President Barack Obama said Sunday no veteran “should ever have to fight for a job, or a roof over their head, or the care that they have earned when they come home.” He touted a program that has helped thousands of vets find jobs in the private sector. He also praised a post-9/11 GI Bill that provides assistance for those who have served to go to college. But an influx of soldiers returning from Iraq and Afghanistan faces an uphill battle to find jobs in a weak economy. And while new rules make it easier to get help for Agent Orange-related conditions and post-traumatic stress, the Veterans Administration is struggling to reduce a backlog of disability claims. Diane and her guests discuss how the U.S. is meeting the needs of today’s veterans.

Guests

  • Matt Stiner director, Justice for Vets.
  • Michelle Joyner communications director, National Military Family Association
  • Paul Rieckhoff CEO and founder of Iraq and Afghanistan Veterans of America, and author of "Chasing Ghosts."
  • Dr. Elspeth Cameron Ritchie M.D., chief medical officer, District of Columbia Department of Mental Health and former chief psychiatrist in the Army. Author of "Battleland" blog at Time.com.

Transcript

  • 10:06:55

    MS. DIANE REHMThanks for joining us. I'm Diane Rehm. Yesterday, President Obama restated the promise he made on the campaign trail and during his first term to provide more benefits and help for veterans of all eras. Joining me to talk about the challenges and opportunities facing those who've served in America's military: Dr. Elspeth Cameron Ritchie of the D.C. Department of Mental Health, Michelle Joyner of the National Military Family Association and Matt Stiner of Justice for Vets.

  • 10:07:34

    MS. DIANE REHMWe do invite you to join us this morning. Give us a call, 800-433-8850. Send us your email to drshow@wamu.org. Follow us on Facebook or Twitter. Good morning to all of you, and thank you for being here.

  • 10:07:54

    DR. ELSPETH CAMERON RITCHIEGood morning, Diane.

  • 10:07:55

    MS. MICHELLE JOYNERHi, Diane.

  • 10:07:56

    MR. MATT STINERGood morning.

  • 10:07:56

    REHMMatt Stiner, I'll start with you. You say that veterans of different eras have different needs. Talk about that, if you would.

  • 10:08:07

    STINEROK. Absolutely. I'll tell you, Diane, that my generation of veterans, Iraq and Afghanistan occurred -- we're on the era of veterans jobs. That's what we need. Currently right now with all veterans, the unemployment rate is 6.3 percent. The civilian national average is 10 percent. But with my -- or excuse me, 7 percent. But with my generation, it's 10 percent unemployment rate. So jobs right now is exactly what we need and also more mental health counseling and opportunities.

  • 10:08:34

    STINERYou know, we've never deployed like this in the history of our military. So multiple deployments, the length of these deployments have really caused kind of a crisis as, I'll say, in mental health. Vietnam veterans, we need to look at also. As they're getting older, their disabilities are going to increase. So we need to make sure we cannot leave them behind. But I think across the board, all veterans in general, we've got to make sure especially on this Veterans Day that mental health access, we take care of the VA backlog, and employment is there for them.

  • 10:09:05

    REHMHow did you react to the president's statement yesterday?

  • 10:09:10

    STINERYou know, I -- with hope. I think President Obama has done a good job. With the Joining Forces initiative, he has helped veteran unemployment rates. But there is more work to be done. But, no, I thought it was great.

  • 10:09:24

    REHMAnd, Dr. Ritchie, to you, the most pressing issues that you see veterans today facing.

  • 10:09:33

    RITCHIEThere are many issues. As Matt mentioned, PTSD -- post-traumatic stress disorder -- suicide and mental health needs are big. Jobs are enormous. A good job is the best intervention for mental health because without a job, people don't feel secure, and their families aren't secure. Another area we haven't talked enough about is the criminal justice system.

  • 10:09:57

    RITCHIEToo many vets are ending up incarcerated. One of my jobs now, I teach police officers on how to work with veterans to try to get them to treatment instead of arrests. And Matt's going to talk a little later, I believe, about veterans courts which are really, really important.

  • 10:10:15

    REHMIndeed. And...

  • 10:10:16

    RITCHIESo jobs, employment, employment, employment.

  • 10:10:20

    REHMAnd to you, Michelle Joyner, you have your focus on families. And yesterday on Bob Edwards', I heard a young man who had served in Afghanistan say that quite frequently, people come up to him and thank him for his service when he says he believes they ought to be thanking his family as well for the incredible sacrifice.

  • 10:10:59

    JOYNERWe hear that a lot, Diane. And the service members will be the first to say, thank my family instead. The difficult thing is that families don't wear a uniform, and so you don't know who they are. And it's very difficult for a stranger to approach you on the sidewalk or buy you coffee or a lunch. But one of the things that we see are difference with this era of veterans is that they're getting out of the service with families.

  • 10:11:21

    JOYNERAnd so the families are moving forward with their veteran. And while the country is rallying around to provide support for veterans and veterans' jobs and veterans' health care, there are no benefit programs for the veterans' families. And so the best way that we can take care of military families is to make sure that their family is shoring up and that they're stable before they transfer from active duty to actually being a veteran.

  • 10:11:48

    REHMWhat happens to that family after they transferred from being active duty to a veteran?

