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Vocapedia > War > Veterans > PTSD > USA




Brandon Matthews, 33,

is a former Army Ranger

exposed to blasts in Iraq and elsewhere

who now has cognitive problems.


The 24 names tattooed on his back

include war buddies

who died in action or who killed themselves

after coming home.


Photograph: Nick Oza

for The New York Times


What if PTSD Is More Physical Than Psychological?


JUNE 10, 2016



































































































Doc Todd    Not Alone ft. Bingx    9 June 2017





Doc Todd - Not Alone ft. Bingx

Music video    9 June 2017

Veterans Crisis Hotline 1.800.273.8255

Entire Album now available on iTunes, Apple Radio, and Spotify


















I Will Go Back Tonight

Kara Frame    8 November 2016





I Will Go Back Tonight

Video    Kara Frame    8 November 2016


The short documentary film,

I Will Go Back Tonight

investigates the long-term effects

of Post Traumatic Stress Disorder

on marital relationships of Vietnam veterans

from the United States Army 5th Infantry Unit,

the "bobcats".



















USA > veterans >

post-traumatic stress disorder    PTSD        UK / USA




when-veterans-cant-access-the-psychiatric-care-they-need - January 6, 2024



















































































































suffer for decades

from night terrors

and post-traumatic stress syndrome










war trauma        USA










pain killers        USA










Puppies Assisting Wounded Servicemembers (PAWS)

for Veterans Therapy Act        USA












Corpus of news articles


War > Soldiers > Veterans >


Post-traumatic stress disorder (PTSD) >






A Veteran’s Death,

the Nation’s Shame


April 14, 2012

The New York Times



HERE’S a window into a tragedy within the American military: For every soldier killed on the battlefield this year, about 25 veterans are dying by their own hands.

An American soldier dies every day and a half, on average, in Iraq or Afghanistan. Veterans kill themselves at a rate of one every 80 minutes. More than 6,500 veteran suicides are logged every year — more than the total number of soldiers killed in Afghanistan and Iraq combined since those wars began.

These unnoticed killing fields are places like New Middletown, Ohio, where Cheryl DeBow raised two sons, Michael and Ryan Yurchison, and saw them depart for Iraq. Michael, then 22, signed up soon after the 9/11 attacks.

“I can’t just sit back and do nothing,” he told his mom. Two years later, Ryan followed his beloved older brother to the Army.

When Michael was discharged, DeBow picked him up at the airport — and was staggered. “When he got off the plane and I picked him up, it was like he was an empty shell,” she told me. “His body was shaking.” Michael began drinking and abusing drugs, his mother says, and he terrified her by buying the same kind of gun he had carried in Iraq. “He said he slept with his gun over there, and he needed it here,” she recalls.

Then Ryan returned home in 2007, and he too began to show signs of severe strain. He couldn’t sleep, abused drugs and alcohol, and suffered extreme jitters.

“He was so anxious, he couldn’t stand to sit next to you and hear you breathe,” DeBow remembers. A talented filmmaker, Ryan turned the lens on himself to record heartbreaking video of his own sleeplessness, his own irrational behavior — even his own mock suicide.

One reason for veteran suicides (and crimes, which get far more attention) may be post-traumatic stress disorder, along with a related condition, traumatic brain injury. Ryan suffered a concussion in an explosion in Iraq, and Michael finally had traumatic brain injury diagnosed two months ago.

Estimates of post-traumatic stress disorder and traumatic brain injury vary widely, but a ballpark figure is that the problems afflict at least one in five veterans from Afghanistan and Iraq. One study found that by their third or fourth tours in Iraq or Afghanistan, more than one-quarter of soldiers had such mental health problems.

Preliminary figures suggest that being a veteran now roughly doubles one’s risk of suicide. For young men ages 17 to 24, being a veteran almost quadruples the risk of suicide, according to a study in The American Journal of Public Health.

Michael and Ryan, like so many other veterans, sought help from the Department of Veterans Affairs. Eric Shinseki, the secretary of veterans affairs, declined to speak to me, but the most common view among those I interviewed was that the V.A. has improved but still doesn’t do nearly enough about the suicide problem.

