Public Hearing to Solicit Information on Post-Traumatic Stress Disorder (Ptsd) in Veterans Returning from Combat

1 BEFORE THE NEW YORK STATE SENATE

STANDING COMMITTEE ON MENTAL HEALTH AND 2 DEVELOPMENTAL DISABILITIES 3 -------------------------------------------------- 4 PUBLIC HEARING 5 TO SOLICIT INFORMATION ON

POST-TRAUMATIC STRESS DISORDER (PTSD) 6 IN VETERANS RETURNING FROM COMBAT 7 ----------------------------------------------------- 8

Legislative Office Building 9 Hearing Room B - 2nd Floor

Albany, New York 10

February 29, 2012 11 10:00 a.m. to 1:00 p.m. 12 13 PRESIDING: 14 Senator Roy J. McDonald

Chair 15 16 17 SENATE MEMBERS PRESENT: 18 Senator Shirley L. Huntley (RM) 19 Senator Lee M. Zeldin 20 21 22 23 24 25 1

SPEAKERS:PAGE QUESTIONS 2

Christopher Delaney 9 21 3 President

9-1-1 Veterans 4

Dr. Yuval Neria 32 43 5 Director of Trauma & PTSD Program

Columbia University's College of 6 Physicians and Surgeons 7 John A. Javis 52 58

Director 8 Veterans Health Alliance of Long Island 9 Dr. Charles Kennedy 63 70

Clinical Director, PTSD Treatment Program 10 Peter Potter

Public Affairs Director 11 U.S. Dept. of Veterans Affairs,

Albany Station 12

Andrew Roberts 76 87 13 Director, Office of Military &

Veterans' Services 14 North Shore - LIJ Health System 15 Carol Davidson 89 98

Director of Veterans' Services 16 Samaritan Village, Inc. 17 Karin Moran 100 107

Director of Policy 18 National Association of

Social Workers - NYS 19

Jonathan E. Gradess 108 114 20 Executive Director

New York State Defenders Association 21

Command Sgt. Major Gary Flaherty 119 124 22 Director

Columbia County Veterans' Service Office 23

Thomas Ronayne 119 124 24 Director

Suffolk County Veterans' Service Office 25 1

SPEAKERS (Continued): PAGE QUESTIONS 2

John Richter 133 138 3 Director

Mental Health Association - NYS 4

Roger Ambrose 144 152 5 Director

Jefferson County Community Services 6

Katherine Maciol 144 152 7 Commissioner

Rensselaer County Dept. of Mental Health 8

Andrew Davis 156 161 9 Director

Saratoga County Veterans' Service Agency 10

Hatty Baldwin, R.N. 163 165 11 Fiancee of John Patrick Jennings

Resident of Suffolk County 12

L.W. Murphy 163 165 13 Chairman

Suffolk County Veterans' Advisory Panel 14

Dennis O'Donnell 170 176 15 Founder

Warriors' Circle Program 16

Joel Abelove 176 186 17 Attorney

OEF Veteran 18 ---oOo--- 19 20 21 22 23 24 25 1 SENATOR MCDONALD: Okay, folks, I'd like to 2 take this opportunity to thank you for being here. 3 We're starting a program, to gather 4 information and all kinds of public input in 5 reference to a very serious topic, and that's, 6 post-traumatic stress, its relationship to the 7 returning men and women in our military who are 8 coming back to New York State, the relationship it 9 has to suicide, and so many other sad things that 10 have impacted these men and women who are serving. 11 It's not just in this war, but in previous 12 wars, and, what we can do to help them out. And 13 we're trying to gather that information, so we can 14 learn from it, so we can turn around and help these 15 folks. 16 We have this hearing. This hearing will go 17 to approximately 12:30. 18 We have several very prestigious speakers; 19 some people who have encountered these problems, 20 some professionals that deal with these problems. 21 And our objective is, here, to learn from 22 that. 23 This will be the first public hearing. We 24 will be doing public hearings in other parts of the 25 state, on this topic. 1 I am Roy McDonald, the senator who is the 2 Chairman of the Mental Health and Disabilities 3 Community -- Committee. Excuse me. 4 I am also a Vietnam Army veteran. And I'm 5 exceptionally proud to -- 6 [Applause.] 7 SENATOR MCDONALD: Thank you. 8 I'm especially proud to introduce a new young 9 senator, Lee Zeldin, from Long Island, who not only 10 is a very bright, intelligent young man, but he's 11 also a very courageous man. He is an Iraqi War 12 veteran. 13 [Applause.] 14 SENATOR MCDONALD: At this time, I would like 15 to turn it over to Senator Zeldin, who will lead us 16 in the Pledge of Allegiance, and also talk about our 17 first speaker. 18 And the flag is, right here. 19 SENATOR ZELDIN: If everybody could stand. 20 (All recite, as follows:) 21 "I pledge allegiance to the flag of the 22 United States of America, and to the Republic for 23 which it stands, one nation under God, indivisible, 24 with liberty and justice for all." 25 SENATOR ZELDIN: If you don't mind, remain 1 standing for a brief moment of silence, and now 2 would be a most important time to say a silent 3 prayer to yourself, for all those that we've lost 4 for post-traumatic stress disorder as a result of 5 their service to our country. 6 (Moment of silence is held.) 7 SENATOR ZELDIN: Thank you. Please be 8 seated. 9 Well, thank you, Senator McDonald. 10 It's been a pleasure to serve as a member of 11 the Mental Health Committee since I joined the 12 State Senate last year. 13 It's also been an honor to serve in the 14 military. I still serve in the Army Reserves. 15 And, going back to my time on active duty, it 16 was one of the saddest -- one of the saddest 17 experiences, to have someone that you know, who 18 deployed, maybe multiple times, they come home with 19 the mental wounds of war. And, despite the fact 20 that they survive a deployment, unfortunately, those 21 mental wounds end up claiming their life afterwards. 22 When I returned home in 2008, I had the 23 opportunity to meet our first speaker. 24 His name is Christopher Delaney. 25 And told me a story of PFC Joseph Dwyer. 1 And as you see in front of you this famous 2 picture of PFC Dwyer, there was a picture in "Time" 3 magazine. All of you have seen this picture. And 4 he was -- he was almost, you know, a poster child of 5 everything right of what we were doing overseas. 6 He returned home with those mental wounds I 7 just discussed. 8 He had a wife, a young daughter. And, 9 unfortunately, PTSD ended up contributing to the 10 loss of his life after a very heroic deployment and 11 service to our country. 12 I wanted to work on some type of a program 13 with, you know, Senator McDonald, and my colleagues 14 here in the Senate and the Assembly, for us to 15 address post-traumatic stress disorder. 16 And, last January, when we were forming a 17 panel in the 3rd Senate District, to help develop a 18 legislative solution, someone that I was close with, 19 named John Patrick Jennings, unfortunately, lost his 20 life. And our panel went from being a 21 Veterans' Advisory Panel to the 22 John Patrick Jennings' Veterans' Advisory Panel. 23 This is something that doesn't get enough 24 attention in the media, throughout our state, and 25 throughout our country. There are veterans that are 1 deployed now that will return home with these mental 2 wounds. 3 There are -- there are veterans from wars 4 past. 5 Maybe we called it something different in 6 World War II or Korea or Vietnam, but, in our ranks, 7 there are members of multiple generations of people 8 that served our country that have post-traumatic 9 stress disorder today. 10 Our state and our country is not recognizing 11 this problem to the full extent as it needs to. 12 It's not addressing this problem to the full extent 13 that it needs to. 14 And Senator McDonald and I are not looking to 15 have a hearing, so that, for one morning, for 16 2 1/2 hours in Albany, we discuss this issue, and we 17 move on. 18 This is a start. 19 And we are going to fight as hard as we 20 possibly can to make sure that there are results, so 21 that New York State, and other states around this 22 country, do more to help with the diagnosis and 23 treatment of post-traumatic stress disorder. 24 I definitely say, thank you, to all of you 25 that traveled so far to be here, especially our 1 speakers. 2 It means so very much. 3 And, at this time, it's my honor to introduce 4 our first speaker, Mr. Christopher Delaney. 5 CHRISTOPHER DELANEY: Good morning. 6 My name is Christopher Delaney. 7 I am an Iraqi Freedom veteran, 2009 to 2010; 8 a VF Post 7279 member; and founder of 9 "HeroArmyPFCJosephDwyer." 10 I am currently the president of 11 9-1-1 Veterans, a small grassroots not-for-profit, 12 dedicated to helping our Long Island veterans who 13 fall on difficult -- who fall on difficult financial 14 times through no fault of their own. 15 I'm joined here today with Brian Dwyer, 16 brother of Private First Class Joseph Dwyer. 17 I was invited here today to testify on issues 18 regarding veterans with post-traumatic stress 19 disorder. 20 I would like to thank Senator Roy McDonald 21 and Senator Lee Zeldin for giving us this 22 opportunity to shed light on a disease which is 23 plaguing our returning combat troops. 24 Born into a family of police officers, 25 Joe Dwyer enlisted in the United States Army 1 two days after the September 11 attacks. Joe was 2 assigned to the Third Squadron, 7th Cavalry 3 Regiment, Third Infantry Division, a scout unit 4 described as "the tip of the tip of the spear." 5 In March of 2003, Operation Iraqi Freedom 6 began. As the first line of attack, Joe's unit 7 pushed powerfully through Iraq, securing river 8 crossings for the forces racing behind them to take 9 the Iraqi capital during the initial surge. 10 Out of the 21 days to get to Baghdad, only 11 4 lacked any combat. 12 On 25 March, 2003, "Army Times" photographer, 13 Warren Zinn, focused his camera on combat medic 14 Private First Class Joseph Dwyer as he whisked an 15 injured Iraqi boy to safety. 16 To those who saw the photograph on the cover 17 of the "USA Today" and "News Day", it symbolized 18 everything that was right about America. 19 One reader even wrote into the paper to say 20 that, "The photo explains, as no words ever could, 21 why so many Americans support this war." 22 This writer also thanked the soldier for 23 being the American many of us aspire to become. 24 PFC Dwyer was hailed a hero, but the Joe 25 I knew never understood the big to-do. Joe would 1 later say, "What you don't see in the picture is the 2 brave men who had my left and right flank. They 3 were protecting me. My rifle was slung." 4 Joe would return home to a hero's welcome. 5 Things people do not know about Joe, was he 6 was a kind, loving person who embraced life and had 7 a great sense of humor. 8 They also do not know that Joe volunteered 9 for this deployment because a fellow soldier, who 10 was also a medic, was supposed to go, was a single 11 mother. Joe insisted she stay home to take care of 12 her child, convincing her he would be okay. 13 Joe also told his parents and siblings he was 14 based in Kuwait, far from the battle, to put them at 15 ease. 16 When this picture emerged on the front page 17 of "News Day", with making mom proud, it did make 18 Joe's mom proud, but it also brought a sense of fear 19 to the entire Dwyer family. 20 Joe returned to the States, to his beautiful 21 wife, Matina, only a shell of who he once was. Joe 22 displayed all visible signs of PTSD. 23 He was diagnosed by the V.A., and yet we 24 failed him and his family. 25 We failed Joe and the Dwyer family, as a 1 community, a state, and a nation. We leave them to 2 bear the toll of the invisible wounds of war. 3 Joe's story started as a heroic tale, as an 4 American who wanted to bring the fight to our 5 enemies so that we can live in peace here. 6 He served his country with honor. He 7 returned home a hero, and then his story turns into 8 tragedy. 9 Now our mission is to turn Joe's story around 10 yet again. 11 Joe never wanted this attention, but accepted 12 it by saying, "If this photo can help a fellow 13 soldier from going through what I am going through, 14 well, I guess, then, it's worth it. 15 PFC Joseph "Doc" Dwyer, or as his family knew 16 him, "Joe," passed away from the side effects of 17 PTSD in June of 2008. Joe is survived by his wife, 18 Matina; daughter, Meagan; parents, and 19 five siblings. 20 We owe it to them to make this right; to make 21 a change on how we care for all our returning 22 service members. 23 I'm not here to talk you to about 24 post-traumatic stress disorder, or, "PTSD." Others 25 here will discuss that. But I do want to address 1 our neglect to our service members. 2 PTSD has been recorded as early as 480 BC, 3 all the way to our current conflicts. 4 PTSD has been called: Nostalgia; 5 survivor's guilt; anxiety disorder; battle fatigue; 6 combat fatigue; combat neurosis; shell-shock; and, 7 Post-Vietnam Syndrome -- just to name a few. 8 In 1980, the Psychiatric Association added 9 the definition of "post-traumatic stress disorder" 10 to their third edition of "The Diagnostic and 11 Statistical Manual of Mental Health Disorders," the 12 bible of psychiatry. 13 Most recently, PTSD has been redefined, yet 14 again, to "post-traumatic stress injury." 15 The first organized military system for 16 psychological treatment of combat fatigue occurred 17 during the Russo-Japanese War of 1904 to 1906, when 18 physicians were placed close to the front in order 19 to perform evaluations of traumatized soldiers. 20 This was known as "forward treatment." This 21 treatment was expanded upon and used effectively 22 during World War I. 23 At the beginning of World War II, we changed 24 to a pre-enlistment screening that was a complete 25 failure, and psychiatrists were no longer assigned 1 to combat divisions during the war. 2 As a result, many of the successful forward 3 treatments of World War I were forgotten. 4 Psychological casualties were 2.5 times greater 5 during World War II than the previous conflicts. 6 The American military had still not corrected 7 its deficiencies in treating PTSD when the 8 Korean War began in 1950. Initial PTSD rates were 9 three times higher than in World War II. 10 This trend continued for the next 62 years, 11 and continues now. 12 I am telling you this because, today, here, 13 we have an opportunity to make a real change in the 14 way we treat our service members. We need to make 15 the real changes, not just introduce a catchy new 16 phrase. 17 We are not here to point fingers and place 18 blame. We are here to change Joe's story back to a 19 heroic tale; to let this iconic photo of Joe serve 20 as a symbol, a reminder to all of us, to do what is 21 right for the brave men and women who defend freedom 22 and liberty. 23 We've noted 13 points that we feel can make a 24 significant difference in how PTSD is perceived and 25 treated. 1 First: We must you address the stigma of 2 PTSD. 3 We firmly believe that Joe never intended to 4 end his life. Although his actions resulted in his 5 death, it was clear to those that knew him, he was 6 only seeking a few moments of peace from the 7 battlefield he never left. 8 Joe's dying words, as he clasped a police 9 officer's hands, were, "I don't want to die. I have 10 a family, I have a daughter." 11 On Joe's death certificate, it states: 12 "Cause of Death: Suicide, due to the side 13 effects of post-traumatic stress disorder." 14 We need to classify to what truly is the 15 result of an invisible combat-related injury. 16 We need to establish a system where everyone 17 returning from combat gets some form of support. 18 Secondly: We need to stop overmedicating. 19 We suggest, instead of giving our service 20 members a cocktail of medications, we use other 21 alternate methods of treatment and therapies. 22 Also, authorization of medications used by 23 outside doctors that the V.A. does not cover. 24 During the demobilization process, upon 25 returning home, you are immediately given a 1 six question psychological screening test. 2 As all service members know, their answers 3 can delay their homecoming. Many answer these 4 questions falsely so they can get home to their 5 loved ones faster, and not fear the stigma 6 associated with PTSD. 7 We suggest, give a one-on-one physical and 8 psychological evaluation, anywhere from one to 9 three months after their deployment, as it sometimes 10 takes this long for PTSD to set in. 11 Fourth: When entering the military, we all 12 go through a military-entrance processing station. 13 To us, this is known as "MEPS." 14 Here, they conduct a full physical, and will 15 not accept you unless you are 100 percent; yet, we 16 discharge our service members who are not 17 100 percent, and return them to society and their 18 families. 19 We suggest that we do not discharge service 20 members who are at risk and not 100 percent. 21 Fifth: The number of veterans who are not 22 enrolled in the V.A. system is staggering. 23 We suggest, before a member can be discharged 24 from the military, they're required to enroll in the 25 V.A. system. 1 Sixth: The proper funding for the V.A. 2 The annual funding of the V.A. is a national 3 disgrace. Make Veterans Administration funding 4 mandatory. 5 Our seventh point is: The reduction in tour 6 length, and decrease the number of combat tours. 7 This applies to National Guard, as well as 8 Reserve units. 9 Our eighth point is: Force the Department of 10 Defense to follow its own regulations, that no 11 PTSD-diagnosed troops should be redeployed into a 12 combat zone. 13 Ninth is: To educate family members of the 14 signs and symptoms of PTSD. 15 Tenth is: To improve and streamline the V.A. 16 claim process. 17 Just as you do not want to sit and fill out 18 redundant forms at your doctor's office, veterans 19 who have health-care needs do not have the time or 20 the energy to devote to lengthy and redundant form 21 process. 22 Most certainly, they do not have the time to 23 wait months for a decision on their claim. 24 Number 11: We suggest training combat 25 veterans as social workers, or in some supporting 1 role. 2 Combat veterans share a bond. And although 3 devoted and dedicated, a civilian social worker who 4 never spent time away from their family in a combat 5 zone may only understand so much, and the veteran 6 might not feel comfortable speaking about his or her 7 experiences. 8 Our twelfth point is: To keep them with 9 their units, the units they share a bond with, until 10 they are ready to integrate to post-combat military 11 life or life after the military. 12 Our final point concerns the decompression 13 time. 14 Decompression time should be mandatory. 15 During our country's earlier wars, our 16 service members had time to decompress on a long 17 sail home, aboard a ship with their 18 brothers-in-arms. 19 Today, you go from Baghdad to your front door 20 in less than 24 hours. 21 We suggest starting the demobilization 22 process in places like Kuwait or Germany. Keep the 23 unit together in an area that is considered 24 friendly, to give the unit time to decompress. 25 Whether by suicide, accident, or enemy fire, 1 individuals who die while deployed are included in 2 war's casualty count. 3 Future memorials will include their names. 4 The nation they served will acknowledge their 5 sacrifice, and their bravery. 6 Stateside deaths, however, are not included 7 in official casualty counts, even if it clearly 8 stems from their military service. 9 The exact number of home-front deaths that 10 take place following combat deployment is unknown 11 because the Defense Department does not collect that 12 information. 13 I challenge anyone to find a memorial of a 14 soldier who passed away from the side effects of 15 PTSD. 16 With Senator Zeldin's help in 2008, we 17 honored Joe Dwyer, by renaming the street he grew up 18 on. 19 Joe ultimately died on a battlefield, but his 20 family has not been given that honor. Instead, they 21 are left picking up the pieces of a grieving family. 22 This is how we treat the brave men and women 23 who answer our country's calling. 24 We need to put our political issues of these 25 wars aside when it comes to how we take care of our 1 service men and women. 2 To this day, the military still denies a 3 relationship between PTSD and deaths away from the 4 battlefield. 5 We could try to look the other way and 6 pretend there is no problem, but we cannot ignore 7 the human suffering that arises from the personal 8 tragedies of domestic violence, homicide, and 9 suicide that emerge as our returning soldiers 10 attempt to reintegrate back into society. 11 I challenge all of you to do what is right: 12 To make the necessary changes so we don't lose any 13 more heroes in our own backyard. To show the nation 14 how we, here in New York, take care of our veterans. 15 Let them follow our lead. 16 Change Joe's story back to a heroic tale. 17 I came across a quote not long ago. I would 18 just like to take this opportunity to share it with 19 you. 20 "You can always tell how a government feels 21 about its people by looking at the way it treats its 22 soldiers." 23 Thank you for your time. 24 And if you have any concerns about the issues 25 raised here today, I would be very happy to address 1 them with you. 2 SENATOR ZELDIN: Thank you, Chris. 3 First, I just want to recognize 4 Senator Huntley, who is here; is also the ranking 5 member on Senator McDonald's Mental Health 6 Committee. 7 Senator Huntley. 8 SENATOR MCDONALD: Senator Huntley has been 9 very active in mental health issues for years now, 10 on this Committee, and we thank her for her service. 11 And she's also very sensitive to the 12 veterans, having been a big supporter for many, many 13 years. 14 So the comments that you've made are very 15 important. 16 I appreciate the written documentation 17 because, especially, the details, that I'm sure you 18 went into great thought, and the emotional issues, 19 that are very illustrative of so many of these men 20 and women. 21 And what a wonderful example, you know, this 22 gentleman was for the rest of the people. 23 And, hopefully, in his name, we can move 24 forward in doing some of these things, and hearing 25 from real people like yourself. 1 I was going to ask you a question, "In your 2 own words, what would you tell the family, and the 3 friends, of the veterans returning home?" -- but you 4 pretty much answered it, in this wonderful, precise, 5 concisive [sic] document. 6 So, I thank you. 7 CHRISTOPHER DELANEY: Thank you, sir. 8 SENATOR MCDONALD: You did a splendid job. 9 It's not going be easy for us to put all this 10 together, but you made it a little bit easier by 11 going into details. 12 SENATOR ZELDIN: Well, the one specific 13 question, Chris, that I wanted discuss, and ask you 14 about, was the concept of doing a peer-to-peer 15 mentorship program in the state. 16 One of the things that I have observed, 17 really, on the street, is, you meet someone with 18 post-traumatic stress disorder, and, they're on 19 their own. They're with their, maybe, family, or 20 friends, but, maybe those friends aren't combat 21 veterans. Maybe they don't suffer from 22 post-traumatic stress disorder. 23 And, one of the things that I wish we'd see 24 more of, in our state, and our country, would be a 25 mechanism, so that when you return to civilian life, 1 you would have access to like-minded individuals 2 that are going through what you've been through, so 3 you know that you're not alone. 4 And, if you wouldn't mind just commenting on 5 the concept of some type of a peer-to-peer 6 mentorship program. 7 CHRISTOPHER DELANEY: In a lot of the 8 dealings that we have on Long Island, and working 9 with our veterans, we're sort of in the trenches. 10 We deal with these guys when they fall on 11 hard times. And a lot of times, when they fall on 12 hard times, and -- it's not just the current 13 conflict that we deal with. You know, we help every 14 veteran on Long Island. And, we deal with a lot of 15 the Vietnam veterans as well. 16 But it seems like to be the one thing that 17 the veterans that are going through, they're 18 suffering from post-traumatic stress disorder, which 19 leads to an array of different problems, such as, 20 homelessness, them being arrested for drugs, and 21 domestic violence, and sometimes other crimes, that 22 are related with the side effects of the disease 23 that they're trying to battle. 24 When we actually can sit down and talk with 25 these guys, there's that level of sense of comfort, 1 because they know that we're not judging them. That 2 there's things that we've done, whether it be my 3 civilian job of working with the Suffolk County 4 Sheriff's Office, or through the military, we've 5 seen the same type of things. 