  • 10:11:57

    JOYNERWell, for the veteran, they are eligible for certain benefits, depending on the length of service that they have been in, depending on their medical condition. They have access to employment preferences and medical benefits through the VA and also sometimes through the retiree system. But the family does not have that same access.

  • 10:12:22

    JOYNERAnd so we're looking at a military spouse unemployment rate that can be as high as 26 percent, and that's because of the difficulty that it's been for military spouses to maintain careers while the veterans serves. The benefits in medical and dental go away, and the support programs aren't there. The preference for employment isn't there. And so we need a soft place for these families to land as they transfer to veteran status with their brave service member.

  • 10:12:52

    REHMMichelle Joyner, she is communications director for the National Military Family Association. So join us, 800-433-8850. Dr. Ritchie, you recently wrote about unequal access for service members.

  • 10:13:14

    RITCHIEYes. I now do a blog on Time, "Battleland", and I've been focusing on ethical issues in the treatment of post-traumatic stress disorder and traumatic brain injury. And what I'm struck by is there are some great programs out there, but they're few and far between. And I'm talking about for active-duty service members now. And then a lot of people don't get any treatment or get minimal treatment. So, for example, there's now what's called evidence-based therapy, such as cognitive behavioral therapy, where you're supposed to go twice a week.

  • 10:13:46

    RITCHIEAnd it works really well if you can get that. But if you can only get an appointment once every two or three months, which is true in many places, then you're not going to get evidence-based treatment. And, unfortunately, in too many cases, the soldier or sailor service member doesn't get better, and then they go to a medical board or at administrative separation and then they're out of the military without the occupational security that it has.

  • 10:14:12

    REHMAnd what is it that makes the difference whether one person gets treatment or the other does not?

  • 10:14:21

    RITCHIESometimes it's where they're located, the installation or post that they're on that has a treatment. Other times, it's the luck of the draw or whether a doctor knows enough to refer them to one of the better programs. We've got a wonderful one near here, the National Intrepid Center of Excellence on the Bethesda campus of the new Walter Reed. But it's only for a few dozen service members every few weeks. So the vast majority of service members are not able to get into these programs.

  • 10:14:49

    RITCHIENow, there's more of the programs being stood up. The new NICoEs are called, National Center of Excellence. There's going to be one at Fort Belvoir and Camp Lejeune. But that's ways away. One of the things that I think is so critical for the audience to hear is how important is the civilian providers as part of the answer. The military medical system is stretched very, very thin. The VA is overwhelmed. But the community providers can really help by stepping up to the plate and learning how to take care of post-traumatic stress disorder and then going out and doing it.

  • 10:15:23

    REHMMatt Stiner.

  • 10:15:24

    STINERYes. And to kind of piggyback off that, doctor, we think about out guard and reservists as well. I mean, we've never deployed our guard and reservists like this in the war on terror, and a lot of these family members, a lot of these reservists and guard members live far from active-duty military bases, so they don't have that infrastructure to receive help. That's an excellent point you made in that the civilian sector has got to step up to help with these problems.

  • 10:15:45

    REHMAnd are you saying that, for the most part, the civilian sector is not well-trained to recognize these kinds of problems?

  • 10:15:57

    STINERI think some entities are, Diane, but I think some are not. There's definitely a difference between combat post-traumatic stress disorder and just, you know, PTSD that happens on the civilian side.

  • 10:16:07

    REHMInteresting. Michelle.

  • 10:16:09

    JOYNERI think that Dr. Ritchie's points about civilian care is extremely important, especially when we're talking about military children. Oftentimes, we need civilian intervention to help strengthen our children. We now have a generation of kids who have been brought up in a war.

  • 10:16:27

    JOYNERAnd it's the school nurses, it's the school counselors, it's the pediatricians that are seeing kids for stomachaches and bad behavior for what possibly might be stress in the home that's caused by, you know, a lot of the stresses that military families are under. So it's definitely training our civilian providers and those who -- caring adults who interact with children on the daily basis.

  • 10:16:52

    REHMMatt.

  • 10:16:52

    STINERYeah -- just chiming in also -- I would also kind of say that even on the active-duty side, guard-reserve side is that some service members are self-medicating while on active duty. I mean, they're turning to OxyContin, might be turning to alcohol, and as result, will get a punitive discharge because of what they did on active duty. So they might get a dishonorable discharge, bad conduct discharge, get kicked out. And then if you get one of those discharges, you absolutely do not qualify for VA benefits at all, and they've got to go find a civilian doctor to get help.

  • 10:17:21

    REHMAnd how many civilian doctors would you say have been trained in this regard to recognize those kinds of problems?

  • 10:17:33

    RITCHIEIt's hard to give an exact answer, but there is a lot of training out there. That's the good news. So the American Psychiatric Association, for example, we've done a military track the last few years, which has been very well-attended. If you go on the Web and Google under the Defense Center of Excellence for training on PTSD or the VA puts out training, there's a lot of training there, most of which is free and easily accessible.

  • 10:17:56

    RITCHIEBut the provider has to go out and train. And it also helps to get some training on military culture and competency. It's not just about PTSD. It's how to call somebody by their rank and to respect their service, how to ask questions about what happened.

