provision to pay for it,” Bilmes said. “Actually, I should correct myself. The liability exists, but it’s actually not sitting on the books. It’s not accounted for, but it’s there. There is no strategy for how we’re going to pay these obligations.”

Overburdened system
Melissa Jarboe tried several times to have her husband transferred from a VA hospital in Richmond, Va., before she was finally successful.

By then she had become well-versed in medical procedures and drugs for those with spinal injuries and wary of some of what she saw of her husband’s care.

“I started seeing inconsistencies in the medical procedures,” Jarboe said. “I started seeing the staff being short-staffed. Medical equipment was not functioning properly. Individuals without proper experience were doing new-wave surgeries without consent or communication to us as a family on what they were going to do.”

Jarboe started sleeping at her husband’s bedside after she arrived early one morning to find he had been taken to surgery without anyone notifying her.

Despite the issues, Jarboe did not blame the medical staff so much as their working conditions.

“The doctors are so short-staffed because of the wages they get, and then the nurses, they’re overworked and understaffed as well,” Jarboe said. “So they compromise the level of training and education needed to get in because it’s like, ‘We need you now.’”

Within the past year, emergency services at Topeka’s Colmery-O’Neil VA Medical Center had to be cut back due to doctor shortages. Earlier this month, U.S. Sen. Jerry Moran, a Republican from Kansas, introduced a bill in Congress to allow qualified physicians from outside the VA system to volunteer their services at VA facilities in an attempt to quell shortages nationwide.

The VA’s annual budget rose from $61.4 billion in 2001 to $140.3 billion in 2013. In large part, the increase is due to the rising cost of health care and the burgeoning number of new VA patients returning from Iraq and Afghanistan.

Bilmes’ research found that as of 2013, 56 percent of the veterans of those conflicts were receiving government medical care, a higher percentage than after past conflicts.

Bilmes said that prior to 2001 there were about 26 million U.S. veterans and 4 million using the VA. Now there are about 21 million veterans and 6.5 million using the VA. The deaths of World War II veterans have reduced the overall numbers, but the influx of Iraq and Afghanistan veterans, and aging Vietnam veterans, has increased the number of them needing medical care.

The new VA patients have increasingly complex cases. More than a third of new returning veterans have been diagnosed with a mental illness such as depression, anxiety or post-traumatic stress disorder, contributing to a doubling in the Army suicide rate.

Armored vehicles helped more soldiers survive the improvised explosive device blasts that were the weapon of choice for insurgents in Iraq and Afghanistan. But the blasts contributed to traumatic brain injuries suffered by more than 200,000 veterans. They also caused widespread tinnitus, a persistent ringing in the ears that can be debilitating.

Bilmes said other health problems stem from conditions on the ground during those wars, including carting heavy packs long distances and living in the extreme heat and desert sand.

Multiple deployments in those conditions contributed to large numbers of veterans coming home with musculoskeletal pain, rashes and eye problems, often in addition to mental illness.

“The average claim of a veteran coming back from Iraq and Afghanistan has 10 disabling conditions on it,” Bilmes said.

About 50,000 veterans of Iraq and Afghanistan are considered “polytrauma” patients, meaning they’ve suffered multiple traumatic injuries. That includes more than 1,600 with significant brain injuries, 1,400 amputees and nearly 1,000 with severe burns.

Bilmes found that the facility now known as Walter Reed National Military Medical Center in Maryland treated more than 100 returning amputees each year from 2010 to 2012, during the Afghanistan “surge.”

Many of them later turned to VA hospitals for expensive prosthetic care, an ongoing medical cost.

According to data released by spokesman Jim Gleisberg, the VA Eastern Kansas Health Care System, which includes hospitals in Topeka and Leavenworth, has treated between 18 and 23 cases of burns and/or amputations each year since 2011, at a cost of about $300,000 in the most recent fiscal year.

Those wounds are expensive, but Bilmes said the number of veterans returning with horrific injuries is a “tiny, tiny fraction” of those with some sort of service-related condition that qualifies them for benefits. That number is likely to grow, she said, because service-connected conditions tend to crop up as veterans get older and their bodies break down.