6 And, they know that we're not going judge 7 them on their actions that they had to take, to 8 return home. 9 War isn't pretty. 10 We all sit down and we watch the, you know, 11 movies and the cinema, and Arnold Schwarzeneggers of 12 the world, and these big-movie action stars, and, 13 they make it like this glorifying thing. 14 But in the actuality of it, when you see what 15 the destruction of a .50-caliber weapon does; or the 16 weapon of a smart bomb, and what it does to the 17 area; and the people who get hit -- just like the 18 injured Iraqi child that Joe was bringing to safety, 19 he got hit with shrapnel -- it's, you're now seeing 20 a part of war that, you know, when you're done 21 playing your video game, you can turn off, and you 22 walk away, and there's nothing wrong. 23 So, it's the guys that see these things, that 24 are lucky enough to return home without a missing 25 limb, or that visible wound or that visible scar 1 that you and I can both see, these guys are left in 2 a shell to deal with it on their own. 3 And the military says: Oh, you know, let's 4 let these guys come forward. 5 But, we don't give them that opportunity to 6 come forward, because, when they do, there's a 7 stigma associated with it. 8 So when they run into us on the street and 9 we're in our regular clothes, and they see a veteran 10 speaking to a veteran, they kind of try to get -- 11 they want to work with us. They end up showing up 12 at our events, because they feel a sense of comfort, 13 of being, I guess, back in that cohesive unit again. 14 Sort of like the unit that they shared a foxhole 15 with, or, you know, some of the experiences with. 16 So, the peer-to-peer is very important. 17 I don't want to rule out and say that 18 professional help also isn't important. 19 But that's why I said, maybe get that combat 20 veteran as part of the support role, in the 21 social-worker aspect. To have that professional 22 aspect of it, of someone who's trained in a 23 professional field; but, then, also bringing that 24 real-life experience, of somebody who can say, "You 25 know, hey, come with me brother into this other room 1 a minute. Cry on my shoulder for a minute. You 2 know, I'll embrace you." 3 I mean, my son, who is 6 years old, came up 4 to me the other day, and he goes, "Dad, I want to 5 shake your hand like you shake your friends' hands." 6 And he shook my hand, and he hugged me. 7 And I guess that's the bond that we share; 8 is, you know, we hug each other, because there's 9 that brotherhood, that relationship. 10 And that might be one of the links that makes 11 it easier for these guys to come out and talk about 12 their experiences, and know that they can come to us 13 and say: Hey, you know, I use drugs because I need 14 to get that moment of peace. 15 And they know I'm not going to say: Oh, 16 well, you know, what? You're using, I don't want 17 nothing to do with you. 18 That's not -- that's not how it is. 19 We're going to be there to get through that 20 problem, and then hopefully get you through the rest 21 of your problems. 22 SENATOR MCDONALD: Here's a question for you, 23 Chris: While you're talking, you're talking about 24 the mentoring program, I was thinking about our own 25 state, and how we're structured. 1 Obviously, Veterans Affairs is a national, 2 you know, division of Veterans Affairs' program that 3 the federal government runs. 4 I think each state tries to help that federal 5 program by being hands-on. 6 In our own state, each county has a veterans' 7 coordinator. 8 And, we have a piece of legislation that 9 Senator Chuck Fuschillo, another State Senator from 10 Long Island, had proposed, that would fund 11 educational programs, to help deal with these type 12 of people. 13 It's almost like localizing it. If we can 14 get down to the county level, and each county has 15 their own -- you know, I believe in grassroots. 16 Sometimes you get so far ahead of yourself, at a 17 state or a federal level. 18 And, we're not a small state. We're a very 19 large state of about 19 1/2 million people. 20 And what we're trying to do, is to bring 21 these types of services down to the personal level, 22 as opposed to just another mass number. 23 You know, and maybe that's something we 24 should explore with our county and our state, you 25 know, veterans' director and our county veterans, is 1 putting these programs together at a local level. 2 And then, when these returnees come in, 3 almost like have a caseworker, that we have some 4 sort of training, that we coordinate through our 5 county director of Veterans Affairs and our State 6 official in charge of Veterans Affairs. 7 So, if you've lived in a county, and -- say, 8 Erie County, you would be dealing with the 9 Erie County people. And, in this area, they would 10 be -- add a little background, a little bit of 11 training from us, what to work with. And then 12 coordinate with the Veterans Administration people, 13 if it's more serious, but we're localizing it. 14 So, the phone call's not coming from somebody 15 from another state, or, you know, or -- and in this 16 big state, another part of the state, but, it's 17 Erie County- or Columbia County-oriented, or 18 Brooklyn-oriented, so they can, not only deal with a 19 peer group, but a neighbor at the same time, that 20 could help them directly. 21 It's a very interesting premise. 22 CHRISTOPHER DELANEY: It's very interesting. 23 And I actually agree with you 100 percent on 24 that, because I'm not-for-profit. 9-1-1 Veterans is 25 a small grassroots not-for-profit, started in a 1 police-academy classroom, and started out raising 2 $8,000, of passing of a can; to, now, where we're 3 raising over $200,000 of it. 4 And, I never once solicited the county, the 5 government, or the state. We do everything through 6 private donations. 7 And, we take care of our veterans in our 8 backyard. And something, like: Oh, well, you won't 9 take care of this veteran? 10 It's not that I don't like the veteran that's 11 in New Jersey, or maybe in Manhattan. It's that we 12 know that we want to dedicate our time to the guys 13 in our backyard, and let people who will take the 14 role model of how we treat our veterans, and go 15 further. 16 Besides the fact, the way our 17 not-for-profit's set up, is, the money that we 18 receive in from our donors, now actually stays in 19 our communities. 20 So, we're helping a veteran who might be 21 waiting on that service-connected disability, for 22 PTSD, or for a visible wound of war. We might pay 23 his mortgage, which now, in turn, helps the 24 community that we're involved with. 25 So I agree that, keeping it close, keeping it 1 personal, is the way to go. 2 And I know, on Senator Zeldin's Advisory 3 Board, there will be a speaker today talking about 4 the -- I believe, the mentor-to-mentor peer 5 counseling that they want to set up on Long Island. 6 SENATOR MCDONALD: That, you know -- 7 Senator Huntley, do you have any thoughts? 8 SENATOR HUNTLEY: In my district, I have, on 9 my staff, someone who is director of 10 Veterans Affairs, a gentleman by the name of 11 Lester Muse, who also has a Purple Heart, and who's 12 been very involved, for years, in my community. 13 So, we set up an advisory board for veterans. 14 We visit them on a regular basis. 15 In fact, the past two weeks, I have spent 16 most of my downtime in my district at the 17 veterans -- St. Albans Veterans' Hospital, where I 18 did a very huge clothing drive. Also, 19 Valentine's Day, because so many veterans have no 20 one. 21 So I am there on a regular basis. 22 And I think my part with veterans is, it hits 23 home with the family, because I come from a family 24 of veterans. My dad, my husband, my two sons, all 25 served their country. And not because they had 1 nothing else to do. Because they felt it was their 2 duty to do so. 3 So I'm very proud of what they will have 4 done. 5 And that's why I work so hard, because I 6 understand. 7 I understand the stress, the families. 8 I also understand, when veterans apply for 9 money, how the government drags its feet. 10 You know, we don't do enough. 11 We don't do enough on the federal level. 12 We don't do enough on the state level. 13 In fact, I think we're doing more now, since 14 Senator McDonald, and, Zeldin, who I'm also sure, 15 was in the service. 16 Am I right? You are a vet? 17 SENATOR ZELDIN: (Senator nods head.) 18 SENATOR HUNTLEY: Okay. 19 -- and I think that's why, now, we're doing 20 something like this. 21 You know? 22 And, whatever I can do, along with them, 23 working together, trying to make life better for our 24 veterans, we need to do that. 25 Because this country wastes a lot of money on 1 nonsense, when we can be helping people who need it. 2 Okay? 3 SENATOR MCDONALD: As you can see, folks, you 4 got some strong support here. 5 Now you got to help us, all of you, in all 6 the other public hearings that we do go to, pointing 7 us in the right direction, so we can do something. 8 But this is the beginning. Okay? 9 We'll be talking to you a lot, obviously. 10 You have your own senator, who's very 11 committed to this. 12 So, we want to thank you for your 13 presentation. 14 We're trying to keep a schedule. 15 And, if you can stay a while, we have just 16 such wonderful people here, gonna be talking. 17 Good for you folks to network with, and get 18 to know. 19 Thank you so much. 20 CHRISTOPHER DELANEY: Thank you, Senator. 21 I appreciate it. 22 Thanks, everyone. 23 SENATOR MCDONALD: We have now, an amazing 24 guest, that we're so grateful to make the trip up 25 from New York City. 1 He's the director of Trauma & PTSD Program at 2 Columbia University's College of Physicians and 3 Surgeons, one of our great universities that is in 4 this state, in the city of New York, who have led, 5 in so many different health-care areas, so many 6 different programs and services all over the place. 7 We're grateful to your university, and to 8 you, Dr. -- 9 And help me with your the name. 10 -- Dr. Yuval Neria? 11 DR. YUVAL NERIA: Neria. 12 SENATOR MCDONALD: Thank you for being here. 13 Thank you for choosing to take your day to 14 come up to Albany. And -- 15 DR. YUVAL NERIA: Thank you. 16 Thank you, Dr. -- Senator McDonald, 17 Senator Zeldin, and Senator Huntley, for conducting 18 this hearing. It's really timely. 19 My name is Dr. Yuval Neria. 20 I am the director of Trauma and PTSD at the 21 New York State's Academy Institute, and professor of 22 clinical psychology at the Department of Psychiatry 23 and Epidemiology at Columbia University. 24 I have worked with war veterans, as a 25 clinician and a researcher, for more than 20 years, 1 in treatment, and in research. 2 I also had some combat experience. Prior to 3 my academic and professional career, I served as a 4 commander of an armored company in the 5 1973 Yom Kippur War between Israel and Egypt. 6 I was injured, and awarded the Medal of 7 Valor, the highest medal awarded in Israel. 8 So what is the problem? 9 Recent and ongoing conflicts in the 10 Middle East have brought the psychological and 11 societal consequences of war to the forefront. 12 Apart from the devastating loss of life, and 13 physical wounds sustained in the tour of duty, a 14 significant number of returning service members, 15 upward of 26 percent, suffer from mental-health 16 problems, of which post-traumatic stress disorder, 17 "PTSD," is the most prevalent. 18 What is it, "PTSD"? 19 In order to be diagnosed with PTSD, an 20 individual must meet several specific criteria. 21 First: Requires a traumatic event to have 22 occurred; a traumatic event involved in 23 experiencing, witnessing, or being confronted with 24 an event that involves actual or threatened death, 25 serious injury, or threat to the physical integrity 1 of self or others. 2 Furthermore, the individual's response to the 3 event must include intense fear, helplessness, or 4 horror. 5 The second criterion requires a constant 6 reexperiencing of the traumatic event, including but 7 not limited to, recollections, nightmares, reliving 8 the event in one's mind, psychological distress, and 9 reactivity associated with exposure to the event. 10 The third criterion includes the avoidance of 11 trauma-associated stimuli and numbing of general 12 responsiveness. 13 Criterion D includes perpetually increased 14 arousal, resulting in insomnia, irritability, and 15 frequent anger bursts, difficulty concentrator, 16 hypervigilance, and exaggerated stutter response. 17 The duration of the aforementioned 18 disturbances must be longer than one month, and must 19 result in clinically significant distress or 20 impairment. 21 How prevalent PTSD is? 22 Among Iraq and Afghanistan veterans, rates of 23 psychological and neurological injuries are high, 24 and rising. 25 According to a similar 2008 Rand study, 1 nearly 20 percent of Iraq and Afghanistan veterans 2 screened positive for PTSD or depression. 3 Troops in Iraq and Afghanistan are also 4 exhibiting neurological injuries. Traumatic brain 5 injury, or, "TBI," has become the signature wound of 6 the Iraq war. 7 According to the Rand study, about 19 percent 8 of troops served reported probable TBI during 9 deployment. 10 These milder injuries are quite complicated 11 and difficult to identify, and they are not easily 12 distinguished from PTSD. 13 Importantly, combat-related mental health 14 problems are not limited to PTSD. 15 Rates of marital stress, substance abuse, and 16 suicide, as we heard, are all increasing. 17 Suicide behavior is a critical problem among 18 war veterans. 19 During the wars in Iraq and Afghanistan, the 20 U.S. Army suicide rate has increased, from 12.4 per 21 100,000 in 2003, to 18.1 per 100,000 in 2008. 22 Depression and PTSD increase the risk of 23 suicidal ideation, which is very highly correlated 24 with suicide attempts. 25 What about risk factors? 1 In the United States, the prevalence rates of 2 PTSD have been found to be significantly higher in 3 minority veterans, across different studies, and 4 different conflicts. 5 Yet, and importantly, studies focusing on the 6 current conflicts in Iraq and Afghanistan, however, 7 found no effect of race, ethnicity, on PTSD rates 8 among those military populations. 9 It is possible that the elevated PTSD rates 10 among minorities during the earlier wars, such as 11 Vietnam War, were influenced, at least in part, by 12 the widespread racial tensions that minority groups 13 had to endure at the time. 14 Importantly, among combat veterans, most 15 studies reported no gender effects, contrary to 16 civilian studies that found women to have double the 17 risk of PTSD as compared to men. 18 Level of exposure, severity of exposure, are 19 considered to be the most meaningful and enduring 20 factors in PTSD. 21 In studies where comparisons were made 22 between service members deployed to Iraq and 23 Afghanistan, or other locations, those deployed to 24 Iraq consistently present with higher PTSD rates. 25 Of the service members deployed to Iraq, 1 93 to 97 percent reported shooting or directing fire 2 at the enemy; 3 About 90 to 95 percent reported being 4 attacked or ambushed; 5 And, more than 94 percent reported seeing 6 dead bodies or human remains. 7 Of those deployed to Afghanistan, only 27, 8 58, and 39 percent reported such combat experiences, 9 respectively. 10 How about treatment? 11 Although screening for mental-health 12 problems, as we heard before, is conducted right 13 after deployment, and is gradually becoming the norm 14 in the U.S. military, and effective state-of-the-art 15 treatment options are available, there is still 16 considerable reluctance among military personnel to 17 seek professional care for mental-health problems, 18 unfortunately. 19 Of all the military-service members who 20 screened positive for mental-health disorder, less 21 than a half expressed interest in receiving 22 professional help. 23 Service members who's positive screen for a 24 mental-health disorder are also twice as likely to 25 be concerned about stigmatization, and other 1 barriers to mental-health care. 2 Even when service members do initiate 3 treatment, only a third receive minimally adequate 4 care. 5 What are the availability of treatments to 6 date? 7 For psychotherapy, exposure therapy is 8 considered to be one of the most effective 9 treatments for PTSD, and clinical practice 10 guidelines consistently recommend it as the first 11 diagnosing of treatment. 12 In the 2007, the Institute of Medicine 13 Committee conducted a detailed assessment of 14 evidence for available treatments of PTSD. 15 They found substantial number of randomized 16 controlled trial studies, comparing exposure 17 therapies to usual care or wait-list control, and a 18 substantial majority of which demonstrated 19 significant improvement of PTSD symptoms or loss of 20 diagnosis in groups who received exposure therapy. 21 The committee judged the over-quality of 22 evidence to be moderate to high, and conducted that 23 exposure therapy is an effective treatment for PTSD. 24 Pharmacotherapy: Selective serotonin 25 re-uptaking inhibitors, "SSRIs," are a class 1 anti-depressant that is currently the most 2 extensively studied pharmacological treatment for 3 PTSD; yet, efficacy of SSRIs are less robust as 4 compared to exposure therapy, suggesting that we 5 currently don't have a powerful enough medication 6 for PTSD. 7 What are the barriers for mental-health care? 8 A number of bills have been documented among 9 war veterans, including, fears of losing performance 10 edge or self-control, expectation of scorn or 11 negative career impact, shaming messages, myths and 12 lack of knowledge, feeling undeserving, and 13 logistical constraints and unavailability of care. 14 Much more efforts are needed to address these 15 barriers. 16 For instance: Initiative to legitimatize 17 acute care and early intervention might help to 18 reduce the barriers of shame and guilt. 19 Policymakers should address logistical 20 constraints and access to care by increasing the 21 number of availability of programs of war veterans. 22 So how to enhance mental-health care for war 23 veterans? 24 Currently, most of the mental-health 25 treatment for Iraq and Afghanistan war veterans is 1 provided in V.A. settings; yet, many war veterans 2 with mental-health problems may be reluctant to 3 enroll in V.A. programs. 4 For many, especially personnel of the 5 National Guard and Army Reserve, the V.A. may not be 6 the first choice. 7 Given the scope of mental-health problems 8 among returning military personnel, more 9 mental-health services for veterans should be 10 developed. 11 An evidence-based treatment for veterans 12 should be provided in multiple and diverse settings. 13 Moreover, previous studies have documented 14 the mental-health problems among children and 15 spouses of war veterans; yet, family members of 16 military personnel are not currently eligible for -- 17 fully, for mental-health care in the V.A. settings. 18 Ignoring the needs of these populations is 19 unfortunate. 20 Treatment programs for veterans coming back 21 from the war should address the needs of family 22 members, and social support is critical for the 23 recovery process. 24 In addition, efforts to address the problem 25 of stigma, and other barriers to care-seeking, 1 should involve outreach, psychoeducation, and new 2 developed approaches to mental-health delivery. 3 In summary: Developing sustainable effective 4 treatment program for war veterans is a major, major 5 challenge. 6 Research has shown that war veterans, both 7 males and females, have a very good capacity to be 8 benefited from trauma-focused evidence-based 9 mental-health treatment when the treatment is 10 provided by well-trained, sensitive, and devoted 11 clinicians. 12 It is our hope that lessons from previous 13 wars, such as the importance of early intervention, 14 the need to address barriers to cares, and the role 15 of family members in post-deployment adjustment of 16 war veterans, will guide public-health efforts to 17 develop quality programs of new generation of war 18 veterans coming back from the war, anticipating to 19 receive safe and effective care for their 20 mental-health problems. 21 Thank you. 22 SENATOR MCDONALD: Thank you, Doctor. 23 I was informed that a recent study by the 24 Marine Corps suggests that feelings of guilt over 25 moral dilemmas, including survivor's guilt faced in 1 combat, are a leading cause of PTSD. 2 You, more or less, verified that in your 3 documentation. 4 DR. YUVAL NERIA: Yes. I mean -- 5 SENATOR MCDONALD: We talked about early 6 intervention, and what's causing it. 7 The early intervention, you mentioned the 8 National Guard and the reservists. 9 It's not always the easiest, especially if 10 you're in upstate New York, the V.A. hospitals, say, 11 like down in New York City, where you can take a 12 subway ride and you can get there quickly. 13 They're spread out. 14 They do a good job, but they're spread out. 15 What thoughts do you have on that? 16 DR. YUVAL NERIA: Well, I have a number of 17 thoughts on that. 18 First of all, I think that the reluctance on 19 the V.A. is a major limitation for effective 20 widespread access to mental-health care, especially 21 in rural areas; but, not only, also in the cities. 22 Access is a problem, but also stigma is a 23 problem. 24 Going to the V.A. for post-traumatic stress 25 disorder shouldn't be a psychiatric issue. It 1 should be a normal care access. 2 You know, so, we should normalize care given 3 to war veterans. 4 We should, in order to combat stigma and 5 shame and guilt, the only way to do that is to 6 create, you know, a variety of services, on campuses 7 and universities. 8 I would recommend, you know, developing a 9 number of center of excellences, as done in -- for 10 other needs. 11 I mean, the community is large and diverse, 12 and channeling everybody to the V.A. seems to be, 13 certainly, I can understand it. 14 I think that's a major limitation for 15 effective and mental-health delivery, especially, 16 because, you know, the -- the source for 17 evidence-based treatment is not really coming from 18 the V.A. 19 The V.A. is educated by research programs, 20 such as, our research program at Columbia, or NYU, 21 or Mount Sinai. 22 And, the V.A. -- until the V.A., 23 incorporating fully, you know, the knowledge about 24 treatment, it takes time and too much effort. 25 So I would say, let's open it up, let's make 1 it more diverse, and let's have the veterans have 2 more choices than the V.A. 3 SENATOR ZELDIN: Doctor, thank you. 4 The fact that Columbia University has a PTSD 5 program, it's something, that, it would be great if 6 it was replicated in every university and every 7 hospital across the country. 8 I'm starting to see with, law schools, are 9 starting to do veterans' programs. 10 And, it's just great that you even have the 11 program that you're directing. 12 And, thank you for being here. 13 The last speaker, I asked a question with 14 regards to a particular problem that I have 15 observed; that individuals just don't seem to have 16 access to others in their communities that share -- 17 are going through the same experience that they are 18 with PTSD. 19 I'm just wondering what your thoughts are on 20 the idea of developing some kind of a peer-to-peer 21 program, where we can connect individuals who suffer 22 post-traumatic stress disorder, just so they know 23 they're not alone. 24 Maybe you can bring another perspective from 25 the medical side? 1 CHRISTOPHER DELANEY: Right. 2 I like the idea a lot. 3 In fact, I like ideas that involve informal 4 social support, and, to traumatized populations. 5 Could be disaster survivors, after 9/11, or 6 war veterans coming back from deployment. 7 It's a great idea. 8 And it should run in parallel to professional 9 evidence-based mental-health care, so you have a 10 system in which, for example, peer-based programs 11 have the capacity and the knowledge to refer 12 somebody who is at need, to a close-by mental-health 13 service program. 14 So you have -- and you have graduates of 15 treatment programs in those specialist centers, 16 coming back to the community and being benefited by 17 the availability of peer-based programs. 