  • 10:18:13

    REHMSo you believe there is a real shortage of providers in that regard?

  • 10:18:21

    RITCHIEAbsolutely.

  • 10:18:23

    REHMDr. Elspeth Cameron Ritchie, she is chief medical officer at the D.C. Department of Mental Health. She's author of the "Battleland" blog at time.com, the former chief psychiatrist in the Army. And if you'd like to join us, 800-433-8850. I look forward to speaking with you.

  • 10:20:04

    REHMAnd on this national holiday, as we honor our veterans, here in the studio, Matt Stiner. He's director of Justice for Veterans. Michelle Joyner is communications director for the National Military Family Association and Dr. Elspeth Cameron Ritchie. She is chief medical officer in the D.C. Department of Mental Health. Matt Stiner, tell us about your experience of coming home from combat.

  • 10:20:43

    STINEROK. Sure. I was actually involved -- well, I spent four years in the Marine Corps from 2000, 2004, and I was a part of the initial invasion of Iraq. Back in 2003, I received a Combat Action Ribbon for that service. And yet coming from combat, you know, my personal experience, it wasn't -- you know, when we came back, we deployed as a unit. We came back as a unit. So I had all my friends around me. That camaraderie was still there. I mean, literally are, those were my brothers.

  • 10:21:10

    STINERI think the biggest shock not only for myself but for a lot of veterans discharging is when you're not around your friends anymore, when you're not around your fellow Marines, your fellow brothers. You know, I certainly remember the -- when I -- my last day in Twentynine Palms, Calif., I mean, I literally packed up my Explorer and drove it back to Broken Arrow, Okla. And I remember that, you know, when I drove up, my dad was mowing the yard. My mom was outside.

  • 10:21:36

    STINERAnd so it was just so surreal in that, well, that time from 18 years old to 22, what I knew as a professional adult is gone. I mean, this is now my new life. And certainly, the, you know, the discipline in the Marine Corps helped me to get my undergrad and my grad degree, but it was a complete shock. And it certainly took me a couple of months -- two or three months to finally kind of settle down.

  • 10:22:01

    STINERI was kind of rowdy when I first got out. But my dad, thank goodness, it kind of goes back to the family's understanding. My dad was a major in the Marine Corps. And so he kind of -- he never went to combat, but he did have an understanding of some of the issues I was going through at the very beginning.

  • 10:22:16

    REHMWhat kinds of issues were you experiencing?

  • 10:22:20

    STINERWell, I still, you know, I think I still felt like I was in the Marine Corps barracks. I mean, we're, you know, fighting, and I just hadn't settled down yet. You know, just some of the things that you do in the Marine Corps that make you a Marine just did not fit into civilian society. And that first semester at college was also a shocker.

  • 10:22:39

    STINERI mean, I'm around 18-year-old kids when I just spent four years -- I taught water survival, martial arts, did a lot of interesting things. I just couldn't relate to really anybody on campus until I met other veterans. And that camaraderie -- I don't mean to switch gears so much -- but it's that camaraderie of meeting other veterans really helped out.

  • 10:22:58

    REHMDr. Ritchie.

  • 10:22:59

    RITCHIETwo points. One is don't forget it's not just a band of brothers. It's a band of brothers and sisters. The services overall are about 15 percent female now. And unfortunately, some people still think that it's only men who are really the true veterans. The second point that I want to pick up on, Diane, is a point about the importance of veteran support groups at colleges and campuses. Lots of vets are going back on the G.I. Bill. Unfortunately, many are struggling. They either have the PTSD, post-traumatic stress disorder, or the traumatic brain injury, or they just can't sit at a desk all day.

  • 10:23:36

    RITCHIEAnd too many are going back and struggling and dropping out or graduating and finding they don't have what it needs to get a job. So there are some really good models out there. George Washington has one, for example, of veteran support groups. And a final point -- back to the idea of civilian providers. For counselors who are working at college campuses, especially the community colleges, it's critically important that they avail themselves of some of the training I talked about earlier.

  • 10:24:04

    REHMBut surely, this is also where families come in, Michelle.

  • 10:24:09

    JOYNERAbsolutely. And this is kind of a difficult issue for families because you have your band of brothers and sisters that service member stays connected to and feels like, you know, they understand. But then the military family wants to be there, and they want to share that experience. And a lot of times, that doesn't happen. And we talked when the war first started about having this mistress, which was the military, and having to compete for that attention. So the family is definitely a great support group, but the expectations that there are going to be that relationship is a bit difficult.

  • 10:24:46

    REHMAnd if you'd like to join us, 800-433-8850. We have a number of callers. I'm going to take a call from St. Louis, Mo. Good morning, Laura. You're on the air.

  • 10:25:02

    LAURAI'm on the air.

  • 10:25:03

    REHMYes. Go right ahead.

  • 10:25:05

    LAURAHi. My name is Laura. I'm calling about my stepfather who lives in Texas, a small town, Kingsland. And the problem is he lives about 15 miles from the closest VA center. And he's to the point in his Alzheimer's where he can no longer walk. Well, I don't know if that's actually part of Alzheimer's, but he can no longer walk, and my mom can't get him in the car to take him to the VA center.