“It’s an epidemic that is not being addressed fully,” said Bob Filner, a Democratic congressman from San Diego and the senior Democrat on the House Veterans Affairs Committee. “We could be doing so much more.”

To its credit, the V.A. has established a suicide hotline and appointed suicide-prevention coordinators. It is also chipping away at a warrior culture in which mental health concerns are considered sissy. Still, veterans routinely slip through the cracks. Last year, the United States Court of Appeals in San Francisco excoriated the V.A. for “unchecked incompetence” in dealing with veterans’ mental health.

Patrick Bellon, head of Veterans for Common Sense, which filed the suit in that case, says the V.A. has genuinely improved but is still struggling. “There are going to be one million new veterans in the next five years,” he said. “They’re already having trouble coping with the population they have now, so I don’t know what they’re going to do.”

Last month, the V.A.’s own inspector general reported on a 26-year-old veteran who was found wandering naked through traffic in California. The police tried to get care for him, but a V.A. hospital reportedly said it couldn’t accept him until morning. The young man didn’t go in, and after a series of other missed opportunities to get treatment, he stepped in front of a train and killed himself.

Likewise, neither Michael nor Ryan received much help from V.A. hospitals. In early 2010, Ryan began to talk more about suicide, and DeBow rushed him to emergency rooms and pleaded with the V.A. for help. She says she was told that an inpatient treatment program had a six-month waiting list. (The V.A. says it has no record of a request for hospitalization for Ryan.)

“Ryan was hurting, saying he was going to end it all, stuff like that,” recalls his best friend, Steve Schaeffer, who served with him in Iraq and says he has likewise struggled with the V.A. to get mental health services. “Getting an appointment is like pulling teeth,” he said. “You get an appointment in six weeks when you need it today.”

While Ryan was waiting for a spot in the addiction program, in May 2010, he died of a drug overdose. It was listed as an accidental death, but family and friends are convinced it was suicide.

The heartbreak of Ryan’s death added to his brother’s despair, but DeBow says Michael is now making slow progress. “He is able to get out of bed most mornings,” she told me. “That is a huge improvement.” Michael asked not to be interviewed: he wants to look forward, not back.

As for DeBow, every day is a struggle. She sent two strong, healthy men to serve her country, and now her family has been hollowed in ways that aren’t as tidy, as honored, or as easy to explain as when the battle wounds are physical. I wanted to make sure that her family would be comfortable with the spotlight this article would bring, so I asked her why she was speaking out.

“When Ryan joined the Army, he was willing to sacrifice his life for his country,” she said. “And he did, just in a different way, without the glory. He would want it this way.”

“My home has been a nightmare,” DeBow added through tears, recounting how three of Ryan’s friends in the military have killed themselves since their return. “You hear my story, but it’s happening everywhere.”

We refurbish tanks after time in combat, but don’t much help men and women exorcise the demons of war. Presidents commit troops to distant battlefields, but don’t commit enough dollars to veterans’ services afterward. We enlist soldiers to protect us, but when they come home we don’t protect them.

“Things need to change,” DeBow said, and her voice broke as she added: “These are guys who went through so much. If anybody deserves help, it’s them.”

A Veteran’s Death, the Nation’s Shame,






Back From War,

Fear and Danger

Fill Driver’s Seat


January 10, 2012
The New York Times


PALO ALTO, Calif. — Before going to war, Susan Max loved tooling around Northern California in her maroon Mustang. A combat tour in Iraq changed all that.

Back in the States, Ms. Max, an Army reservist, found herself avoiding cramped parking lots without obvious escape routes. She straddled the middle line, as if bombs might be buried in the curbs. Gray sport-utility vehicles came to remind her of the unarmored vehicles she rode nervously through Baghdad in 2007, a record year for American fatalities in Iraq.

“I used to like driving,” Ms. Max, 63, said. “Now my family doesn’t feel safe driving with me.”

