Veterans for Common Sense

September 15, 2008 – A 24-year-old Iraq War veteran was growing increasingly upset about deductions on his pay check. He became more and more irate.

The woman distributing the checks didn’t know what to do, but she found Inda’vie Pugh, a Vietnam-era veteran.

Pugh put his hand on the young veteran’s hand and said, “Let’s talk.”

For the next two hours, they talked. The young veteran told Pugh about losing his family and wanting to give up.

Pugh got him to the right people for mental health support.

Now, the young veteran tells that story often in Vet to Vet meetings. That talk saved his life, he says.

The Vet to Vet program is a peer support program for veterans that is integrated into the services of the Central Alabama Veteran Health Care System, which has medical centers in Montgomery, Tuskegee and other clinics throughout the region.

Pugh went through the program when it started in February 2005. He is now a facilitator, who mentors and discusses a wide range of topics that affect veterans — relationships, medical conditions, military service, suicide, substance abuse, post traumatic stress and how to deal with those conditions.

This week was National Suicide Prevention Week and recently the Army released figures that show if the trend continues, the suicide rate for the Army could top that for civilians this year.

Last year, the Army had an all-time high of 115 suicides. If this year’s trend continues, the rate could exceed the 2007 rate of 18.1 suicides per 100,000. U.S. civilians in the same demographic commit suicide at a rate of 19.5 per 100,000.

Veterans also are taking their own lives at an alarming rate.

The most recent VA data from 2006 showed the highest number of suicides for veterans of Afghanistan and Iraq — 141 who left the military after Sept. 11, 2001, committed suicide from 2002 to 2005. The next year, another 113 committed suicide.

Although the numbers are not broken down by state, the central Alabama group reports five suicides since 2004. Those did not occur in CAVHS facilities, but the veterans were receiving care through the system.

The Vet to Vet program is designed to break through the stigma attached to asking for help regarding mental health issues and to combat the rising suicide rates by getting veterans the help they need.

The facilitators have been through the program and have gone through several months of training. They’re required to keep up their own treatment.

“They’re familiar with their own stressors and high risk factors and can help identify those in others,” said Dr. John Campbell, the acting chief of CAVHS Psychology Service. “Emotions change, different stressors can become more aggravated.”

The veteran facilitators also recognize when the level of care needs to change, he said.

Campbell recalled one facilitator who phoned a group member who seemed distressed at a meeting. During that phone conversation, the group member admitted having suicidal thoughts. The facilitator kept him on the line, got staff members involved and had him admitted to CAVHS within 20 minutes.

The veteran later told them the call was pivotal in getting him help and saved his life.

“He was comfortable saying that to another veteran,” Campbell said.

Pugh said the Vet to Vet program provides a comfortable environment for them to talk.

“Once they’re in a calm atmosphere they can tell us what’s going on in their lives and we can direct them to where they need to go,” he said. “We’ll let you talk all day if you want to talk.”

It took Pugh, a former Marine, 38 years to seek help for his mental health issues, but he’s realized it’s good work to help others and therapeutic for him as well.

It’s a mentorship environment and a natural extension of the military structure — trust is more easily built because of shared experiences.

“There’s an old saying in the military, ‘You can’t tell me how to get there if you ain’t been there,'” Pugh said.

Each facilitator has dealt with some sort of issues, physical or mental, that are likely service-related. They each have gone through the VA system for treatment. Other veterans look at that as a guide since the facilitators have done it and are continuing to do so. It signals that asking for help is OK.

Many younger veterans don’t want to come in for mental health appointments at all, let alone take off work for those appointments, Campbell said.

The Vet to Vet program helps ease that, as does training non-clinical and other staffers so that they recognize mental health issues when veterans come in for other appointments to help prevent more serious problems.

The Vet to Vet program offers nine meetings per week at three facilities — one in Montgomery, Tuskegee and Columbus, Ga. One of those groups is specifically for female veterans and has a female facilitator. If they aren’t comfortable with a mixed group, they have that option to meet with their peers.

Campbell and Pugh said interest is high, so they need to pace growth so facilitators don’t get burned out. They’re also trying to grow their own from the veterans in the program.