  • 10:25:34

    LAURAAnd he has to be there for an appointment at least once a year to be re-certified, so he can continue to get his benefits. Well, he has to be there again by December, so my mom has been trying and trying to find a way to get him there. She has gone through every agency she can locate trying to find transportation. No one will come to this small town -- no one, absolutely no one.

  • 10:25:58

    REHMAll right. Hold on a minute. Matt Stiner?

  • 10:26:02

    STINERYeah, certainly. I think my response to that would be, you know, try -- call the Disabled American Veterans. I mean, they provide transportation for issues like this, for those who struggle to get to the hospital on time. Also look at, possibly, Telehealth. You can do a lot of these...

  • 10:26:18

    REHMSpell that for us.

  • 10:26:19

    STINERTelehealth, T-E-L-E...

  • 10:26:22

    REHML-E.

  • 10:26:23

    STINERRight, yes. Health, H-E-A-L-T-H. I think that would be another option. And in some cases, too, the VA ought to go out to that house. So I would look at those areas.

  • 10:26:33

    REHMAnd Dr. Ritchie.

  • 10:26:34

    RITCHIETelehealth is part of telemedicine, which is usually a phone call or a video teleconference. And to the VA's credit, they are doing more with that, but it's still small and pilot programs. I think this call -- and I sympathize with you Laura -- it sounds a like a difficult situation. But it brings up the question or the issue -- this isn't just a VA issue. They can't do it all. It's a national issue. And hopefully, somebody who's heard will step forward and help either Laura and her family or all of the other struggling veterans.

  • 10:27:04

    REHMLaura, go ahead.

  • 10:27:07

    LAURAThe VA says they will come to the house and do a doctor call if she would live 50 miles within the radius. And a nurse came to their house through the VA, and she said the distance was exactly 50 miles. My mom has been calling and calling the VA and trying to get this through to them, that the distance is, you know, if it's not exactly 50 miles, it's close enough. And they're not even responding to her calls, so...

  • 10:27:32

    REHMGood gosh. That is so frustrating. Matt.

  • 10:27:36

    STINERNo, exactly. And I can -- I completely sympathize with you. I'm from Oklahoma and live about two hours from a VA medical center. But hopefully, like the doctor said, somebody's listening and can help out. Maybe somebody from the VA is listening and can do something.

  • 10:27:51

    REHMMichelle.

  • 10:27:52

    JOYNERWell, I would definitely encourage her to contact somebody at the VFW or the American Legion, in addition to DAV, because they do have local centers that are in a lot of smaller towns, and they provide those types of services.

  • 10:28:06

    REHMLaura, good luck to you, and I hope you will try these suggestions that have been offered this morning. Here's an email from April, who runs a homeless shelter in soup kitchen in Northern Oklahoma. She says, "We have a number of homeless veterans from the Iraq and Afghanistan combat. Because of their severe addiction issues and mental health issues, we find it very difficult to either employ or house them. What can your guests recommend that we do for them?" Dr. Ritchie.

  • 10:28:51

    RITCHIELet me answer that two ways. One is the individual, what you can do, and the other is a policy. And I think the policy about discharging people under less and honorable discharges has to be re-examine. I believe firmly that if you serve in this military, you should be able to get some kind of veteran's benefits 'cause, otherwise, it's just practical. People end up in the public mental health system with no benefits, tremendously expensive.

  • 10:29:18

    RITCHIETaking care of the homeless is very, very expensive, hundreds of thousands of dollars a year. So that's one piece, a practical policy piece. The other piece in terms of these folks is if somebody can help them get eligible for benefits, appeal to the Army Board of Correction of Military Records to get them benefits that may help. But I tell you, that's a cumbersome process.

  • 10:29:41

    REHMIndeed. And joining us now from New York City is Paul Rieckhoff. He is CEO and founder of Iraq and Afghanistan Veterans of America. Thanks for joining us, Paul.

  • 10:29:57

    MR. PAUL RIECKHOFFMy pleasure, Diane. Great to be with you.

  • 10:29:58

    REHMI know this is really a busy day for you. You just heard that caller frustrated beyond belief because of her father-in-law. You've also heard people talking about their frustration as to getting help. Talk about the transition that veterans make coming home from deployment when perhaps there is addiction or homelessness involved.

  • 10:30:33

    RIECKHOFFWell, it can be very difficult. I came home in 2004, and I remember that I was in Baghdad one week and in Brooklyn the next, and it really was a tough adjustment. And I think that many folks are facing a variety of challenges. One thing that we're focused on, really, is the unemployment rate, which, for new veterans, is over 10 percent. But I think what your caller also reveals is that there's a lot of bureaucracy, and especially at the VA.

  • 10:30:58

    RIECKHOFFThe VA has not adjusted to be responsive, in terms of customer service, as it should be. There's still almost 1 million disability claims that are backlogged. G.I. Bill checks continue to be late for young veterans who are in school and doing all the right things. And I think you have to think also about places like the East Coast right now. There are 177,000 new veterans in New York and over 78,000 in New Jersey that have been also impacted by Hurricane Sandy. So they're trying to get back on their feet as well.

