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 suffered from
Substance abuse disorder
1.8 million of any age met
criteria
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: – 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
President’s New Freedom Commission (2003)
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 Care Recovery 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 (
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 annual report, Washington, DC, Available at:
Gamache, Rosenheck, Tessler. Am J Public Health. 2003;93(7):

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
Violence History
Percent
Lifetime history of physical assault
77%
Physical assault in prior 12 months
20%
Lifetime history of rape
80%
Rape in prior 12 months
13%
Legal Issues
Currently on parole 3%
Currently on probation
29%

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. National Coalition for Homeless Veterans
Where to Find Help
National Coalition for Homeless Veterans

27. Where to Find Help VA Medical Centers Homeless Coordinator
Phone: VETS

28. Where to Find Help State Director of Veterans Affairs
Website:
Veterans Service Organizations and Auxiliary Organizations (VSOs)
AMVETS
Blinded Veterans Association
Disabled American Veterans
Veterans of Foreign Wars
Vietnam Veterans of America

29. Summary
Questions?