18 So, I think it's a great idea. 19 It's not either/or. It should be conducted 20 in parallel, and should be really tailored and 21 coordinated in a nice way. 22 So, I think, overall, it's a great idea. 23 SENATOR ZELDIN: My only other question I 24 actually have -- I can take up a couple of hours 25 asking you questions -- but, for the sake of today, 1 we, as a state, have more of an influence in the 2 say, with regards to interaction with our 3 National Guard unit. 4 When they're on Title 32 status, they belong 5 to the State. But the -- 6 DR. YUVAL NERIA: Right. 7 SENATOR ZELDIN: -- when they're mobilized 8 and deployed, as well as the active duty and the 9 reserve components, when they're on Title 10 status, 10 it's really something that, hopefully, Congress can 11 do, and the Pentagon can do, a better job 12 addressing. 13 But, what can we do, as far as -- you're a 14 doctor; you're at Columbia University. You have 15 looked into post-traumatic stress disorder, I'm 16 sure, just so far beyond the norm. 17 Meanwhile, the best source of how to identify 18 the service member with the symptoms of 19 post-traumatic stress disorder is at the unit. 20 It is a specialist sergeant. You know, it's 21 the platoon leader. The company commander or first 22 sergeant. 23 And many of them, you know, they're not 24 doctors. They don't have the experience and the 25 depth of knowledge that you do. 1 So, what's the best way that we could be 2 doing a better job to prepare those leaders to help 3 with the diagnosis and treatment of post-traumatic 4 stress disorder? 5 DR. YUVAL NERIA: Right. 6 And two comments on that. 7 I think that, overall, there is a nice 8 progression. I think there is more consciousness. 9 And I think, army personnel, military 10 personnel, overall, is very much educated about 11 post-traumatic stress disorder, about the effect of 12 exposure. 13 So I think, overall, there's recent progress. 14 The problem is, really, reacting in a timely 15 manner to a distress of a fellow soldier, or fellow 16 veteran; and, who will do that. 17 And I agree with you that, friends, and 18 platoon commanders, and sergeants, are those who 19 will be the first to notice that there is a 20 deterioration of mood. That there is some issues; 21 somebody's closed, somebody doesn't feel right. 22 And then, you know, if -- if barriers of 23 stigma and shames are removed, you know, there 24 should be a quick referral to a mental-health 25 specialist. 1 The problem with Reserve and V.A., especially 2 National Guard units, is that they don't have the -- 3 they're under-resourced, in terms of medical 4 personnel. 5 You know, Reserve are a little bit better, 6 but I think National Guards suffer from, kind of, 7 unavailability of mental and medical personnel. 8 This should be discussed, and considered. 9 And I think, perhaps, you know, our discussion today 10 can kind of facilitate that. 11 It is very -- availability is really the name 12 of the game: Availability of peer-based program, 13 availability of mental-health professionals, 14 availability of friends, availability of a spouse, 15 that noted something is not all right. 16 And this is only way, really, to intervene, 17 and to intervene on time. 18 And it's a process. 19 And it's a process of education. 20 SENATOR ZELDIN: Well, it's a -- definitely 21 an interesting challenge to pass your knowledge down 22 to the average person. 23 You're very informed in your testimony. 24 Thank you for being here, Doctor. 25 DR. YUVAL NERIA: Thank you. 1 SENATOR ZELDIN: Senator Huntley. 2 SENATOR HUNTLEY: Yes, Doctor, what type of 3 outreach do you use for your program? 4 For instance: A veteran who lives in the 5 south Bronx, east New York, I mean, how do they know 6 about your program? 7 DR. YUVAL NERIA: Right. 8 So, I can talk a little bit about my 9 Trauma and PTSD program at Columbia. 10 We are located as the medical campus of 11 Columbia University. 12 We have a big trauma program that is funded 13 by the National Institute of Mental Health, 14 primarily. 15 You know, a little bit by -- a little bit by 16 private foundations. 17 We have never received, for example, funding 18 from the State, but we are funded to do research. 19 Now, our research programs are about 20 treatment. 21 We are testing new treatments. We are 22 pushing the envelope, really to understand better 23 why some people react to treatment, and others don't 24 react to treatment. 25 We are, pretty much, successful in bringing 1 in civilian population with PTSD. 2 We are not successful, unfortunately, of 3 bringing in war veterans with PTSD. 4 And, believe me, we are doing our best. 5 You know, we are going to the Bronx. We are 6 going to -- we are going Harlem. We are going to 7 downtown New York. 8 We have -- there is a certain reluctance of 9 veterans with PTSD to seek civilian help. And, the 10 availability is there. 11 There is no-cost treatment available for 12 them, and there is -- still, there is a gap in 13 access, that we should do everything in order to 14 bridge it, actually. 15 SENATOR HUNTLEY: Now -- okay, now, with your 16 research, does that include people of color also? 17 DR. YUVAL NERIA: Oh, yeah. Yeah, yeah, 18 yeah. 19 We are doing very well with minority 20 populations. At least half of our patients are 21 Hispanics and Blacks. 22 And, actually, we are obliged to make our 23 patient samples as representative as possible. And 24 we are working very hard on that. 25 SENATOR HUNTLEY: What are the numbers, in 1 terms of male and female, that -- 2 DR. YUVAL NERIA: About 60/40 percent. 3 60 percent females, and 40 percent males. 4 SENATOR HUNTLEY: Thanks. 5 DR. YUVAL NERIA: So, a slight elevations for 6 females. 7 SENATOR ZELDIN: Thank you so much, Doctor. 8 DR. YUVAL NERIA: Sure. 9 Thank you. 10 (Senator Huntley leaves the hearing 11 room.) 12 SENATOR ZELDIN: At this time, I would like 13 to call Mr. John Javis. 14 John is the director of the Veterans Health 15 Alliance of Long Island. 16 Mr. Javis, thank you. 17 At this point, for the sake of time, and all 18 of our speakers know, we're going to try to cover 19 everyone within a 5-minute time frame. 20 I'll keep -- 21 JOHN A. JAVIS: Of course. 22 SENATOR ZELDIN: -- the big challenge for you 23 are the -- becomes the questions from us, because 24 you're probably all better at sticking to 25 5-minute timelines than we are. 1 But, thank you for being here. 2 JOHN A. JAVIS: Okay, I'll make it brief. 3 I'll cut it down. 4 So, I'm here to advocate for peer support as 5 a valuable tool to help veterans deal with 6 post-traumatic stress disorder. 7 In 2011, the New York State Health Foundation 8 and the Rand Corporation released a study of 9 New York State veterans from Iraq and Afghanistan, 10 that showed that 22 percent of those veterans met 11 the criteria for PTSD or depression. 12 Unfortunately, only about one-third of those 13 individuals actually sought help for their 14 condition. 15 One major reason cited for not seeking help, 16 was that veterans had no one to encourage them or 17 assist them navigating what can be a very complex 18 system of care. 19 Those of us who have served in the military 20 know the importance of the buddy system. 21 It is known by various names, such as, 22 "your Ranger buddy," "your battle buddy" or 23 "your wingman." 24 Buddies are responsible for keeping each 25 other safe. 1 In a combat zone, it might mean providing 2 covering fire for your buddy. 3 After deployment, it might mean driving your 4 buddy home after he's had one too many drinks at the 5 bar, or bringing to him see the chaplain if he's 6 talking about suicide. 7 A few years ago, the U.S. Army developed a 8 concept called "Battle Mind," to help soldiers and 9 family members deal with issue of deployment and 10 reintegration. 11 The "B" in "Battle Mind" stood for "buddies." 12 It reminded veterans to have friends, or buddies, 13 when they returned home to civilian life. 14 What was happening to these individuals, felt 15 that could only trust the buddies they served in 16 combat with, and would not share their feelings with 17 their spouses, family members, or anyone else, for 18 that matter. 19 It was these suppressed feelings that led 20 some to suicide. 21 Battle Mind taught veterans that buddies who 22 would care for each other were also necessary in 23 civilian life. 24 In the civilian mental-health context, the 25 New York State Office of Mental Health encourages 1 the use of peer specialists, and highlights the role 2 of them. 3 A "peer specialist" is an individual that is 4 a current or former user over mental-health 5 services. They are open about disclosing this, and 6 they share the secrets of their recovery, in an 7 effort to help others. 8 The roots of mental-health peer support 9 actually come from AA and other 12-step support 10 groups. 11 In the mental-health world, peer support is 12 not meant to replace traditional mental-health 13 services. It is intended to come complement other 14 services. 15 People who may not want to partake in 16 traditional services, because of stigma, might be 17 inclined to try peer support. 18 At a later time, peer support leaders may be 19 able to encourage the individual to seek traditional 20 services if appropriate. 21 A model of veteran-specific peer support 22 already exists, called "Vet to Vet," that was 23 started by a Vietnam veteran by the name of 24 Mo Armstrong. 25 Moe Armstrong was a medical corpsman in 1 Vietnam, and has written extensively about his 2 battles with trauma and substance abuse after the 3 war. 4 Complete manuals about starting Vet to Vet 5 groups are available online from the "Vet to Vet" 6 website. 7 I feel that this model can be easily brought 8 to New York State. 9 At the MHA in Nassau County, we are in the 10 process of starting a pilot of peer support, in both 11 group and individual sessions, in collaboration with 12 the Mental Health Association of New York State, 13 using a grant from the Bristol-Myers Squibb 14 Foundation. 15 I would urge that the Office of Mental Health 16 be provided with funds to put out an RFP for 17 non-profits to hire one full-time veterans' peer 18 specialist in each of the five OMH regions. 19 These individuals would be responsible for 20 outreaching and engaging veterans in their area, for 21 leading peer-support groups, providing individual 22 peer support, and developing volunteer leaders who 23 could run their own peer-support groups, again, much 24 in the manner of AA. 25 The estimated cost for this would be about 1 $400,000. 2 In conclusion: After the media coverage of 3 the Walter Reed and V.A. scandals in 2007 brought 4 nationwide attention to the poor treatment given to 5 veterans, people, like myself, have been advocating 6 that New York State have a comprehensive 7 mental-health policy in regards to veterans. 8 And, to date, we have not seen any new 9 funding or new initiatives in this regard. 10 During the same period, we have seen massive 11 regulatory changes in the mental-health system, such 12 as, PROS, clinic reform, and health homes. 13 These new initiatives are designed to save 14 money. 15 Would it make sense, then, for some of these 16 savings to be reinvested to assist veterans with 17 mental-health concerns? 18 Our veterans are paying the price for 19 inactivity. 20 There's a little secret out there that won't 21 show up in any statistics or research study. 22 There is a pool of veterans from Iraq and 23 Afghanistan who have dropped off the radar. 24 They live at home with their parents and 25 relatives. They're not going to the V.A., they 1 don't go to work, they don't go to school. 2 They spend their days in isolation, using 3 substances, and playing on-line video war games. 4 Some have concurrent drug and alcohol 5 problems, PTSD, and traumatic brain injuries. 6 Many of them have caring families who 7 desperately want, and encourage them to get help. 8 We feel that peer-support encouragement from 9 a fellow veteran who has been there might be the 10 method to assist these individuals to reengage in 11 our community. 12 Thank you. 13 SENATOR ZELDIN: Mr. Javis, first, as a 14 senator on Long Island, I just want to say, 15 thank you, because I see your activity around the 16 Island, and your interest, just in helping veterans. 17 And that's really something to be applauded. 18 Thank you for traveling up here from 19 Long Island, for this, and speaking specifically 20 about the peer-to-peer mentorship concept. 21 And the idea of the -- you know, the 22 proposal, I guess, with regards to OMH, which we'll 23 look more closely at. 24 Senator Huntley had a question before she 25 left, which has been a topic of conversation between 1 us, and the Veterans' Advisory Panel out in Suffolk. 2 It was a question of, you know, she has 3 constituents in her Senate District. And, here we 4 have a director of, you know, PTSD for 5 Columbia University. 6 And one of, I think, the challenges that face 7 mental-health providers, maybe you could speak to it 8 on Long Island, is, making sure that everyone knows 9 where these services are available. 10 So, if maybe you can speak to your experience 11 there, and how we might be able to be helpful. 12 JOHN A. JAVIS: I think we need two 13 approaches. 14 You know, one is a high-tech approach; one is 15 a low-tech approach. 16 You know, and so we know, that, for many 17 younger veterans, the Internet is probably the way 18 to go. 19 You know, they're all computer-savvy. They 20 grew up on the Internet. And, so, you know, some 21 kind of a website, or some kind of an interactive 22 web page, would be, you know, the way to attract 23 those folks. 24 However, if you're an older veteran, you 25 know, a veteran who's struggling, bordering on 1 homelessness, you're not going have a wireless 2 router or a smartphone or, you know, a laptop 3 computer. That, you need the low-tech approach. 4 That's the peer-support person that, kind of, 5 boots on the ground, would be identified as the 6 person who would be able to do that outreach 7 engagement. You know, visit people in the 8 community. 9 I think you need both approaches: both a 10 high-tech approach, as well as a low-tech, "boots on 11 the ground," approach. 12 SENATOR ZELDIN: Thank you. 13 SENATOR MCDONALD: I'm sorry. I had to step 14 out for a moment, to talk to some people, and I 15 missed part of your dialogue. 16 I'm sure we're going to be talking, though, 17 individually. 18 I too want to thank you for what you've done, 19 what you're doing, and what you hope to do in the 20 future in this area. 21 The one common thing that I've been hearing 22 since we started picking into this topic, is a 23 mentoring program; whether it's vet to vet, or buddy 24 to buddy -- whatever -- wingman, I see the different 25 terminologies. 1 It seems to be a logical way to do that; to 2 have somebody caring, but also to have somebody who 3 has some basic knowledge that we help provide, 4 whether it's on a regional basis; or, if it's -- you 5 know, if you're in the metropolitan New York City 6 area, delivering services and people, it's a little 7 bit easier than if you're in the upstate New York 8 area, where you go from a small urban area to a 9 rural area, quite quickly. 10 And some of these folks don't have that kind 11 of transportation capacity, or knowledge. And you 12 start talking along miles, to get from one place to 13 another. 14 JOHN A. JAVIS: Well, again, I think a 15 thought there: Again, if you had one person, if 16 they could develop volunteers in little areas -- 17 SENATOR MCDONALD: Volunteers. And, of 18 course, I go by the county concept in upstate, which 19 provides so many well-needed services. 20 But it is the general premise, in speaking 21 generally, is that's an amazing way to go; to enlist 22 this corps of volunteers, get them trained, working 23 for, you know, a full-time professionals, our county 24 veterans' directors and coordinators, along with the 25 State. 1 We don't want to duplicate what the federal 2 government's doing. We want to help the federal 3 government deliver the services. 4 And if they can't get to everywhere as 5 quickly, the State's already got, you know, veterans 6 on the ground, if you will, in the county. 7 And, certainly, in every county in the state, 8 there's a variety of veterans who live there. 9 So, I mean, this is an issue that's not going 10 away. 11 Too often, people think these wars end, and 12 the official ending of the -- what was it, the Iraq 13 War, December 15th, or something, of last year? 14 I mean, it doesn't end on December 15th for 15 the soldiers, the men and women who served there, 16 and their family structure. 17 And a parade is nice, and the yellow ribbons 18 are nice, but these folks are looking at hard-core 19 issues; whether it be, jobs, education, housing, 20 health care, mental-health care. 21 And not just for them. We've got family 22 structures. 23 And, you know, the one thing that amazed me, 24 from the difference between the military, when I was 25 in the Vietnam Era, to the military today: When I 1 went to Vietnam, young guys, don't have that family 2 structure yet. Don't have, in many cases, they 3 were, you know, full-time military people. 4 Today, they're older people, with, you know, 5 a family structure, children, commitment to their 6 community, jobs that are needed, and all the 7 emotional baggage that goes along with this. 8 And, so, you know, if we're sending them off 9 to fight for us, we have to take care of them when 10 we come back. 11 And we start with the emotional problems. 12 Thank you for your time. 13 JOHN A. JAVIS: Thank you. 14 SENATOR MCDONALD: Next, we're honored to 15 have with us, Dr. Charles Kennedy, clinical 16 director of PTSD Treatment Program at the 17 U.S. Department of Veterans Affairs, right here in 18 our own local Albany Stratton V.A. Hospital, which, 19 I think, if you're a local person, like myself, you 20 know very well. 21 They treated my father who was a World War II 22 veteran, as well as me, and my uncles and relatives 23 who actually spent much time in there. 24 And with you, Dr. Kennedy, would you 25 introduce your guest. 1 PETER POTTER: Peter Potter. I'm the public 2 affairs director. 3 SENATOR MCDONALD: Peter Potter, is public 4 affairs director. 5 First off, we thank you for coming. It's a 6 shorter distance, but I know you've got a busy 7 schedule. 8 DR. CHARLES KENNEDY: Senator McDonald and 9 Senator Zeldin, thank you very much for inviting us 10 to come share with you our experience serving our 11 veterans, and, to seek your partnership in helping 12 us care for what is a huge number of folks that 13 deserve our help: our veterans; but, most 14 especially, their families, as well as our veterans. 15 And if we help their families, we, in turn, 16 will be helping them. 17 They'll help a veteran access treatment, and 18 overcome stigma, the kind of things that we've heard 19 from the previous speakers. Mr. Delaney, 20 Dr. Neria, Mr. Javis, all highlight very, very 21 important issues and obstacles to our veterans 22 accessing treatment. 23 Approximately 3 million people have now 24 served in Iraq and Afghanistan. 25 Of that 3 million, 1.75 million have 1 completed their military service. 2 Of those completing military service, 3 48 percent are presenting to the V.A. with problems, 4 with post-traumatic stress disorder, major 5 depression, and substance-abuse problems. 6 Many of these people are isolated. And in 7 that isolation, they are in danger of taking their 8 own lives. 9 We need everybody we can access, to reach out 10 to the folks that are isolated, because it is the 11 isolation and the avoidance that is potentially 12 lethal. 13 All the previous speakers noted how difficult 14 it is to come to the V.A. 15 Imagine, if you will, what it's like to say: 16 Geez, I've got something wrong with me. It's 17 unmanly, this thing that I have wrong with me. And 18 then I got to go into the V.A., to seek services. 19 And, in our case, if you push the number "10" 20 in the elevator, everybody on the elevator knows 21 you're going to the mental-health floor. 22 So, you're revealed, especially if you're 23 sensitized to this. 24 We are especially struggling to help connect 25 with the youngest cohort, those from 19 to 26. 1 They'll come, and they'll go. 2 They'll come, and they'll go. 3 So, as Dr. Neria said, we don't need to 4 have enclaves of treatment. We need to push 5 treatment out into the community, onto our college 6 campuses, into our community colleges, and out into 7 the areas, up to the border, for us. 8 And we are making efforts to do that, but we 9 need all of the help we can get to do it. 10 We have 11 community-based outpatient 11 clinics, from the Canadian border, down to 12 Dutchess County. 13 We have, in the PTSD program, 5 of the 11 of 14 us have telemental health equipment. 15 And much to my surprise, this is a wonderful 16 way to reach people in Plattsburg, and out in Utica. 17 There are issues that one -- the clinician 18 needs to be concerned with, to ensure safety, but at 19 the same time, we're able to offer psychotherapy, 20 based on the empirically supported treatments, to 21 people as far away as Plattsburg. 22 So, we're making some headway, that way. 23 Soon to come out of our research at the 24 Stratton V.A., which is actually one of the homes of 25 the PTSD diagnosis, Dr. Larry Kolb, a 1 psychiatrist, was instrumental, in the '70s, in 2 bringing to the attention of the mental-health 3 community, the fact that there was this thing, which 4 we were then to call "post-traumatic stress 5 disorder," which had been deleted from the 6 "Diagnostic Manual" in 1952. 7 So, when Vietnam veterans returned from 8 Vietnam, when Korean War veterans returned from 9 Korea, there was no diagnosis to describe what was 10 happening to them, and to suggest what the 11 treatments might be. 12 So, it was not until the late '70s, and 13 Dr. Kolb and others' work, that led us to have 14 this "post-traumatic stress disorder" diagnosis. 15 I also want to add, and tell you about the 16 local situation. 17 I've been with the PTSD program for 24 years 18 now. 19 When I started, there were two of us. 20 When I started, we couldn't get anybody to 21 show up and come for treatment. 22 In 2000/2001, that fiscal year, we had 23 194 combat-veteran participants. 24 In 2004/2005, we had 253 combat-veteran 25 participants. 1 In -- from April of 2010 to April of 2011, we 2 had 716 participants. 3 I had predicted for this year that we would 4 exceed 900. I'm afraid we're going to reach 5 1,000 this year, of folks that we'll be treating in 6 the PTSD program here. 7 Interestingly, about 51 percent of those that 8 are presenting for treatment at the Stratton V.A., 9 are Iraqi and Afghani veterans. 10 Fully, 43 percent of brand new referrals, 11 first-time people seeking treatment, are Vietnam 12 veterans coming in for the first time. As they hit 13 retirement age, as they lose a spouse, as they have 14 physical problems, their PTSD comes back full-blown 15 after they've led successful lives. 16 I guess what I'm trying to say is, we need 17 all the help we can get from everybody we can get it 18 from, who are knowledgable and caring about the 19 issues of veterans. 20 Let me say one other thing: Many folks have 21 commented on how important, for those in need, to 22 be -- have connection with veterans. 23 And that's very true. 24 I remember, as a young psychologist, a combat 25 veteran saying to me, "You young buck, what are you 1 doing? How can you help me? You have not been to 2 war." 3 And, of course, I would have to say, "No, I 4 have not." 5 And there seemed a real face validity to 6 their criticism, and I felt at a loss to be helpful, 7 because of my lack of experience in the military. 8 But over the years, the veterans that I've 9 worked with taught me some things that were very 10 special. 