Illinois leads way in helping veterans

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Illinois leads way in helping veterans
By Philip Dine
POST-DISPATCH WASHINGTON BUREAU
12/23/2007

WASHINGTON — By mid-January, Illinois will become the first state to require screening of all returning National Guard troops for traumatic brain injuries. And a hotline will provide around-the-clock psychological help for veterans who wake up in the middle of the night panicked by combat-related stress.

Illinois officials have spent months preparing, including training clinicians and securing funding, as they seek to help soldiers who have fallen through large cracks in care at the federal level.

Illinois is among several states that are beginning to assume responsibility for the detection and treatment of post-traumatic stress disorder and traumatic brain injuries, which military experts are calling the "signature wounds" of the Iraq and Afghanistan conflicts.

The amounts are relatively small but growing, as is the number of states cobbling together funding and programs. Illinois legislators have appropriated $8 million this year; Missouri's governor intends to ask the Legislature for money as well.

"It shouldn't be the responsibility of the Illinois taxpayer, but these are our sons and daughters," said Tammy Duckworth, director of the Illinois Department of Veterans Affairs and an Iraq veteran who lost both legs to a rocket-propelled grenade in 2004. "If we don't take care of these veterans through this program, we'll be taking care of them in our prisons or our homeless shelters."

Missouri Gov. Matt Blunt said that his state "cannot afford for Washington to fail our veterans." When he delivers his State of the State address to the Missouri General Assembly on Jan. 15, Blunt plans to call for $617,760 for mental health services geared to families of veterans suffering from combat-related trauma.

The money will set up or expand crisis intervention, family counseling and therapy by the Missouri Department of Mental Health.

"The interest from state legislators is growing," said Heather Morton, legislative analyst with the Denver-based National Conference of State Legislatures.

This year, 18 states have passed legislation covering mental-health challenges, many aimed at filling gaps left by the Defense Department or Veterans Administration. That compares with just four states last year.

"States are doing things because the federal government hasn't stepped up to the plate to help the veterans," said Rep. Phil Hare, D-Ill., of the House Veterans Affairs Committee. RELATED LINKS
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"I don't think they had a clue that the war would last this long, that they would have these numbers of people in theater, this many people with psychological problems."

A report by the Pentagon Task Force on Mental Health over the summer said the military "falls significantly short" in providing psychological care to service members, blaming inadequate resources and the stigma attached to such problems in the military.

A NEW PRIORITY

John Scocos returned last month to Wisconsin from a combat tour in Iraq, and on Nov. 30 was elected president of the National Association of State Directors of Veterans Affairs. He said his top goal would be more resources for states to help returning veterans.

"There is a growing number of cases of post-traumatic stress disorder or traumatic brain injury, and we need to be ready at the state level to assist them, especially if the federal government isn't," he said. "We have to be active, we have to be outspoken, we have to work with our state legislatures and our governors."

Hare said Illinois' mandatory screening was critical because soldiers often were unaware of their problems.

"You could be in Iraq on a Monday and you're at your kid's soccer game on a Thursday. It's just unbelievable," said Hare. He recently met the parents of a soldier from his Central Illinois district who received a perfunctory "10-minute debriefing" on what to look for after their son returned from combat. Not recognizing the danger signs, they lost him to suicide.

Although state involvement is important, federal authorities need to better coordinate the effort, said Romana Joyce of the American Legion. "The United States as a whole is at war, not the state of Illinois," she said.

Dr. Ward Casscells, the Pentagon's assistant secretary of defense for health affairs, said the federal-state relationship needed to be examined. "If states are taking initiatives, we should have a dialogue, see what is going on here, share information and improve the programs," he said.

ROOTS OF THE PROBLEM

Several factors have complicated the federal response, spurring activities by states. Among them is the diagnosing by the Defense Department of more than 100,000 service members as suffering from "pre-existing personality disorders." Of those, 23,000 have been discharged, often receiving limited treatment and benefits, as reported in recent months by the Post-Dispatch.

Some have ended up in the office of Linda Schwartz, Connecticut's commissioner for veterans affairs, who recently spoke with the mother of a young soldier who slept in his truck for two years after returning from duty in Iraq, where he dispatched troops to respond to suicide bombings.

"The military psychiatrist told him that when he went into the service, he was already slow," said Schwartz, a nurse in the Vietnam War who has secured $1.1 million from the Connecticut legislature for mental-health care for veterans.

"His complaint to me was, 'They said I'd been this way all the time, and I haven't been this way all the time.' We thought he was having problems with post-traumatic stress disorder, but they kind of minimized his whole combat experience. It's very disappointing that that is the mindset of the military."

More broadly, states are jumping in because the sheer volume of mental health problems — stemming from the Iraq war's duration and multiple deployments — has overwhelmed federal officials. In addition, the insurgents' use of explosives has led to a mounting toll of traumatic brain injuries.

Compounding matters are gaps in medical knowledge about such injuries and soldiers' reluctance to seek assistance. "We're starting to get to the point where some of the stigma is wearing away," the Pentagon's Casscells said. "Now it's up to us to provide proper treatment."

Coordination between the Pentagon and the Veterans Administration, and between the federal government and the states, is often better on paper than in practice.

The states' growing role appears unlikely to diminish anytime soon.

When the National Association of State Directors of Veterans Affairs met in Annapolis, Md., a couple of months ago, Kentucky's commissioner of veterans affairs, retired Brig. Gen. Leslie Beaver, got the group to adopt his Interstate Partnership Plan. It knits together all 50 states, with the veterans director in each state contacting every returning soldier at bases in that state and then alerting the soldier's home state of his or her needs and arrival date. The average cost is likely to be around $100,000 per state.

Meanwhile, a Minnesota program to reintegrate veterans into communities impressed federal officials enough that the defense bill now at the president's desk contains $23 million to help other states adopt it.

And, to spread the word about Illinois' programs, Hare has asked Duckworth to testify before the House Veterans Affairs Committee once Congress reconvenes next month.

pdine@post-dispatch.com | 202-298-6880


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