  • 10:31:28

    RIECKHOFFHere in Manhattan, the 23rd Street VA is still closed. It was underwater after Sandy and will be indefinitely. So there are a variety of challenges facing our veterans, but we also believe that they're part of the solution. At the same time, in the last couple of days, they've been across the East Coast, participating in rescue efforts. They're on the front lines doing relief work, and we think that they're the new greatest generation. So this time on Veterans Day, we believe that they're not just a charity. They're an investment...

  • 10:31:52

    REHMIndeed.

  • 10:31:52

    RIECKHOFF...and they're one of the best investments out there.

  • 10:31:54

    REHMTalk about the veteran jobs initiative.

  • 10:31:59

    RIECKHOFFWell, you know, a real challenge now is there's so many of them. They're fragmented. There are some great ones on the corporate side. We partnered with a group called Veterans on Wall Street in the financial industry. A few weeks ago, we partnered with the advertising industry during Adweek, and we continue to partner with companies who really understand the value of a veteran.

  • 10:32:18

    RIECKHOFFOn the government side, the only jobs bill that passed Congress last year was a veterans jobs bill, the VOW to Hire Heroes Act, which was a huge bipartisan success. But unfortunately this year, the Veterans Jobs Corps failed. The first lady has launched an initiative called Joining Forces, which is really, I think, helping change the dialogue. But the bottom line is we've got a long way to go.

  • 10:32:38

    RIECKHOFFTen percent unemployment for veterans coming home from Iraq and Afghanistan is unacceptable. It should be unacceptable for all Americans. And we tell them if you want to support the troops, hire them. It's a great thing for your business, it's a great thing for our country and it's a great thing for those veterans.

  • 10:32:51

    REHMAnd you're listening to "The Diane Rehm Show." I would gather there's a lot more retraining that needs to happen, Paul.

  • 10:33:02

    RIECKHOFFThat's right, ma'am. Yeah. We do a lot of work at IAVA. We're a nonprofit veteran support group, but what we do are resume workshops. We do interview training. We do mentorship, and we try to help folks make that transition and understanding it's not just about getting them a job interview, but preparing them for a career. And there's a lot of work to be done, but they're highly motivated. They're dynamic. They're great in teams.

  • 10:33:24

    RIECKHOFFThey're early adopters of technology, and they're extremely entrepreneurial. So we really think that they represent a tremendous boost to our economy if properly tapped into. And if you think back to the World War II generation, when they came home, they built businesses and really helped create the middle class. So we think there's enormous potential there, and this is the time to tap into it. And now that the election is finally over, we hope this is one issue that both parties can agree on.

  • 10:33:48

    REHMAnd you've probably heard Michelle Joyner of the National Military Family Association talk about the families themselves and the unemployment rate being even higher among those families. What do you think needs to be done there?

  • 10:34:09

    RIECKHOFFWell, the families are the backbone of our military. You know, we sign up, and they kind of get drafted. But they've been shouldering tremendous burdens for going on 10 years, and they need to be a part of a comprehensive approach. Their unemployment rate is also significantly higher. And I think one thing everybody listening should think about is that the government does not have this under control themselves.

  • 10:34:28

    RIECKHOFFOnly about 51 percent of new vets are enrolled in the VA. And the VA, we want it to succeed. We know it's improving. But community groups, nonprofit groups, veterans groups are really at the point of attack, and they need money. They need support. After 9/11 here in New York, there was a fund launched to support survivors and folks wrestling with health impacts, and it was about a $1 billion fund that was spread out to a couple of 100,000 people.

  • 10:34:53

    RIECKHOFFWe've got 2.5 million men and women who served in Iraq and Afghanistan, and there's nothing like that. So a lot of these great groups are still living hand to mouth. They need financial support. They need operational support. They need volunteers. So we hope everyone will think about it. Yes, it's Veterans Day, but our goal as Americans should be to make every day Veterans Day, and that can start today.

  • 10:35:13

    REHMAnd looking ahead, what are the biggest challenges you see for veterans?

  • 10:35:20

    RIECKHOFFWell, I think making sure we're not forgotten. We know that Afghanistan will wind down in a few years, and Iraq is already over. And there's a tremendous amount of attention on us now where we've really got to think long term and build for the next 20 to 30 years. Vietnam veterans are still wrestling with the impacts of Agent Orange. World War II veterans continue to get care. So we've got to help everybody understand that this is a lifelong commitment we make as a nation to these folks.

  • 10:35:42

    RIECKHOFFAnd an especially concerning issue that's often off the radar is the skyrocketing rate of suicides. A few months ago, the number of suicides just in the Army active duty was 35. There's a veteran suicide about every 18 hours. So this is a huge issue that we don't even have really good research on, but is literally taking lives daily. And we've got to get the entire country galvanized around that, which I think will continue to be a challenge for the next few years.

  • 10:36:09

    REHMDr. Ritchie.

  • 10:36:10

    RITCHIEYes. I want to echo several things there. One is long-term effects of this. Often people do OK after they get out. They cover it up. They shoulder on, and it's when they get older and disabilities come up. You're seeing that in the Vietnam veteran now. You're going to see this in this generation 30 to 40 years from now. Secondly, the importance about suicide in the active duty, everybody's got to be part of the solution because active duty members go out and seek treatment or interact with the civilian world.

