After combat, treating mental illnesses is the new battle

ALBANY COUNTY — On a Sunday afternoon, a 43-year-old veteran who had served in the military for half of his life disappeared from his rural home, sending a text message that he wanted to kill himself.

His wife called the police. He was arrested after numerous weapons and other materials were found. Police had seen the weapons in the man’s home while looking for him, and returned with a search warrant to seize them.

The search for the veteran continued late into the night. Police eventually discovered that he was staying in a motel about 30 miles from his home. A police crisis negotiator spoke to him for 10 or 20 minutes before he agreed to leave his room and turned himself in.

By the early morning, the veteran was in police custody. A loaded AR-15 rifle was found on the bed inside his motel room.

“He was clearly despondent … ,” said the crisis negotiator, who would not comment on the veteran’s mental-health status. “We were just talking general stuff … just day-to-day life.”

The Enterprise is withholding the veteran’s name so that his story may be told without jeopardizing his recovery.

The veteran was taken to jail without bail. He was charged with second-degree criminal possession of a forged instrument and criminal possession of a firearm, both felonies; and with five counts of fourth-degree criminal possession of a weapon, unlawfully possessing or selling noxious material, and possession of fireworks, all misdemeanors.

Two months later, he pleaded guilty to one count of criminal possession of a firearm. He was sentenced to time served and five years of probation. During his trial, the veteran’s lawyer requested a mental-health examination for him.

The lawyer said that her client’s experience in the military had lasting effects on his mental health, though she declined to elaborate on his diagnosis.

“Our main goal was to get him help and treatment … ,” she said. “So he could be a father for his family.”

His lawyer said he remained in jail until his case was decided for his own well-being, and since then he has been able to get treatment.

“It sounds bad, but we had to get some service in place for him,” his lawyer said. She later noted that mental health is a “major problem” for veterans.

“He’s never been in trouble, he served his country … but, when he needed help, the services weren’t there,” she said.

“The only way we could get him into treatment was we had to invoke law enforcement,” said the veteran’s wife.

The veteran’s wife, who like her husband will remain anonymous, said that she was grateful that he was protected in jail and that police understood that he needed to be arrested to receive that protection and mental-health treatment.

But now, she said, added to the burden of his illness is a legal burden that will follow him on every job application and background check.

“He’ll be dealing with the legal difficulties for the rest of his life,” she said, adding that it was for the crime of “a soldier in possession of a gun.”

She said the biggest hurdle in dealing with mental illness can be getting help for someone when that person is not actively seeking it. She lamented that there is no middle ground between declaring someone insane and not doing anything at all.

“And I don’t know how you could correct it without leaving it ripe for a lawsuit,” she said.

She has yet to see someone try to fix this dilemma, such as by creating some kind of “medical proxy,” the veteran’s wife said.

 

The Enterprise — Michael Koff
The Albany Stratton Veterans Affairs Medical Center offers several different types of mental-health treatment, staff says, including
use of new technology for long-distance treatment and virtual exposure therapy.

 

 

 

The statistics of mental illness

Aside from his military experience, the veteran, a white man in his early 40s living in a rural area, is a statistical fit when it comes to suicidal tendencies. A collection of data on violent deaths from 1999 to 2015 from the Centers for Disease Control and Prevention found the highest rate of death by suicide to be in white males, aged 50 to 54, living in non-metropolitan areas.

A study by the CDC released in October 2017 using trends in suicide rates from 2001 to 2015 found that death rates were highest for rural counties — 17.32 per 100,000 people, compared to 14.86 per 100,000 for medium or small metropolitan counties, and 11.92 per 100,000 in large metropolitan counties.

Suicide rates for males were four to five times higher than females. By race, the highest suicide rate in metropolitan counties was for whites, and in rural counties, the highest rate was for Native Americans.

Military service increases that risk. A study from the federal Department of Veterans Affairs found most veterans are at an increased risk for suicide, although the rates vary depending on age and gender. According to the study, compared to civilians’ stable rate, suicide rates have increased for younger veterans. Rates of suicide have also increased among middle-aged veterans, while also increasing for middle-aged civilians.

A survey of veterans enrolled in VA benefits from 2001 to 2014 found that the the percentage of veterans diagnosed with a mental illness or substance abuse increased substantially, with suicide rates increasing for these patients as well. Rates were also elevated for those who abused opiates.

