Veterans And Homelessness presented by F. Chris Esmurdoc, LISW-S Kathleen Penman, PMHCNS-BC

1. Veterans And Homelessness presented by F. Chris Esmurdoc, LISW-S Kathleen Penman, PMHCNS-BC

2. Objectives • Identify the specific reasons that Veterans may become homeless and may be especially vulnerable to homelessness • Discuss the importance of the Recovery Model in working with Veterans • Recognize the special needs that returning Veterans have • Be able to interact with a Veteran who has experienced homelessness

3. Veterans • There are approximately 23.4 million U.S. Veterans • 8 million from Vietnam Era • Over 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

4. Substance Abuse • National 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 disorder • remains 1 of the top 5 diagnoses • in the VA system

5. Other Problems Veterans Face • Homelessness • 1/3 of the nation’s homeless are Veterans • VA estimates the number being 75,000 last date • 76% experience alcohol, drug, or mental health problems • Incarceration • There are 140,00 Veterans in prison • 81% justice involved and 60% in prison with substance abuse • Suicide • Veterans: 17.5 – 22 per 100,000 • General 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

6. Definition of a Trauma The 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

7. Traumatic Events • Combat • Captivity • Sexual assault/Rape • Childhood physical and sexual abuse • Motor vehicle and other accidents • Natural/Man-made disasters • Violence • Street crime • Domestic abuse

8. 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

9. CHALENG Why 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

10. 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

11. CHALENG Community Homelessness Assessment, Local Education and Networking Groups • An important part of obtaining this input focuses on the importance of the Recovery Model

12. 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

13. 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

14. 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 driven 3: Disparities in mental health services are eliminated 4: Early mental health screening, assessment, and referral are common practice 5: Excellent mental health care is delivered and research is accelerated 6: Technology is used to access mental health care and information

15. 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. • 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.

16. Recovery Model You become instrumental in supporting the recovery model and working collaboratively with the Veteran towards the goal of recovery

17. SAMHSA Consensus Statement (2006) has been adopted by VHA

18. Recovery The first step to recovery is to admit needing help

19. 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

20. 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.

21. 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

22. Characteristics of Women Veterans who are Homeless

23. Implications: Homelessness Risk Factors Lack 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

24. 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

25. How You Can Help • Support emergency shelters • Volunteer as mentors, counselors or legal aide • Raise funds for programs • Volunteer at Stand Down programs • Develop Homeless Veteran Burial Programs • Partner with your local VA to ensure Veterans can access hospice services

26. Where to Find Help National Coalition for Homeless Veterans E-mail: nchv@nchv.org

27. Where to Find Help • VA Medical Centers • Homeless Coordinator • www..va.gov/homeless • Homelessvet@va.gov • Phone: 1-877-222-VETS

28. Where to Find Help • State Director of Veterans Affairs • Website: www.va.gov/statedva.htm • Veterans Service Organizations and Auxiliary Organizations (VSOs) • AMVETS www.amvets.org • Blinded Veterans Association www.bva.org • Disabled American Veterans www.dav.org • Veterans of Foreign Wars www.vfw.org • Vietnam Veterans of America www.vva.org

29. Summary Questions?