New mental health services for veterans and their families

Credit: Norbert von der Groeben

An Iraq War veteran, Ekk Phixitxonh is the intake coordinator for a Stanford Hospital program to address the mental health needs of veterans.

As a veteran of the Iraq War, Ekk Phixitxonh knows firsthand the stresses of military service, and the readjustment problems veterans and their families often face upon returning to civilian life.

In late 2003 and early 2004, Phixitxonh served in the U.S. Air Force Reserve as a medical technician at a Baghdad medical facility that stabilized wounded service members for transport to a military hospital. Though he wasn’t in combat, he treated those who were wounded in the war, emotionally as well as physically. “We saw guys who had psychological issues from what they’d seen, like a soldier who’s out on patrol and his buddy gets hit,” he said. Meanwhile, the facility where Phixitxonh worked was attacked almost daily by mortar shells, creating an atmosphere of fear.

When his tour was over and he came home to the Bay Area in 2004, Phixitxonh—an Air Force reservist from 1996 to 2007—said he felt “lost” and had “feelings of abandonment.” He also missed the sense of purpose and structure that military service offered. “When you come back, you lose that structure, and you feel like you have to start over and re-establish yourself.”

Now, as the intake coordinator for a new Stanford program called Stanford Vets Connect, Phixitxonh is working to help other Bay Area veterans and their family members—a group with unique stresses and challenges—to get mental health services to help them readjust to life after military service. The program offers free, confidential evaluation and treatment through Stanford Hospital & Clinics’ Department of Psychiatry and Behavioral Sciences for Iraq and Afghanistan veterans and family members who haven’t sought or don’t want to receive care through the VA system. Stanford Vets Connect provides four to six months of treatment, including evaluation, psychotherapy and medication, as appropriate, for veterans and close family members, including spouses, significant others, parents and siblings.

“We know there is a real need here,” said Bruce Arnow, PhD, Stanford Hospital’s clinical director for Stanford Vets Connect and professor of psychiatry and behavioral sciences. “There are returning veterans who have problems with readjustment, who are struggling with depression and PTSD (post-traumatic stress disorder), who are falling through the cracks because they aren’t getting care. We have an obligation to help them. This is what we in Stanford’s psychiatry department can do.”

More than 1.8 million U.S. service members have been deployed to Iraq and Afghanistan, according to the Department of Defense. A July study, based on Department of Veterans Affairs data, found that 37 percent of Iraq and Afghanistan veterans have mental health problems, including depression, PTSD and substance abuse. That was a nearly 50 percent increase from the last time the prevalence was calculated, in a 2007 study.

The emotional toll is evident in an increasing suicide rate. According to U.S. Army statistics released in January, the number of suicides among U.S. soldiers in 2008 rose for the fourth year in a row, reaching 128—the highest level in nearly 30 years.

The stresses of military service also have a serious impact on veterans’ relationships, contributing to domestic abuse and divorce. “When a veteran comes home, it’s very difficult for the spouse,” noted Alan Schatzberg, MD, professor and chair of psychiatry and behavioral sciences, who has played a key role in establishing the Stanford Vets Connect program.  “A lot of these guys come back with depression. They feel stressed out and vulnerable. Maybe they can’t find a job, or they’re disabled and they can’t work. All of that has a marked impact on the family.”

Stanford Vets Connect is not meant to duplicate services already offered by the VA, but provides another point of access for veterans and family members whose well-being has been affected by military service and who aren’t receiving treatment for these problems. The program, for example, offers individual therapy to veterans’ family members—a service for which family members usually aren’t eligible under the VA system.

And while veterans from the military reserves and National Guard are eligible for all VA services, some assume they aren’t covered and thus don’t seek care. Other veterans are wary of seeking help through the VA because they don’t like to identify themselves with their veteran experience.

Stanford Vets Connect is a partnership with Welcome Back Veterans, a national campaign launched last year by Major League Baseball and the McCormick Foundation to raise awareness about the challenges facing today's veterans and to raise funds for programs and services for them. Stanford Vets Connect is funded through a $250,000 grant from the McCormick Foundation.

As part of Welcome Back Veterans, Stanford is working with two other participating medical centers—Weill Cornell Medical Center in New York, and the University of Michigan Health System—to refine mental-health treatment protocols for the spouses and dependents of veterans. This will entail identifying the greatest unmet needs among family members and determining which treatment approaches work best for which individuals.

Stanford Vets Connect will work closely with the VA Palo Alto Health Care System to share information on unmet needs and best practices, to educate veterans about VA services and to refer interested veterans for VA care. The program’s director, Steven Lindley, MD, PhD, is director of outpatient mental health at the VA-Palo Alto, as well as assistant professor in Stanford’s psychiatry department.

A major focus of both Welcome Back Veterans and Stanford Vets Connect is to raise awareness about the heavy toll of depression and PTSD among veterans, and to encourage veterans and their families to get help. That can be difficult, Phixitxonh acknowledged, because of the stigma that’s still associated with seeking mental health care, particularly in the military culture.

“There is an unwritten code [in the military] that says, ‘Be a man. Work through your problems on your own, and don’t talk about them,’” Phixitxonh observed. But he has a different message: “My message to veterans would be, you served your country. Now it’s our turn to help you.”

How to get help

If you are a veteran of the Iraq or Afghanistan wars (or a family member of a veteran) who is having trouble readjusting to life after military service and is not receiving treatment for these problems elsewhere, help is available through the Stanford Vets Connect program. Contact them at (650) 725-9981 or VetsConnect@stanford.edu, or visit http://vetsconnect.stanford.edu.