11 One: My ignorance was a valuable tool, 12 because, not only were the veterans presenting for 13 treatment right, I didn't understand what it was 14 like to be in the terror and horror of combat, but 15 they didn't understand what was happening to them. 16 They did not have words to explain these 17 things, where, they were trying to talk to their 18 wife or to their son, and they would have such a 19 powerful, vivid, intrusive experience, of back in 20 Vietnam, or over in Iraq, or in Afghanistan, that 21 they would not be able to concentrate on the remarks 22 being made to them by a loved one. 23 And they would feign, that everything was 24 okay, and that they were doing just fine. 25 And on and on, these intrusions would come. 1 And, in order to avoid embarrassing 2 themselves, they isolated in the basement, playing 3 the video game, or abusing marijuana, or something 4 like that. 5 So, I learned to, with a genuine authentic 6 ignorance, help them find the words to tell me, as 7 best they could, what was going on for them. 8 And, in that way, they began to understand 9 themselves, and be able to communicate, not with 10 just other veterans, but with people they cared 11 about; and reconnect, and reinvest, in the civilian 12 world, as well as have that special connection and 13 bond to their fellow veterans. 14 I'll conclude my remarks with that, and take 15 any questions that you have. 16 SENATOR ZELDIN: If -- right now, as we're 17 here, one of the beauties of Facebook and the 18 Internet, that people are watching this exchange. 19 So, if there's anyone out there that wants to 20 get help from their V.A., if you wouldn't mind just 21 sharing some information of where they can go. 22 DR. CHARLES KENNEDY: Well, absolutely. 23 Simply call the "626-5000" number, at the 24 V.A., and get routed to the PTSD program. Or, to 25 immediate help, up in the mental-health clinic, if 1 that's the case. 2 There is a Veterans' Suicide-Prevention 3 Hotline. 4 I don't have that. 5 Do you have that with you now, Peter? 6 PETER POTTER: I don't have the hotline. 7 But, if you go to our website, and that's, 8 AlbanyVA.com; 9 We also have our Facebook page, which is 10 "VAalbany," simply; 11 And, you can connect, for any of that 12 information, for the suicide hotline, for enrolling 13 for veteran services, both for benefits and health 14 care. 15 SENATOR ZELDIN: We have a veterans' 16 crisis-line phone number here, for the V.A., of 17 1-800-273-8255. 18 Apparently, press "1," and you'll get -- 19 PETER POTTER: That's to talk, yeah. 20 SENATOR ZELDIN: -- get some help. 21 Thank you very much for being here. 22 Senator McDonald. 23 SENATOR MCDONALD: Yeah, we were talking with 24 some of the previous speakers, and the difficulty in 25 a state like New York. 1 You would think the difficulty would be, that 2 some of the public officials would say, in this day 3 and age, the hard economic times, we don't want to 4 do anything. 5 That's not a difficulty. It's just the 6 opposite. 7 The difficulty of us, now, is we're united to 8 do something, and we're willing to do what has to be 9 done, but we want to capture the bureaucracy of 10 everything. 11 This is a very large physical state. 12 If you're talking to somebody from Indiana, 13 they think everybody lives between 150th Street and 14 the Bowery in New York City. Them don't realize 15 it's such a big and wonderful state. 16 And some of the state is more metropolitan, 17 or congested, in a sense, where the population 18 lives, and you can deliver services much easier. 19 As you go beyond Poughkeepsie, and you start 20 spreading out into our great state, and you folks 21 know it firsthand, because Albany Medical, or 22 V.A. Hospital, services more than just the people, 23 say, in the city of Albany or Albany County. 24 It's a great capital region that goes up to 25 the Canadian border, to the New England, and goes 1 quite a bit west. 2 And the issue is, is that a lot of these 3 folks are in the rural areas, and getting the word 4 to them. 5 And, you start out, in your first statement, 6 saying, "partnership." 7 And that's what we're looking for. 8 We're not looking for any kind of a 9 criticisms or adversarial relationships, you know, 10 saying: We don't think that you're doing what 11 you're supposed to. 12 It's a tough issue. 13 It's come a long way since the Korean War or 14 the Vietnam War, and we want to be sure that we 15 capture that, okay, that good feeling of the public, 16 and the public officials. 17 So, put some thoughts on to us, as, how do we 18 communicate? 19 It certainly is important, when you have 20 1-800 numbers, and things like that. But I'm into, 21 sometimes I think people want to see one face 22 looking at another face, and talking to a human 23 being, and expressing, that only -- only you can do 24 that, individually, the emotions, the problems that 25 they have, that they don't want to share over the 1 phone. They want to sit there, and they want to 2 have that kind of emotional attachment. 3 And, we have been -- talked about 4 partnerships, and we're talking about mentoring 5 programs, and working with our counties, and the 6 State Division of Veterans Affairs, and you folks, 7 the Veterans Administration. 8 So, I don't know if there's any kind of 9 special programs that you see throughout the 10 country, that you might have in a smaller state, or 11 any state, that might be applicable, that we 12 customize. 13 We're open to any suggestions that you might 14 have, and what your organization is doing in, Texas 15 or Minnesota, or whatever, because we're going to 16 review it, and anything that makes your life easier, 17 delivering that soldier, and their family structure, 18 to professional help. 19 DR. CHARLES KENNEDY: In Arizona, there's a 20 Dr. Michael Marks, who is a psychologist -- 21 clinical psychologist, Vietnam veteran. He is the 22 chief of psychology and the PTSD team leader. 23 He and a colleague have put together a 24 program at the University of Arizona, called 25 "Scholars in Camo." 1 SENATOR ZELDIN: What was that? "Scholars 2 in," what, now? 3 DR. CHARLES KENNEDY: Excuse me? 4 SENATOR MCDONALD: "Scholars in"...? 5 DR. CHARLES KENNEDY: "Scholars in Camo." 6 SENATOR MCDONALD: Oh, okay. 7 DR. CHARLES KENNEDY: In, like, "camouflage." 8 SENATOR MCDONALD: Yeah. Yep, yep. 9 DR. CHARLES KENNEDY: It is a cohort program, 10 in which they bring veterans into the university, 11 together. They have three or four courses that all 12 of the veterans take together. 13 And they have increased the successful 14 completion of the bachelor's degree, from what was 15 3 or 4 percent in some returning veterans with PTSD, 16 up to, 90, 95 percent. 17 This is the kind of resilience, 18 non-mental-health-stigmatizing approach that we 19 should try to find ways to do everywhere. 20 At our community colleges, at our state 21 universities, at Columbia -- everywhere we can -- we 22 should try to identify, and invite, our veterans to 23 form a community. And then, to help them in that 24 community, within the context of the university, to 25 succeed. 1 SENATOR MCDONALD: I think that's the new 2 words that we're going to talk about: Mentor 3 programs and partnerships, and partnerships with 4 education. 5 Whatever we can do. 6 And we're very grateful of your time here, 7 and what you've done. 8 I know your hospital, because of so many of 9 my relatives being there, and they were always 10 treated well. 11 Thank you. 12 SENATOR ZELDIN: Thank you. 13 DR. CHARLES KENNEDY: Thank you for the 14 opportunity. 15 SENATOR ZELDIN: Our next speaker is 16 Mr. Andrew Roberts. 17 Mr. Roberts is the director of the Office 18 of Military & Veterans' Services, 19 North Shore - LIJ Health System. 20 While Mr. Roberts comes up, just some 21 additional information that we have. 22 There's a website at: VeteransCrisisLine.net. 23 This also belongs to the U.S. Department of 24 Veterans Affairs. 25 "VeteransCrisisLine.net." 1 You can also text to 838255, to receive free, 2 confidential support, 24 hours a day, 7 days a week, 3 365 days a year. 4 Although, I guess this year would be 366 days 5 a year. 6 And, Mr. Roberts, with that, thank you for 7 being here. 8 SENATOR MCDONALD: Mr. Roberts, before you 9 start, first off, I want to thank you. You have a 10 very impressive resume. A West Point graduate. 11 We're honored that you're here. 12 We're trying to keep on schedule, to get 13 everybody to talk. So, we're trying -- sometimes, 14 people like me and Lee like to talk. 15 And, you're an Iraqi War veteran as well. 16 Thank you. 17 And thank you for being the director of 18 Military & Veterans' Affairs Liaison Services for 19 the North Shore - Long Island Jewish Medical 20 School -- Center. Excuse me. 21 Thank you. 22 ANDREW ROBERTS: Thank you very much. 23 Thank you both for your service, as well. 24 So, I'm Andrew Roberts. I'm a West Point 25 graduate, and a former Army captain. 1 I served in Iraq from 2003 to 2004, and was 2 in command of a unit of about 90 American soldiers. 3 When I was putting my testimony together, I 4 was originally going to talk about a few incidents 5 that I actually had, where I was engaged with -- by 6 the enemy, but I realized it really wouldn't 7 accurately reflect the majority of the time that I 8 spent in Iraq. 9 The reality is, that most of time that I was 10 there, I was on the ground, working with my soldiers 11 and the Iraqi people, to help them to build their 12 fledgling democracy. 13 I admit, I was constantly aware that I could 14 be attacked, and greatly concerned for my safety and 15 the safety of the men that I was responsible for. 16 And actually feel that I had fairly positive 17 experiences over there; and, yet, I was still 18 intensely impacted by my experiences. 19 I've been working with veterans now for over 20 five years. And, I can say that, based on my own 21 experiences, compared to many others that I've seen, 22 my troubles were probably on a scale of about 3 out 23 of 10. 24 And I'm going to talk a little bit about some 25 of any experiences. And, I'd like you to think 1 about how my -- you know, someone going through what 2 I went through, and how that could impact somebody's 3 family. 4 When I came from home from Iraq, I left the 5 Army and moved to California. 6 I used to drive to work, scan the hilltops, 7 looking for the silhouettes of enemy heads that I 8 was always looking for when I was in Iraq. 9 I occasionally wondered if the vehicles that 10 I was driving next to had weapons in them. 11 I had a very high startle response. 12 Once, my girlfriend at the time stepped on 13 some bubble wrap in the living room. 14 And, I didn't realize what had happened, and 15 it sounded as though she had crept up behind me and 16 fired an M-16 right behind my back. 17 To say that it startled me is an extreme 18 understatement. 19 A startled response caused by combat 20 deployment, triggered by an unexpected noise, is an 21 awful, uncontrollable visceral reaction that shoots 22 through your entire body. 23 I saw an animal get electrocuted on TV one 24 time, and its physical reaction to the high voltage 25 is similar to how I felt inside of my skin when that 1 happened to me. 2 I don't have kids, and I didn't at that time 3 either, but, I can only imagine how my actions might 4 have impacted them if they had to experience 5 somebody that was going through that. 6 I felt very alone when I was back in America. 7 I felt like I was in a country that no longer 8 understood me, and that I no longer understood. 9 I remember standing in an airport one time, 10 and feeling as though everybody in that airport was 11 together, and I was alone. 12 I hated my job, and I was unhappy with the 13 relationship that I was in. 14 So, there was a lot of stress in my life at 15 that time, but I realize now, that the majority of 16 it was directly related to Iraq. It just didn't 17 seem that way at the time. 18 I never had a nightmare or a flashback. And, 19 as it's been referred to a number of times here, 20 although I had some bad days in Iraq, I really 21 wasn't involved in the combat that I grew up 22 watching on TV, and that I had seen on the movies. 23 So, really, in my own mind, I never connected 24 what I was experiencing when I came home, with my 25 experiences in Iraq or my service in Iraq. 1 I felt normal, and that's how I felt in Iraq 2 for a long time. And, it felt normal to me to feel 3 the way that I was. 4 The one thing I was aware of, was that I was 5 unhappy. 6 I felt as though my job was meaningless. And 7 compared to life-or-death decisions that were being 8 made on a regular basis in Iraq, it's just how I 9 felt. 10 I ended up quitting my job, moved back east. 11 For six months, I was unemployed, and lived 12 with my parents. I was 30 years old, West Point 13 graduate, and unemployed. 14 I was a miserable person. 15 I eventually got a job and moved to 16 New York City, but it was three years after I came 17 home before I finally got help. 18 Although my startle response had been 19 reduced, basically, to nothing, I was still very 20 angry. And nothing really felt better than to get 21 extremely angry and upset about things that were 22 going on in my life. 23 My dad even mentioned at the time, 24 "Maybe this has something to do with Iraq"; which 25 is, now, it's very obvious that it had everything to 1 do with my service in Iraq. But at the time, again, 2 I still just wasn't making that connection. 3 I went through a period of time, trying to 4 figure out, over a weekend, of whether or not I was 5 actually going to seek help. 6 And what inspired me to get help, was that I 7 wanted to serve other veterans. I wanted to be an 8 advocate. 9 And I knew that the first question that any 10 other veteran was going to say to me, if I asked 11 them to get help, was going to be, "Well, did you 12 go?" 13 And I knew I'd have no credibility if the 14 answer was no to that. 15 So, I did; I seeked -- I sought therapy, and 16 it gave me a chance to -- what I describe as: 17 Gave me a chance to step outside of myself, and see 18 how I was actually behaving. 19 I believe it's very hard to do this without a 20 professional, trained, and evidence-based therapies. 21 And that's exactly what I needed to do in order to 22 learn from my experiences, and to understand why I 23 was still suffering. 24 I feel that I have come out of therapy 25 stronger than I was before. 1 And I think it is worth mentioning, that I 2 didn't go to the V.A. for help, although, I've 3 worked with many people from the V.A., and admire 4 and respect many of them. 5 It's, just, I didn't feel, at that time, that 6 that was something that was for me. I didn't want 7 to bump into anybody that might know me. 8 And, I just want to let you know, that that's 9 how I found my therapist, was on a website for 10 people looking for therapy in New York City, which I 11 then sort of realized, also, that almost everybody 12 in New York City is getting some type of therapy. 13 [Laughter.] 14 ANDREW ROBERTS: So, it wasn't as big of a 15 deal as I thought, but it was extremely hard for me 16 to ask for help. 17 And I even asked myself, at one point, if I 18 was mentally ill. 19 And, that is that stigma that is so heavy -- 20 weighs so heavily. 21 And I'm a person that would have believed, or 22 recommended somebody else go for therapy. I just 23 didn't think that I needed it. 24 And it was very challenging for me to go. 25 So, I went five years ago. 1 I had a family that enabled me to get back on 2 my feet, and I've become an advocate for veterans. 3 I worked for the Iraq and Afghanistan 4 Veterans of America; 5 I was formerly a deputy director for the 6 New York State Division of Veterans Affairs, here; 7 And now I'm the director of the Office of 8 Military & Veterans' Liaison Services for 9 North Shore - LIJ Health System, and part of my 10 role, is administrator of the Rosen Family Wellness 11 Center. 12 And I just want to briefly discuss this 13 example of behavioral health as a potential 14 community partner. 15 But working for the Rosen Center, we treat 16 law enforcement, military veterans. 17 Senator Zeldin came to visit us about a 18 couple of months ago. 19 But, I realized how much PTSD can impact a 20 family, which we haven't heard a lot about that 21 today, but it really can. 22 We've treated parents of family members, 23 dealing with their children that are suffering. 24 We've dealt with the brother of a veteran -- 25 or, correction, the -- yeah, the brother of a 1 veteran who lost his leg in Iraq, and the child was 2 emotionally impacted by the experience. 3 We've dealt with wives that are nearly 4 crippled with anxiety, due to the deployment of a 5 loved one. 6 And, of course, we've treated many veterans, 7 and other military members. 8 And we view ourselves as a supplement to 9 V.A. care. And we're proud to be able to provide 10 services that the V.A. just isn't really designed to 11 provide. 12 And, we'll also be opening Unified Behavioral 13 Health Center, for military veterans and their 14 families, in Bay Shore, New York. And this is going 15 to be a collaboration with the V.A., where, 16 North Shore - LIJ, and staff from the V.A., will be 17 operating, side by side, under one roof. And, we'll 18 be able to treat the families; the V.A. will be able 19 of treat the veterans. 20 Both of these organizations are providing 21 care at no cost. 22 And I think these are examples of public and 23 non-profit partnerships that are critical to care 24 for the veteran and his or her family. 25 Now, from my experience, I know that is very 1 hard to ask for help. But, I also believe that you 2 could be, basically, handing out $100 bills at your 3 organization, and, if it doesn't get -- the word 4 doesn't get out to the right veteran, they're not 5 going to come. 6 It goes against everything that our service 7 sort of trains us to do, to ask for help, but, it's 8 also not fair to just look at one organization, like 9 the V.A., or the Department of the Defense, to 10 handle all of these issues. 11 And I believe, you were talking about it 12 earlier, this concept of working with communities. 13 And I think that's critical, because, sometimes 14 veterans just aren't even aware that there could be 15 a service right in their backyard. They wouldn't 16 even know to look. 17 I don't think I would have known to look in 18 my county for help, when I got back. 19 I haven't worked with the State. 20 I see it as a tremendous resource, and it is 21 right there in the community. 22 And I just want to encourage that. 23 I think we can all do more to serve those who 24 serve us. 25 Communities are usually aware of these small 1 local resources, sort of like the Rosen Center that 2 exists. 3 There should be a net of services, to catch 4 any veteran that comes home from war, to ensure that 5 they and their family are aware of them, and how to 6 go about accessing them. 7 It's challenging to gets veterans to come in 8 for treatment, post-operational stress conditions, 9 but, it's a critical step. And, the sooner they get 10 treatment, the faster they can get back on their 11 feet. 12 I'll take any questions. 13 SENATOR ZELDIN: Just one comment, is: Going 14 forward, any ideas that you have, where we can be 15 helpful, Senator McDonald's office, my office. 16 There are -- many of our colleagues have 17 served. As Senator Huntley mentioned, you know, 18 that have loved ones who have served. 19 And we do have a speaker, later on, to 20 testify from the family perspective. 21 You know, our first speaker, Chris Delaney, 22 you know, talking about his best friend, and brought 23 up PFC Joseph Dwyer's brother. 24 And, we definitely realize the impact on the 25 family. 1 We're looking forward to soliciting more 2 testimony. 3 And, for that sake, I'll just turn it over to 4 Senator McDonald at this point. 5 SENATOR MCDONALD: Andrew, we really liked 6 that concept of the partnership with the Veterans' 7 Hospital administration down there. 8 We're probably following up on that. 9 ANDREW ROBERTS: Okay. 10 SENATOR MCDONALD: It's a great illustration 11 to do, as we go across the state, getting as many 12 organizations working together, including, in many 13 cases, for instance, the county I live in, in 14 Saratoga County, mental-health services for the 15 county is actually located in the local hospital. 16 So, we're partners in so many other things, 17 and this would -- we got to continue to explore this 18 partnership, and deliver that service. 19 And I thank you for your service. 20 Thank you. 21 SENATOR ZELDIN: Thank you for your service 22 as well. 23 ANDREW ROBERTS: Thank you both, very much. 24 SENATOR MCDONALD: Next we have a wonderful 25 guest, senior director of Veteran Services, 1 Samaritan Village, Inc., Ms. Carol Davidson. 2 Hello. 3 CAROL DAVIDSON: Thank you. 4 Good morning. 5 SENATOR ZELDIN: And for all the speakers 6 that will be testifying, if we don't end up asking 7 as many questions as we'd want to, please, just 8 understand that it's for the respect of the other. 9 witnesses to follow, to make sure we get everyone 10 in. 11 CAROL DAVIDSON: Good morning, 12 Senator McDonald, Senator Zeldin. 13 Thank you both for your service, and, welcome 14 home. 15 Thank you very much for inviting me to 16 participate in this meaningful dialogue about the 17 psychological, emotional, and spiritual impact of 18 combat service on our military-service members; and 19 the ways in which we, as a community, can assist our 20 veterans in homecoming, healing, and successful 21 reintegration. 22 It is my privilege today to represent the 23 president of Samaritan Village, Tino Hernandez. 24 And, it is my hope that I can contribute to 25 the discussion, from the perspective of a dedicated 1 community-based agency that has been providing 2 specialized programs and services to veterans for 3 the past 15 years. 4 There are well in excess of 1 million 5 veterans living in New York State. And, there are, 6 currently, as many as 10,000 veterans coming home 7 from active duty to New York every year. 8 Veterans are a diverse group of men and women 9 who embody the richness of American culture. 10 They personify the spirit of patriotic 11 service, leadership, courage, and sacrifice. 12 They are resourceful, resilient, and 13 motivated. 14 The warrior ethos that they live by is based 15 on core commitments: To place the mission first, to 16 persevere against all odds, and to take care of one 17 another at all costs. 18 These service members and veterans are 19 real-life heros. 20 Sometimes we forget that they're also 21 real-life human beings whose lives are changed 22 forever as a result of their experiences. 23 The wounds of battle are not always visible, 24 but the impact of trauma, grief, guilt, and horror 25 can be as debilitating as any other catastrophic 1 injury. 2 The writer Paul Fossil described 3 post-traumatic stress disorder, when he said, that 4 he joined the Army to fight the war for its 5 duration, but, discovered that he would have to 6 fight it every day and night for the rest of his 7 life. 8 The Committee's interest in this compelling 9 issue, and willingness to create a forum for public 10 education, discourse, and collaboration, will 11 benefit, both, our veterans, community, and our 12 provider network. 13 If I may, I'd like to begin my comments by 14 just telling you a little bit about 15 Samaritan Village, and our work with veterans. 16 Samaritan Village is a non-profit 17 social-service provider in New York State, with a 18 history of 50 years, and a thriving continuum of 19 services. 20 The current roster of services includes, 21 both, outpatient and intensive residential programs 22 for chemical-dependency treatment, shelter and 23 transitional housing programs for the homeless, 24 health and mental-health services, vocational 25 rehabilitation for our program participants, and an 1 active senior center. 2 Our facilities are located throughout 3 New York City and in Ulster County, and serve over 4 3,000 clients annually. 5 The treatment programs are licensed by the 6 New York State Office of Alcoholism and Substance 7 Abuse Services. 8 We administer three residential facilities 9 for military veterans who is have substance-abuse 10 disorders, and the spectrum of life problems that 11 are associated to chemical dependency, including 12 specialized services for the treatment of trauma and 13 PTSD. 14 Our programs include a 48-bed -- 15 I see a typo to there. 