Military Mental Health Assessment Didn’t Include the Military

Officials from the San Diego County Health and Human Services Agency were at a loss to explain why a four-hour session was unattended by those it needed feedback from and intends to help. The session was one of a series conducted by agency officials, held to assess the best way to spend millions of dollars in fiscal year 2009 to meet the mental health needs of the military, former military, and their families.

About 30 people attended last Tuesday’s forum. Of these, there were mental health providers, veterans’ advocates, and those who work for agencies that deal directly with war veterans. To open the forum, Alfredo Aguirre, director of the county’s adult and children’s mental health department said, “This is an opportunity to focus specific resources for this (military) population." Aguirre said this to a room void of those to whom he was speaking.

In a North County Times article about the meeting before it was held, forum leaders said they knew why military servicemembers don’t seek services (i.e.: because they want to avoid being stigmatized and avoid adverse effects on their career; because they don’t know what’s wrong). Still, the forum leaders were flummoxed by the lack of military participation. I’m flummoxed by the inability to connect the dots.

I can explain why they (and some of those from their Commands) didn’t show up – and you (forum leaders) don’t even have to ask. There’s reason one why you had no-shows. You didn’t ask. You told them to come to you – even after saying you had knowledge and understanding of servicemember hesitation and refusal to seek services, and even after saying you were aware of Command neglect.

Those who work with the homeless, substance abusers, and abused children know you cannot reasonably expect those in need to first meet your desire. It’s telling enough that you couldn’t be bothered with going to them. Must you then also express what can only be described as insincere bewilderment?

You know the answers to your own questions. You said as much before the meeting, and still you don’t know what to do next. That’s such a bungled approach, one wonders if you aren’t all students of the federal government. Those in need may well not know they’re in need, but as educated, experienced, and trained persons of the help professions, why don’t you know?

What you’ve done (and what has been done by many civilian and military “help” agencies) is the opposite of a magician pulling a rabbit from a hat. Those in need are tired of their problems reappearing before their very eyes – unsolved and unresolved after each and every assist.

You’ve got to get another hat.

A handful of informal support groups meet for those in need right here in the North County area. It is not enough to meet the need; sharing experiences and getting support and camaraderie right now in what they consider a safe place beats attending a forum and answering questions for the umpteenth time in order to create programs that might come into existence next year.

Suggesting to those in need that they take time away from what few resources they do have to discuss the possibility of resources that might come to pass is ludicrous. Perhaps, though, in light of your surprise that no one showed up for your litmus test, it is more likely you haven’t made the effort to get acquainted with the resources that already exist. This is curious (if not a wee bit suspect) because some of those resources have appeared in the same print media as the article announcing the forum.

In lieu of asking questions of those in need, you instead discussed their absence. You concluded that some of the money should be spent on reaching out to them. Any validation of that effort would be glibly enabling, so let’s try this instead: How could educated and reputable professionals in the position of receiving millions of dollars be so blind?

Yes, you should reach out to them, assuming that by “reach out” you mean “go to them” and not “come to us” – what with that having worked so well. If, however, you still expect them to stand in line to fill out paperwork and answer questions posed by those who still don’t know where to start, you’ll be alone in your disappointment in much the same way you were last week.

Saying you’re not looking to duplicate services is perplexing because you want would-be recipients to tell you what they need. By profession, you know what they need. By your own admission, you know what they aren’t getting. Since you’re out to help in whatever million-dollar way you can, it’s a good bet that a person could go to you for screening, diagnosis, and treatment – and get it.

That, my dear forum leaders, is a duplication of services.

Your own To-Do-To-Whom list includes “those at risk of suicide, substance abusers, homeless veterans, female service members, troops booted out of the military on bad conduct discharges (rendering them ineligible for benefits), and gay and lesbian service members.” A homosexual, suicidal, and homeless vet with a bad conduct discharge in hand will have to go to at least four different places to get what s/he needs. Remove any one component of that equation and s/he is still going in three different directions.

That disconnected wild goose chase is already in place, courtesy of the federal government’s treatment of the war wounded. To be fair, your doing the same would technically be more a duplication of hindrance than service.

The reality is that there already exists every service necessary to provide for those in need. What does not exist is quality, consistency, proximity, and longevity of care.

Consolidate, subsidize, and improve the care of already-existing services. There, we’ve got it sorted.