Veterans of the wars in Iraq can suffer from post-traumatic stress disorder due to a number of factors, according to the United States Department of Veterans Affairs. These can include long periods away from home, as the wars in Iraq and Afghanistan have been the longest since the Vietnam War, as well as sexual assault or harassment, repeat deployment, and more severe combat exposure such as a extreme injury or seeing others killed.

Veterans returning from war may also have physical reactions, such as insomnia, upset stomach, rapid heartbeat, or headaches. They suffer, too, from emotional reactions, such as flashbacks, guilt, agitation, and hopelessness.

“Band-Aid treatment”

A month after the veteran was released from jail, his wife said their family’s situation was going “well-ish.”

“If it could stay like this forever, we would be good,” she said.

Her husband is now home and receiving treatment at a VA hospital, but she said this initially began with what she described as “hand-wavey” treatment.

When the veteran was released from jail, he was scheduled for an evaluation two months later. His wife said he was fortunate as his civilian counterparts would not receive treatment for another six months after being released.

“You screwed up badly enough to be in jail, you’re obviously having some input/output correlation issues,” she said, adding that he should have been given treatment immediately after his release.

While awaiting treatment, the veteran was offered what his wife described as “Band-Aid treatment,” and met in a substance-abuse group, as she said her husband had been on prescription drugs for “what he perceived as his symptoms,” and got ever-increasing doses of what turned out to be medication he shouldn’t have been prescribed.

“Within a week, his symptoms were to the point where he was unmanageable,” she said. He was brought to the VA hospital for inpatient treatment and remained there for week, after which he was re-diagnosed and prescribed new medication.

The veteran is currently allowed three one-hour psychiatric visits a month, something she said is considered the “gold standard” of care. His wife compared this to when she hyperextended her wrist and had three one-hour physical therapy appointments in a week for six weeks.

“I don’t think we do a good job with mental health care,” she said. “We don’t make it easy for people to get started; we don’t make it easy for families to start the process.”

The wife said that this ordeal has required her to go “toe-to-toe” with the system, ultimately leading to the determination that her husband’s diagnosis, of PTSD, was incorrect.

She does not work in the medical field, she said, “But I know how to read scientific papers.” She has read articles and found multiple sources on a subject and analyzed data. The veteran was ultimately diagnosed with major depression with psychotic features instead of PTSD.

“I think it’s the only thing that saved my husband — that I was able to put this all together and record it,” she said. She was able to show her records to a psychiatrist at the hospital who recognized the root cause and listened to her saying that the diagnosis was incorrect.

She said that most families dealing with mental illness know this situation. “You yell and you scream and they just don’t listen,” she said.

The veteran’s wife said depression focuses you on yourself and the things in your head, rather than what’s going on around you and or on others who may be affected by your actions. Depression also makes you more likely to put off treating a problem like mental illness.

“The inside of your fishbowl becomes your world,” she said.

 

The Enterprise — Michael Koff
Soldier On plans to renovate the former Ann Lee Home in Colonie to house homeless veterans. The home, which is near the Albany airport, closed a decade ago.

 

Half a life-time in war

Growing up, the veteran’s wife said, her husband did not experience “fairydust and roses,” noting that some of his mental-health issues stem from his childhood. After high school, he joined the military, and served almost two decades. He last served as a medic in the Air Force.

“It was all of his adult life,” said his wife.

She said that she first realized her husband was suffering from mental illness when he came home from Iraq in 2007.

“By that summer, I knew there was a problem,” she said. “But I couldn’t have told you what it was.”

The veteran’s wife was pregnant at the time, and shortly before the couple’s daughter was born he volunteered to return to Iraq.

At the time, the veteran’s wife wasn’t sure if there was a physical injury causing him to act that way, but no one offered to help them.

Consequences of actions in war, said the wife, are instantaneous, unlike consequences in civilian life that involve tasks such as paying a mortgage or sending children to the right school.

“Honestly, war is easy … in war you have the luxury of the immediate, you only have to care about things that are going to matter in the next few minutes,” she said.

Her husband worked as medic, a career he would later continue as a civilian nurse, during the Iraq War troop surge that lasted from 2007 into 2008. His wife said that he tended to around 2,400 casualties, many of them highly severe such as burns, severed limbs, or other near-death injuries. He was discharged after an improvised explosive device detonated and was himself severely injured.

