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06 February 2016

Yet another summit

There was a national summit this week, where the VA said loudly and often that the suicide rate among veterans is much too high and something Needs To Be Done. They want to have more veterans participate in the VA health care system, so when things go wrong maybe the signs can be spotted earlier. Spotting the signs, or symptoms, that vets are depressed and on the path early is a good thing-- and it's hard to say anything but "yeah, that's a good thing" in response. The problem is that it is very easy to fall through the cracks of the VA health care system, so just being in the system isn't enough. The system has to be one that works, and equally important, it has to be one that we as veterans trust.

Things go wrong in the military, early, often, and sometimes badly. When my unit got orders to deploy to the Desert, there was a several inches thick binder that made up our deployment plan. There's always a plan. During peacetime, you make a plan for what happens when wartime arrives. Then, when wartime arrives, you realize that the plan you made up then bears little resemblance to what you need to do now. After a while, once you realize that that's how it works, you rely on adaptability and quick thinking. It's not enough to just know your job, you have to know how to learn to do your job a little bit differently when the need arises. Everyone shifts and adapts. We all do our own job the best we can, even if it's in the middle of a shitstorm, and that's how we accomplish the mission. If nothing has gone wrong today, that means that something most certainly is either about to go wrong or is starting to go wrong and no one knows what it is yet.

My point is that as vets, we're used to things being fucked up. Where do you think SNAFU (situation normal, all fucked up) came from?

I fight depression, anxiety, and PTSD every day. It's always there. Some days I do a good job of dealing with it, and I get a lot done. Some days I struggle, and accomplish maybe a little (or a lot) less. PTSD symptoms have at various times really messed up my life. In finding ways to cope, I rely heavily on things I learned in the military, including a lot of things that I didn't understand when I was on active duty nearly as well as I do know. Lately, since everything that happened with being homeless and the lack of support I got with that, I've become much more self reliant. I don't trust as many people and institutions as I used to, the VA being at the top of the list.

Trust and mistrust are both earned, not given. Like freedom, they are not free.

I was put back on the street after being in transitional housing, and the VA not only wasn't willing to help but told me that I was a freeloader, "after nothing but free meals and a free bed". Never mind that I was working the entire time, or that I'd re-enrolled in college, or that I was one of the few vets in the program that were actually clean and sober.  I have my own apartment now, that I found on my own; later this summer I'll have had my own place again for two years. No one has ever called from the VA and checked on how I'm doing. Once you leave a VA homeless veterans program, they forget about you.

Last year, I was in a drop-in group for veterans who have been through prolonged exposure therapy for PTSD. I stopped attending when the schedule changed, and they shortened the sessions to 30 minutes, and put a limit of six session in six months on attending the group. Mind you, the highest number of vets that attended any session that I attended was four; and the group was run by a succession of interns. At least once the group was cancelled while I was sitting in the waiting area, waiting for it to start. Talking to other veterans helped, and that's why I went... the interns were just random people.

I don't have a psychiatrist at  the VA anymore. I have a pharmacist who is supposedly trained and certified to prescribe psych meds. Two appointments ago she cancelled and no one called me, so I went in anyway and fussed until I got to talk to someone whose name I didn't get and wouldn't remember anyway. The appointment was rescheduled, and I missed it (it was a morning appointment, and I work nights). I never heard anything more after that. The last time I refilled my psych meds prescriptions by phone I had to request renewals, and someone did them but I don't know who. I've stopped taking my psych meds-- all of them. When I don't refill them I doubt anyone will notice or care.

I've needed to make a primary care appointment for a while now. With everything that's happened, the VA primary care clinic is the last place I want to go, but I need to suck it up and make the appointment. When I go they'll first read my name, then a set of standard questions, from a computer screen. I'll talk to a nurse, and maybe an NP or a PA, but not to an actual doctor. They'll ask how my meds are working and I'll tell them that the meds they gave me that made me throw up still make me throw up and so I'm not taking them. They'll give me similar pills again anyway. I won't remember their names and they won't remember mine.

If I really make a fuss, I'll probably be able to get referred back into mental health for an appointment, but honestly they don't have any new therapy to offer that I haven't already been through. I'll get assigned to another intern whose name I won't bother learning, and the process will repeat. Except that it won't, because I'm not going down the same road that led to me being homeless, on the street, and out of school the last time.