For thousands of combat veterans, driving has become an ordeal. Once their problems were viewed mainly as a form of road rage or thrill seeking. But increasingly, erratic driving by returning troops is being identified as a symptom of traumatic brain injury or post-traumatic stress disorder, or P.T.S.D. — and coming under greater scrutiny amid concerns about higher accident rates among veterans.

The insurance industry has taken notice. In a review of driving records for tens of thousands of troops before and after deployments, USAA, a leading insurer of active-duty troops, discovered that auto accidents in which the service members were at fault went up by 13 percent after deployments. Accidents were particularly common in the six months after an overseas tour, according to the review, which covered the years 2007-2010.

The company is now working with researchers, the armed services and insurance industry groups to expand research and education on the issue. The Army says that fatal accidents — which rose early in the wars — have declined in recent years, in part from improved education. Still, 48 soldiers died in vehicle accidents while off duty last year, the highest total in three years, Army statistics show.

The Pentagon and Department of Veterans Affairs are also supporting several new studies into potential links between deployment and dangerously aggressive or overly defensive driving. The Veterans Affairs health center in Albany last year started a seven-session program to help veterans identify how war experiences might trigger negative reactions during driving. And researchers in Palo Alto are developing therapies — which they hope to translate into iPhone apps — for people with P.T.S.D. who are frequently angry or anxious behind the wheel.

“I can’t talk with somebody who is a returned service member without them telling me about driving issues,” said Erica Stern , an associate professor of occupational therapy at the University of Minnesota, who is conducting a national study of driving problems in people with brain injuries or P.T.S.D. for the Pentagon.

Though bad driving among combat veterans is not new — research has found that Vietnam and Persian Gulf war veterans were more likely to die in motor vehicle accidents than nondeployed veterans — experts say Iraq and Afghanistan veterans are unique, for one major reason: their combat experiences were frequently defined by dangers on the road, particularly from roadside bombs.

“There is no accepted treatment for this,” said Dr. Steven H. Woodward , a clinical psychologist with the Veterans Affairs Palo Alto Health Care System who is leading a study of potential therapies for veterans with P.T.S.D.-related driving problems. “It’s a new phenomenon.”

Though there has been some research into road rage among veterans, therapists and psychologists have only recently begun to view traumatic brain injuries and P.T.S.D. as factors in prolonging driving problems, probably by causing people to perceive threats where none exist — such as in tunnels, overpasses, construction crews or roadside debris.

“In an ambiguous situation, they are more likely to see hostile intent,” said Eric Kuhn , a psychologist with the Palo Alto Veterans Affairs Health Care System, who has studied driving problems. He said his research found that veterans who report more severe P.T.S.D. symptoms also tend to report being more aggressive drivers.

Experts note that driving problems are not always the result of the disorder. In some cases, returning troops may be reflexively applying driving techniques taught in Iraq during the height of the insurgency — for example, speeding up at intersections to avoid gunfire or scanning the roadside for danger instead of watching the road ahead.

In a study of Minnesota National Guard soldiers who returned from Iraq in 2007, Dr. Stern and fellow researchers found that a quarter reported driving through a stop sign and nearly a third said they had been told they drove dangerously in the months immediately after their tours. Both results were higher than the answers reported by National Guard cadets who had not been deployed.

Though driving problems seemed to decrease the longer the troops were home, they did not always vanish. Dr. Stern found that many Guard members remained anxious about certain roadway situations, including night driving or passing unexpected things.

“Those are things they associated with threats they saw in combat,” she said.

Ms. Max, a grandmother of four, was deployed at the age of 60 to Iraq, where one of her jobs was to carry large sums of cash to Iraqi reconstruction projects outside fortified American bases. She said she learned to be hypervigilant on those trips.

Upon returning to California, she struggled with P.T.S.D. and took time off from her nursing job. She also noticed feeling nervous for the first time in her life about driving — a major problem because she had to drive to visit patients.

“My whole driving behavior changed,” she said. “I live in a state of anxiety when I’m driving.”

