Veterans And

Homelessnesspresented by

F. Chris Esmurdoc, LISW-SKathleen Penman, PMHCNS-BC

ObjectivesIdentify the specific reasons that Veterans may become homeless and may be especially

vulnerable to homelessnessDiscuss the importance of the Recovery Model in working with VeteransRecognize the special needs that returning

Veterans haveBe able to interact with a Veteran who has

experienced homelessness

VeteransThere are approximately 23.4 million U.S. Veterans

8 million from Vietnam EraOver 2 million from the wars in Iraq and

Afghanistan

Approximately 7.2 million enrolled in the VA

5.5 million receiving healthcare; 3.4 million receiving benefits

Substance AbuseNational Survey on Drug Use and Health Report:

¼ of Veterans age 18-25 suffered from Substance abuse disorder

1.8 million of any age met criteria

Substance abuse disorderremains 1 of the top 5 diagnoses in the VA system

Other Problems Veterans Face

Homelessness1/3 of the nation’s homeless are Veterans

VA estimates the number being 75,000 last date 76% experience alcohol, drug, or mental health problems

IncarcerationThere are 140,00 Veterans in prison

81% justice involved and 60% in prison with substance abuse

SuicideVeterans: 17.5 – 22 per 100,000General Population: 11 per 100,000

Male Veterans are 2 times likely to commit suicide than non military men

4 to 5 Veterans commit suicide each day

Definition of a TraumaThe person has been exposed to an event in

which: There is actual or threatened death or injury,

or a threat to the physical integrity of oneself or others

The person’s response

involves intense fear,

helplessness, or horror

Traumatic EventsCombatCaptivitySexual assault/RapeChildhood physical and sexual

abuseMotor vehicle and other accidentsNatural/Man-made disastersViolence

Street crime Domestic abuse

Military Trauma: Combat and Captivity

Diagnostic Criteria for Traumatic Event Involve actual or threatened death or

serious injury to self or others Firefights Seeing mutilated bodies, atrocities Death and dying Medical care in the field Being held captive Torture

Include a response of intense fear, helplessness, or horror

CHALENGWhy are we involved?1992 Federal Task Force on Homelessness and

Severe Mental Illness described “outcasts on Main street”

Need for an integrated system of treatment housing and support services which needed to include

Outreach Case management Range of housing options

Principle/Purpose No single agency can provide the full

spectrum of services required to help homeless Veterans become productive members of society

Enhancement of coordinated services to raise awareness of homeless veteran’s needs is necessary

Focus on improving systems so that service delivery would be more effective

CHALENGCommunity Homelessness Assessment, Local

Education and Networking Groups

• An important part of obtaining this input focuses on the importance of the Recovery Model

A Consumer Driven Recovery Model

Recommendations for system designs have generally been made with little consumer input

Provider priorities differ from consumer perceptions of need

Addressing needs identified by homeless Veterans improves likelihood of engagement

President’s New Freedom Commission (2003)

www.mentalhealthcommission.gov/reports/Finalreport/FullReport.htm

A future when mental illnesses can be prevented or cured

A future when mental illnesses are detected early

And a future when everyone with a mental illness at any stage of life has access to effective treatment and supports - essentials for living, working, learning, and participating fully in the community

We envision a future when everyone with a mental illness will recover

President’s New Freedom Commission

(2003) (cont’d)Goals:

1: Americans understand that mental health is essential to overall health

2: Mental health care is consumer and family driven3: Disparities in mental health services are eliminated4: Early mental health screening, assessment, and

referral are common practice5: Excellent mental health care is delivered and

research is accelerated6: Technology is used to access mental health care and

information

Philosophy of VA CareRecovery Model

The VA is looking to build a new structure to create a more Veteran focused, recovery oriented mental health system:

Recovery has different meanings and definitions.a. According to Davidson et al. (2006), it is a process

in which a person engages to figure out how to manage and live with his or her disorder.

b. According to SAMHSA (www.samhsa.gov): Mental health recovery is a journey of healing and transformation, enabling a person with a mental health problem to live a meaningful life in a community of his or her choice, while striving to achieve his or her full potential.

Recovery ModelYou become instrumental in supporting the recovery model and working collaboratively with the

Veteran towards the goal of recovery

SAMHSA Consensus Statement (2006) has been adopted by VHA

RecoveryThe first step to recovery is to admit needing

help

Background: Women Veteran

Population Fast growing segment of

military and Veteran population

15% of active duty military

20% of new military recruits

U.S. women Veteran population numbers more than 1.8 million

Women Veterans who are Homeless

Estimated 1 in 4 homeless adults are Veterans Relative to homeless male Veterans, women

present different needs related to privacy, gender-related care, physical & sexual trauma treatment, housing support, and care for dependent children

Scant research on homeless women Veterans 1996 study: Women Veterans 3-4x more likely to

become homeless than non-veteran women Full magnitude of homelessness among Women

Veterans is unknown

Sources: National Law Center on Homelessness and Poverty. 2007 annual report, Washington, DC, 2008. Available at: http://www.nlchp.org Gamache, Rosenheck, Tessler. Am J Public Health. 2003;93(7):1132-6.

Objectives: Study of Homelessness among Women Veterans

Describe characteristics of women Veterans who are homeless

Identify risk factors for homelessness in women Veterans

Obtain homeless women Veterans’ perspectives on service needs and barriers

Characteristics of Women Veterans who are

HomelessViolence History PercentLifetime history of physical assault 77%Physical assault in prior 12 months 20%Lifetime history of rape 80%

Rape in prior 12 months 13%Legal IssuesCurrently on parole 3%Currently on probation 29%

Implications: Homelessness

Risk FactorsLack of financial and social resources are significant risk factors (just as in non-veterans)

Strongest predictors: being unemployed, disabled, not married

Skills & services to address these risk factors are needed to transition out of homelessness – e.g., job training identified as high priority need

Information gaps found – outreach and education needed for women Veterans not receiving VA care

Pre-military risk factors may also be important

Implications: Trauma and Violence

High levels of violence exposure, including military sexual trauma (MST)

Compared with non-veteran women, women Veterans have added risk factor of MST – this may account for women Veterans’ increased risk

Many VA and contract programs cannot accommodate or are not structured to address privacy and gender-specific concerns of women, particularly those with trauma histories or children

Expanding geographic availability of female-only residential and mental health treatment programs will facilitate access to needed care

How You Can HelpSupport emergency sheltersVolunteer as mentors, counselors or legal aideRaise funds for programsVolunteer at Stand Down programsDevelop Homeless Veteran Burial ProgramsPartner with your local VA to ensure

Veterans can access hospice services

Where to Find HelpNational Coalition for Homeless Veterans

E-mail: nchv@nchv.org

Where to Find HelpVA Medical Centers

Homeless Coordinatorwww..va.gov/homeless Homelessvet@va.gov

Phone: 1-877-222-VETS

Where to Find HelpState Director of Veterans Affairs

Website: www.va.gov/statedva.htm

Veterans Service Organizations and Auxiliary Organizations (VSOs)AMVETS www.amvets.orgBlinded Veterans Association www.bva.orgDisabled American Veterans www.dav.orgVeterans of Foreign Warswww.vfw.orgVietnam Veterans of America www.vva.org

Summary

Questions?