She said the government has spent about $2 trillion on the recent wars and can expect to spend another $1 trillion to $1.5 trillion going forward to treat those who served in them. That doesn’t include social and economic costs, and Bilmes said she’s likely underestimating the final tab.

“I’ve tried to be pretty conservative in my assumptions, and every year the numbers are coming out higher than what I’ve predicted,” Bilmes said.

Debt-financed wars

During World War I and World War II, the U.S. sold bonds and asked citizens at home to sacrifice by eating from “victory gardens” and submitting to rationing.

However, the most recent wars were financed largely through debt. Bilmes said she was disturbed to see that method used again in August to provide $15 billion in emergency aid to the VA.

“Not only have the rest of us not fought in the war, we haven’t actually paid for it either,” Bilmes said. “We just put it on the national credit card. But the funding of current veterans benefits by putting that on the card is sort of a new and disturbing financial approach.”

The emergency bill allowed $10 billion for veterans who live more than 40 miles from a VA medical facility to get services at private hospitals and another $5 billion to help VA facilities hire more staff.

She said the ad hoc spending method leaves veterans in danger of having their benefits reduced or eliminated in the future.

“We’re in the middle of a national mood that is favorable to veterans,” Bilmes said. “Congress could (someday) just decide there isn’t enough money, and they could cut these benefits. It’s unlikely, but they could.”

Her research found that as of last year the United States had spent about $260 billion in interest on the $2 trillion in debt it incurred fighting the wars, which accounted for 20 percent of the total debt accumulated by the country during the war years.

Bilmes said she has long supported the establishment of a war tax or bond sales to support a national veterans trust fund. She testified for the fund before the U.S. House of Representatives Veterans Affairs Committee in September 2013.

But Jarboe said she’s wary of the idea of a trust fund, a large pot of money she fears could be misappropriated.

“Who’s going to manage the trust fund?” Jarboe asked. “That’s scary to me.”
However, she does want to see more resources put into support for veterans, through both the VA and organizations like the Military Veteran Project. She’s learned that the needs are too big for anything less than a national commitment.

“I thought when I started a small little nonprofit in Topeka, Kansas, I would basically advocate and empower and honor veterans,” Jarboe said. “That was my goal. But when I started digging into some of the cases, people would contact us from all around the world, all across the nation, at all hours of the day, and some of the cases were just inconceivable.”

Jarboe said voters should hold elected officials accountable for their rhetoric about supporting veterans. She says she prefers to stay out of politics and is wary of politicians who frequently reach out to her foundation. The one exception is former U.S. Sen. Bob Dole, himself a wounded World War II veteran and Kansan, who wrote the foreword to Jarboe’s memoir.

“He’s never once asked me for a photo (with him),” she said. “I like him.”

More accountability

Jarboe watched her husband endure more than 100 surgeries in the final year of his life. She believes some of the procedures were unnecessary and certainly outside the experience of the doctors who performed them. Walter Reed Army Medical Center closed a few months after he was treated there.

Jarboe has learned that the “Feres doctrine” complicates, and in some cases prevents, suing the federal government for medical malpractice in military or veterans hospitals. She’s also learned that military and VA doctors are not regulated by the medical boards in the states where they practice. While she wants more accountability for military and VA medical personnel, Jarboe said she’s not necessarily interested in suing anyone for what happened to her husband.

She wants to work within the system to make it better for other military families.

“Even through everything my husband endured and everything we’ve seen, we’re still very pro-government, pro-military, pro-VA,” Jarboe said. “Because there’s no way I can go up against and fight with them. Why not work with them and help them change things with the power of numbers?”

“There’s no sense in pushing more negativity out,” she added. “I’ve already had enough negativity in my life to last a lifetime. I’m good. Plus, my husband told me not to.”

The KHI News Service is an editorially independent initiative of the Kansas Health Institute. It is supported in part by a variety of underwriters. The News Service is committed to timely, objective and in-depth coverage of health issues and the policy-making environment. All News Service stories and photos may be republished at no cost with proper attribution, including a link back to KHI.org when a story is reposted online. More about the News Service is at khi.org/newsservice or contact 785-233-5443.
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