Ms. Max recently participated in a clinical trial to develop and test therapies, such as deep breathing, that might overcome such anxieties. In a Pontiac Bonneville sedan outfitted with equipment to track the driver’s visual focus, heart rate and breathing, as well as to measure changes in the speed and direction of the car, the researchers take patients onto highways and observe their reactions to traffic hazards, real and imagined.

On a recent spin through the hills of Palo Alto, Ms. Max drove while Dr. Woodward monitored her heart rate and breathing on a laptop in the back seat. In front, Marc Samuels, a driving rehabilitation specialist who offers one of the only programs for P.T.S.D.-related driving problems in the nation, directed her along a preplanned route, prepared to grab the wheel if anything went awry.

Ms. Max mostly drove fine, but was startled slightly when passing a construction site and then again when two cars momentarily boxed her in. Finally, when her stress level spiked in a small parking lot, Mr. Samuels told her to stop the car and regain her composure.

Ms. Max said that the clinics had made her more aware of the things that made her nervous, a first step to conquering them. But she says she does not expect to ever feel truly comfortable driving again and has no plans to replace her beloved Mustang, which she sold just before her deployment.

“Why get a hot car?” she said. “I’m not going to enjoy it.”

    Back From War, Fear and Danger Fill Driver’s Seat, NYT, 10.1.2012,






Looking After the Soldier,

Back Home and Damaged


September 27, 2011
The New York Times


RAY CITY, Ga.— April and Tom Marcum were high school sweethearts who married after graduation. For years, she recalls, he was a doting husband who would leave love notes for her to discover on the computer or in her purse. Now the closest thing to notes that they exchange are the reminders she set up on his cellphone that direct him to take his medicine four times a day.

He usually ignores them, and she ends up having to make him do it.

Since Mr. Marcum came back in 2008 from two tours in Iraq with a traumatic brain injury and post-traumatic stress disorder, his wife has quit her job as a teacher to care for him. She has watched their life savings drain away. And she has had to adjust to an entirely new relationship with her husband, who faces a range of debilitating problems including short-term memory loss and difficulties with impulse control and anger.

“The biggest loss is the loss of the man I married,” Ms. Marcum said, describing her husband now as disconnected on the best days, violent on the worst ones. “His body’s here, but his mind is not here anymore. I see glimpses of him, but he’s not who he was.”

Ms. Marcum has joined a growing community of spouses, parents and partners who, confronted with damaged loved ones returning from war who can no longer do for themselves, drop most everything in their own lives to care for them. Jobs, hobbies, friends, even parental obligations to young children fall by the wayside. Families go through savings and older parents dip into retirement funds.

Even as they grieve over a family member’s injuries, they struggle to adjust to new daily routines and reconfigured relationships.

The new lives take a searing toll. Many of the caregivers report feeling anxious, depressed or exhausted. They gain weight and experience health problems. On their now frequent trips to the pharmacy, they increasingly have to pick up prescriptions for themselves as well.

While taking comfort that their loved ones came home at all, they question whether they can endure the potential strain of years, or even decades, of care.

“I’ve packed my bags, I’ve called my parents and said I’m coming home,” said Andrea Sawyer, whose husband has been suicidal since returning from Iraq with post-traumatic stress disorder. “But I don’t. I haven’t ever physically walked out of the house.”

Those attending to the most severely wounded must help their spouses or adult children with the most basic daily functions. Others, like Ms. Marcum, act as safety monitors, keeping loved ones from putting themselves in danger. They drive them to endless medical appointments and administer complicated medication regimens.

One of the most frustrating aspects of life now, they say, is the bureaucracy they face at the Department of Defense and the Department of Veterans Affairs, from problems with the scheduling of medical appointments to being bounced around among different branches of the system, forcing them to become navigators and advocates for their loved ones.

A variety of care services are offered to the severely injured. But many family members do not want their loved ones in nursing homes and find home health services often unsatisfactory or unavailable.

