It's Wednesday morning, a couple of weeks before Christmas, and the VA mental health clinic in Mission Valley is busy. The seats in the clinic's relatively large waiting room are already filled, mostly by men in their 50s, many of whom have that look about them that leads one to assume they're Vietnam vets.
Experts in combat-related post-traumatic stress disorder warn that VA clinics like the one in Mission Valley could, over the next couple of years, be inundated with soldiers returning from Iraq and Afghanistan seeking counseling and psychiatric services. Just how many vets might need help is anyone's guess. Post-traumatic stress can be acute, surfacing immediately after a soldier returns home (or even while a soldier is still on active duty), or PTSD can fester undetected for months or years. A 2003 study by Army doctors, published in the New England Journal of Medicine, concluded that 16 percent of soldiers currently serving in Iraq suffer from PTSD. Repeat tours of duty and the unknowns that come with fighting an urban war could drive that number higher.
San Diego County's VA medical system, serving the fourth largest veteran population in the U.S., seems to have its hands full with the people it cares for already, largely Vietnam vets. Jeffrey Matloff, who directs the San Diego VA system's Post Traumatic Stress Clinical Team, says the Mission Valley PCT clinic, one of five VA outpatient clinics in San Diego County, has seen an increasing, though not overwhelming, number of vets coming back from Iraq and Afghanistan seeking counseling. But so far, it's only the tip of the iceberg, he said.
"I think the wave we're expecting is probably going to be in a couple of years," he said, "when people have gotten out and [recognized] that maybe things aren't going well."
Matloff said that for awhile he feared a "perfect storm" would hit San Diego's VA system-the impossible task of trying to accommodate the veterans his clinic already sees as well as the new vet population. "We were ready to call uncle," he said, but recent additional federal funding plus promising grant applications have left him feeling more optimistic that they'll have the resources to handle an increase in clients.
"I think the VA is in much better shape certainly than it was in dealing with other conflicts prior to this," he pointed out. "We have 25 years of research. We have people trained to deal with this stuff. We have more interventions. As a whole, I think we're much better prepared."
Working in tandem with the county's VA system are San Diego's two Vet Centers, one in Vista, the other in downtown San Diego. Vet Centers, historically, were storefront community centers set up by Vietnam vets fed up with the bureaucracy of the government-run VA system. Originally staffed by veterans, Vet Centers now are the go-to place for so-called "readjustment counseling"-group or individual therapy intended to help combat vets transition back into civilian life. These days, Vet Centers are staffed by professionally trained counselors, funded by the Department of Veterans Affairs and have a more symbiotic relationship with the VA system than they might have had in the past.
At both the Vista and downtown Vet Centers, projections for the next couple years are the same: things could get busy for their small counseling staffs, but no one's panicking. Sgt. Joe Costello, the counseling team leader at the Vista center-and a reservist who recently returned from a year in Afghanistan-says his staff is "emotionally and physically preparing" for an increased caseload.
"I expect we'll be much busier," he said, "but there's a lull. People get back and everything's peachy. They're home with their wives or girlfriends or husbands and everything's just great because anything's better than being [in Iraq]. Then the problems start showing up a couple of months later-then we start to see them."
Costello said that last month his counseling staff saw 611 vets-a typical number-and worked with 59 families. Of those clients, 34 were new and nine were vets who fought in Iraq or Afghanistan.
"We try not to pathologize what's going on because not everybody has PTSD," said Costello. "We approach it as, hey, there's going to be natural readjustment issues, natural transition issues. Some of them may be transitory and some of them may be more than that.
"We try to provide as non-threatening an outreach effort as we possibly can," he said.
The Department of Veterans Affairs recently hired 52 outreach coordinators nationwide. San Diego County got one-and he's tasked with covering parts of Riverside County as well. It's the outreach worker's job to hit up colleges, military bases, National Guard armories-anywhere where vets might be-and let them know about counseling services available to them at San Diego's two Vet Centers. A team of two outreach workers also attends weekly Transitional Assistance Programs held by the Department of Defense for active-duty soldiers about to be discharged from the military. Last year alone, between 45,000 and 50,000 active-duty soldiers were discharged from local bases, according to figures provided by the Transitional Assistance Program.
Karen Schoenfeld-Smith, Costello's counterpart at the downtown San Diego vet center said her staff of four has seen an increased caseload, but nothing they can't handle. On any given day, each counselor will see five clients and facilitate one group. To prepare for the future, Schoenfeld-Smith said her staff has been considering setting up a peer-to-peer support network that would pair older vets with younger vets.
"Those people who have been through treatment and are concerned about our new veteran population can share some of their own experiences to help facilitate healing," she said. This process offers older vets, especially those who served in Vietnam, a chance to give value and meaning to what they went through, she added.
Matloff, too, says he sees this kind of outreach-Vietnam vet to Iraq vet-becoming more frequent. "There's a lot of altruism," coming from vets of previous wars, he said, "in terms of reaching out and visiting the hospital, just trying to be there."
Jerry Stadtmiller, PTSD program director for the nonprofit Vietnam Veterans of San Diego, said a vet's ability to provide peer support depends largely on where that person is in his or her own recovery. One veteran of the first Gulf War Stadtmiller is currently working with came in for counseling after he found that media coverage of the current war was opening old wounds he hadn't dealt with.
Stadtmiller said he has to remind some of the vets he works with not to pay too much attention to the news-get the information you need, he tells them, but don't become addicted to it. For the most part, though, the vets he counsels, especially those who fought in Vietnam, are "gearing up" as he puts it, to assist their young counterparts.
"When these kids come home, I'm sure that Vietnam vets, veterans who have fought in [Central] America, veterans who have fought in Desert Storm, they're going to come out and embrace them and be there for them in a meaningful way, not just the flag-waving kind of way," said Stadtmiller.
A Vietnam vet himself, Stadtmiller was shot in the head and, as a result, lost most of his eyesight and a portion of his face. He doesn't mince words when he talks about the impact war can have on a person and why it's so important to find someone who can relate to that experience. He still recalls, vividly, the first guy he killed in Vietnam. "It was the most abhorrent thing I've ever had to do in my life, even though this man was trying to kill me," he said. "In my experience, the righteousness of politics is not as core as the ugliness of [war]."
Like Stadtmiller, Costello can empathize with the soldiers he counsels because he's been there, too-and says he'll go back if asked. "Being constantly shot at; being exposed to a high level of anxiety day in and day out-there's never a break," he said. "When people shoot at you, it's really, really intense. It's as scary as it gets."
Costello said he'll never forget the first time he realized someone's gun was aiming for him. "It's a life-changing event," he said. "It's not in the realm of normal human experience."