  • 10:36:40

    RITCHIEAnd then we don't have a good handle -- never have -- on suicides in veterans. We need a much better way to get accurate data on suicide in veterans. Many states don't even have, whether you're on a veteran, on the death certificate. So there's got to be a national effort. And I keep repeating myself on this, but I'm going to make the point one more time. The VA can't do it all. The military can't do it all. They are overwhelmed. It's got to be at a national level.

  • 10:37:05

    REHMDr. Elspeth Cameron Ritchie. And thanks to you, Paul Rieckhoff, CEO and founder of Iraq and Afghanistan Veterans of America, for joining us. And thank you for your service.

  • 10:37:23

    RIECKHOFFThank you, Diane.

  • 10:37:24

    REHMAll right. And we'll take a short break here and be back with more of your calls. Stay with us.

  • 10:40:04

    REHMAnd welcome back. We've had many responses to our first caller, Laura, who was concerned about getting help for her relative. And many of them say, tell Laura to contact her congressman.

  • 10:40:25

    REHMThere is no excuse for the VA not to return her calls. Here's another email from Peter who says, "Battlefield medical care is saving the lives of many servicemen who would have died in previous conflicts. Most of them have physical and mental disabilities that make employment difficult to impossible. What's being done to assist them in education or retraining into fields where their disability is not an issue?" Dr. Ritchie.

  • 10:41:08

    RITCHIEYes. Battlefield medicine is absolutely saving people with severe disabilities. However, I think that the military and the VA together, this is a bright spot. They are doing an incredible amount with assistive technology, with prosthesis, with computers, with adaptive things. And in many cases, I think what they're doing now is going to help the civilian world as well. One of my pet interests has been the use of animals -- service animals.

  • 10:41:34

    RITCHIEAnd the military is using service animals to help with mobility and hearing problems and seeing problems as it's traditional, but that's moving. And they're a leader in complementary and alternative medicine, a leader in acupuncture and yoga. So actually, I think that's a real bright spot. I think the difficulty is often those who aren't physically wounded and who are just leaving the military and don't have that same amount of help available.

  • 10:42:02

    REHMAll right. To Novi, Michigan. Jorgine, (sp?) you're on the air.

  • 10:42:09

    JORGINEThank you, Diane. I am a career consultant in the Greater Detroit area. I have gone to our local veterans' court to volunteer time to help the veterans. I do resume writing and all of the re-careering kind of activities for civilians. I also went out to the VA hospital in Ann Arbor and spent a day and offered my services.

  • 10:42:33

    JORGINEIn both areas, they're so very busy that no one had a chance to really see how I could incorporate into the programs, and I'd sure like to give some time in that way. Also, I noticed with civilian resumes, you have to break it down skill set by skill set, not by certification. Someone mentioned to me that the vets have certification in the military, but they can't get the civilians and companies in our country to accept their certification.

  • 10:43:04

    JORGINEI would suggest that in the resume review, perhaps those who are working with the vets are not breaking down their certification, actual skill set to skill set -- What did you do? What did you do? What did you do? -- and matching it to the requirements of the companies who are looking for high-tech people. I know the skills are there in a lot of those vets, and they need help in finding exactly how do I match the skill sets not the certification names?

  • 10:43:33

    REHMMichelle.

  • 10:43:35

    JOYNERDiane, that's actually a big issue for our veterans and for military families. Definitely for veterans, there needs to be a way to have a skills translator, and there's been a lot of talk about doing that in, you know, different levels of success for making that happen. Also, this is a state's issue because the certification is a state certification for many job occupancies. For military spouses, if you want to be a teacher, if you're in the medical field and you move from place to place, your certification will not transfer with you.

  • 10:44:06

    JOYNERAnd so that's what contributes to the high unemployment rate for military spouses, is that if you're a teacher in Texas, to be a teacher in Virginia, you have to go through an entirely different process that takes you out of the job market for a while. But it's an issue that has tentacles on both sides, whether it's in being able to translate what you do and then being able to test for that certification. Oftentimes, it's just a testing and then other times being able to transfer it from state to state. And so that's definitely...

  • 10:44:39

    REHMI see.

  • 10:44:39

    JOYNER...something that companies and states and employers can work on to make a difference.

  • 10:44:44

    REHMMatt...

  • 10:44:45

    STINERYes.

  • 10:44:45

    REHM...Jorgine mentioned a veterans' court. You've been involved in this Veterans Treatment Court. Tell us about that.

  • 10:44:54

    STINERYes, absolutely. I actually implemented a third Veterans Treatment Court in Tulsa, Okla., before I came on to implement these nationally. They were seeing across the nation that, you know, we're -- have all these front-end solutions. But a lot of veterans -- it's a macho environment. They're not going to ask for help. Mental health on the rise, subsidies on the rise, too many of them now because of those issues are being charged stemming from issues as a result of their service.

  • 10:45:21

    STINERAnd so in Veterans Treatment Courts, instead of sending a veteran to jail or prison, we divert their sins and put them on a docket where they get that help, where they get the accountability but also that judge, prosecutor, defense counsel all come together to give that veteran treatment instead of incarceration.

  • 10:45:39

    REHMAnd how well does that work?