Despite Ms. Marcum’s cheerful manner and easy laugh, she has started taking antidepressants and an anti-anxiety medication when needed. She has developed hypertension, takes steroids for a bronchial ailment that may be stress related, and wears braces to relieve a jaw problem.

“I just saw all of my dreams kind of vanishing,” she said.

Over the past few years, advocacy organizations like the Wounded Warrior Project lobbied Congress to pass a law providing direct financial compensation and other benefits to family caregivers of service members. In 2010 they succeeded, and by mid-September, the veterans agency had approved 1,222 applications, with average monthly stipends of $1,600 to $1,800. Caregivers can also receive health insurance and counseling.

“We know it doesn’t replace full lost income,” said Deborah Amdur, who oversees caregiver support for the agency. “It’s really a recognition of the kinds of sacrifices that are being made.”

While families express deep gratitude for the help, questions remain about who will qualify and how compensation is determined, advocates for veterans say. Furthermore, the law applies only to caregivers of service members injured in the line of duty on or after Sept. 11, 2001, eliminating help for thousands who served in earlier conflicts.

And the emotional strain is still palpable as families struggle to adjust to what many call their “new normal.”

In a reversal of the classic situation in which adult children help out ailing parents, a substantial number of the caregivers of post- Sept. 11 service members are parents caring for their adult children.

Rosie Babin, 51, was managing an accounting office when a bullet tore through her son Alan’s abdomen in 2003. She and her husband rushed to Walter Reed Army Medical Center and stayed at his side when Alan, then 22, arrived from Iraq. He lost 90 percent of his stomach and part of his pancreas. His kidneys shut down and he had a stroke, leaving him with brain damage. He eventually underwent more than 70 operations and spent two years in hospitals, his mother said.

Ms. Babin fought efforts by the military to put her son in a nursing home, insisting that he go into a rehabilitation facility instead, and then managed to care for him at home.

But since her son’s injuries, her doctor has put her on blood pressure medication and sleeping pills. Now, while deeply grateful for her son’s remarkable recovery — he gets around in a wheelchair and has regained some speech — she sadly remembers the days when she looked forward to travel and dance lessons with her husband. Instead, she helps Alan get in and out of bed, use the bathroom and shower.

“I felt like I went from this high-energy, force-to-be-reckoned-with businesswoman,” she said, “to a casualty of war. And I was working furiously at not feeling like a victim of war.”

Research on the caregivers of service members from the post-Sept. 11 era is just beginning, said Joan M. Griffin, a research investigator with the Minneapolis V.A. Health Care System who is leading one such study. (The V.A. estimates that 3,000 families will benefit from the new caregiver program; 92 percent of the caregivers approved so far are women.)

What makes the population of patients receiving care different, Ms. Griffin said, is their relative youth. “The V.A. has not had a significant influx of patients of this age group since Vietnam,” she said, with a result that caregivers are looking at a “long horizon of providing care.” And one in five returning service members, a previous study found, report symptoms of post-traumatic stress disorder or major depression.

Ms. Griffin’s research shows that many family members spend more than 40 hours a week providing care. Half feel that they do not have a choice.

“They feel stuck,” Ms. Griffin said.

Some walk away.

For Ms. Marcum, 37 — who has an 18-year marriage and two sons, ages 14 and 11, with Tom, 36 — there was never a question of leaving. “I’m his wife and it’s my job, whether he’s hurt or not, to make sure he’s O.K.,” she said.

When she first asked for a leave of absence from work to care for him, she expected it would be for just a few weeks, while doctors got to the bottom of the migraines keeping him in bed for days on end. When he was up, he often seemed confused and sometimes slurred his speech. After 12 years in the Air Force, where he worked as a weapons specialist, he was suddenly having trouble taking a phone message or driving home from the base.

Mr. Marcum, who endured several mortar attacks in Iraq, one of which knocked him unconscious, eventually was given diagnoses of traumatic brain injury and post-traumatic stress disorder.

“My wife, I would imagine, probably felt as if she was a single parent for a while,” said Mr. Marcum, who is now medically retired from the Air Force. “She had to raise two boys. And now at times she probably thinks that she’s raising three boys,” he added with a laugh.

