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Iraq, Afghanistan veterans need more help at home

More resources may be needed to help care-givers cope with a rising caseload of damaged or suicidal veterans in need of counseling.

November 11, 2009|STEVE LOPEZ

Floyd Meshad, Vietnam vet, was in a Ralphs supermarket in Westchester when his cellphone rang at 9 o'clock one evening not long ago.

It was Meshad's suicide hotline, and a soldier was being patched through.

Meshad, a psychiatric social worker, walked outside the store so he could concentrate while trying to talk the soldier out of killing himself. He gets lots of calls like this from all over the country, more now than ever, and he knew one thing:

This soldier, calling from Florida, was serious.

"He was an Iraq vet being sent back for his fourth tour, his wife had left him after the third tour . . . his house was being foreclosed on, he had two kids," said Meshad, who runs the crisis line as part of his National Veterans Foundation, a Los Angeles-based nonprofit with a full menu of services for soldiers and vets.

You don't tell a desperate soldier you understand, Meshad told me, or he'll jump all over that. He'd want to know how you could understand a nightmare you're not living.

"You listen, and you try to find some holes in his anger and frustration," Meshad explained. "You say, 'I'm here for you. I know you're frustrated, but we're here to talk. I've been to war, I've been back. Let's look at some options.' "

After two hours on the phone with the Florida vet, Meshad had reason to hope for a good outcome. He checked the next day and the soldier was still alive. But that's just one day and one soldier.

There's a growing crisis, Meshad told me on the eve of Veterans Day, with two wars being fought simultaneously. We spoke almost one week after Army psychiatrist Maj. Nidal Malik Hasan allegedly killed 13 soldiers and wounded 30 others at Ft. Hood in Texas.

I don't know what we'll learn in the weeks to come regarding Hasan's motivation and what looks like an incomprehensible breakdown by intelligence officials who knew of his contact with a militant cleric. But regardless, the rampage has led to questions about whether there's adequate mental health counseling for soldiers, or for mental health workers whose workloads keep growing. As of the end of October, 134 soldiers had committed suicide this year, a record-setting pace.

Are we doing enough, or are we asking men and women to risk their lives in Iraq and Afghanistan and then skimping on healthcare when they come home broken physically or mentally?

At the VA in West Los Angeles and satellite locales, psychiatrists handle caseloads of as many as 400 to 500 patients at a time, said Jonathan Sherin, associate chief of psychiatry and mental health. And the numbers are growing.

"Clinicians talk about being overloaded a lot," Sherin said, and they're naturally fearful about missing a sign that a patient is a threat to himself or others.

There's a culture among soldiers of bucking up and holding back, if they seek help at all, which raises the stakes for doctors. Sherin said doctors ask if there's any sleeplessness, mood changes, irritability, substance abuse, domestic problems or a feeling of hopelessness. An experienced clinician can often detect that a soldier is hiding something, Sherin said, but that takes time, and sometimes there isn't enough of it.

Richard Pineda, a 32-year-old soldier from Los Feliz, didn't want to accept that he had a problem when he got back from Iraq three years ago with traumatic brain injury (TBI).

"I didn't want to go" to the VA "because I didn't want to get stuck there," Pineda told me, and he said that's how a lot of soldiers feel.

But Pineda's disorientation and forgetfulness meant that he couldn't always remember how to get home after an outing. When he freaked out at a fireworks show, he knew it was time to go to the VA.

I met Pineda in August at a surf camp the VA uses to help soldiers overcome the fear triggers that cause post-traumatic stress disorder (PTSD). Pineda told me this week that regular treatment has him feeling better, although he still relies on a GPS and Palm Pilot to stay organized and figure out directions. He's in a work-therapy program at the VA, helping out in the chaplain's office.

Dr. Sherin, meanwhile, is trying to modernize a fragmented, bureaucracy-heavy mental health program so it's easier to attract active soldiers and vets and easier for them to move from one program to another.

Getting to reluctant soldiers through better outreach is a continuing focus, said Ralph Tillman, chief of external affairs for the VA's Greater Los Angeles Healthcare System. But for those who come through the door, he said, "the VA has made great strides in providing access and immediate services."

Some would argue there's still a long way to go. The VA does good work, said Meshad, who helped set up a re-socialization program there after the Vietnam War and studied and treated post-traumatic stress disorder. But he said it can be difficult for vets to navigate the VA bureaucracy or develop enough patience for the paperwork, and that's a dangerous thing.

"Anxiety is off the charts" in Iraq and Afghanistan, Meshad said, due in part to the prevalent use of improvised explosive devices that make for constant stress. And the soldiers are bringing the war home.

"PTSD is rampant, TBI is rampant, suicide is rampant, divorce is rampant, violence is rampant," Meshad said. "We're in a world of trouble with our veterans. . . . They're coming back angry, frustrated, broke, they can't get jobs. . . . We're going to see violence. We're going to see homelessness."

If anyone cares to help, Meshad said, they can support nonprofit organizations that are trying to help. Or they can pressure Congress and the Obama administration to give soldiers not just the resources they need to fight wars, but the resources they need to rebuild their lives back home.

As for the soldier whose call he took while shopping at Ralphs, Meshad said he's been in regular contact and is trying to get help for him in Florida.

"So far," he said, "so good."

--

steve.lopez@latimes.com

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