“Otherwise I think he would have pushed to the limit and died,” she said. “Because that’s all he thought he was worth.”

The veteran has sustained multiple traumatic brain injuries, lung damage, and shrapnel damage.

When he came home, he was given Xanax and Ambien. His wife describes Xanax as a “dissociative hypnotic” that caused him to stay caught in his flashbacks, and Ambien, she said, increases memories of negative events.

“But fundamentally the American protocol is to throw a drug at it,” she said, of mental illness. If he couldn’t sleep, he was given a sleeping pill. And, if he was anxious, he was given anti-anxiety medications.

“He was one of the best of the best medics and people believed him and wrote him prescriptions,” she said.

She could never get anyone else to help her husband, she said. “He couldn’t put words to the fact that what was bothering him was in his mind and not his body.”

The stigma of mental illness

The veteran and his wife also experienced treatment from people who felt that his mental illness was a moral failing. His wife said that people would tell him, “You can’t have PTSD; you’re too good a medic.” Or they would say he was too smart, or, “Only weak minds have mental illness,” or, “If he has PTSD, how can he be allowed to be a nurse?”

She said that friends and family told her that her husband’s mental illness was a form of abuse, and that she should leave him.

“And they told me that to make me feel better, so that I would know it wasn’t all my fault,” she said. “It wasn’t all my fault; it’s just a disease.”

“Everything in our system is geared around the premise that mental health is a moral failing, that somehow you’re responsible for your own problems,” she said.

She believes that only the symptoms of mental illness are currently being treated, which is like treating only a fever and not the infection that caused it. She says this is in part because the knowledge of mental illness isn’t there yet.

People serving in the military may also avoid treatment for fear of being dismissed for having a mental disability, said the veteran’s wife. She said a way to avoid this would be to have a more traditional retirement system, rather than incentivize service members to remain for 20 years in the military. The military recently introduced a new retirement system.

“A soldier is just a commodity,” the veteran’s wife said. “It’s just a resource.”

Dr. Annette Payne, a lead psychologist at the Albany Stratton Veterans Affairs Medical Center, said that one of the ways the hospital attempts to reduce the stigma of mental illness, or perhaps go around it, is to include a mental-health checkup within a physical.

“I do think that there has been a long-standing stigma in our society,” she said. She added that this can be especially notable among Vietnam War veterans. But she also said that society is changing in this regard.

Peter Potter, the communications director for the Stratton VA, noted that veterans are also concerned that, should they be diagnosed with a mental illness, that they cannot own a firearm of qualify for certain jobs, particularly in careers similar to their military background.

With the exception of the Brady Handgun Violence Prevention Act, patients’ medical records are protected under federal law, including the Health Insurance Portability and Accountability Act, or HIPAA.

In compliance with the Brady Handgun Violence Prevention Act, the VA will report those deemed mentally incompetent to a national database that gun dealers must check. Veterans may submit an appeal if they are prohibited from buying a gun.

However, the VA has been scrutinized in the past for HIPAA violations, and the Albany branch is not an exception.

“I think that there are a lot of vets that are reluctant to seek out treatment,” said Bruce Buckley, the chief executive officer of Soldier On, a not-for-profit organization that provides housing and resources to veterans. But he said that the veterans who Soldier On works with are usually homeless or in jail; they have reached a point at which they are willing to take any treatment, often because they didn’t seek treatment before.

Transitioning to civilian life

The veteran’s wife said it is difficult for servicemen and women to return to civilian life so quickly after serving in combat. She described how soldiers in World War II took long trips together on ships to return home and had time to process what they had gone through.

Today, people in the military can return home by plane in a matter of hours after serving in a short tour. National Guard and Army Reserve members often don’t even have a military community to return to, she said.

“We don’t provide transition … ,” the veteran’s wife said. “We treat our military members like they’re G.I. Joe dolls that can be put on a shelf until they’re needed and then pulled back out …

“And, as bad as it is to come home to people who say, ‘You’re a baby killer,’ it’s almost as difficult to hear the people who go, ‘Oh, thank you for your service!’. Neither group understands, and makes it glaringly obvious that you’re somehow other and different; that doesn’t help reintegrate,” she said.