Ms. Marcum has found relief at a weekend retreat for military wives in her situation, and on a private Facebook page where caregivers vent, offer emotional support and swap practical advice. Participants say online communities like these are often more supportive than their extended families, who sometimes retreat in the face of such overwhelming change.

Financially, at least, things are looking up for the Marcum family. Ms. Marcum was awarded the highest tier of coverage through the veterans agency’s new caregiver program, giving her a monthly stipend of $1,837. Physical, occupational and speech therapy have all helped Mr. Marcum improve, but she worries that his progress has plateaued.

“We kind of have been in the same spot for a while,” Ms. Marcum said.

As proud as she is of her husband’s service, Ms. Marcum feels guilty that neither of them now works, and hopes that one day she will again hold down a job, while continuing to care for him. She pictures herself working somewhere relaxed, like a Hallmark store, where she could chat with people and help them with cards and gifts. It would be an escape, she said, from the stress at home.

Looking After the Soldier, Back Home and Damaged, NYT, 27.9.2011,






Vets’ Mental Health Diagnoses Rising


July 17, 2009
The New York Times


A new study has found that more than one-third of Iraq and Afghanistan war veterans who enrolled in the veterans health system after 2001 received a diagnosis of a mental health problem, most often post-traumatic stress disorder or depression.

The study by researchers at the San Francisco Department of Veterans Affairs Medical Center and the University of California, San Francisco, also found that the number of veterans found to have mental health problems rose steadily the longer they were out of the service.

The study, released Thursday, was based on the department health records of 289,328 veterans involved in the two wars who used the veterans health system for the first time from April 1, 2002, to April 1, 2008.

The researchers found that 37 percent of those people received mental health diagnoses. Of those, the diagnosis for 22 percent was post-traumatic stress disorder, or PTSD, for 17 percent it was depression and for 7 percent it was alcohol abuse. One-third of the people with mental health diagnoses had three or more problems, the study found.

The increase in diagnoses accelerated after the invasion of Iraq in 2003, the researchers found. Among the group of veterans who enrolled in veterans health services during the first three months of 2004, 14.6 percent received mental health diagnoses after one year. But after four years, the number had nearly doubled, to 27.5 percent.

The study’s principal author, Dr. Karen H. Seal, attributed the rising number of diagnoses to several factors: repeat deployments; the perilous and confusing nature of war in Iraq and Afghanistan, where there are no defined front lines; growing public awareness of PTSD; unsteady public support for the wars; and reduced troop morale.

Dr. Seal said the study also underscored that it can take years for PTSD to develop. “The longer we can work with a veteran in the system, the more likely there will be more diagnoses over time,” said Dr. Seal, who is co-director of the mental health clinic for Iraq and Afghanistan veterans at the San Francisco veterans medical center.

The new report joins a growing body of research showing that the prolonged conflicts, where many troops experience long and repeat deployments, are taking an accumulating psychological toll.

A telephone survey by the RAND Corporation last year of 1,965 people who had been deployed to Iraq or Afghanistan found that 14 percent screened positive for PTSD and 14 percent for major depression. Those rates are considerably higher than for the general public.

“The study provides more insight as to just how stressed our force and families are after years of war and multiple deployments,” said René A. Campos, deputy director of government relations for the Military Officers Association of America. “Our troops and families need more time at home — more dwell time, fewer and less frequent deployments.”

The study was posted Thursday on the Web site of The American Journal of Public Health.

Dr. Seal cautioned that, unlike the RAND study, the results from her research could not be extrapolated to the roughly 1.6 million veterans who have served in Iraq or Afghanistan because about 60 percent of them were not receiving health care through the veterans system.

But she noted that the number of Iraq and Afghanistan war veterans receiving care through the veterans system was at a historic high, 40 percent, potentially making the study’s results more universal.

The study also found that veterans older than 40 with the National Guard or the Reserves were more likely to develop PTSD and substance abuse disorders than those under 25. A possible reason, Dr. Seal said, is that older reservists go to war from established civilian lives, with families and full-time jobs, making combat trauma potentially more difficult to absorb.

