I was doing some additional reading on homeless vets, trying to find some stats and predictions on those serving in the Afghanistan/Iraq wars and I came across an article in Social Psychiatry and Psychiatric Epidemiology, written by G. Gamache, R. Rosenheck, R. Tessler. S entitled The proportion of veterans among homeless men: a decade later. I won't bore you with the entire article as journal pieces are often tedious and boring to read through for the layperson (see the post, A Case For Better Healthcare, below), but I did think their discussion was worth sharing because I suspect it can easily be applied to those coming home from our most current wars.
If what they've found to be true with Vietnam era vets is applicable to our troops currently in combat, we're going to be inundated with homeless vets in the next decade and it will be a problem that stays with us for many more decades to come - and yes, they did address the differences between "drafted" and "all volunteer" forces, which makes it a particularly disconcerting analysis....
(The "discussion" comes after the article posted here.)
Home from America's wars, yet homeless in its suburbs
BEDFORD -- John McCarthy hails from a proud military family. He was named after a great-uncle gassed by the Germans in World War I. Both his grandfather and father fought in World War II.
McCarthy himself spent six years in the Navy as a petty officer first class in a fast-attack nuclear submarine.
But recently the 46-year-old found himself homeless, with little to show for his military career.
"I'm trying to get totally back on my feet and back into the swing of things -- which is easier said than done when you're starting from scratch and have no resources," said McCarthy, when he was enrolled last month in a 40-bed shelter for homeless veterans at the Edith Nourse Rogers Memorial Veterans Hospital in Bedford.
McCarthy is one of a significant number of homeless veterans living in the shadows in the suburbs, perpetually navigating a revolving door between shelters, temporary homes, and the street. Some veterans advocates say the ranks of homeless vets may soon be joined by a flood of troops returning from Iraq and Afghanistan suffering from serious health and mental health problems needing care not now available.
"Basically, we're very concerned that the condition is going to get worse," said Raymond O'Brien of Stoneham, national chairman of the Veterans of Foreign Wars' Homeless Veterans and Rehabilitation Committee and an appointee to the new Governor's Advisory Council on Veterans' Services.
O'Brien is among those attempting to address the issue now. He said the advisory council will work with the Legislature's Joint Committee on Veterans and Federal Affairs in coming months to try to ensure that a safety net is in place in time.
Federal government surveys show that one-third of adult homeless men and nearly one-quarter of all homeless adults across the country have served in the armed forces. The ratio of veterans among the homeless is the same in Massachusetts, according to research by the joint legislative committee. The Bedford center is one of only two in the state run by the federal government for veterans; the other is in Brockton. Other homeless shelters -- some exclusively for veterans, others not -- are run privately or by the state.
While the extent of the problem in area communities cannot be quantified, local officials and homeless shelter operators say homeless veterans drift in and out of their programs.
Lowell veterans agent Eric Lamarche said that since he began working there last September, he has sent about a half-dozen homeless veterans from his office to the local homeless shelter.
At the 90-bed Lowell Transitional Living Center, where clients sit outside at makeshift tables in a gritty concrete pen surrounded by chain-link fence, executive director Joseph Tucker says the facility takes in veterans from time to time. He says he cannot give firm numbers because the clients do not always identify themselves as former military.
Veterans like these become homeless for many reasons, said Deborah Outing, a spokeswoman for the Bedford veterans hospital. Many have drug- and alcohol-abuse, marital, or unemployment problems. Others suffer from post-traumatic stress disorder -- a belated reaction to combat causing anger or other behavioral problems, making it impossible to hold a job. The syndrome can take years to develop.
A report by the Department of Veterans Affairs released in 2006 shows that about half of all homeless veterans across the country suffer from mental illness; more than two-thirds from alcohol or drug abuse; and nearly 40 percent from both problems.
That squares with the experience of McCarthy, who said he had been homeless since 2003, when he and his wife separated. McCarthy said he responded by drinking heavily with buddies, also homeless veterans. Sometimes they found a bed at night, sometimes they hit the street, he said.
A 2005 veterans affairs report said Massachusetts had 1,680 homeless veterans, but only 378 beds to accommodate them, while New Hampshire had 350 homeless veterans, with only 36 beds for them. Not surprisingly, new local facilities for homeless vets in both states are seeing a flood of applicants.
Caritas Communities Inc., a private nonprofit corporation opening a facility for homeless veterans in September at the Bedford hospital, last month had 85 applicants for 60 rooms, said Mark Winkeller, executive director.
Peter Kelleher, president and chief executive officer of Harbor Homes Inc. in Nashua, said his new 40-bed facility for homeless vets was quickly filled, and last month had 50 on the waiting list. Kelleher said he is "quite certain it will continue to grow as more people return to New Hampshire from various places in the world."