16 -- 48-bed residential program for male 17 veterans in Manhattan; a 50-bed program for male 18 veterans in Queens; and, 25-bed residential program 19 for women veterans in Ulster County, which I'm very 20 proud to say is the first program of its kind in 21 New York State, funded by OASAS. 22 In 2011, Samaritan Village was awarded a 23 grant, for the first time, directly from the 24 U.S. Department of Veterans Affairs, to develop a 25 Supportive Services for Veterans' Families program, 1 which is designed to assist homeless veterans and 2 their families who may be at risk for homelessness. 3 Samaritan Village began to develop treatment 4 services for veterans over 20 years ago, when the 5 clinical staff identified a subculture of Vietnam 6 veterans within the existing treatment programs. 7 Those veterans often had histories of 8 previous treatment failure, and had been unable to 9 stay sober for any significant period of time. 10 Most of the treatment options that were 11 available during that era focused exclusively on, 12 either, of the substance abuse problem or the PTSD. 13 Samaritan Village developed an integrated 14 clinical model for simultaneous treatment of 15 substance abuse and co-occurring mental-health 16 disorders, including PTSD. 17 Our first veterans' program opened its doors 18 in 1996, and we have continued to work diligently 19 since that time on creating a clinical culture that 20 honors veterans, builds on their inherent strengths, 21 and offers pathways to personal healing, that are 22 grounded in trauma-informed care, mutual self-help, 23 and evidence-based clinical practice. 24 Samaritan Village veterans range in age, from 25 their mid-20s, up into their late 60s, and include 1 both combat and peacetime veterans who represent 2 every era. 3 We have begun to see an influx of 4 Operation Iraqi Freedom and Operation Enduring 5 Freedom veterans over the past few years, and we 6 certainly anticipate that we'll see many more in the 7 years ahead. 8 In 2011, the Rand Corporation prepared a 9 "Needs Assessment of New York State Veterans" report 10 for the New York State Health Foundation. 11 The highlights of the report indicate, that, 12 while about 20 percent of combat veterans screened 13 positive for symptoms of PTSD, less than half had 14 received any mental-health services in the prior 15 year. 16 In addition to combat-related trauma, 17 veterans may also develop PTSD in response to 18 incidents of military sexual trauma, which occur 19 with a alarming frequency. 20 The U.S. Department of Labor - Women's Bureau 21 released a recent report, that estimates a range of 22 20 to 48 percent of women in the military experience 23 some form of direct sexual assault. 24 I will not attempt to address these issues in 25 any real depth within the scope of my comments 1 today, but, I will summarize a few key points that 2 reflect my experience of working with veterans at 3 Samaritan Village. 4 Less than 1 percent of Americans have borne 5 the full burden of military service in the wars in 6 Iraq and Afghanistan. 7 The nature of guerrilla warfare, shifting 8 mission objectives, multiple deployments, and the 9 particularly harsh conditions faced by our current 10 service members create conditions that are likely to 11 result in high rates of PTSD and other mental-health 12 problems among this generation of veterans. 13 No one returns from war unchanged, and no one 14 hates war more than the warriors who have lived it. 15 A PEW Research Center report cites that 16 98 percent of post-9/11 veterans are proud to have 17 served, but 51 percent describe that readjustment 18 has been difficult; and, fully, 49 percent admitted 19 that they had some degree of post-traumatic stress 20 reaction. 21 PTSD is a disorder of both memory and 22 meaning. 23 Service members can withstand enormous 24 amounts of adversity and trauma, but, they're prone 25 to derive meanings from their experience that 1 involve irrational self-blame, that erodes character 2 and self-esteem, and engenders self-destructive 3 behaviors. 4 Readjustment problems, including PTSD, create 5 a cascade of consequences that may include, 6 addiction, health problems, marital and family 7 problems, vocational dysfunction, loss of housing, 8 criminal-justice involvement, and, in the worst case 9 scenario, suicide. 10 Some of the barriers to effective service 11 delivery for our veterans include their own 12 reluctance to seek help, because, they perceive it 13 as a sign of weakness, or they fear being 14 stigmatized, they have concerns about taking 15 medications, and, have various challenges and doubts 16 about accessibility to competent care. 17 The U.S. Department of Veterans Affairs needs 18 significant support from community-based providers 19 to deal with the numbers of combat veterans who are 20 on their way home in next few years. 21 Providers need training to develop necessary 22 clinical competencies. 23 The course curriculum for most mental-health 24 professionals does not include any content about 25 military-cultural competence, trauma-informed care, 1 or evidence-based practice for PTSD. 2 Effective treatment for PTSD includes the use 3 of evidence-based practices, like prolonged exposure 4 therapy, eye-movement desensitization and 5 reprocessing, cognitive-processing therapy, 6 et cetera, that is delivered within a context of 7 respect for military service, and provides an 8 opportunity for the veteran to connect with a 9 support network of his or her peers. 10 Finally, it is the moral, social, and 11 practical imperative for American society to 12 mobilize all necessary resources across multiple 13 systems, systems to assist our OIF, OEF, OND, 14 veterans, as well as veterans of all eras. 15 The responsibility for war, and its 16 aftermath, is rightfully shared by a whole culture. 17 In closing: I would like to reference a 18 young OIF veteran named Billy, who talked about the 19 difference between, coming back, and, coming home. 20 It's perfectly normal for human beings to 21 have profound emotional responses to horrific 22 war-time experiences. 23 Our warriors possess incredible resources 24 that they will utilize to benefit society, if only 25 we'd work together to assist in their healing, and 1 help them to rediscover a sense of meaning and 2 purpose, and a place in the community as rightfully 3 honored veterans. 4 Thank you for allowing me to share my 5 observations. 6 SENATOR MCDONALD: Carol, we think highly of 7 your organization. 8 CAROL DAVIDSON: Thank you. 9 SENATOR MCDONALD: We would like to know more 10 about it. 11 You mentioned something about, down in 12 Ulster County -- 13 CAROL DAVIDSON: Yes. 14 SENATOR MCDONALD: -- you have a new 15 facility. 16 I think I would like to visit some of those 17 things. 18 We're moving our schedule along because we 19 want to make sure that we get everybody in. 20 CAROL DAVIDSON: Okay. 21 SENATOR MCDONALD: Okay? 22 But you're going be hearing from us. 23 And, first off, I want to thank you for what 24 you've done so far for these folks. 25 CAROL DAVIDSON: Thank you very much. 1 SENATOR MCDONALD: It's obvious that 2 non-profit organizations have a role in what we're 3 doing here. And they've already established some, 4 you know, really great programs. 5 CAROL DAVIDSON: If I could add just one 6 point that hasn't been mentioned yet? 7 And, you know, again among kind of 8 unspeakable things, that, there are some incredible 9 war heroes/veterans of these conflicts, and all 10 eras, who, for one reason or another, and including 11 reasons that may be associated to PTSD, end up with 12 bad discharge status that disqualifies them from, 13 you know, accessing services at the V.A. 14 And, so, it's -- 15 SENATOR MCDONALD: Well, we're going to be -- 16 CAROL DAVIDSON: -- another reason -- 17 SENATOR MCDONALD: -- these are things -- we 18 do have limitations, and the federal government does 19 supercede us, but we certainly are going to try to 20 personalize the New York State veterans, so we know 21 them as a person, not a number. 22 CAROL DAVIDSON: Thank you very much. 23 SENATOR MCDONALD: Thank you. 24 Next we have another wonderful guest, 25 Ms. Karin Moran, who is director of policy, 1 National Association of Social Workers in 2 New York State, which already sees a great deal of 3 emotional trauma on regular basis. 4 We are trying to keep, Karin, a schedule, so, 5 please help us out. 6 Now, we do know some of the stuff you do, and 7 we do know that there's an overlap. 8 KARIN MORAN: Yes. 9 SENATOR MCDONALD: So -- 10 KARIN MORAN: Thank you. 11 SENATOR MCDONALD: -- and you don't have to 12 read the whole thing. 13 Highlight, if you will, some of the areas 14 that you feel that haven't been covered, that you 15 are unique in. 16 KARIN MORAN: Okay. 17 Thank you, Chairman McDonald, and 18 Senator Zeldin. 19 My name, as you mentioned, is Karin Moran, 20 and I am the director of policy for the 21 New York State Chapter of the National Association 22 of Social Workers. 23 As such, I have spent a considerable amount 24 of time, over the course of the last several years, 25 working on veterans' issues; specifically, the 1 preparedness of the mental-health workforce in 2 relation to meeting the needs of returning service 3 members and their families. 4 I would like to thank you for providing this 5 opportunity to address a critical area of concern 6 regarding veterans and the care available to them. 7 As you are acutely aware, the state of 8 New York, and the country at large, are facing 9 formidable challenges in serving the mental-health 10 needs of our veterans returning from active duty in 11 Iraq and Afghanistan. 12 Since 2001, 2.6 million American service 13 members have deployed to the combat theaters of Iraq 14 and Afghanistan. 15 It is estimated that New York alone, has, to 16 date, assigned over 85,000 troops to 17 Operation Enduring Freedom, Operation Iraqi Freedom, 18 and Operation New Dawn, many of whom have been 19 assigned to multiple deployments. 20 With each deployment, our service members 21 encounter extreme strains on their physical and 22 mental health, which, in many cases, has resulted in 23 unprecedented rates of health and mental-health 24 problems, most notably, post-traumatic stress 25 disorder and traumatic brain injuries. 1 Equally alarming are the numerous reports 2 that I have -- that have identified PTSD and TBI as 3 risk factors of suicide. 4 And, reportedly, individuals with traumatic 5 brain injury are 1 1/2 times more likely than a 6 healthy individual to complete suicide. 7 Other risk factors include, PTSD, depression, 8 chronic pain deployment to combat, and substance 9 abuse. 10 As evidenced by a number of reports, 11 including a landmark study in "The Journal of 12 American Medical Association," post-traumatic stress 13 disorder rates are, reportedly, as high as 14 24 1/2 percent for National Guard and Reserve troops 15 serving in Iraq. 16 In addition to high rates of PTSD, providers 17 in the mental-health community have reported 18 increased cases of TBIs sustained in Iraq and 19 Afghanistan theaters of combat, due in large part to 20 the use of improvised explosive devices. 21 Also disturbing is the rate at which TBI has 22 been misdiagnosed as PTSD. 23 Numerous reports have told the stories of 24 soldiers returning from Iraq and Afghanistan with 25 brain trauma, but because visible head wounds and 1 symptoms -- because there are no visible head 2 wounds, symptoms, such as memory loss and confusion, 3 are often mistaken as indicators of PTSD. 4 In addition, the Department of Defense Task 5 Force on Veterans' Mental Health has reported 6 elevated rates of major depression and substance 7 abuse, while post-deployment health reassessment 8 data show that, up to 38 percent of soldiers, and 9 31 percent of Marines, are suffering from negative 10 psychological symptoms. 11 Hence as service members return to New York, 12 they and their family members are often in need of 13 expert mental health-care; yet, there continues to 14 be a short supply of mental-health professionals who 15 are adequately trained in veteran-specific 16 mental-health issues. 17 In addition, providers need to be well versed 18 in the unique context of mental health within the 19 military culture. 20 The recent Rand Corporation needs health -- 21 "Needs Assessment of New York State Veterans," 22 released January 2011, confirms such, as they all 23 clear for increasing the number of providers trained 24 in the provision of evidence-based treatment. 25 In response to such an identified workforce 1 issue, NASW partnered with the New York State 2 Psychiatric Association and the Medical Society of 3 the State of New York, each of whom have 4 representatives here today, in the development and 5 the facilitation of the Veterans' Mental-Health 6 Training Initiative, a multi-year comprehensive 7 training project focused on increasing the number of 8 community mental-health professionals knowledgeable 9 about the assessment and treatment of mental-health 10 issues specific to veterans and their families. 11 One of the initiatives was funded through a 12 legislative grant, and delivered in five separate 13 locations throughout the state. 14 In addition, the New York State Office of 15 Mental Health utilized the model to train their 16 workforce, cumulatively resulting in over 17 1,000 mental-health providers statewide. 18 While this is indeed a tremendous feat, and 19 even far exceeded our initial expectations, the 20 number of returning veterans, and the derth of 21 mental-health professionals specifically trained to 22 meet the needs of continued -- to meet their needs, 23 continue to be documented in study after study, such 24 as the Rand "Needs Assessment," the Department of 25 Defense's Task Force on Veterans' Mental Health, and 1 many others. 2 Building upon the success of year one, we 3 moved forward with two year of the project funded 4 through a grant by the New York Health Foundation, 5 expanding the project to reach -- to include higher 6 levels of clinical skill-building, in addition to 7 PTSD and TBI introductory curriculum. 8 This project is currently underway, and to 9 date, we have completed 1 of 4 training institutes 10 for 150 mental-health participants. 11 With an eye toward the future; and, yet, 12 additional identification of needs surfacing, we, 13 again, work in partnership with the New York State 14 Psychiatric Association, The Medical Society of the 15 State of New York, to expand the breadth and scope 16 of the project, to include training -- a training 17 track specific to primary-care physicians. 18 As evidenced in recent reports by the 19 Veterans Administration, "The Journal of American 20 Osteopathic Association," the Department of Defense 21 and Division of Psychiatry, and Behavioral Sciences 22 at Walter Reed Army Institute, just to name a few, 23 public-health authorities anticipate that many 24 returning soldiers will initially consult their 25 primary-care physicians regarding health problems; 1 however, the diagnosis of PTSD is often missed in 2 primary-care settings. 3 NASW and its partner organizations believe 4 our veterans deserve access to a comprehensive 5 system of care, one that is staffed with the most 6 highly qualified individuals, and as such, we are 7 dedicated to our role in assuring that New York's 8 health and mental-health workforce continue to lead 9 the nation in preparedness to meet the needs of our 10 veterans. 11 It is with this in mind that we thank you, 12 Senator McDonald, and Senator Zeldin, in addition to 13 numerous other members of your House, with a special 14 note of appreciation to Senator Fuschillo, who's 15 initiative you referenced earlier, and, 16 Senator McDonald, for being such avid champions, 17 both past and present, of our initiative, as well as 18 inviting us to speak today, about our work, our 19 ongoing efforts, to promote continuation of this 20 final project. 21 Thank you. 22 SENATOR MCDONALD: Thank you. 23 It would seem, as we've been talking to the 24 various groups, that one what major role for 25 New York State could be the coordination of all of 1 the different services, so we can cut that 2 bureaucracy. 3 The social workers, and I had experienced at 4 a local county level, as a member of a county 5 legislature in Saratoga County, are there, in many 6 sad situations. And some of time, these sad 7 situations overlap. 8 Your organization, and your membership, can 9 be very helpful, helping us to identify, when 10 they're talking to some of these folks that have, 11 you know, financial problems. 12 And we all know, social services, more than 13 finance, it's a -- dysfunctional families, and 14 things of that nature, as well, that gets 15 highlighted, that we could become -- have them also 16 become part of our team, where they're able to help 17 us, and say: There's a dysfunctional situation, and 18 it happens to involve a military family. 19 For them to be on the alert, and, more so now 20 as these men and women come back. 21 So, the challenge for you folks is to help us 22 out. 23 And our challenge is to get this bureaucracy 24 manageable, so we can get it down to that individual 25 level: the name, not the number, of the person. 1 KARIN MORAN: Absolutely. 2 And it was actually the field that started 3 contacting us, five years ago, which was part of the 4 impetus of this project, because, we had social 5 workers calling us, whether it be from county 6 mental-hygiene offices -- 7 SENATOR MCDONALD: Right. 8 KARIN MORAN: -- or, in a private practice 9 somewhere, that said: We have a freshman combat 10 veteran sitting across from us, and we have no 11 specific training in how to meet these needs. 12 SENATOR MCDONALD: That's what 13 Senator Fuschillo's bill calls for. 14 And that's what Lee and myself, and the rest 15 of us, are going to be pushing this year. 16 Thank you so much. 17 KARIN MORAN: Thank you. 18 SENATOR ZELDIN: Thank you. 19 SENATOR MCDONALD: Next we have, as our 20 guest, Jonathan Gradess, who's executive director of 21 the New York State Defenders Association. 22 Another sad reality about returning veterans, 23 and PTSD, and these type of issues, is some of these 24 folks, not only have the emotional problems that you 25 get from serving in combat, in the military, 1 economic problems, but, you know, family problems, 2 but they also have legal problems. 3 And, there's no justification for breaking 4 laws and doing criminal activity, but there's 5 certainly an understanding that some of these men 6 and women are under undue pressure. 7 And for us to highlight them before they do 8 that, where they help them, so they don't do 9 anything worse than, you know, the original crime 10 they're arrested for. 11 And, Jonathan is the executive director of 12 Defenders Association, which I believe is all of the 13 county defenders in the 62 counties that make up 14 New York State. 15 Jonathan, we are working on a time issue -- 16 JONATHAN E. GRADESS: I understand. 17 SENATOR MCDONALD: -- but I know you talk 18 fast. 19 JONATHAN E. GRADESS: I've been editing as 20 quickly as I could. 21 I want to tell you a story about a soldier, 22 who was driving in the North Country, down the 23 middle of the road at night, followed by an unmarked 24 police car, who comes to a stop sign, and quickly 25 turns around it, without stopping. There's a 1 6-pack, or a 24-pack of beer on the front seat, and 2 a shotgun. 3 And a confrontation that occurs in a case 4 like that, with shots fired, results in a charge of 5 attempted murder of a police officer. 6 What I'm here to talk to you about, is how to 7 translate that experience when I happens, if it 8 happens, into a defense for combat veterans who are 9 suffering from the experience of combat, and bring 10 it home with them. 11 And I want to share with you the background 12 of that story, but I want, first, to say one thing: 13 What I'm going to talk about is, in no way, 14 applies to every veteran. And it's important, for 15 your listening audience, and for everyone, to 16 appreciate that. 17 But, there is a small segment of people, 18 growing segment of people, who, suffering from TBI 19 and post-traumatic stress disorder, from suicide 20 risks, and from depression, from alcohol and drug 21 addiction, from the things that attach like 22 barnacles in service to their lives. 23 That class of people can find themselves in 24 the criminal justice system, and it's that class of 25 people that we're seeking to talk about. 1 The history of this, for me, is, in part, 2 personal, and somewhat longstanding. 3 43 years ago, I worked in the criminal courts 4 of the City of New York, and I watched the class of 5 combat veterans from Vietnam who found themselves 6 enmeshed in the criminal justice system, poorly 7 treated, in my opinion, by the lawyers who 8 represented them; not so much because they -- I 9 think there was a cognitive dissidence. 10 It was before the findings of PTSD. It was 11 back in the late '60s and early '70s. It was a 12 decade before we recognized the defense, but the 13 mitigating circumstances that could have been used 14 in those cases were often missed. 15 And we now have a gigantic cohort of Vietnam 16 veterans in the State prison system. It's our 17 largest, our Vietnam-Era veterans. 18 So as we approach the Iraq and Afghanistan 19 War, the Defenders Association, having had that 20 experience personally, we wanted to be ahead of the 21 wave of Iraq and Afghanistan returnees. 22 We had also handled the very first PTSD 23 defense in this state, in 1980. And it was -- or 24 assisted with it, I should say. It was handled by 25 Steve Wax, who's now the federal defender for 1 Portland, Oregon. 2 That client is still serving time in prison. 3 That defense was not easily recognized at the time. 4 And, today, we have a system in which the 5 public defense lawyers who represent poor people in 6 the 62 counties of this state, are radically 7 underfinanced, are without investigative support, 8 have very little access to experts. 9 And, so, you could imagine a veteran who does 10 not want to reveal and disclose their situation, 11 coming in contact with a defense lawyer who does not 12 have the time to explore that situation. You can 13 imagine how those people can be wrongly propelled 14 into the state's criminal justice system if we don't 15 do something to interdict that. 16 About five years ago, we received a small 17 planning grant, to try and do some planning around 18 that, for public defense services. We wanted to set 19 up a military and veterans' defense unit. 20 We ended up really spending more time 21 learning how much we didn't know; and being in touch 22 with some of the witnesses who were here today, and 23 some of those issues, learning about the barriers, 24 learning about the unreliable identifications, 25 learning about the real institutional resistance to 1 reporting. 2 And, some of that data, which in my written 3 testimony, I'm not going read it again, is 4 absolutely flabbergasting, when you put up that 5 against non-reporting, non-disclosure concerns, 6 stigma, up against lawyers who are not trained to 7 look for, find, and defend in these cases, you have 8 a real calamity about to occur in our state. 9 And that's really what I'd like us to 10 address, is, as we talk about "providers," we mean 11 lawyers who will represent clients, who have been 12 combat veterans, who have a story that needs to be 13 told to juries, who have issues that need to be 14 presented to prosecutors, who need to be diverted 15 from the system, who need to have the kind of care 16 and concern that every client should have, but, 17 particularly, people who -- many of whom, have had 18 inculcated in them, specifically because of their 19 combat experience, issues, which, if translated into 20 criminal behavior, are very hard to explain. 21 They seem incongruous. 22 You heard a witness earlier today, who I want 23 to talk to, who said: Driving along the Long Island 24 Expressway, or wherever in Long Island, looking for 25 silhouettes; or, responding to bubble wrap; 1 Or, the reason you turn past the stop signs, 2 is because that's habitual behavior, after not 3 stopping at corners; 4 That, I think, Senator, is something that 5 happens in combat. And, it's happened in Iraq. 6 Those kinds of things need to be explained. 