“It’s the disparity between their lives at home, which they are settled in, and suddenly, without much training, being dropped into this situation,” she said.

In contrast, the study found that among active-duty troops, veterans under 25 were more likely to develop PTSD and substance abuse problems than those over 40, possibly because those younger troops were more likely to have been involved in front-line combat, Dr. Seal said.

Vets’ Mental Health Diagnoses Rising,






Talking Veterans Down

From Despair


April 22, 2008

The New York Times



CANANDAIGUA, N.Y. — Nancy Nosewicz was busy fielding calls at the new national veterans hot line on a recent afternoon when someone from the Department of Veterans Affairs in Topeka, Kan., phoned. He had a 55-year-old Army veteran from the Northwest on the line who had called to complain about his benefits, but now the guy, drunk and crying, was talking about not wanting to live. Could Ms. Nosewicz pick up?

In a slurred voice, heavy from weeping, the veteran, named Robert, told her that he was homeless and wanted to “just lay down in the river and never get up.”

Ms. Nosewicz, a social worker, listened. Then in a voice firm and comforting like a big sister, she said: “We don’t want you to either. Today we’re not thinking about the alcohol or the housing, Robert. Today it’s about keeping you safe.”

She gave an assistant Robert’s phone number to find his address and alert local police to stand by. The chain of care resembled a relay race, with one runner trying not let go of the baton until the next runner had it in hand.

The veterans hot line is part of a specialized effort by the Department of Veterans Affairs to reduce suicide by enabling counselors, for the first time, to instantly check a veteran’s medical records and then combine emergency response with local follow-up services. It comes after years of criticism that the department has been neglecting tens of thousands of wounded service men and women who have returned from war zones in Iraq and Afghanistan.

On Monday, a class action suit brought by veterans groups opened in San Francisco charging a “systemwide breakdown,” citing long delays in receiving disability benefits and flaws in the way discharged soldiers at risk for suicide had been treated. Kerri J. Childress, a department spokeswoman, said Monday that there were an average of 18 suicides a day among America’s 25 million veterans and that more than a fifth were committed by men and women being treated by Veterans Affairs.

Up and running since August, the hot line tries to respond to at least some of those in crisis. Over eight months, it has received more than 37,200 calls and made more than 720 rescues — sending out, from a narrow office here in upstate New York, emergency responders all over the country to find someone on a bridge, with a gun in his hand, with a stomach full of pills.

Paul Sullivan, the director of Veterans for Common Sense, one of the groups involved in the lawsuit, said of the department: “I’m pleased they’re responding. However, much more needs to be done so vets aren’t turned away from health care and don’t have to wait for benefits.”

Mr. Sullivan says suicidal patients have not been able to get care promptly; he cited the case of Jonathan Schulze, who was turned away twice from a Veterans Affairs hospital before he killed himself in January 2007.

“More than 600,000 veterans are waiting, on average, more than six months for disability benefits,” said Mr. Sullivan, who worked at the department monitoring benefits.

Experts agree that veterans are more likely, perhaps twice as much, to commit suicide as people who have never served in the military. Meanwhile, a study released last week by the RAND Corporation estimates that roughly one in five veterans of Iraq and Afghanistan has symptoms of post-traumatic stress disorder, which heightens the risk of suicide.

Yet whatever larger failings may exist, the staff of social workers, addiction specialists and nurses who keep the hot line running — 24 hours a day, seven days a week — can count at least some victories by the end of each shift.

Unique about this hot line, said Janet Kemp, the national suicide prevention coordinator with the department, is that now the counselors have medical information at their fingertips, which they use to connect vets with counseling near their homes. The model evolved from a new research program on suicide prevention paid for by the department.

“For years people thought that asking questions about suicide put the thought in people’s mind, but now we know that’s not true,” said Dr. Kemp, who travels throughout the country training V.A. staff.