Currently, there are nine facilitators. Several are on leave, since they recognize they need time to take care of themselves in order to help others, Pugh said. The facilitators rotate between groups and facilities, to prevent them from taking ownership of a group.

“It’s not your group, it’s a Vet to Vet group,” Pugh said.

From October 2007 to August 2008, 320 groups met with 6,019 visits. That figure includes repeat participation. In October 2007, the average group attendance was 15. Last month, the average was 23.

Among women, there have been 163 visits as of August.

Only 0.3 percent of the Vet to Vet participants ask to see a staff member after the group meetings.

Sams said that’s an indicator that it’s working.

That kind of data doesn’t exist yet for the Operation S.A.V.E. program, which is an awareness program in place at most VA facilities nationwide, including in Montgomery, Tuskegee and Birmingham.

Sarah Robertson is the suicide prevention coordinator at the Birmingham VA Hospital. She said the program grew out of the Joshua Omvig Veteran Suicide Prevention Act of 2007, which required the VA to implement several things such as educating staff on suicide.

“Obviously not everyone is forthcoming with the fact that they’re suicidal,” Robertson said. “It’s increasing the employees’ own comfort level with suicide and talking about it so that they can work with someone that is suicidal.”

The training covers risk factors and warning signs as well. Robertson said white males over 40 are more likely to complete suicide. They also look out for those who have had a recent major loss, such as the death of a family member, physical loss, loss of health or employment. Substance abuse, mental illness and having family members that have completed suicide in the past are other risk factors, she said.

The VA also has created a suicide hotline that received 33,000 calls in the year that it’s been operational. Of those, more than 1,600 were considered rescues — when workers talked someone out of suicide or were otherwise able to intervene.

The increased attention to mental health also is reflected in staffing.

At the Birmingham VA, there were only 30 mental health professionals three years ago. Now there are closer to 130, said Jeff Hester, the hospital’s spokesman. A new mental health center also is in the works in Birmingham. He said the center is in the final design stages now and construction should begin next year on the hospital grounds.

But the clinical staff and veterans agree it doesn’t matter how they get there as long as they do.

“They will open up to us and we can take them to the right place and get them the help they need,” Pugh said. “And that’s the bottom line.”

September 10, 2008 – A House subcommittee is set to shed new light on the problem of sexual assault in the military today, when it will hear testimony on sexual assault numbers, prevention and response as part of its ongoing investigation into the issue.

“A woman who signs up to protect her country is more likely to be raped by a fellow soldier than killed by enemy fire,” said Rep. Jane Harman (D-CA), who introduced a bill this summer to increase and encourage the investigation of prosecution of sexual assault and rape cases in the military and is attending today’s hearing.

It will be the second such hearing this summer but is highly anticipated because Dr. Kaye Whitley, the director of the defense department’s Sexual Assault Prevention and Response Office, will testify. Whitley was a no-show at the session July 31, even though the committee had subpoenaed her to attend.

Principal Deputy Under Secretary of Defense for Personnel and Readiness Michael Dominguez prohibited Whitley from attending that hearing, saying that his decision was based upon consultation with the assistant secretary of defense for legislative affairs and the general counsel of the DOD.

“It is inappropriate to question Dr. Whitley about the program when Mr. Dominguez, the decision maker responsible for the program and for the program’s results, is available to answer those questions,” said Cynthia O. Smith, a DOD spokeswoman, adding that while Whitley is responsible for implementing policy, Dominguez has “full accountability and responsibility.”

The decision outraged the Committee on Oversight and Government Reform’s Chairman Henry Waxman (D-CA), who sent a letter to Secretary of Defense Robert Gates Aug. 12 demanding the department’s staff cooperate with the investigation into sexual assault in the armed forces. He said Whitley’s testimony was vital because the office she leads “serves as the single point of accountability for the Department of Defense sexual assault policy.”

At the hearing, Waxman questioned what the DOD was “trying to cover up” and said it has “a history of covering up sexual offense problems.” He announced Aug. 13 that the DOD had agreed to cooperate and that Whitley would be made available.

The DOD announced last month that it will implement a new strategy in Oct. 2009 to help troops protect their fellow servicemembers from sexual assault, but Rep. Harman says it’s not addressing the problem now.