  • 10:45:42

    STINEROh, it's working out just marvelously, just fantastic. The first Veterans Treatment Court was founded 2008, in January in Buffalo, N.Y. They've had 83 graduates, and not one veteran has been rearrested yet. Tulsa, their graduation rate is 96 percent. Rochester, their graduation rate is 98 percent. So these programs are just working out great.

  • 10:46:02

    JOYNERThey are working out great. Another piece that I've mentioned before, but I wanted to highlight again, is teaching police officers, usually crisis intervention team officers, to recognize veterans and to work with them to avoid them either getting arrested or worse outcome such as we see too often, such as suicide by cop. So the more you can teach everybody in the criminal justice system to avoid them getting to needing to be locked up and incarcerated.

  • 10:46:31

    REHMI do want listeners to know that we have links at our website, drshow.org, to a CBS "60 Minutes" segment on Veterans Treatment Courts. We have a link to Dr. Ritchie's "Battleland" blog on Time.com website. We have another link to the National Military Family Association website, and we have another to Paul Rieckhoff's Iraq and Afghanistan Veterans' of America. All those are on our website. Let's go to New Braunfels, Texas. Good morning, Elvie, you're on the air.

  • 10:47:23

    ELVIEThank you for taking my call.

  • 10:47:24

    REHMCertainly.

  • 10:47:24

    ELVIEI am a female navy veteran and a social worker. And my studies have been regarding the veteran population and their challenges. My comment is that we see this problem, and I think that the policy needs to be in place regarding how the Department of Defense and the Veterans Administration will work together to create a system to address these needs before they even come back. We are -- we're putting a band-aid on a issue that needs more than that.

  • 10:48:02

    REHMMatt.

  • 10:48:02

    STINERYeah. And first of all, thank you for your service that you just -- that's such an excellent point. And I can tell -- and I should've brought this up about my transition -- one of the most surreal things on Earth is that when you get out the Department of Defense, we get out of the military, it is so bizarre in that you have to re-enroll yourself, literally, in the VA. It doesn't make any sense as to why the DOD and VA cannot have a better line of communication.

  • 10:48:25

    STINERYou literally take your medical records from the Marine Corps, and they go the VA and then prove your service to get enrolment. And so you just made such a great point in that if the DOD and VA at some point can get together -- I know they've got pilot programs to make that -- streamline that -- that would solve so many front-end issues.

  • 10:48:47

    RITCHIEThey have been talking about doing that for years. The term seamless transition was around, I think, since 2003 or 2002. Similarly, the electronic health records they've been talking about integrating for years, I think it's tougher than it sounds. So it's not for lack of people trying. But it's certainly disappointing that this many years into the war, they haven't done it better.

  • 10:49:10

    RITCHIEI know that when I retired two years ago, I haven't been able to get into the VA, and I'm a retired '06 colonel with friends over there. Now, when I call them, they don't even answer the phone. They say we have too many calls. So -- and if I have problems doing it, then what about an E3 who's had four years in combat and just trying to find their way around...

  • 10:49:31

    REHMCould please...

  • 10:49:31

    RITCHIE...especially if they have TBI or PTSD.

  • 10:49:33

    REHMI hope somebody is listening today.

  • 10:49:36

    STINERWell, and that -- but I just truly think it's unacceptable. I mean, we're the country that built the atom bomb. I mean, we just took out Osama bin Laden. I mean, we can do these things. This is something that we can accomplish.

  • 10:49:46

    REHMAll right. To Crystal Springs, Pa. Hi there, Jenny.

  • 10:49:51

    JENNYHello. I'm a disabled veteran. I rate at 50 percent disabled. I have a back injury. And because of the nature of my injury, I have not been able to have a job for the last 15 years. And my income then is, you know, quite low, and I haven't been able to afford dental care. And so the result is I have a whole mouthful of very broken and messed up teeth.

  • 10:50:16

    JENNYAnd I could get dental care at the VA, but they charge a humanitarian fee that is way higher than a dentist would have charged. And I can't afford a regular dentist, and I know that I'm not alone because I talked with the other veterans. They'll treat my heart disease, but we know the connection between illnesses and, you know, dental health. And yet the VA doesn't seem to look at this.

  • 10:50:40

    REHMMatt.

  • 10:50:41

    STINERNow, I think -- first, have you -- well, first off, thank you for service. Have you tried voc rehab as far as employment training?

  • 10:50:49

    JENNYYes, I have.

  • 10:50:50

    STINEROK. So have you exhausted all those resources?

  • 10:50:53

    JENNYPretty much. Yeah.

  • 10:50:55

    STINERI will still try to go back. Voc rehab is a great program for disabled veterans to get them back training and working again. I'm not too familiar, though, with VA dental care. I don't know if any of my other colleagues are.

  • 10:51:07

    RITCHIEAnd just for the listeners, voc rehab is vocational rehabilitation.

  • 10:51:10

    REHMOf course. Yeah.

  • 10:51:12

    RITCHIEI also can't speak to the VA's dental policy. I think what you are expressing -- and I feel and so many -- is just a frustration with how difficult the VA is to get into.

  • 10:51:25

    REHMI sure hope that someone out there listening, especially today, can take into account what people out there need rather than on the incredible bureaucracy.

  • 10:51:41

    JOYNERDiane, I'd like to go back to a point that Paul had made on this issue...