The department is spending about $3 million to start and operate the hot line during its first year, said a spokesman, Daniel Ryan, and another $2.9 million on a mental health research center at the sprawling red-brick V.A. Medical Center in Canandaigua. Referring to the hot line’s relay model, Kerry Knox, the director of the new research center, said, “You don’t want them to fall through the cracks.”

With Robert, for example — whose last name was not provided for confidentiality — Ms. Nosewicz gradually nudged him to agree to be taken to a hospital and to give his name and Social Security number so she could check his file and put him in contact with the department’s suicide prevention coordinator in his area.

Meanwhile, Denise Slocum, a health assistant, relayed questions from the local police dispatcher. “The police are asking if you’re near an elementary school,” asked Ms. Nosewicz, who then nodded her head at Ms. Slocum.

“No, no, no — no handcuffs,” Ms. Nosewicz reassured Robert. “You’re going to go to the hospital.”

“Do you have a tissue to blow your nose? Then use your sleeve.”

“When they come in, you put them on the phone with me, and I’ll tell them to treat you with respect.”

Twenty minutes later, Ms. Slocum called the police again to confirm that Robert had been taken to a hospital. Ms. Nosewicz alerted the prevention coordinator. One is at each of the department’s 156 health centers.

Robert’s name was added to a board near the doorway so that the staff could follow up to ensure a local counselor actually met with him.

Of course, sometimes a crack is unavoidable.

“He’s going to do it. He’s really going to do it,” said Terri Rose, a counselor who was working the noon-to-midnight shift. She was wiping her red-rimmed eyes. A caller from Texas, who said he was 65 and a helicopter gunner in Vietnam, said he had a suicide pact with his friend, but the friend had gone off and killed himself. Now he, too, was ready to die, saying he had even found a coffin for $150, said Ms. Rose, who is an Air Force veteran herself. The veteran hung up and had stopped answering her calls.

Sometimes veterans have a lot of trouble asking for help, said Jacalyn O’Loughlin, a counselor. “They keep saying, ‘I’m sorry, I’m sorry, I’m sorry,’ ” Ms. O’Loughlin said. “Especially marines. They feel they’re weak if they reach out.”

Mr. Ryan said about half the calls to the hot line — 1-800-273-TALK (8255) — were from veterans, split fairly evenly between Vietnam and Iraq. Family members and friends also frequently call. About 30 percent of the veterans are women.

A couple of months ago, Ms. O’Loughlin said, a distraught woman called from Oregon who was driving to the woods and then threatened to “walk and walk and walk and never come back.” Ms. O’Loughlin rang the tiny silver bell on her desk to signal the health technician. The health tech checked the area code and phoned the closest Veterans Affairs health center.

“And lo and behold, that suicide prevention coordinator knew her just by her first name,” Ms. O’Loughlin said. The tech called the police and the coordinator called the woman’s husband, getting the car’s make and model. Ms. O’Loughlin kept her on the line; when she hung up, Ms. O’Loughlin called her back. “This went on for hours,” she said. “I could hear her getting out of the car. I could hear the rustling from the leaves.”

Meanwhile, the police and her husband were driving up and down roads. They spotted the car, dashed through the trees and found her. She had a bottle of pills in her hand but had not yet swallowed them.

Sometimes, the victories are smaller but no less satisfying. That morning, Ms. Nosewicz spoke to a veteran whose house was destroyed by Hurricane Katrina; he had been relocated to a different state.

“He called crying because he can’t find a job, saying ‘my teeth are so rotten and my mouth stinks,’ ” Ms. Nosewicz said.

Dental referrals are not exactly part of the job description, but Ms. Nosewicz tried dental schools in his area until she found a school to do the work. “He was crying on the phone,” she recalled, “and said, ‘Thanks so much. Thanks so much.’ ”

All in all not a bad day’s work, Ms. Nosewicz said, as she got ready to leave. “Three rescues, four consults and one set of teeth.”



An earlier version of this article referred incorrectly

to the Department of Veterans Affairs, known as the V.A.,

by its former name, the Veterans Administration.

Talking Veterans Down From Despair,










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