“We don’t have 13 months to wait,” Harman said.

She also said “bright red lines” need to be drawn about personal behavior in the military and that the prosecution of these crimes needs to increase to combat the “epidemic.”

“There are a lot of questions I want answered,” said retired Colonel Ann Wright, a 29-year veteran of the Army and Army Reserves who is advocating for an investigation into sexual assault and “suspicious” suicides in the military.

“The warnings to women should begin above the doors of the military recruiting stations, as that is where assaults on women in the military begins before they are even recruited,” Wright wrote recently on her website.

A recent Government Accountability Office report found that the DOD does not adequately provide guidance on implementing sexual assault policies and programs in deployment areas, that not all commanders support such programs, that prevention and response training is not consistently effective, and that a shortage of mental health care providers affects victims’ access to mental health services.

“Left unchecked, these challenges can discourage or prevent some servicemembers from using the programs when needed,” the GAO said. It based its findings on surveys conducted with 3,750 servicemembers at domestic and deployed units and a 2006 DOD survey. 103 servicemembers reported being sexually assaulted within the previous year, and 52 did not report the assault.

The GAO identified additional factors in non-reporting, including: “the belief that nothing would be done; fear of ostracism, harassment, or ridicule; and concern that peers would gossip.”

The Associated Press reported in July that of all the women who have visited a VA facility after serving in Iraq or Afghanistan, 15 percent of them screened positive for military sexual trauma.

“That means they indicated that while on active duty they were sexually assaulted, raped, or were sexually harassed, receiving repeated unsolicited verbal or physical contact of a sexual nature,” the report said.

September 13, 2008, Fairbanks, AK – The John McCain campaign rejected suggestions Friday that Republican vice-presidential nominee Sarah Palin was linking the Sept. 11 terror attacks to the current conflict in Iraq as part of her remarks at Fort Wainwright.

“You’ll be there to defend the innocent from the enemies who planned and carried out and rejoiced in the deaths of thousands of Americans,” Palin told the 1st Stryker Brigade Combat Team, 25th Infantry and their families at Thursday’s deployment ceremony. “You’ll be there because America can never go back to that false sense of security that came before Sept. 11, 2001.”

The governor’s oldest son, Track, is part of the brigade, and she had been scheduled to speak at the ceremony weeks before accepting the No. 2 spot on the Republican ticket.

But within hours of the News-Miner posting video of the speech on YouTube, commenters began questioning if Palin was asserting the attacks on New York and Washington D.C. were a primary reason for invading Iraq. The Washington Post also highlighted the comments on a story posted on its Web site.

“The folksy Republican hockey mom VP candidate just linked the 9/11 tragedy to the Iraq war,” posted the YouTube user known as unapimper. “How can anyone so clueless and ignorant be a heartbeat away from the presidency?”

“I get the feeling some people believe they can vote for an alternative reality,” wrote YouTube user SpitFireOFatJ. “It’s as if they believe if McCain wins that means history will record that they were right all along and Saddam was behind 9/11.”

The Bush administration once promoted the view that Iraq may have had something to do with the Sept. 11 attacks, but has since backed off such claims due to lack of evidence. It is, however, widely believed that al-Qaeda has an active presence in Iraq post-invasion.

McCain-Palin spokesman Ben Porritt, however, said it was ridiculous to think Palin was insinuating a direct connection between Sept. 11 and the Iraq war.

“In her praise of the brave men and women heading overseas Gov. Palin was clearly stating that our troops are going to Iraq to defend Iraqis and continue the efforts on the ground.” he said. “Drawing conclusions that she was saying anything else is an overreach.”

September 12, 2008 – This week, as we remember the nearly 3,000 American citizens who died in the rubble of the World Trade Center and the Pentagon or in a remote field in Pennsylvania on Sept. 11, 2001, we also should think about the civilians who are still dying in Afghanistan.

Consider, for instance, the recent American airstrikes on Azizabad, a village in western Afghanistan, on Aug. 22. The United Nations, Afghan government officials and independent witnesses all say that the United States killed about 90 civilians in these strikes, most of them women and children. Cellphone videos of the scene show motionless children lying under checkered shawls and veiled women shrieking alongside them.