7 But, if you have a client who is unemployed, 8 or homeless, on drugs and alcohol, and in denial 9 about that, or maybe not in touch with it, it's a 10 very real task. 11 So we're hopeful, that, together, we can work 12 to help continue the training of defense lawyers, 13 and develop some of the issues that we think could 14 help solve these problems. 15 SENATOR MCDONALD: I have a question right 16 now, and then I'm going to give it to my colleague. 17 JONATHAN E. GRADESS: Yes. 18 SENATOR MCDONALD: That would be an excellent 19 proposal that your organization can make us in a 20 more detailed fashion. 21 JONATHAN E. GRADESS: We would love to do 22 that. 23 SENATOR MCDONALD: We have veterans' courts, 24 as you know. 25 JONATHAN E. GRADESS: Right. 1 SENATOR MCDONALD: They're popping up in 2 different locations, that are special courts for 3 returning veterans. 4 And, you know, the training might be 5 something, that we might be able to go to the local 6 bar associations. Each county has a bar 7 association. New York State has a bar association. 8 And if I'm correct, they're are required to do a 9 certain amount of, you know, charity-type work, if 10 you will. 11 But, we have somebody sitting right next to 12 me, who's not only a combat veteran of Iraq, but 13 also an attorney. 14 Do you have any thoughts on that, Lee? 15 SENATOR ZELDIN: Well, my question actually 16 was: When you're talking about, to be able to 17 explain this story to the jury, are you focusing 18 primarily on the liability end of the case, or are 19 you talking about mitigation during sentencing? 20 JONATHAN E. GRADESS: Well, I'm talking 21 about, in criminal, I think there's three classes of 22 cases that we're interested in. 23 The veterans courts are a good example, and 24 I'm glad you raised it. 25 There are four of them operating now, and 1 there's about thirteen in the hopper, for this 2 state. 3 We actually have a little bit of concern 4 that -- that not all focus should be on those courts 5 because they are dealing with lesser cases, 6 important cases. 7 They're working well. The mentoring process 8 is excellent. 9 We're talking, in part, about very serious 10 cases which go wrong, which are going to be charged 11 as felonies, that are going to be brought into court 12 and prosecuted, in which defense lawyers are going 13 to need to have an entire array and repertoire of 14 understanding of these cases, of understanding of 15 what the combat situation was of a then-defendant 16 combat and military record, they're going to need to 17 have access to experts and diagnostic treatment, and 18 to be able to explain the circumstances in 19 mitigation, to prosecutors, to juries, as to why 20 lesser punishments, or even acquittals, should 21 occur. 22 Very complicated, but it has an analogue in 23 mitigation work that is done every day in very 24 serious cases. 25 But it is a problem in New York, because 1 people are so underfunded and so overwhelmed, that 2 it isn't going to come naturally unless we intervene 3 to make it happen. 4 SENATOR ZELDIN: Yeah, I would absolutely 5 agree on the -- you know, the mitigation point, that 6 someone's service to our country, and the mental 7 wounds that they bring home, and how that 8 contributes to the act that they committed. 9 While there may be a need for a guilty 10 verdict, and to hold them responsible for what 11 happened, maybe it should be considered, in certain 12 cases, as far as mitigation. 13 So, I would agree with that. 14 SENATOR MCDONALD: You know an enlightened 15 legal system of what we've got here, and it's been 16 said several times: You send men and women off to 17 war. You think you send them off individually, you 18 don't, because they have some kind of -- hopefully, 19 some kind of friendship and family structure behind 20 them. So that means they're going to war with them. 21 And when they come back, the war isn't over 22 on a particular time or a date or a year, for them. 23 And they're going to be -- you know, it's a 24 different world on the other side of the world, when 25 you're in combat. And they're going to have to 1 adjust to that. 2 Now, we don't justify any crimes. It's 3 America; you pay the price. 4 But we have to turn around and recognize that 5 these men and women have got to be defended, with 6 the understanding that they came from a place -- 7 JONATHAN E. GRADESS: And the -- 8 SENATOR MCDONALD: -- that was barbaric. 9 JONATHAN E. GRADESS: -- I think there needs 10 be an understanding for all of us, on the difference 11 between, accountability for behavior, and, the 12 nature of what then happens, to send someone, for 13 example to prison, who's in a state already of 14 hypervigilance, where that hypervigilance is going 15 to be increased in prison, and they're going to 16 learn survival skills there that are like combat; 17 but, then, come home, break up their family to do 18 so. 19 When, in Minnesota and California, we already 20 have statutory schemes, which we'd also like to 21 share with you, that are diverting veterans for this 22 reason. 23 So we'll -- 24 SENATOR MCDONALD: I see this, though, we'll 25 work together -- 1 JONATHAN E. GRADESS: Great. 2 SENATOR MCDONALD: -- but, please get us 3 back, with some detailed comments -- 4 JONATHAN E. GRADESS: We'd be happy to do 5 that. 6 SENATOR MCDONALD: -- on what the training 7 would be. 8 JONATHAN E. GRADESS: Very happy to be -- 9 SENATOR MCDONALD: Much like the -- and who 10 are the non-profits that we could utilize, such as 11 the bar associations, and things of that nature. 12 Thank you. 13 JONATHAN E. GRADESS: Thank you very much. 14 SENATOR MCDONALD: Next we have, 15 Command Sergeant Major Gary Flaherty. 16 And we have been talking about county 17 veterans, county veterans' directors, and the State 18 program. 19 And, Gary is the director for the 20 Columbia County Veterans' Service Office. 21 And we're lucky to catch him in, because he's 22 a gentleman that spends less time in the office, and 23 more time going out to see the men and women, and 24 their families, that need him. 25 Thank you, Gary. 1 SENATOR ZELDIN: And, Senator McDonald, and 2 Mr. Flaherty, if you wouldn't mind, Mr. Ronayne, 3 Tom Ronayne, is here. 4 Would you mind just coming up, as well? 5 Tom is the director of the Veteran Services' 6 Office for Suffolk County, who has been advising -- 7 advising me and my office as well. 8 SENATOR MCDONALD: Fine. 9 And we have a third one, but we'll get to 10 him, from Saratoga. 11 This is, what in the Army we called, 12 "the ground troops." The grunts, they see the real 13 things. 14 Thank you. 15 And your name again, sir? 16 THOMAS RONAYNE: Thomas Ronayne. 17 SENATOR MCDONALD: Nice to meet you, sir. 18 Thank you. 19 We'll start with Gary, then we'll go over to 20 Thomas. 21 COMMAND SGT. MJR. GARY FLAHERTY: Senators, 22 thank you for the opportunity for me to appear 23 before you today. 24 I gave a lot of papers, the background 25 information, so I'm -- with your permission, I'd 1 like to go off script, and tell you about the 2 successes we've had in Columbia County. 3 When I went down and took over the director 4 of Veterans' Services at Columbia County, the office 5 was more of a walk-in. If you needed veteran 6 services, and you walked in and asked for them, and, 7 they did what they could for you. 8 I turned all that around, and started an 9 outreach program. And, my outreach program includes 10 doing mail-outs to veterans. 11 I get a list out of Washington once a year, 12 that has every veteran who was discharged during 13 that year, and I send them a already letter, 14 welcoming them home. And, also, giving my cell 15 phone, my home phone, my e-mail, asking them, if 16 they need services, to call me. 17 I do not spend very much time in my office. 18 I make house calls, day and night. 19 We've been very successful in linking our 20 services with the V.A. services. 21 And, in particular, with post-traumatic 22 stress syndrome, TBI, for all areas of the wars. 23 I spent my time in Vietnam, and suffered 24 many, many years with post-traumatic stress syndrome 25 myself. 1 And I thank God, and I thank the Albany V.A., 2 or I probably would not be setting before you today. 3 We've also started a program, as directed by 4 the -- Judge Teresi (ph.) in Albany, and called the 5 "Veterans' Justice Outreach Program." 6 And, we coordinate with a coordinator at the 7 V.A. We work with all of our legal people at the 8 V.A. -- at the county level: the district attorney, 9 the sheriff's department. The -- Judge Nichols 10 oversees the program. 11 Most places, they have a drug court; which we 12 have a drug court. And they put us into the 13 drug-court program. 14 However, we're in the process of working a 15 model, where it would -- we would have a separate 16 time that Judge Nichols would hear the cases of only 17 combat veterans, or veterans, who have committed 18 non-violent crimes. 19 This past year, we've been successful, that 20 we were able to keep eight veterans out of prison, 21 and get them into treatment. 22 Judge Nichols, instead of sentencing them 23 back to jail, he'll direct them to work with me, to 24 get into mental or physical health, as needed. 25 Oftentimes, I'll get a call from the 1 sheriff's department, that they picked up somebody. 2 And when I go to visit the veteran at the sheriff's 3 department, they ask me two things: 4 "Did you ever serve in a war zone?" 5 And, "Did you have any effects after being in 6 combat?" 7 And, once you establish that role, they 8 immediately open up to you. 9 And, I've had 24 people this year, and in 10 every case, it's become more of a friendship, 11 mentoring program, than it has, "go get help." 12 And our -- the other part of our outreach 13 program is, we brought all the department heads 14 together in Columbia County. 15 And, our chairman directed that they, on 16 their intake form, they change it, to ask the first 17 question, "Did you ever serve in the military?" 18 rather than, "Are you a veteran?" -- because, a lot 19 of people who previously were in the Reserves or 20 National Guard don't consider themselves veterans. 21 And, when they ask that question -- 22 SENATOR ZELDIN: That's changed. 23 COMMAND SGT. MJR. GARY FLAHERTY: Pardon me? 24 SENATOR ZELDIN: That's changed. 25 COMMAND SGT. MJR. GARY FLAHERTY: That's 1 changed, yes, correct. 2 But when they -- if they answer "yes," then 3 they're to be directed to our office for help from 4 us, from a veteran standpoint, rather than 5 social services, or Office of the Aging, or 6 whatever. 7 SENATOR MCDONALD: Let me ask you a question, 8 Gary. 9 We were talking about partnerships. 10 And I think you, and your colleague sitting 11 next to you from Nassau County, and your colleague 12 from Saratoga County who will be speaking in a 13 little bit, getting this one-on-one mentoring 14 program -- 15 Some of these non-profits already have it. 16 We heard hospitals, and different groups. 17 -- it really is important, in upstate 18 especially. 19 You're a small county of about 60,000 people. 20 And if we can do that, in using Senator Fuschillo's 21 bill as a springboard to getting a little training 22 money, it would seem to me that this is tailor-made, 23 especially in upstate, for our county governments. 24 Would you agree with that? 25 COMMAND SGT. MJR. GARY FLAHERTY: I totally 1 agree. 2 And I feel that, you know, as we would say in 3 the military, "If you don't have the boots on the 4 ground," you know -- 5 SENATOR MCDONALD: Right. It's easy to talk 6 to all the agencies in a small county. It's 7 tougher, obviously, Nassau County's bigger than some 8 states, obviously, in population. 9 COMMAND SGT. MJR. GARY FLAHERTY: But we were 10 able to train 13 mentors, and besides myself. And I 11 oversee all of them. And if I get veterans -- and 12 some of them are females. If I get a veteran that I 13 want to refer to another mentor, then I have the 14 veterans -- 15 SENATOR MCDONALD: Well, I think you bring up 16 a good point. 17 COMMAND SGT. MJR. GARY FLAHERTY: -- trained, 18 standing by. 19 SENATOR MCDONALD: With so many female 20 veterans, it's important that we recruit mentors for 21 females too, whoever they're comfortable with. 22 COMMAND SGT. MJR. GARY FLAHERTY: But I -- I 23 would -- in the interest of time, I would tell you, 24 that our program has been so successful, that the 25 judge in Greene County calls on me to come to his 1 court. 2 I've now been called to court, down in 3 Ulster County, to help veterans down there. 4 And, last night, as an example, I -- we did 5 have one veteran this year end up, before they 6 called me, and he had already made an arrangement, 7 or a deal, with the DA, and a public defender, that 8 he would take 1 1/3 to 3 years' probation. 9 But after I talked to the judge, the judge 10 wrote a letter, saying, give him an early parole 11 hearing. 12 And I received a call from him last night, 13 and he already has it, after a month and a half, and 14 will be getting out in -- the 2nd of July. 15 And, he called me back a half hour later, and 16 said: I've been talking to the officer in charge of 17 our block, which is all veterans. There's 18 60 veterans in that block. And he wants to know if 19 you'll come out to the prison near Rochester, and 20 present your program to us. 21 SENATOR MCDONALD: You have such a good 22 program, I'm going to personally visit you. It's so 23 close to the capitol. 24 And I'm so grateful that you're here, and I'm 25 grateful for your service. 1 COMMAND SGT. MJR. GARY FLAHERTY: Thank you. 2 SENATOR ZELDIN: Thank you, Gary, for your 3 service as well. 4 And, Senator McDonald, just by way of 5 introduction, Tom Ronayne, last name spelled 6 R-O-N-A-Y-N-E, has been running the 7 Veterans' Service Office in my home county of 8 Suffolk for a few years, and has served our 9 community very well. 10 And something to offer up to the Committee 11 is -- is a program called -- it's called the 12 "Baghdad to Brentwood in 24 hours" program. 13 And I represent the Brentwood community, 14 which, the program involves Suffolk County police 15 officers, who, before going from -- before getting 16 their firearm back, and going right back to the 17 street on a patrol, they go back to the academy for 18 retraining and screening. 19 And if -- Mr. Ronayne, if you wouldn't mind 20 giving us the abbreviated 2-minute version of the 21 program, and any additional thought, for sake of 22 time, though. 23 I appreciate the last-minute invitation. 24 THOMAS RONAYNE: Before you do, 25 George Basher, I just want to -- I didn't have a 1 chance to just recognize him. 2 He's the former director of Veterans Affairs 3 for New York State. 4 Thank you for being here. We're going to be 5 talking to you later, to get your input. 6 GEORGE BASHER: Yes, sir. Thank you. 7 SENATOR MCDONALD: Thank you, George. 8 I'm sorry, sir. 9 SENATOR ZELDIN: Thank you, Mr. Ronayne. 10 THOMAS RONAYNE: Thank you, Senator. 11 The program that Senator Zeldin refers to, we 12 affectionately refer to it, in Suffolk County, as 13 "Baghdad to Brentwood in 24 hours." 14 And -- 15 SENATOR MCDONALD: Doesn't sound like a train 16 I want to be on. 17 COMMAND SGT. MJR. GARY FLAHERTY: Well, 18 much -- 19 SENATOR MCDONALD: Or, maybe on, but going 20 the other direction. 21 THOMAS RONAYNE: Much to the credit of the 22 leadership in the Suffolk County Police Department, 23 they recognized, a number of years ago, that the 24 issue of police officers, who, in many instances, 25 were National Guard members, were returning from 1 their military duty. 2 Upon arrival home, they could, effectively, 3 immediately report for duty; pick up their ID card, 4 pick up their weapon, and return to patrol. 5 It was recognized that maybe this wasn't the 6 best way of approaching the issue. 7 And what they did was, they designed a 8 program, wherein, when the police officers return 9 from combat duty, before returning to regular patrol 10 assignments, they would go back to the police 11 academy, which makes a great deal of sense, not only 12 for the issue of the delay in returning the weapon, 13 but, allowing them to be retrained in issues of all 14 that may have occurred during their absence, and so 15 forth. 16 But as a part of their retraining, they would 17 also be invited to participate in a psychological 18 screening. 19 One of the components that I find most 20 beneficial in this program, is that it is not 21 intended only for the police officer. The 22 psychological evaluation, the counseling, and the 23 ability to come in and speak with the individuals 24 involved, extends to that police officer's family as 25 well. 1 And we all know, and we've heard excellent 2 testimony here this morning, that the family 3 members, the loved ones, those closest to these 4 veterans, are, very often, the first ones to 5 recognize that these issues may exist at all. 6 Certainly, far sooner than, in many of our cases, 7 ourselves. 8 SENATOR MCDONALD: This is an excellent 9 illustration of what we can do. 10 One of the problems you have, is, when some 11 of these -- if you're in the police department, and 12 you're coming back to Suffolk County, people are 13 gonna know who you are, and they're going to have 14 some background. 15 We get people discharged in our communities, 16 we didn't even know they lived in our communities. 17 Some of these communities are bigger, and maybe 18 their family members moved. And, all of a sudden, 19 and we can't -- freedom of information, okay, won't 20 get you that material from the federal government. 21 They're protecting their privacy. 22 So it's a never-ending issue, how do you get 23 somebody who doesn't have that network? 24 And, certainly, every police department I've 25 ever seen has a network of discipline and 1 responsibility and affection for their colleagues. 2 How do we get these people, coming out? 3 Because we're not going to get a list, 4 generally speaking, from the federal government. 5 Or -- and I think that's -- that's the 6 never-ending issue of your jobs, is, they come -- if 7 somebody says, go see you, okay, then your jobs 8 become more relevant, not less relevant, okay, as 9 they war returnees come back. 10 COMMAND SGT. MJR. GARY FLAHERTY: There is a 11 computer base that I found in Washington, that 12 provides the name and address, last address known, 13 of every veteran, on an annual basis, that is coming 14 out of the service. 15 And that's what I use as -- for my outreach 16 program. 17 SENATOR MCDONALD: Okay. 18 THOMAS RONAYNE: We also subscribe to it. It 19 is referred to as the "RONA List." The, R-O-N-A, 20 List. 21 It is available to governmental agencies. 22 And it, essentially, is a list of those service 23 members separated from service during the previous 24 year. 25 It is something that is only released to 1 governmental agencies, and a few others. It is done 2 by request. 3 It's extremely helpful. It's a wonderful 4 resource. But we have found that the return rate, 5 the information is not always already current. 6 SENATOR MCDONALD: Sure. 7 SENATOR ZELDIN: I want to personally thank 8 both of you for your military service. 9 And I think this illustrates the need, going 10 forward, for us to communicate with all of the 11 Veterans' Service Offices of all of the counties of 12 the state, because we allow diverse ideas of how to 13 connect to different levels of government to help 14 our returning veterans. 15 So, thank you for being here. 16 SENATOR MCDONALD: I think you guys are the 17 infrastructure that we need to reach out to the 18 grassroots, and we just have to put all the pieces 19 together. 20 Thank you, each of you. 21 SENATOR ZELDIN: Thank you. 22 COMMAND SGT. MJR. GARY FLAHERTY: Well, I 23 look at it, as you know, command sergeant majors 24 took care of their troops. 25 Now I feel it's my obligation to take care of 1 our veterans. 2 SENATOR MCDONALD: Thank you. 3 THOMAS RONAYNE: Thank you for this 4 opportunity, and Suffolk County is never more than a 5 phone call away if we could be of service. 6 SENATOR MCDONALD: I appreciate it. 7 Thank you. 8 Next we have, Mr. John Richter, director of 9 Mental Health Association - New York State. 10 And I would also appreciate, it's not that 11 we're trying to get you through fast, but, we tried 12 to get as many people, and we would love talking to 13 them, but we have to keep on our schedule. 14 JOHN RICHTER: Understood, Senators. 15 SENATOR MCDONALD: That's all right. 16 And we're grateful for what you do. 17 JOHN RICHTER: Thank you for introducing me. 18 I don't need to do that job now. 19 And thank you both, Senators, for your 20 service in the military, and, particularly for 21 calling attention to this -- the particular issue 22 that you chose to focus your attention, I think is 23 so important here, because, what we've been 24 learning, I think, and seeing today, is that PTSD, 25 although there's a lot that can be said about 1 causality, it seems to be the culprit in so many 2 different issues and problems that veterans and 3 families struggle with. 4 So, zeroing in on that, I particularly -- 5 SENATOR MCDONALD: Yeah, you don't have to 6 read the whole document -- 7 JOHN RICHTER: I'm not gong to. 8 SENATOR MCDONALD: -- but if you can hit 9 that, you know, what to do, and how -- you can help 10 us. 11 JOHN RICHTER: Sure, I'll cut right to the 12 chase, in terms of where we come at this from. 13 We're looking at untreated PTSD and 14 under-treated PTSD, in particular, and the 15 disconnects for why that occurs; 16 And, then, how military families, as been 17 alluded to already, can play an important role in 18 overcoming some of the barriers that exist. 19 So, with that said, I will get right to the 20 focus. 21 You've heard already, a lot about the other 22 comorbid things that go along with PTSD, that what 23 it -- the havoc that it wreaks on families and 24 communities when it's unchecked, when it's 25 untreated. 1 We've talked about -- you've heard about, you 2 know, the incidence of PTSD. You've heard about, 3 that anywhere from a third to a half, as far as we 4 know, of cases of PTSD go untreated. 5 That that untreated PTSD is costly to 6 society, costly to families. It takes its toll on 7 the family, in marriages, in substance abuse, and 8 other mental illnesses that can occur as well, not 9 only in the veteran, but also in family members. 10 So, you know, we're -- we want to focus in on 11 the clear disconnect between the illness and the 12 treatment; and that's where we come at this from, 13 and, how do we overcome some of the barriers. 14 A lot of those have been discussed today. 15 Stigma is a big barrier. 16 We all face that in trying to -- with 17 mental-health services. 18 Veterans, I believe, have probably a more 19 intense, perhaps, stigma, that owes itself to 20 military culture, and other norms, and things like 21 that, but, nonetheless, they're stepping into a 22 situation, where, when they do come home, that 23 their -- that stigma is a big issue that keeps them 24 from getting treatment. 25 Fears of negative career implications, for 1 how they answer on some of the screens that are 2 already in place, it can be a problem that keeps 3 them from it. 4 And, finally, the difficulty navigating 5 barriers to service, that we all have to negotiate 6 when we decide we need help. 7 Okay? 8 SENATOR MCDONALD: Right. Yep. 9 JOHN RICHTER: So, there's those things. 10 Overcoming those, even if we have the most 11 advanced and sophisticated treatment system you can 12 imagine, that unless -- for the people who don't 13 overcome these barriers, it's kind of meaningless. 14 So, to focus on mitigating some of the damage 15 that occurs when PTSD goes untreated, the approach 16 that we've taken, is to work with families while -- 17 while the military folks are still deployed, when 18 they've been deployed, when they come -- and when 19 they come home, to give them tools, to equip them 20 with everything, from recognizing some of the signs 21 and symptoms of PTSD, where to get help, how to get 22 help, but, perhaps, more important, how to stay 23 engaged in recovery; how to keep with the program, 24 so to speak, until you've made it through recovery, 25 and the family's got their feet back on the ground 1 again. 