Potter said that one way to help veterans transition to civilian life is to offer things like veterans’ lounges, such as at the Albany International Airport. Potter, himself a Navy veteran who attended the University at Albany after serving, said that similar services provided at colleges are also helpful.

Service members who leave the military may go through voluntary resilience training. Almost a decade ago, the Army, for example, initiated a program called Comprehensive Soldier Fitness. The program uses online assessments and instruction modules, and in-person training.

Treatment

“There’s lots of different ways veterans come in for mental-health treatment,” said Payne.

Veterans who served in combat after Nov. 11, 1998, are eligible for free medical care for five years after being discharged. Payne said that veterans who come in for a physical exam see a physician, a nurse, and a social worker, and it may be determined then that they should seek further mental-health treatment. The VA also offers a walk-in clinic for mental-health treatment, she said, but the most common way veterans are directed to this treatment from having a physical exam.

Potter noted that the hospital is making an effort to get veterans to come in at all. He said that the federal departments of Veterans Affairs and of Defense are working to enroll service members who recently left the military in VA health-care benefits. Staff is trying to contact veterans within a month after they are discharged. Enrolling veterans often involves working with community groups, he added.

The Stratton VA serves around 42,000 veterans from the Canadian border, to Utica, to Massachusetts and Vermont, said Potter. To reach veterans, the medical center has set up video-chats at local health centers so that patients do not have to travel as far, he said.

An added benefit, he said, is that the room a veteran can go into for a video-chat is not labeled for any particular specialty, meaning the patient would not even be seen seeking mental care.

Payne said that, when patients stay at the facility for mental-health treatment, they are offered either one-on-one or group therapy once or twice a week. Group therapy, she said, offers peer support, and also can make it easier for veterans to understand they need help when a peer addresses it.

Options for mental health range from medication to holistic methods, she said. One option uses virtual reality as exposure therapy. There is also treatment for substance abuse, which often is tied to mental illness.

Payne said that the latest change in services at the Stratton VA is an increase in choices for care, with connections to services in the area.

“Early intervention is the key,” said Payne.

The VA also uses evidence-based treatment, said Payne, based on prior research and studies that determine what treatment would be the most effective for specific symptoms.

Other forms of treatment include prolonged-exposure therapy, which teaches veterans to gradually confront memories of trauma in order to decrease symptoms, and cognitive-behavior therapy, which modifies dysfunctional behaviors and emotions. The therapy can be offered either individually or in groups.

“They comfort each other, they support each other,” said Payne, of group therapy.

Potter said that veterans speaking to other veterans can be helpful in itself. He described how he met another Navy veteran who told him he preferred to go to his basement to relax because it’s cool, damp, and quiet. He was surprised when another Navy veteran they met told him the same thing.

Soldier On provides two clinical psychologists as well as several case managers and peer-to-peer services to help veterans, said Buckley.

He said that Soldier On also works with Dr. Steven Zodkoy of Freehold, New Jersey. Zodkoy, a chiropractor and nutritionist, has written about treating adrenal fatigue, a condition in which adrenal glands are overtaxed by stress. The condition is not recognized in medical science, and the disease has been dismissed by the Endocrine Society and others.

Buckley said that Zodkoy has developed a holistic approach to treating PTSD that involves nutritional supplements and and desensitizing triggers.

“I don’t think you’re ever cured 100 percent,” said Buckley. “We don’t see that … I don’t feel there’s one magic pill for PTSD.”

Instead, Buckley said, the organization can address issues associated with mental illnesses and offer support.

Soldier On also works with Albany County’s jail, and has created a veterans’ jail pod where veterans are housed together and receive counseling from Soldier On.

“Mental health is a big part of homelessness … ,” said Buckley. “We try addressing it more as a symptom than a cause.”

The jail program makes sure veterans with mental-health problems have been diagnosed and also makes sure sure veterans are taking any prescribed medications.

Veterans in the jail program may go into Soldier On’s transitional or permanent housing. The organization has permanent shelters in Leeds and Pittsfield Massachusetts, as well as a transitional facility in Pittsfield.

Soldier On also intends to build a facility at the former Ann Lee Home in Colonie. Buckley said that, should the organization receive money from New York State in time, the facility should be ready for housing in the summer of 2019.

 

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