Your improper planning indicates the way the money will be managed. That notwithstanding, let us consider that it took several upstanding citizens four hours to conclude what would’ve taken civic-minded third graders about 30 seconds: Reaching out to those in need would be a good place to start. Unfortunately, that’s not where you started. You started by telling those in need to reach out to you.

Your lack of knowledge about those in need is glaring, and perhaps you ought to stop advertising this to those you hope to help. You don’t know (or choose to ignore?) their schedules, which is to say you didn’t consider their use of the resources they were using that would have precluded a visit to the altar at which you hoped those in need would come a-kneeling. This speaks volumes of how ill prepared you are to do anything for them.

Having already run a gauntlet of empty promises and heartbreaking disappointment, those who didn’t grace you with their presence have more reason than injury and mental illness for not showing up at what many of them have come to regard as a do-gooder convention. They know you don’t know what they need, and they know you should. They also know the likelihood of you giving them what you think they need or should have rather than what they tell you they need.

For every shrugged shoulder, rolled eye, and exclamation of outrage this article may provoke from even its most prestigious reader, there are thousands of war veterans in the San Diego area who are still in need because of myopic, misguided, misappropriated, and uninformed “help.” That’s “thousands,” not potentially hundreds, as asserted by Karen Schoenfeld-Smith of the San Diego office of the Department of Veterans Affairs.

Approximately 377,000 former service members and active duty Marines call San Diego County home. Add in their spouses and children, and deduct from that those who have not suffered at all or whose needs have been attended. Schoenfeld-Smith herself said of serving in a war zone, “Everyone comes back from that experience changed."

Still think we’re talking “hundreds”?

Operation Homefront (OH) has you dead to rights, but you’re ignoring the model, as well as the information and experience. Established in 2001 to support servicemembers and their families, OH knows how many are in need and what they need. They deliver as best they can with what (and who) they have. More importantly, OH Southern California chapter head, Jae Marciano, knows stigmatized labeling of services will not create the desired draw. Don’t call your services “therapy,” Marciano says.

People are not projects. Their needs are not best met by those looking for a fixer-upper. The way you’ve used your resources thus far indicates a greater disconnect than would exist if you lived in the White House and had the means to legislate into place what those in need must have to heal: complete, consistent care and rehabilitation, and a livable income that would allow them to maintain home and family now compromised by their injury and lack of treatment.

The motivation of those with the means to help is clear. From where many a servicemember and veteran stands, that motivation is rife with mock altruism. Insisting your need to be needed onto those who require care exacts an unfair price from those in need. It is irresponsible and insincere of the gracious to expect the recipient to accept what is given, even if it doesn’t meet the need; or expect the recipient to be unconditionally grateful, even if what is done creates further problems.

Consider the desperation and hopelessness your intended audience faces everyday. Note how quickly and deeply their new lifestyle of pain and deprivation has been ingrained. Apply what you know about learned helplessness. Those in need have shut themselves down out of self-preservation and they’ve shut themselves off from those who have since come along. Many of them are now isolated and are sure they are the only one when in reality they aren’t even the only one-thousandth.

Your intended audience (do stop referring to them as “targets”) is made up of men and women who were contributing members of society and the cornerstones of their families. They had every reason to get up of a morning and they were depended on, not dependent. That shift was their undoing and there was no one there to acknowledge, much less help them navigate, those waters.

They have come to associate any attempt to secure assistance with invalidating humiliation and a call for effort on their part – an effort that often renders nothing and costs them dearly. What a ridiculous thing to ask of someone who is tired and in pain. We would never invite a cancer patient to tell us what they need and how best to meet that need. Why are we still expecting this of our mentally ill – especially those who willingly provided for our defense?

As mental health professionals and those who work with vets, you already know what they need. Tell them what that is instead of asking them questions they can’t answer or answer well. PTSD, anxiety, guilt, and overwhelming feelings of worthlessness are not normal, but these conditions are now the norm for this particular group of people. Tell them what you can do for them instead of soliciting their advice on a matter that has both confused and enveloped them.

If you really want to help, you’re going to have to check your titles at the door, remove your neckties, kick off your high heels, and get your hands dirty. That’s going to mean more than the nice, neat, and safe effort that is throwing around millions of dollars from behind a podium.

You’ve racked ‘em up. Now come to play or go the hell away.

CC:
San Diego Network of Care
Operation Homefront Southern California Chapter Head, Jae Marciano
Marine Corps Base Camp Pendleton Public Affairs Office, The Scout
North County Times staff writers, Denis Devine and Mark Walker