According to a report by Carlotta Gall of the New York Times, dozens of freshly dug graves are scattered in the village’s cemeteries, some so small they could fit only children. The U.S. initially said that many fewer civilians had died, but it has now promised a thorough investigation.

It’s a grisly story but hardly an isolated one. The month before the Azizabad incident, Afghan officials say that American airstrikes near Kabul killed 27 civilians at a wedding party — including the bride. In another incident, on March 4, 2007, nine civilians died when their mud home north of Kabul was hit by two 2,000-pound bombs dropped by U.S. aircraft. American officials said they were aiming for two insurgents seen entering the house after firing a rocket at a U.S. military outpost, according to Human Rights Watch.

Not surprisingly, civilian casualties infuriate Afghans. This was brought home clearly in May 2006 after an American military convoy on a road north of Kabul lost control and plowed into a group of Afghans, killing five. In the days that followed, mobs of Afghans attacked businesses and hotels owned by foreigners; at least 14 died and more than 90 were injured.

Areport last September from the United Nations concluded that Western airstrikes were among the chief inspirations for suicide attackers within the country and that they engendered resentment against both the Afghan government and Western forces. The number of suicide attacks in Afghanistan went up six times from 2005 to 2006, to 136, and Taliban insurgents carried out more than 140 suicide bombings in Afghanistan in 2007.

Civilian casualties also seem to be a key factor in the marked erosion of support by Afghans for the American presence in their country. In 2005, 68{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of Afghans rated U.S. efforts in Afghanistan positively, but that number dropped abruptly to 57{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} in 2006 and to 42{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} in 2007.

The casualty numbers remain high even seven years into the war. According to a Human Rights Watch report released this week, in 2006, 230 civilians died as a result of U.S. or NATO attacks, 116 of them during airstrikes. In 2007, at least 321 Afghan civilians were killed by Western airstrikes. So far in 2008, at least 119 have been killed by U.S. or NATO airstrikes.

The 2008 estimate does not include the airstrike near Azizabad because the U.S. military has maintained that only five to seven Afghan civilians were killed in that incident. Cellphone videos of the carnage don’t conclusively prove this wrong, but they do raise enough questions that Gen. David D. McKiernan, the senior NATO commander in Afghanistan, has ordered a high-level investigation.

Aware of how politically sensitive the issue is, Afghan President Hamid Karzai has been calling for years for Western forces to show greater restraint in carrying out airstrikes in civilian areas. Indeed, shortly after the Azizabad strikes, he ordered a review of whether U.S. and NATO forces should be allowed to use airstrikes in or around villages.

Why are U.S. and NATO forces causing so many civilian casualties? One explanation may be that there are too few Western boots on the ground. Afghanistan, which is 1 1/2 times the size of Iraq and has a larger population, only has about 70,000 American and NATO soldiers stationed there. In Iraq, by contrast, there are about 145,000 American troops on the ground. This translates to heavier Western reliance on airstrikes in Afghanistan and the inevitably higher cost in civilian casualties those produce.

According to the U.S. Air Force’s Central Combined Air and Space Operations Center, between January and August there were almost 2,400 airstrikes in Afghanistan — three times as many as in Iraq.

Another factor is the Taliban’s execrable tactic of using civilians as human shields. Because the Taliban operates in and around settled residential areas, it is inevitable that operations by the U.S. against the group will involve civilian casualties.

Civilians in Afghanistan have been caught in the crossfire for too long. Over-reliance on airstrikes is counterproductive in the battle for Afghan hearts and minds. President Bush’s announcement this week that he will send nearly 5,000 additional troops to Afghanistan is a good way to start ameliorating this situation, but it is not enough.

The overall rules of engagement in Afghanistan need to change, as was promised by NATO Secretary-General Jaap de Hoop Scheffer, who said in July that the alliance would start using smaller bombs in Afghanistan in an attempt to decrease civilian casualties.

Limits on the size of bombs dropped were indeed imposed, but civilian casualties have continued at a level that is unacceptable. In a welcome development, McKiernan announced this week that NATO troops will focus more on house searches led by Afghan forces, with the permission of the homeowner sought first, and he also has reminded his top commanders of the importance of proportionality and restraint.

