Nothing to Lose

Four men sit together in a room, having two things in common: they served their country in uniform, and they know what it's like to be homeless. These four veterans - Rick, Russell, Darryl and Brian - could easily be dead.

Rick, who discovered "chemical courage" during the Vietnam War, had his suicide all planned out until friends intervened and got him to a VA medical center. Russell, suicidal after 40 years of post-traumatic stress disorder, walked into a VA center and "just gave myself over to them." Darryl swallowed 80 painkillers and a bunch of other pills; when he came to, his stomach was being pumped at a VA hospital. Brian, addicted to crack cocaine, confessed to his brother he was going to kill himself: "He told me he didn't want to see me die, and he drove me to the VA."

These four men are real people, homeless veterans who stood at the edge of self-destruction, looked into the darkness, then slowly withdrew - helped by people they didn't know. They are survivors. Now, when they talk about their futures, hope can be heard in their voices. With drug and alcohol abuse, reckless behavior and failed relationships behind them, they've achieved a measure of clarity in their lives.

"Having that moment of clarity is valuable," says Rick, who served as a forward air controller directing strikes in Vietnam. "When you're on the street, you get used to the judgmental dismissals, but you internalize them," he says. "In addition to the helplessness, hopelessness and self-loathing that you feel, you also lose an ability to trust. The moment of clarity can be brief and fleeting, but without that, the chasm would have been too wide."

After spending time in a suicide-prevention ward, Rick's mind began to clear. VA got him into a housing program run by HVAF of Indiana, a community-based service in Indianapolis that helps homeless veterans and their families. Rick got the treatment and therapy he needed to defeat his depression. Now he works full time for HVAF as a counselor and case manager, working with homeless veterans like Russell, Darryl and Brian.

"All the other treatment centers I've been to, I've never been to one like this - it's vets helping vets," Brian says. He is one of 20 veterans who has a bed, meals and a roof over his head at HVAF's transitional housing facility (another 40 beds were added in October). Knowing that veterans are helping other veterans put their lives back together is important to him and the others.

"It's just the camaraderie that we have with one another, picking each other up, building our self-esteem," Darryl says. "When I got here, I didn't know what to expect, but you don't really have to expect anything. Just bring your body, and the rest will follow, because the brotherhood is here."
Russell is so pleased to be in an outreach program for veterans that he vows to "do anything I can in my future to help support them. If it wasn't for veterans and veterans organizations, I'd have been in a lot worse shape, and I probably wouldn't be here."


THE CAUSE. Eighty percent of U.S. veterans own houses. So what can go so terribly wrong in the lives of so many veterans - up to 400,000 throughout any given year - that they have no place to call home?

"I think a lot about that question, and it's sort of stunning," says Steve Berg, vice president for programs and policies at the National Alliance to End Homelessness (NAEH) in Washington. "I can give a lot of answers, but I think the main problem is, there's no one who has taken it upon themselves to make sure it doesn't happen."

Until recent years, VA and DoD paid little attention to the homelessness phenomenon among veterans. The problem was virtually non-existent after World War II because troops who returned from the war with serious mental or physical damage were typically cared for by their families.

Pete Dougherty, who runs VA's homeless veteran programs, says the World War II generation came back to an America where families had stronger connections than they do today. "Most of them grew up in the same towns that their parents had grown up in," he says. "Most of them lived with extended families. As we got to the Vietnam-era veterans, that family cohesion had largely changed. We became a much more mobile society."

As the century progressed and increased mobility spread families farther apart, it became difficult for extended families to care for their own. Veterans returning from Vietnam often had smaller family networks to depend on, yet many of them needed more care. They had lost limbs in battle. They suffered mental anguish that became post-traumatic stress disorder.

"As a department, as a nation, we didn't even recognize, until years after Vietnam ended, that there was such a thing as PTSD," Dougherty says. "Now if there is affective disorder and it becomes PTSD, we now recognize it."

Veterans don't become homeless overnight. It usually takes a while for physical and mental maladies to percolate and boil over. It takes a while before drug and alcohol abuse throws relationships into jaded standoffs. Eventually, families and friends give up on them.

"People take a lot of steps before they get there," says Nan Roman, NAEH president. "Usually, by the time they're homeless, they're not earning enough money, they've worn out their families and friends, they've moved, so they have no support networks. People do just about everything to keep themselves from becoming homeless."

With their social bridges burnt, and unable to earn steady incomes because of disabilities or substance abuse, a wave of Vietnam War veterans were forced into the streets during the 1970s and '80s. Cheryl Beversdorf, CEO and president of the National Coalition for Homeless Veterans (NCHV), says about 45 percent of the homeless veteran population served during the Vietnam era. Most of the remainder represents more recent veterans, including men and women returning from Iraq and Afghanistan - an estimated 20 percent of whom have suffered traumatic brain injuries.