2 You know, we -- again, we believe that 3 through these trusted relationships, families and 4 friends are the strongest allies in overcoming these 5 barriers. 6 You know, and I ask you to bear in mind, 7 these things, as we present a particular approach 8 to -- that we've already started in two counties in 9 this state, to address this with military families, 10 to give them the tools that they need, and equip 11 them, for, basically, the battle that they face when 12 their loved ones come home. 13 And I know that has been alluded to already 14 today enough, and I'll get right to the project. 15 This project that we've been engaged in with 16 2 of our MHA affiliates -- we have 31 MHA 17 affiliates, total -- they reach into 54 counties. 18 And that is, very much, I think directly goes 19 to Senator McDonald's point, about, how we engage 20 folks in their communities. 21 And because our MHAs have been doing -- 22 providing services in their communities -- 23 24 25 1 SENATOR MCDONALD: We don't want to 2 duplicate. 3 In fact, we want to do something just the 4 opposite. We want to highlight, and maximize the 5 impact that, already, our mental-health community, 6 because we have an established mental-health system 7 in our counties, in our state. 8 Now we're just asking them, which is a big 9 ask, and I recognize that, just to help us out, and 10 highlight these possible issues with the PTSD. 11 And, you know, PTSD, we're talking about the 12 military. 13 And, we had a gentleman from Suffolk County, 14 it even occurs in police departments and the fire 15 departments. 16 And, so, you know, we just don't say, we're 17 helping the soldiers. That's highlighted it, 18 because so many are coming back, and so many are 19 having problems with these types of issues. 20 But on a day-to-day basis, you have other 21 people who are impacted, which is traumatic events 22 in the course of their occupation, like a policeman 23 or a firefighter. 24 So we're trying to do the right thing. 25 And, we want to work closer with the 1 mental-health entities, because we really want to 2 show the public that we need this kind of support in 3 our society. 4 JOHN RICHTER: And we absolutely do 5 believe -- 6 SENATOR MCDONALD: Yeah, and we're going to 7 have -- 8 JOHN RICHTER: -- that families are a glue. 9 And they're the conduit, we believe, through which 10 we overcome these barriers, and connect people with 11 services. 12 So, we're doing this in Jefferson County, 13 we're doing it in Nassau County, under a grant 14 through the Bristol-Myers Squibb's foundation. 15 SENATOR MCDONALD: Sure, yeah. 16 Jefferson, of course, is the home -- is that 17 the home of, uh -- 18 JOHN RICHTER: National Guard? Or -- oh, 19 Fort Drum Airbase. 20 SENATOR MCDONALD: Yeah, yeah. 21 JOHN RICHTER: Fort Drum military base, yes. 22 SENATOR MCDONALD: So you have got -- 23 JOHN RICHTER: And a disproportionately 24 number of deployments -- 25 SENATOR MCDONALD: Well, I was just going to 1 say -- 2 JOHN RICHTER: -- as compared to other places 3 of deployment in the country. 4 SENATOR MCDONALD: -- well, and just a large 5 percentage of the total population is 6 military-oriented. 7 JOHN RICHTER: Absolutely. 8 And many of their families live on the base. 9 SENATOR MCDONALD: What a great learning 10 process for us -- 11 JOHN RICHTER: Absolutely, sir. 12 And Nassau County, of course, has one of the 13 highest levels of veterans living there, in the 14 state. 15 So, two counties that make sense to really 16 cut our teeth in this pilot. 17 What's really important about the pilot, is 18 the specific tools that we try to give to families. 19 And we start work -- again, we start working with 20 them while their loved one is deployed. 21 And these include, peer supports, and peer 22 groups, these -- that was alluded to earlier, 23 this -- the notion of a mentor. 24 We include wellness tools, and training for 25 the families themselves. 1 These are tools that help them to manage 2 their own difficulties that may come up with mental 3 illnesses; PTSD, in particular, in this case. 4 Advanced directives; trauma-informed care; 5 trauma-recovery tools; and, Safe Talk, which is a 6 suicide-prevention program. 7 So this is what we're trying to impart on 8 families, you know, to give them some tools, to know 9 what to recognize. 10 When someone comes home -- the last thing 11 that I think a veteran needs, when they come home to 12 their family, is that their family is just as 13 misinformed about all of these issue as the rest of 14 the population; and, yet, they are -- they have -- 15 they hold the keys to overcoming some of the stigma, 16 and some of the -- 17 SENATOR MCDONALD: Yeah, and it's been that 18 way forever. 19 JOHN RICHTER: And, so -- 20 SENATOR MCDONALD: John, what we need from 21 you -- 22 JOHN RICHTER: Yes, sir? 23 SENATOR MCDONALD: -- is to be a part of our 24 team as we put these programs together -- 25 JOHN RICHTER: Absolutely. 1 SENATOR MCDONALD: -- and working with one of 2 our staff -- Dr. Carpinola [ph.], for instance -- 3 so we can turn around and coordinate, and help those 4 folks at the baseline. 5 And the baseline is, I'm beginning to see 6 more and more, the grassroots -- 7 And it goes, from the grassroots, right up to 8 the federal government. 9 -- is, the county governments and their 10 mental health and their veterans and their social 11 services. 12 And so many of these people have got so much 13 experience already, and such big hearts, and that it 14 could be very helpful. 15 So, we're going to review your policy, but 16 we're going to get back. And think of that role 17 that your team of members that you have can play 18 with us. 19 JOHN RICHTER: Yes. 20 SENATOR MCDONALD: And think of a diagram 21 that we can present to our colleagues in the 22 Assembly and the Senate and the Governor's Office, 23 so we can see, how, instead of working from the top, 24 down, we're working from the bottom, up. 25 So, my sensitivity, is that, that family, 1 whatever county, your community, in New York State 2 throughout, they don't feel like they're part of the 3 masses. 4 JOHN RICHTER: Yes. 5 SENATOR MCDONALD: They feel that we know 6 their name, it's not a number. And that we're going 7 to talk to them the best way we can. 8 Now, we know it's not going to be an easy 9 task, and we have a big bureaucracy. But we need a 10 path through that bureaucracy, to the individual 11 family or individual veteran, with the help. 12 You guys are going to be very critical, 13 because you've already -- you folks have already 14 been trained in this area: the sensitivity, the 15 understanding of it. 16 And, it might be helpful as we talk to them. 17 So, we're going to need your help, John. 18 JOHN RICHTER: Yes, sir. 19 And we're prepared, and we're right there 20 with you. 21 SENATOR MCDONALD: Thank you. 22 JOHN RICHTER: Whatever we learn from this 23 project, we want to share. And we certainly look 24 to, hopefully, replicate it. 25 SENATOR MCDONALD: You put thoughts on it, 1 get back to us. As we go around, we've got some 2 other communities we have to do this in. 3 And I just want to make sure I get through. 4 There's, some of these people, we tried to 5 put the ones that traveled the farthest away, up 6 front. 7 JOHN RICHTER: Understood, sir. 8 Thank you, both, Senators. 9 SENATOR ZELDIN: Thank you. 10 SENATOR MCDONALD: Thank you, John. 11 Okay, Roger Ambrose; 12 And, Kathleen Manasio [sic], 13 Rensselaer County person, just as we... 14 KATHERIN MACIOL: Yes, sir. 15 SENATOR MCDONALD: Roger is director of 16 Jefferson County Community Services; 17 And, Katherine is the commissioner of 18 Rensselaer County Department of Mental Health. 19 I want to thank you both for being here. 20 I want to thank you for what you're doing. 21 We just talked to your colleague John, head 22 of the Mental Health Association - New York State. 23 And, you can see where we're going. 24 KATHERIN MACIOL: Yes. 25 SENATOR MCDONALD: You had a lot of patience, 1 sitting through some of the dialogue. 2 KATHERIN MACIOL: Yes, sir. 3 SENATOR MCDONALD: We're looking for 4 partners; we're looking to extend that helping hand 5 to these young -- not so young. Men and women of 6 all ages who are our veterans, and their families. 7 KATHERIN MACIOL: Great. 8 SENATOR MCDONALD: Roger. 9 KATHERIN MACIOL: Well, thank you. 10 ROGER AMBROSE: Thank you, Senator. 11 KATHERIN MACIOL: I'll begin. 12 First of all, I'd like to say, that, I'm also 13 here as a daughter of a World War II veteran. 14 And my father, John Maciol, was a 15 Marine Infantry, and he was stationed in the 16 Philippines during World War II. 17 And, my father is watching this, and he says 18 to you, sir, "Semper Fi." 19 Good morning, Senator McDonald, 20 Senator Zeldin, other esteemed members of the 21 Senate. 22 And I'd like to thank you for having us here 23 on, behalf of the Conference of Mental Hygiene 24 Directors. 25 One of the challenges in writing this 1 testimony today, I think, actually speaks to the 2 larger system, and -- larger problem meeting the 3 needs of veterans at the local level, as I hear you 4 talking a lot about. 5 That has been some of the systems set up for 6 veterans and returning service members that have not 7 been effectively integrated with or channeled 8 through counties. 9 For example: While counties contract 10 State-aid dollars for mental health, substance abuse 11 and developmentally disabled service providers, 12 there is little or no involvement of the directing 13 of funds or programmatic development for 14 veterans-specific services. 15 While the Veterans Administration has 16 moved -- been moving at break-neck speed to increase 17 capacity in services in their systems, we do not 18 have the corresponding growth and planning for 19 veterans taking place in our local systems. 20 That is something that we would like to see 21 changed. 22 We do not mean to say that veterans cannot or 23 should not be served in existing county systems; 24 but, rather, that these existing systems need to be 25 enhanced in their ability to meet some of the unique 1 needs of our veterans, and incorporated in the 2 larger statewide, and even national, planning 3 process for meeting the needs of our veterans in the 4 future. 5 I'm now going to turn the microphone over to 6 my colleague, to get into some more detail on the 7 challenges he sees every day in Jefferson County. 8 ROGER AMBROSE: Good morning, Senator. 9 As you mentioned, Jefferson County is the 10 home of Fort Drum, which is an incredibly large 11 military Army base, and houses about 19,000 troops. 12 We also have the privilege of having most of 13 those families living in our community, but that 14 does present us with challenges as well. 15 In terms of veterans and PTSD, many of the 16 newly discharged veterans stay in our community, and 17 they face a lot of challenges as they're 18 reintegrating into our system, including, housing, 19 which is usually the very first issue they face. 20 And not all servicemen plan for the financial needs, 21 to provide housing for themselves as they're 22 discharged. 23 Also, employment issues are a challenge. 24 In our county, going back to the housing 25 issue just for a moment, housing is incredibly 1 expensive, and rare. There's just not enough 2 housing. 3 We have buildings going up all the time, but, 4 to try to meet the demand is a challenge. 5 And, also, providing employment. 6 Those are two factors that we know are 7 protective factors for people with PTSD, as well as 8 other mental-health issues. 9 So those are issues that we really want to be 10 able to provide adequate coverage of. 11 And, our systems, I have to say, on the 12 mental-health side of things, are overwhelmed at 13 times. 14 The deployment schedules of our troops makes 15 it very difficult to keep up with what kinds of 16 capacity needs we're going to have, from time to 17 time. So, we're consistently challenged. 18 And we work very closely with the 19 Department of Defense. We work with the V.A., and 20 the V.A. Center in our community. They're all very 21 helpful, they're all very cooperative, but it's 22 still a challenge, on the private sector -- or, the 23 public sector, excuse me, to meet the needs, not 24 just for the service member, but also the families. 25 The Mental Health Association project that 1 was just mentioned, we had a -- I'm on that advisory 2 board for Jefferson County. And it does reach out 3 to families, which, a lot of times, are -- is going 4 to be our access to the individual who may be 5 actually suffering post-traumatic stress disorder, 6 or experience a TBI while in combat. 7 That's what's going to bring them into the 8 system, so that project is very valuable to us. 9 I think -- I tried to summarize here, so that 10 I wouldn't take up too much time. 11 We do have 19,000 troops. And in the spring 12 of this year, we expect most of those 19,000 troops 13 to be home, for the first time, all at one time, 14 which means their family members are going to be 15 there as well. 16 So, anything that we can do. We certainly 17 want to partner with the state organizations, as 18 well as our community organizations, do their very 19 best to work together, to try and make sure that 20 we're meeting all the mental needs of our community, 21 as well as those of our military population. 22 It can be a challenge. 23 And, then, also working with the V.A., the 24 vet centers, and, you know, making sure that we're 25 not overlapping services, but making sure that we're 1 not missing anything as well. 2 So -- 3 KATHERIN MACIOL: In addition to what Roger 4 had to say, there's two key areas that I'd like to 5 leave you with, and those are: our service capacity, 6 and our program expertise. 7 Now, in 2010, and it was through your office, 8 Senator, that there was a study done in 9 Rensselaer County, and, they looked at families and 10 veterans in Rensselaer County. 11 And, about 30 percent of those interviewed in 12 these focus groups identified mental health as a 13 primary need in access to mental-health services. 14 The issue of -- that Roger mentions, are 15 definitely not unique to Jefferson County. 16 Veterans have a -- should have a choice where 17 they want to receive their services. However, our 18 local mental-hygiene systems do not always have the 19 appropriate training materials for their staff, and 20 the demands on clinicians, at this point, the 21 productivity levels are very high. 22 And we're very reliant on insurance payments 23 for our reimbursement to keep on functioning. 24 As you know, the major insurance 25 reimbursement for those in the military, at least 1 for the first five years upon discharge, is TRICARE 2 insurance. 3 TRICARE is for active duty also. 4 And, the rate paid by TRICARE does not cover 5 the rate that it costs to deliver that service. 6 The other issue is, that TRICARE is -- has 7 very high criteria for who though will reimburses. 8 For example: Most clinics have licensed 9 mental-health professionals; however, they have to 10 meet a certain level of licensure that is not 11 often -- it's very expensive, number one, and 12 they're in very high demand. 13 So, in order to be reimbursed for those, we 14 have to have those licensed professionals on staff. 15 We run a mental-health clinic in 16 Rensselaer County. 17 I pulled the statistics on TRICARE for 18 recipients in our county, and these are families and 19 children. And we found that we were not paid for 20 half of the services through TRICARE. 21 And when we were reimbursed, it was about 22 $50 per session, which is less from the Medicaid 23 going rate. 24 So, that is a big issue for us. 25 And, that they also do not license clinics 1 overall. They license individuals. 2 Many insurance companies will license you as 3 a clinic. So, when someone comes in, they can pick 4 the clinician they'd like to have. 5 We have to assign a clinician, who might not 6 always be available to service that family. 7 So, it really limits the range of services 8 that the military -- the veterans, active military, 9 but most, also, of their family members, their 10 children. 11 So, I guess I'd just like to say, that, you 12 know, on behalf of the conference -- my colleagues 13 at the conference, to thank you, to thank all of our 14 veterans, for your service. 15 And, I really, we really, look forward to 16 working with you, and bringing those services to the 17 local level. 18 SENATOR MCDONALD: Well, I appreciate that. 19 We're going to have very serious objectives, 20 and you're going to be a major part of it. 21 So you got to talk to me, not now, but in a 22 white-paper type of thing, a memo, about the details 23 of the training that you need, and about the 24 financing. You know, where do we get to pay the 25 bills? 1 Will it be the federal government, or the 2 State? -- since, obviously, we can't pass on undue 3 expenditures to the local county governments. At 4 this point in time, they can't afford them. 5 Okay? 6 It's not reasonable. 7 So, if you could highlight that, for the 8 organi- -- you know, the people you represent, and, 9 you know, with the gentleman who was just sitting 10 here earlier, John, that could be very helpful. 11 Think of this as a program that's going to be 12 a macro program, starting with the feds. 13 Now, obviously, most counties are not like 14 Jefferson, where you have a gigantic military base 15 that has a variety of program services and 16 employees. 17 Most of them are going to be, you know, not 18 that closely associated to active duty, but more 19 associated to actual veterans. 20 So put some thought on that. 21 And if you have any statistics, Roger, on 22 what you're seeing, overall, when these troops come 23 in, like, P -- you know, post-traumatic stress, and 24 some of other issues, criminal issues, things of 25 that nature, and, we'd be interested in seeing those 1 statistics. 2 That might not be able to illustrate it for 3 everybody, but it certainly is something that we -- 4 all of those numbers are educating in the long term. 5 Now, if you work with your association 6 organizations, maybe in a month or so, if you guys 7 come into Albany, for whatever -- 8 I'm talking about, across the state, and I 9 know they do, on regular basis. 10 -- we'd like to start talking to these 11 people. 12 And this is -- we're putting a team together. 13 We're putting our other military operation together, 14 and people are going to have particular roles. 15 And you guys are going to have a major role, 16 along with the county veterans' coordinators, and 17 the State Division of Veteran Affairs, and, of 18 course, the federal government, and the individual 19 military operations, and such. 20 ROGER AMBROSE: We'll do that for you. 21 SENATOR MCDONALD: Thank you. 22 KATHERIN MACIOL: Thank you. 23 ROGER AMBROSE: We'd love to have you come up 24 to Fort Drum sometime. 25 SENATOR MCDONALD: Well, actually, let me 1 tell you a true story. 2 About five or six years ago, Joseph Taluto, 3 the two-star general who was the head of the 4 42nd Infantry Division, invited me up, and they were 5 getting sent to Iraq. 6 Now, I was in Vietnam, in an air-mobile 7 Infantry unit. And when I got out of there, I said 8 I never want to see helicopters and rifles -- I 9 don't like jumping out of helicopters -- ever again. 10 One of my staff person, at the time, was a 11 retired Army colonel, who spent a couple tours in 12 Vietnam, and we went out there. And it was quite 13 a -- you know, an observation, on my part. 14 I'm much older now; a father, grandfather. 15 And all these young men and women, and 16 they're getting ready to ship out to Iraq. 17 And I asked the general, who I think very 18 highly of, I said, "What can I do for you? I feel 19 frustrated. As an old soldier, what can I -- how I 20 can help out?" 21 And he said: He had lots of issues. 22 The biggest issue, of course, was going to 23 Iraq in about two weeks, with all of his people. 24 But the other issues were, that he felt the 25 most significant thing that I could help him out in, 1 is with the emotional problems of the family 2 structure and the soldiers, and all the... 3 I was thinking in terms of something else, 4 but it was the emotional problems. 5 And the first thing I thought: What a great 6 general this man is, to care that much about his 7 troops, and their own personal lives; 8 And, the second thing is: That we got to do 9 something about this issue. 10 So help us to fulfill his requests. 11 ROGER AMBROSE: Thank you. 12 SENATOR ZELDIN: Thank you. 13 KATHERIN MACIOL: Thank you, Senators. 14 SENATOR MCDONALD: I'm proud to now introduce 15 my director of Veterans Affairs for Saratoga County 16 Veterans' Service, Andrew Davis, who is also an 17 Army, Iraqi War veteran. 18 Andrew, thank you. 19 ANDREW DAVIS: Thank you, Senator, for having 20 me today. 21 I'm here, as not only a client and patient at 22 the V.A., but also a three-time combat veteran, 23 having served in both Afghanistan and Iraq as an 24 Army Ranger. 25 I've been the Veterans' director in 1 Saratoga County for two years. Been a congressional 2 staffer. And, I've seen these issues, from the 3 federal level, down to the local level, and I 4 appreciate the chance to be here. 5 You have my testimony; you have some details 6 I think are important. 7 I'm going to just gloss over a couple 8 important items, and save time for you. 9 The issues we're looking at here, with this 10 population, are ever-changing. 11 We have a more geographically dispersed and 12 mobile veterans' population, a more married 13 veterans' population, and a population that needs to 14 be served in their local communities. 15 We, as citizens, sent our veterans to war. 16 We need to bring them home from war. 17 It's not a V.A. program or government 18 program; it's a community program, and it's what 19 you're speaking to. 20 I challenge the folks, like you, to look at a 21 program that I would like to call "Veteran-Friendly 22 Communities." 23 And that's a program, where we can go out to 24 the individual communities, train every interested 25 party, on a "no wrong door" referral process, for 1 veterans to gets the care they're entitled to 2 receive. 3 I want to give you an example of what we're 4 looking at in Saratoga County, where we have the 5 Saratoga Veterans' Resource Initiative. 6 We have, in Saratoga County, 16,870 veterans, 7 as of September of 2011. And we serve, in my 8 office, about 7,000 of those veterans. 9 The State serves an additional 3,000, and a 10 remaining 7,000 seek no services whatsoever. 11 My office accounts for 41 1/2 percent. 12 Of that 41 1/2 percent, of the total 13 population, we've done 237 claims for post-traumatic 14 stress disorder since 1994, which translates into 15 about 3.3 percent of the population filing those 16 types of claims. 17 That does not mean, how many folks have PTSD. 18 That means, how many folks have pursued it, 19 officially, with the V.A. 20 That is in line with what the V.A. will tell 21 you they can track. 22 And we can only track what's been officially 23 diagnosed, not what's been surveyed. 24 Across the board, 2.3 million veterans. 25 About 740,000 in this country seek care with the 1 V.A. 2 So, we have a big gap in who's entitled to 3 things, and who gets it; and the county and the 4 local community is what starts that process. 5 Veterans who attempt get to care, at any 6 level, encounter a group of systems and 7 bureaucracies, that, by all appearances, are several 8 cars, on separate roads, driving towards the same 9 destination. 10 That system has to stop. 11 It needs to be, no matter what door you walk 12 in, you end up getting the same care, and the same 13 referral, no matter where you go. 14 By all appearances, V.A. realizes this, but 15 is not staffed to do proper outreach, and depends 16 upon the folks in the grassroots, like us, and like 17 you. 18 So, to close: I believe, we, as veterans' 19 advocates, serve an important role in this process. 20 And, all told, we, as a nation, and state, 21 must stand committed to ensuring that the 22 sustainable, quality supportive services exist in 23 our communities. 