Still, veterans in need sometimes refuse services. In Arlington, a homeless Vietnam veteran periodically stops by the town's veterans' services office, said director Bill McCarthy, but usually declines help. "He's a fairly intelligent guy, but he doesn't want to work," McCarthy said. "He just likes to drink his beers and hang around."
Helping such vets should fall in part to local and state officials, said state Representative Linda Dean Campbell. The Methuen Democrat, herself a veteran, is on the joint legislative committee trying to beef up the state's outreach.
Governor Deval Patrick recently signed off on $15 million in funds for homeless veterans in the budget year that started last month -- an increase of more than $700,000 from last year, said committee staffer Sarah Keller-Litkins.
She said the committee will hold hearings, probably this fall, to examine how the expanded resources can help deliver veterans better access to care, including a roof over their heads.
Discussion ( Psychiatry Quarterly):The central issue addressed in this study was whether the period of highest risk of veteran homelessness continues to be in the youngest age group, or whether the highest risk has now shifted to middle adulthood, as the cohort first identified in 1987 has aged. A decade later, the results point to a cohort effect.
Regardless of whether the comparison is with all domiciled veterans or limited to low-income and unattached domiciled veterans, we find that veteran men are still over-represented among the homeless. The cohort of veterans aged 20–34 that was most at risk for homelessness a decade ago in 1987, although now no longer the youngest group, still has the highest relative risk.The new cohort of young veteran males is also over-represented, but not to the extent found among young men 10 years ago.While attenuated, the over-representation of homelessness in the youngest cohort of veterans has not disappeared, perhaps due to the continued high prevalence of substance abuse problems in this group.
Empirical support for this interpretation can be found in differential rates of lifetime prevalence of drug abuse between the age cohorts. The proportion of veterans with drug use problems was 76% in the age cohort 35–44 – much higher than for any of the other age cohorts in the NSHAPC sample. By comparison, the next highest lifetime prevalence, found in the age cohort 45–54, was 57%. The elevated lifetime prevalence of drug problems in the age cohort 35–44 was also apparent in subgroup analyses of White and Black veterans. The cohort effect related to the men who in 1996 were aged 35–44 may reflect the continuing influence of some early problems in recruiting for the All Volunteer Force (AVF). The change to a volunteer military was accompanied by a mis-norming of the Armed Forces Qualification Test, which resulted in the acceptance of a number of lesser qualified personnel [8]. In contrast to the national draft,which promised a fair representation of the entire population of draft-eligible young men, the AVF also had the potential to attract young men with fewer alternative opportunities.
Increased pay, a successful advertising campaign based on the widely disseminated slogan “Be All that You Can Be,” and the positive image of the military inspired by the Persian Gulf War may have increased interest in military service among young adult men, and as a result enabled the military to become more selective in recent years. Any increase in the adaptive capacity of recruits would have the indirect effect of reducing vulnerability to homelessness after leaving the service.
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Lack of formal and informal supports may also play a role. In terms of formal supports, the increased risk of homelessness that was identified among younger veterans may reflect an unmet need for in-patient care.Thus, homelessness associated with psychiatric disability, substance abuse,or both,might be explained by the closing of mental health in-patient beds in the VA system. However, this is unlikely to be a factor, as several recent studies have failed to demonstrate adverse effects associated with VA bed closures [9–12].
An alternative interpretation is that informal supports may be less available to veterans due to the separation from the family of origin during young adulthood that military service entails. Since military service represents a break in family ties, it may be that veterans who become homeless come from disadvantaged backgrounds, and are unable to resume economically dependent positions in their families once their military service is over. This may be especially the case among veterans for whom family ties were already strained, or for those who experienced severe adversity in childhood. Without a family of origin to turn to,veterans have less support in making the transition back from military to civilian life.
A limitation of the current study is that it is not longitudinal, and the same individuals were not followed over time. In addition, the cities and communities included in the CPS sample are not identical to those included in the NSHAPC sample, although both samples are nationally representative.Moreover, the 1987 sample of homeless men combined the Urban Institute’s 1987 survey with three single city studies conducted around the same period,whereas the 1996 sample was limited to the Urban Institute’s new national survey. There were also some differences in the sampling strategies behind the two Urban Institute studies.However, none of these differences provides a plausible alternative interpretation of the cohort effect.
It is notable that in the 1996 study, as contrasted with the earlier one, veterans from the
In conclusion, the likelihood of veteran homelessness appears to be related both to youth and to era of service. However, the immediate post-Vietnam era cohort continues to be at greatest risk for homelessness. As the authors of the earlier report suggested, this probably reflects the influence of the All Volunteer Force and the reduction of veterans’ benefits for non-wartime service. If this cohort effect continues, then by 2006 the over-representation of veterans among the homeless should be highest in the age group 45–54.