Hopefully, more coalition boots on the ground and revised rules of engagement will lessen the continued Western reliance on bombing from the air. After all, American civilians are not the only innocents to have suffered the results of the horrific Sept. 11 terrorist attacks.

Peter Bergen is a senior fellow at the New America Foundation, and Katherine Tiedemann is a program associate there.

September 13, 2008 – Thursday was a great day for veterans in the U.S. House of Representatives, nationally and especially locally.

Not only did the House pass a cost-of-living increase for disabled veterans and dependents of deceased veterans, it authorized $131 million for the construction of a VA outpatient clinic in Cape Coral.

Rep. Connie Mack IV, R-Fort Myers, deserves credit for dogged pursuit of the project over the last few years.

Besides serving a major part of Mack’s constituency – the district has 124,000 retired and active service members, the country’s fourth-largest veterans population – the new clinic should stimulate economic growth by drawing health care services and health-related companies to the area.

“This is a critical project for Southwest Florida,” Mack said. “It is a fitting tribute to the tens of thousands of veterans in Southwest Florida who courageously served our country.”

The building could open as early as 2011. Mack urged the Senate to pass the bill quickly and we join him in that call.

Our veterans have waited long enough. And our area needs a shot in the arm.

September 3, 2008, Scottsdale, AZ – Police identified Michael Murray, 22, of Scottsdale, as the motorcyclist who died Monday evening after crashing his 2008 Honda into a pole near the 4300 block of Hayden Road.”

The report does not mention that Murray, a former member of the 3rd Marine Division and a two-tour combat veteran of Afghanistan and Iraq, was a casualty of war.

“That isn’t what the official records say, but there is a lot of truth to that,” said his mother, Silvana Smith. “A lot of these kids come back from the war and they have such burdens in their hearts, like Michael did, that they can’t quite readjust.”

The director of a local U.S. Department of Veterans Affairs (VA) program aimed at helping returning soldiers with post-traumatic stress disorder told me recently that many Iraq war vets show signs of PTSD. They have trouble concentrating, difficulty with anger management, survivor guilt and controlling what they know to be reckless impulses. For example, driving a motorcycle a little too fast at night on a city street.

“Michael was the jewel of our family,” his mother told me. “But it wasn’t the military part of his life that made him so. It was his heart. He was a mediator. A peacemaker. He was our heart and soul. Sounds strange for a boy who was in the Marines, doesn’t it?”

She said that Michael joined the service out of high school because he was looking for a challenge. During a tour in Afghanistan he pestered his mother to send candy and over-the-counter medicines for impoverished civilians.

“Iraq was different,” she said. “We found out just recently that he had to put one of his best friends in a body bag. He didn’t talk to us about that.”

Michael returned from his final combat tour in May. From the beginning, his family noticed changes.

“He would have to compose himself to stop from reacting angrily when people thanked him for his service,” his mother said. “He was burdened by the death that he saw, I guess. He felt guilty for surviving. He couldn’t appreciate the good things happening to him. It was as if he felt that he didn’t deserve them.”

Michael went to the VA. His large Italian family wrapped him in a blanket of support.

“But that’s not always enough,” Silvana said. “Michael’s father made a good point. He said that in the Marines you’re trained to be tough and independent and not to ask for help. That helps you survive in a war. But back home, that can kill you.”

Michael was enrolled in community college, with thoughts of becoming an emergency medical technician. He had a girlfriend. He volunteered at an animal shelter. He was a gardener. His future was filled with bright possibilities; his past with dark memories.

“I think that every returning soldier or Marine should be forced to go to therapy,” Silvana said. “As it is, they have to ask, and I know that Michael felt like he didn’t want to take up space when someone else might need it more. I believe that a lot of these kids think that way and it keeps them from getting help.”

The former Marine was on his way home from his grandmother’s house when he lost control of his motorcycle, struck a curb and crashed. An accident like that could happen to anyone. His family knows this. They also know that the location of the tragedy, though reported accurately in the newspaper, can be misleading.

Michael Murray was on American soil when he died, but he had not left Iraq.