  • 10:51:45

    REHMSure.

  • 10:51:46

    JOYNER...about the splintering -- splintered resources because people need a lot. But families and our service members, they're incredibly resilient. But since 2001, they have recorded 40,000 charities registered with the IRS that support military families and military service members. There are 10,000 websites that support military families. There are 3,500 DOD websites with information for our military service members. And so sometimes, there is not a lack of support.

  • 10:52:23

    JOYNERIt's drowning in that sea of goodwill, not knowing where to go, who to turn to, who offers the best program. And so at the National Military Family Association, we're addressing that issue on the military family side and have started with an app called My Military Life, but there's a lot of work to be done here. We're competing for resources, money, volunteers, supports functions. And our service members and our families are the ones who are struggling in the meantime.

  • 10:52:53

    REHMSo if she simply came to you, to your website, could you direct her to dental services that might help her?

  • 10:53:04

    JOYNERWe could definitely get her on the right path, but I would say that the folks at IAVA are the best to help her because she was in the service. We...

  • 10:53:13

    REHMIAVA?

  • 10:53:13

    JOYNERYes, Iraq and Afghanistan Veterans of America, Paul's group, they deal wonderfully with the service members.

  • 10:53:20

    REHMAnd you're listening to "The Diane Rehm Show." Let's go to Reidsville, N.C. Hi there, Andrew.

  • 10:53:29

    ANDREWHi, Diane. How are you?

  • 10:53:30

    REHMGood. Thanks.

  • 10:53:31

    ANDREWSo here's my quick comment. So many people have thanked me for my service. While I appreciate their thanks, I can tell by the way they divert their eyes that I think they're somewhat hollow. I mean, let there be no doubt that they're sincere. However, they have no idea what they're thanking me for. As a veteran of Iraq, Afghanistan and Kosovo, serving in the 173rd Airborne and the 82nd Airborne...

  • 10:53:53

    RITCHIEHooah.

  • 10:53:54

    ANDREW...it's my sole purpose now to show non-veterans what we veterans have endured. After graduating at the University of North Carolina at Greensboro, I bundled the collection of short stories and self-published them on Amazon. The reason I did this was twofold: one, to give me distance and perspective of my own experiences and, two, to allow my friends, family and others into the world of a veteran. In doing this, I -- there is a recession of bitterness and resentment in me because, after I got out of the service, I felt like that there is a disconnect between society and the veterans.

  • 10:54:23

    ANDREWPeople are more interested in, like, a flavor of the month or the most recent reality TV show. But because I was -- been able to do this and people have actually read my work and commented on it, I feel like I've been able to move forward with my life. And, of course, I couldn't have done this without the VA. I couldn't have done this without vocational rehab.

  • 10:54:39

    REHMWell, I hope you don't think this sounds hollow, Andrew, but I do. Thank you for your service. I'm glad that the writing has helped him, Matt.

  • 10:54:52

    STINERNo. Actually, I'm glad that veteran, you know, found something that can help him. You know, we've got to be innovative. I think kind of a comment on the VA, you know, it's just about increasing their budget every year. We need to be innovative. One area that the VA has been extremely innovative is their Veterans Justice Outreach Program.

  • 10:55:09

    STINERIn my line of work with Veterans Treatment Course, the VA -- literally each VA hospital -- puts a Veterans Justice Outreach specialist in that court to make those appointments, to get them connected to the benefits. And they are saving lives, and that's an area where the VA is being proactive in.

  • 10:55:24

    REHMSo for families, what's next?

  • 10:55:29

    JOYNERThat's the question we asked ourselves each day because we still have families that are deployed to other places around the world, not just to Afghanistan. There are new families that are coming into the service everyday, and there are families that are moving into veteran status. And so we're watching carefully how military families make that transition. But we're hopeful that there are resources like through the GI Bill transferability for military spouses.

  • 10:55:56

    JOYNERWe are happy to see attention being drawn to schools for military children. But I'll tell you, there's never enough. And so we're always working to make sure that our families and our service members stay strong and that the community does support them, but it takes individual help.

  • 10:56:14

    REHMAnd a great many people have said, what can I do? Where can I offer my volunteer services?

  • 10:56:23

    RITCHIEA very promising approach is to go state by state and get the VA, the DOD, the academics, the non-governmental organizations together in that state -- North Carolina is a leader in this, for example -- and to say, OK, here are the needs and here are the resources 'cause as others have said, there's a lot of people who want to volunteer but you want to be able to match the needs and the resources there. So I would look at your local state Veterans Affairs, talk to them is a place to start and say, what are you doing in your state?

  • 10:56:55

    REHMDr. Elspeth Cameron Ritchie, chief medical officer of the D.C. Department of Mental Health, the author of "Battleland" blog at Time.com, a former chief psychiatrist in the Army. Michelle Joyner, communications director for the National Military Family Association, and Matt Stiner, director of Justice for Vets. Thank you all so much for being here...

  • 10:57:26

    STINERThank you.

  • 10:57:26

    JOYNERThank you, Diane.

  • 10:57:27

    RITCHIEA pleasure.

  • 10:57:28

    REHM...and offering your help to our listeners. And thanks for listening, all. I'm Diane Rehm.

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