My life is far from perfect, and the future is made up of a thick fog of question marks. I'm trying to make it in tech, where being older and having a disability like PTSD aren't listed in the "ways to make it big in tech" articles.

I'm clean and sober, and stubborn enough that I keep trying even when things go wrong and even when I fail. Exactly why I'm able to be clean and sober I don't know. Maybe I'm just awesome? I really don't know. Maybe I'm a little bit lucky and more than a little bit stubborn? Probably. I'm lucky that I have a skill or two-- I can tell computer what to do, and they listen (usually). Not all veterans have a skill or resources that matter in civilian life. Not all veterans manage to stay clean and sober.

Organizations like the VFW and American Legion that run bars that offer support by selling cheap booze don't help us either.

I once spoke at a meeting of a campus organization for suicide survivors and supporters. These were college kids who had either attempted suicide or come very close, and were still here. Many of the reasons they talked about, the situations they were in, were things like getting two C's in a semester or failing a class in college when in high school they'd been A students. I respected (and I still respect) these students because in their worlds, these were the worst things that they could imagine happening, and they'd actually happened.

This was before I became homeless.

After becoming homeless the first time, and two more times after that, and having the VA tell me how there was nothing they could do to help, I feel I'd have been damn well justified in making an attempt on my own life. Being evicted from transitional housing right before final exams killed my grades that semester and put me in debt. If ever there was a time to do it, that would have been it.  With all I've been through, I'd certainly be justified in having made an attempt, but I haven't even considered it.

A few months after finding my own apartment, my person at the Vet Center proclaimed me fine. She said I'd had enough visits and that since I was actually showing up I was doing all right and didn't need to come in for more. I haven't heard from the Vet Center since around this time last year. Yet I can't walk down the street without thinking that the car that's parked on the curb with someone sitting in it, motor running, might blow up any second. I can't form close relationships with other people because I don't trust anyone. I keep my phone silenced, do not disturb feature on, all the time. I used to be Mr. Happy Go Lucky, but now some days if you bump into me on the sidewalk on a bad day I'm going to lower my shoulder and stand my ground. When I fly, I look out the window occasionally to see if we've picked up a fighter escort.

I am alive and kicking, but I struggle every day. On the worst days I wonder when my luck and energy will run out.

In the military, in the Desert, things went haywire all the damn time. (I've read dissertations written by service academy cadets and Air War College officers that listed everything that went wrong during the Persian Gulf War and the reasons why things went wrong.) There were a lot of just plain fuckups, my unit included. There were times I know I fucked things up. I also know that when things went wrong, and it sometimes took several of us to fix whatever one of us had done wrong, we all pulled together and fixed whatever needed to be unfucked and fixed. I won't say we were always happy about it, and I can't say we never grumbled as we were doing the work. But when shit went wrong, shit got fixed.

It is a fine thing to have a national summit to talk about what needs to change to reduce the number of veterans who reach the point that they see suicide as the only remaining answer. It looks good on the news and the website. It was also a fine thing to say that homelessness among veterans will end by a certain calendar date. Fine things won't change anything though, not as long as the preferred method of treatment for PTSD is throwing different cocktails of pills at us until we stop complaining. Things won't change as long as support groups are limited to the only times that interns (whose names we don't even bother learning) have available.

A secure message from the VA, from a counselor or therapist or someone that can actually help, simply saying that we haven't heard from you in a while and want to know if you're all right would go a long way towards helping build respect and trust. One of the interns I saw last year said she'd never received an account to use MyHealtheVet. Know why? That's one of the ways she knew she could get around communications between us being documented. She "didn't use" the normal appointment system either-- again, a way to make sure her ass was covered.

(Side note: I read the VA OIG reports. I've learned a lot from them.)

How about a text from someone at the VA whose name and number we actually know, just letting us know you're there to help if we need it?

How about meaningful follow-up, when we miss appointments or stop therapy altogether, instead of just writing us off. Sending a form letter that says we missed an appointment and you're documenting it just to cover your ass? Doesn't help. We don't show up? Ask us why, and really care why.

Don't declare war on veteran suicide, if you're going to fight the same way you did when you declared war on veterans sleeping on the street.

And, one more thing: it should be an immediate firing offense for any VA employee, from the Secretary on down, to ever utter the words "yeah well that's just the VA". If that's how you feel, you need to start fixing things or GTFO.

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