While PTSD and other mental traumas are a major factor for homelessness among veterans, they aren't the only cause. "The second is economic security - dealing with employment," Beversdorf says. "They need skills in order to get a job again, but the skills they acquired in the military may not be transferable to the civilian sector."

A third factor that makes many veterans homeless is the scarcity of affordable housing. Linda Kaufman thinks it may be the most problematic. As chief operating officer for Pathways to Housing in Washington, she's placed many homeless veterans in transitional housing.

"People can't afford to get their own home," she says. "That is the biggest problem in the United States today causing homelessness. And if you couple that with people who were in battle - who may have had some kind of injury - that makes it harder."

Right now, some veterans and their families are having trouble paying their rents or home loans. If they are turned out, who will help them? "It's just wrong," Roman says. "Nobody in a country like this should be living without a home, and certainly veterans. It's just not acceptable."


THE CURE. The highest priority, most national experts say, is simply to get more homeless veterans off the streets and into housing and treatment programs. There's an entire continuum of care available, but it starts with outreach and trust-building: a simple handshake and hello. That's what outreach teams do. They hit the streets, going to emergency shelters, missions, parks and doorways. They introduce themselves, start conversations and get veterans - many burnt out on government bureaucracy - to communicate.

Charles Haenlein, CEO and president of HVAF, says his outreach teams "get a really good reception because they've been there. And that's one of the first things they tell these guys: ‘We know you can do this, because we've been where you are.'" Team members are also veterans, which gives them a lot of credibility. Sharing memories of bone-chilling days in boot camp at Great Lakes can lead to a nod of agreement to the question: "Would you like to see what our program's about?"

Philip Thomas is a homeless veterans coordinator for HVAF. He knows that once people get into their program, they start to feel better about themselves; they stop drinking and start looking for work. But change can't be forced upon them.

"Our job is to try to meet them where they're at, find out what they want. A lot of them don't necessarily want to stop drinking or stop using drugs right away. They want to get off the street. Sometimes it's hard for them to buy into a program when we say, ‘You know, there are a few strings attached to our housing.' So it's our job to have faith and hope in them."

Although the Department of Housing and Urban Development (HUD) provides funding for a lot of transitional and permanent housing for homeless veterans, each municipality administers its own program. When it comes to veterans who lapse back into alcohol or drug abuse, the rules of the game vary. In some programs, violators must leave their homes and return to the streets. That attitude no longer prevails among housing providers.

"It's pretty hard to stay sober if you go to a program in the daytime, go back to the street and drink with your buddies at night, and go back to the program the next day," Haenlein says. "But if we can put someone in a house and surround him with supportive services, then we've changed his environment, and now he can focus on his recovery. We have a policy that you cannot drink, but if someone does relapse, we don't throw him out with the garbage."

Instead, a treatment team meets to find out why the veteran had a relapse, work it out, and keep the person in the program. Yes, there are consequences from breaking the rules, but going back to the street isn't one of them. "We're on the right track now," Haenlein says. "It's got to be a housing-first model."

HUD and VA seem to have gotten that message, because their joint effort to alleviate chronic homelessness among veterans is gaining momentum. The program is called HUD-VASH (Veterans Affairs Supportive Housing) and operates on a voucher system that subsidizes permanent housing and support services for homeless veterans. HUD pays for housing, and VA pays for services; tenants pay 30 percent of their monthly income.

Last year, Congress provided $75 million to HUD-VASH for 10,000 housing vouchers. Beversdorf and other advocates pushed hard for that funding; their major ally on Capitol Hill was Sen. Patty Murray, D-Wash. "This is a problem I've been tracking for some time, and have held hearings on it," Murray said. "I was amazed to hear about the increasing number of veterans who are coming home, can't get a job, are dealing with PTSD or traumatic brain injury, and are ending up homeless."

Murray, whose father was a World War II veteran, worked at the Seattle VA Medical Center during the Vietnam War.

Of all the veterans who move in and out of shelters and other housing throughout the year, about 20 percent are chronically homeless; programs such as HUD-VASH are designed for them. But veterans who just need help paying for their housing are a different matter and need a different answer. Mary Cunningham, a senior researcher at The Urban Institute, says that a significant housing program for low-income veterans does not exist.

"There are no programs to help them pay for their housing," Cunningham says. "There's transitional housing, but returning vets with families don't really fit into that model. "If you are responding to your mental-health needs, trying to pay your rent, trying to transfer your skills to civilian employment, there's probably a period of time when you're going to need help paying for housing." It only takes one missed payment to get in trouble with your bank or landlord, and today's national wave of foreclosures may, indeed, help to create a new generation of homeless veterans.

Cunningham suggests that VA should pay more attention to the housing stability of veterans. "VA is not in the business of providing housing, but if you're a veteran, you go and get all your services at VA. So somebody there has to care about housing, especially because we know veterans are disproportionately homeless," she says, referring to studies that identify veterans as 20 to 25 percent of the total U.S. homeless population.


THE OUTLOOK. On its own initiative, HUD has asked for another $75 million next year to fund 10,000 more HUD-VASH housing vouchers. If that trend continues for another five years or so, virtually all chronically homeless veterans - those with serious health or substance-abuse problems - could be housed, along with their families.

The first 10,000 residences are associated with 132 VA medical centers that will provide support services, everything from physical therapy to drug counseling. Some of these homes were allocated to every state, Puerto Rico and Guam. VA is also paying for 290 case managers nationwide to help all those veterans get into permanent housing and maintain it.

VA likes the voucher program because it provides permanent housing (five-year leases with five-year renewals) exclusively for veterans. "The units stay available for another veteran if one moves out," Dougherty says. "In the past, when a veteran moved out, the unit went away, the voucher went away and somebody else got the use of it." Federal law now requires the vouchers to roll over automatically to other veterans.

What about the cost of such a program? Is it worthwhile for the taxpayer? Cunningham, at The Urban Institute, says yes: "It may sound like a really expensive option to the taxpayer, but we've found that if you help someone who's chronically homeless move into an apartment, you actually save money. Or else it costs about the same as the services they would use: emergency hospital services, mental-health services, policing, jail. So you can offset the costs. It's better for them, and it's better for the taxpayer."

VA has another successful antidote to veteran homelessness called the Grant and Per Diem Program. It is designed for veterans who need around-the-clock intensive case management, structured with rigorous support services for health and substance-abuse problems. Facilities vary from regular apartments to a room shared by two or three veterans.

Besides the efforts of Sen. Murray, who says she will continue to press for more funding of housing vouchers, Congress is considering two bills that could help veterans at risk for homelessness. One, the Homes for Heroes Act, directs HUD to help nonprofit groups that provide housing for low-income veterans and their families. The other, H.R. 5823, was introduced by Rep. Steve Israel, D-N.Y., to allow a taxpayer to donate $3 on income tax forms to help homeless veterans.

"There can be any number of important causes," says Rep. Peter King, D-N.Y., one of the bill's 55 cosponsors. "But when you're asking someone to literally take a bullet for their country, the least we can do is to make sure they've got a roof over their heads."

The American Legion has long played an active role in addressing the homeless veteran problem. Its Homeless Veterans Task Force (HVTF), supported by the Legion's 55 departments worldwide, augments the efforts of VA, NCHV, the Department of Labor and other service providers.

Each Legion department has an HVTF chairman and an employment chairman. Both coordinate activities with Legion posts to help homeless veterans and prevent returning veterans from joining their ranks.

"A local post can have a very strong impact on helping a young warrior reintegrate," says John Driscoll, NCHV vice president for operations and programs. Legionnaires can do the most good by supporting veterans in their own communities who are in trouble. "The trick is to identify them and help them open up, before they're at risk of becoming homeless," Driscoll says. "If you've got 300 Legion members, there's got to be a rental property, a job, and access to training in there somewhere."

American Legion posts are well-positioned to join other community-based groups in reaching out to homeless - or nearly homeless - veterans. Having a clean, well-lit place to stay, regular meals, hot showers and friendly conversations with veterans - even for a few days - can make a lot of difference to warriors who have lost their way.

Darryl, the Navy veteran who tried to end his life with 80 painkillers, found his way again. "I got to thinking, this is my third suicide attempt. And I really tried to end my life, but it didn't work. Then I figured, I'm not successful at killing myself, so why not try living for a change?"

Others - such as Rick, the Air Force veteran who directed air strikes in Vietnam - are proof positive that veterans really do help other veterans. He's got some advice for those who still need to find their way back from the parks, streets and underpasses of America: "You are the same person who deserves the respect, the dignity, the care and the concern, who put on that uniform, did his duty, her duty, protected our rights, defended our freedom, earned your place in this country. You have greater contributions to make. You deserve and have earned more than you're experiencing.

"Try a little trust. You've got nothing to lose. It might just be real."


Philip M. Callaghan is managing editor of The American Legion Magazine. Lauren Wright is a freelance writer who lives and works in the Washington, D.C. area.