24 V.A. can lead this charge, but lacks 25 geographical dispersement [sic] and resources, and, 1 many times, we can fill that gap. 2 The V.A. can't be blamed solely or be solely 3 responsible for integrating our veterans fully into 4 our communities. 5 We, as citizens, sent our young men and women 6 to war, and we need to bring them back from war. 7 We need to continue to break the stigma of 8 asking for help, for what can be summed up as a 9 normal reaction to an abnormal situation; or, PTSD, 10 in my opinion. 11 However, we need to do it carefully, by 12 acknowledging fact-based figures that do not harm a 13 population that is already finding it difficult to 14 gain meaningful employment and assimilate back into 15 society. 16 We cannot continue to only stress the harmful 17 and negative effects of war, or we will have the 18 potential of causing great harm to those who are not 19 affected by these disorders. 20 There's no better example of that, Senator, 21 than your generation of Vietnam veterans who came 22 home to a country much less supportive than this one 23 is now, and now lead our great institutions, like 24 the New York State Senate, Fortune 500 companies, 25 and other political bodies. 1 So I thank you again for this Committee's 2 time. 3 I know we're getting to the end, it's snowing 4 outside, but I wanted to make sure we get the point 5 across. 6 We in Saratoga County are ready to do the 7 local things you're asking. We're already trying to 8 do it. 9 I just need some help in training some of the 10 other agencies out there. 11 SENATOR MCDONALD: Andrew, you're very 12 succinct, and I appreciate it. 13 I also appreciate it as a citizen of 14 Saratoga County, and a veteran, what you do for us. 15 The training's gonna come. 16 And I like your attitude, to take anybody who 17 wants to help. 18 We'll train those volunteers, people who 19 care. 20 And, fellow veterans talking to each other, 21 that seems to be the vet-on-vet, whatever 22 terminology, in incorporating every entity that we 23 can to become a partnership. 24 And that will spill over. People have become 25 more aware of mental-illness problems with veterans 1 and post-traumatic stress disorder. 2 They'll also become more aware that 3 human beings are not, all, always going on 4 100 percent. Sometimes some of our family members 5 and friends need some assistance. 6 And it may not be post-traumatic stress, it 7 may not be veterans, but we're here to serve all the 8 people in New York State, and to highlight the 9 mental health is a legitimate concern. 10 And not only, we'll help those people, but in 11 case there's any kind of sad reactions, incidents, 12 hurtful situations, we'll try to eliminate that. 13 And we don't want just people walking down 14 the street, with no hope, and their family structure 15 falling apart, ripped apart, by it all. 16 Going to be a lot of work. I know you're up 17 for the task. 18 I appreciate it. 19 We've had three great county directors here 20 today: one from Suffolk County, one from 21 Columbia County, and yourself. 22 And I know the rest, some we asked couldn't 23 be here, but the rest of them had the heart. 24 All of a sudden, the mental-health services 25 of our counties, the Veterans' Services of our 1 counties, just to look at two, the spotlight's going 2 to shine on you folks. 3 You've become very important to us, and I'm 4 grateful that you're here. 5 Thank you. 6 ANDREW DAVIS: Thank you, Senator. 7 SENATOR ZELDIN: Thank you for your service. 8 SENATOR MCDONALD: Our next speaker -- 9 SENATOR ZELDIN: Actually, Senator McDonald, 10 if I can steal your thunder on this one -- 11 SENATOR MCDONALD: Okay. 12 SENATOR ZELDIN: -- Hatty Baldwin is someone 13 that has been very special for our 14 Veterans' Advisory Panel down in Suffolk County. 15 She's coming up with L.W. Murphy, who's been 16 the chairman of our Veterans' Advisory Panel. 17 Earlier in my introduction, I spoke of 18 John Patrick Jennings, who passed away, and we named 19 our panel in honor of. And when John passed away, 20 Hatty was John's fiancee. 21 Obviously, a very different and important 22 perspective that Hatty can share with us this 23 morning, as a loved one. 24 SENATOR MCDONALD: And we apologize for 25 rushing you along, but we've got snow, which is 1 unusual in Albany at this time of the year, this 2 year. 3 But it finally caught up with us, and I got a 4 lot of folks that got to get to other meetings. 5 Thank you so much. 6 HATTY BALDWIN: Well, I will skip everything 7 about everything that everyone else has spoken 8 about. 9 I'll just tell my story, and John's story. 10 When I met him, initially, he was a 11 law-school graduate. He looked like he was doing 12 great. 13 He did tell me that he had PTSD, and that he 14 was in treatment. 15 And, as a nursing student, I thought: Well, 16 that's fine. I can -- we can fix this. 17 And, he continued to go on, and he did very 18 well. He made a lot of friends. 19 He was a very charming guy. 20 Senator Zeldin knows him. 21 You know, he did, and he -- there was a 22 disconnect between what he needed and what he was 23 able to find. He couldn't find the services that he 24 needed. 25 The V.A., he got care from them, but it 1 wasn't enough. He needed more, and we didn't know 2 where to find it. We didn't know where to look, we 3 didn't know where to start. 4 He started to go downhill the last year of 5 his life. 6 And, finally, at the time of his death, he 7 was on over a dozen medications. All prescribed, 8 nothing recreational. Just what he needed to get 9 through the day. 10 And he -- when I came home from work, he was 11 unresponsive, and not breathing. And -- 12 SENATOR ZELDIN: Hatty, Senator McDonald, and 13 anyone else who's here, one of -- maybe the best 14 point that I can -- I can provide the entire day, 15 while we do this hearing, and beyond, was, I had 16 spoken to a newspaper reporter. I won't mention 17 what newspaper, but I spoke to a newspaper reporter 18 while John was alive, because he was doing a story 19 on post-traumatic stress disorder. 20 And I shared John's story, and it was very 21 interesting. And the newspaper reporter met with 22 John, for hours. Took pages and pages worth of 23 notes, but never wrote a story, because it wasn't 24 sexy enough for a print. 25 And then John passed away. 1 And he revisited all of his notes, and the 2 phone conversation, and the meeting, and now he had 3 a story. 4 There was no story to tell while John was 5 alive and suffering of post-traumatic stress 6 disorder, but there was when he had passed away. 7 And, I think that, maybe our mission up 8 here -- and we all have the mission that we're 9 sharing, but I feel, as part of my mission, here in 10 the State Legislature, is making sure that the 11 stories of John Jennings are told before that person 12 passes away, not after it's too late. 13 HATTY BALDWIN: Yeah, the -- one of the 14 things that was the hardest about going to the 15 committee, was, after all of the time of going back 16 and forth to the V.A., and admissions, and 17 everything else, when I went to the committee, the 18 first time, I was handed a stack of paper. 19 And on that stack -- in that stack of paper 20 was all of the resources that I didn't know about, 21 and all of things we could have -- 22 SENATOR MCDONALD: Well, that is the problem 23 we've got: It's a shotgun approach, as opposed to a 24 rightful approach. 25 And, even though we can't bring the gentleman 1 back, what we can do is, in the future, try to, you 2 know, bring it down to the personal level; that 3 we're dealing with human beings, okay, and try to 4 have a support network that people in that 5 community, not necessarily the State Capital, or the 6 federal capital, or the big city that's closest, 7 whatever that community is, that we'll have that 8 awareness, that we can turn around, and try our best 9 to get him to somebody that can help him, and 10 somebody that cares. 11 And the constant thing we have to say, as Lee 12 alluded to, they didn't want to talk about 13 post-stress. They talk about, you know, it wasn't 14 hip enough, till somebody dies. 15 Well, we're not going to wait for that 16 moment. Okay? 17 And just out of the frustrations of my own 18 life, it was very difficult watching people that I 19 served in the military with, in a war that lost 20 almost 60,000 soldiers. You know, Airmen, Marines, 21 Navy. 22 That's a whole bunch of people. 23 That's more than we lost in World War I, in 24 Vietnam, and nobody really cared. 25 Unless you had a good family structure at 1 home -- a mother, a father, which is unique today, 2 by the way, extended family, siblings, the whole -- 3 nobody cared. 4 Well, I think America's changed dramatically 5 since then. I think the American public does care, 6 and we have their blessings to go out and do 7 something. 8 So, I think we have to take advantage of 9 that. 10 So, you guys become more important. 11 But in the memory of your friend, and as a 12 friend of the veteran, as the way that you were 13 described, they have -- we have not forgotten, and 14 we will go forward. 15 This will not be an issue that's Republican 16 or Democrat. It's not New York State; upstate, 17 downstate. It's not the southern part of the 18 country, the northern part of the country. 19 Because, all those soldiers you read about 20 dying over there, they're from all of over America: 21 All different colors, all different backgrounds. 22 So, thank you. 23 We're not going stop now. We just started. 24 SENATOR ZELDIN: And, thank you, L.W., who is 25 a fellow Vietnam vet. 1 L.W. MURPHY: Yes. 2 SENATOR ZELDIN: Very active with the 3 Patriot Guard Riders, and a lot of veterans' causes, 4 Disabled American Legion. 5 Gary Vertichio, who's here from the Disabled 6 American Legion as well. 7 And, for being a very close friend of John's, 8 as well as I know that you were. 9 L.W. MURPHY: I'm going to give you a 10 10-second reply. 11 John was a very close friend, and I was 12 devastated when he passed. 13 But, the reward is, that when this committee 14 was put together, this panel was put together, and I 15 asked the Senator to let me chair it, I have seen an 16 enormous amount of increased involvement and 17 interest in PTSD. Resources that could choke a 18 horse. 19 SENATOR MCDONALD: we got to public behind 20 us -- 21 L.W. MURPHY: If the goal is to put it all 22 together, and make it all work, I'd be gratified 23 till the day I die. 24 SENATOR MCDONALD: They you, both. 25 SENATOR ZELDIN: Thank you, L.W. 1 And, thank you, Hatty. 2 SENATOR MCDONALD: Thank you, Hatty. 3 Our next guest is, Mr. Dennis O'Donnell, 4 founder, Warrior Project member, of the Patriot 5 Guard Riders, which has received a lot of attention, 6 and we're grateful for it. 7 They have some of those folks up here, if I'm 8 correct. 9 DENNIS O'DONNELL: Outstanding. 10 SENATOR MCDONALD: We have our own chapter. 11 And when they say "Patriot Guard Riders," 12 they mean just that: they guard. 13 Dennis, please understand that we're -- 14 DENNIS O'DONNELL: Absolutely. 15 Thank you for the introduction. 16 Thank you for the invitation. 17 Aside from my pride in volunteering with 18 Wounded Warrior Project, Patriot Guard Riders 19 "Ride to Recovery," I'm proudest of being a parent 20 of an active-duty United States Army Infantryman, 21 Specialist Sean O'Donnell. 22 I'm here, largely as a parent, to describe, 23 briefly, my frustration, and my activity; my 24 frustration with the inability to help my son, and 25 his brothers, upon returning from combat. 1 Sean came home from Iraq, after nine months, 2 and was demonstrating all of the typical signs of 3 post-traumatic stress. 4 He is with the Florida National Guard. I was 5 here. And, as is with most of our -- most parents, 6 our children are just beyond our reach when they 7 come home from war. 8 They're adults now, and you respect the fact 9 that they're warriors, so, you give them their 10 space. 11 However, I was frustrated by the inability of 12 finding non-military, non-governmental resources to 13 direct him, for help with his PTSD. 14 Born out of that, and through my volunteer 15 work with the Wounded Warrior Project, and the 16 Patriot Guard -- I'm sorry -- and, "Ride to 17 Recovery," I do physical programs with them. 18 We put warriors on bicycles, and take them on 19 long-distance trips. 20 But, by "warriors," I mean injured warriors: 21 amputees, PTSD victims, and the like. 22 So I began to ask them: What do you need? 23 What are you lacking, and, what would you like? 24 What could you use? 25 And to a man, for two years, every single one 1 of them have told me the same thing: The 2 professional help is wonderful, but we need time 3 with our brothers. They're the only ones who will 4 understand, and to whom we can speak about what 5 we've been through. 6 The healing occurs during those sessions. 7 I've witnessed it myself on the cycling events. 8 I've gotten my son involved with 9 Wounded Warrior Project, and he's breaking out of 10 his shell. 11 So, I believe it's a balance of government 12 resources, mental-health resources, military 13 resources, and, non-affiliated grassroots 14 organizations. 15 And from that frustration of not being able 16 to direct him, I created my own program. 17 It is designed, and is being implemented. It 18 is based on the organization, the meeting format, of 19 Alcoholics Anonymous, of which I'm a member. 20 It seems to suit the format -- the anonymity, 21 the privacy, the mentorship -- that we've all been 22 speaking about all day long. 23 So, I'm using that as a basis. 24 I was introduced to Alcoholics Anonymous 25 through the good people of New York State, 17 years 1 ago, when I needed help. 2 I'm calling today on the State to take the 3 lead, in encouraging -- in taking the issue of PTSD 4 as an illness, as an ailment, and increasing public 5 awareness of it, and professional awareness of it; 6 To remove the stigma that's attached to it, 7 as the State did, through the Department of Health, 8 with alcoholism, and HIV infection. 9 It was successful then, it can be successful 10 now. 11 It will help draw -- I believe it will help 12 draw those warriors who have been -- who slipped 13 through the cracks at demobilization, who have not 14 yet found themselves in a precinct, a courtroom, or 15 a hospital, based on their PTSD behaviors, and 16 perhaps draw them out of the shadows of the living 17 rooms and the basements that have been alluded to; 18 that, living in isolation and fear of being 19 discovered, and thought less of, or weak as a 20 warrior. 21 I believe, if we remove the stigma, with the 22 State taking the lead, and the various agencies that 23 are presented here, professionals and the like, in 24 partnership with grassroot organizations that 25 provide a safe haven, a safe place, an anonymous 1 place, for these warriors to go, and partner, and be 2 with their brothers, share their experience, 3 strength, and hope, especially the Vietnam veterans, 4 who have found a way to survive all these decades. 5 I look at among -- at my Warriors' Circle 6 program is just one of many organizations, 7 grassroots organizations, non-professional, around 8 the state that would benefit from, and could use the 9 professional support and leadership of the 10 peer-to-peer mentor trainees that I've heard spoken 11 of in various counties and situations. 12 I look for that partnership to occur. 13 So I'm asking for that. 14 I'm asking for the State to take the 15 leadership role in increasing public awareness. 16 Training, on the law-enforcement level, I've 17 heard it mentioned in one county, and one instance, 18 where, when a -- when called to a domestic-violence 19 situating, or other situation, that the warrior was 20 questioned: Are you a veteran? Have you seen 21 military service? 22 And then redirect, accordingly, and away from 23 the criminal justice system. 24 I don't want to take much more time, but I 25 wanted to add something that I haven't heard 1 mentioned yet: You're looking for ideas. 2 I mentioned that I work with Wounded Warrior 3 Project "Soldier Ride," and another group called 4 "Ride to Recovery." 5 Okay? 6 It's cycling. It's a physical challenge for, 7 both, physically and mentally and spiritually 8 challenged warriors and veterans. 9 I implore you to look into, and include, them 10 in your conversation. 11 The benefits that I have observed, and that 12 been documented, from physical challenges, and the 13 comrade -- camaraderie that comes from getting out 14 there on the open road, or doing a physical 15 challenge, with their brothers-in-arms, is enormous, 16 and they should be part of the conversation. 17 It's not just about mental health. As we all 18 knowing, mental and physical health go hand in hand. 19 So, I would suggest that we do that. 20 In closing: I would like to thank, again, 21 the State of New York for their leadership. 22 You gentlemen, for taking the lead here. 23 And, I'll do everything I can to help. 24 25 1 SENATOR MCDONALD: I'm going to call you on 2 that, Dennis. 3 Lee's going to work with you down in 4 Long Island, and all of these non-profit groups, 5 we're going to learn. 6 And instead of trying to duplicate them, 7 we're going to make them part of our teams. 8 Because, you know, most of what I've seen 9 with these non-profit groups, they start out with 10 somebody who cares a great deal. And then they 11 realize they're up against a big issue, and we're 12 going to be there to help them out with the big 13 issues. 14 SENATOR ZELDIN: Couldn't agree more. 15 SENATOR MCDONALD: And tell your son, thank 16 you. 17 Thank him for his service. 18 DENNIS O'DONNELL: Thank you all. 19 SENATOR MCDONALD: We care. 20 SENATOR ZELDIN: Thank you, Dennis. 21 SENATOR MCDONALD: I want to thank everybody 22 for being patient, and I want to invite our final 23 guest, a local attorney, Joel Abelove, who is an 24 Iraqi War veteran. 25 He might be an Afghanistan War veteran as 1 well. 2 And, we thank him for his service. 3 And, he came in a little later, but we're 4 looking for all of the good folks who are attorneys, 5 because there was a nice presentation earlier about 6 defense. 7 Joel, we're fighting the snow and the time 8 and other meetings. We've been here since about 9 quarter of ten. 10 We're so grateful that you spent the time. 11 JOEL ABELOVE: I understand. 12 And, thank you for having me, Senator, and 13 inviting me, Senator Zeldin, I appreciate the 14 opportunity to come and address your Committee. 15 I know I'm going last, and people are looking 16 to probably get out of here, and beat the weather. 17 And I appreciate your patience, and bearing 18 with me. 19 As you said, my name is Joel Abelove. I'm an 20 Afghanistan War veteran. I did not serve in Iraq. 21 And I would like to share with you some of my 22 experiences. 23 I am an attorney, with nearly 17 years of 24 experience as a prosecutor. I consider myself 25 fairly educated. 1 I've got degrees in, history, and political 2 science. I'm married with two wonderful children. 3 I've got an extensive family support system. 4 And I'm currently in my 17th year of service 5 with the New York Army National Guard. 6 I spent 8 years as an enlisted soldier in the 7 Military Police Corps, and then I rejoined the Guard 8 after 9/11, as an officer in the Judge Advocate 9 General's Corps. 10 In January of 2008, I mobilized with the 11 27th Infantry Brigade Combat Team, and deployed to 12 Kabul, Afghanistan, as part of Task Force Phoenix. 13 And, I have PTSD. 14 It's one thing to know what PTSD is, and what 15 symptoms are generally associated with it. 16 It is quite another to experience those 17 symptoms yourself. 18 I need not delve into the clinical aspects of 19 PTSD, as I'm sure other individuals who have spoken 20 with this Committee are eminently more qualified 21 than I to do so. 22 Rather, I would like to share my experiences 23 and my perspective on how I came to have PTSD, its 24 effects on me and my family, and how I'm dealing 25 with it. 1 Prior to my tour in Afghanistan, I had never 2 served in combat. And like many others new to the 3 experience, I had own expectations of what to 4 expect. 5 I had spoken with those who had gone before 6 me, I had attended countless briefings, and 7 undergone months of pre-deployment training. 8 I learned how to spot and react to IEDs; how 9 to perform first-aid on an open chest wound; how to 10 interact with local population, given their 11 particular customs. 12 I read books and manuals, to prepare for my 13 job, and I made a list of important phone numbers 14 for my wife. 15 I spend time with my young children, and hope 16 for the best. 17 But, it wasn't enough to avoid PTSD. 18 Even with all the training, nothing prepares 19 you for the unexpected. 20 Nothing prepared me for my boss, 21 Lieutenant Colonel Jim Wiley, committing suicide 22 during our tour. 23 I didn't anticipate having to disarm one of 24 our own enlisted soldiers who, overwhelmed by 25 stress, sought out a superior, intent on causing him 1 harm. 2 I wasn't prepared for the seemingly endless 3 memorial services held on our base for the dozens of 4 service members killed in action. 5 Each service included a short biography of 6 the soldier or Marine, his military experience, and 7 his family left behind. 8 Each time, it concluded with a salute, and 9 then immediately back to work. 10 We were losing multiple men at once, so that, 11 one day, the chaplain's assistant came into my 12 office, asking whether anyone had an extra pair of 13 boots that could be used for the ceremonies. 14 I gladly gave up an extra pair or mine, and 15 watched as my boots repeatedly appeared beneath the 16 rifle and helmet of our fallen comrades. 17 After redeploying, I hadn't given those boots 18 another thought. But months after returning home, I 19 found the motivation to unpack my duffle bag. 20 Suddenly, I pulled out a pair of brand new 21 boots, and a pair of blank dog tags spilled out, 22 with a clank on the concrete basement floor in my 23 house. 24 I felt like I had been hit in the chest with 25 a sledgehammer. 1 I immediately knew their significance, and 2 suddenly a wave of emotions flooded my head. 3 This was, as I was to learn, called 4 "a trigger." 5 For Reservists and National Guardsmen, the 6 challenges of returning home and reintegrating into 7 society presents unique challenges. 8 One day, you're spending every minute with 9 your fellow warriors, eating together, working 10 together, going on patrols and convoys together; 11 And the next day, you're home, and you don't 12 see them much at all. 13 You're back to your family and friends, none 14 of whom can be expected to understand what you've 15 been through. 16 And after two weeks of being home, I went 17 right back to my civilian job, where I suspect I 18 appeared to resemble a zombie for a number of 19 months. 20 One day, I'm scanning traffic for suicide 21 bombers, and the next, I'm waiting for an elevator 22 in the Corning Tower. 23 When I came home, everything was different, 24 because I was different. 25 I looked at the world differently. I looked 1 at people differently. 2 I didn't care about things that used to 3 concern me. 4 Having endured 120 degree heat in full battle 5 gear, it's hard to listen to people complain about 6 the weather. 7 Having seen injured soldiers anxious to get 8 back to their units to perform their mission, I 9 scowled at civilians who contemplated calling out 10 sick because they had a stuffy nose. 11 I learned that the behaviors that worked for 12 me overseas, that kept me alert and alive, worked 13 against me here at home: hypervigilance, distrust of 14 those around me, skepticism, and emotional 15 separation from the human condition. 16 I longed for a return to a world that I knew, 17 where my feelings and behaviors seemed to fit. 18 After about 25 hours of travel, that took us 19 home through Kurdistan, Ireland, through Maine, we 20 landed at Fort Bragg, North Carolina, to undergo our 21 four-day demobilization. 22 The briefings and paperwork came fast and 23 furious, and most of us just wanted to be done with 24 it, and get back to our waiting families. But, we 25 listened to a representative of the V.A. at 1 Fort Bragg. 2 I don't recall anybody from the 3 New York State Division of Veteran Affairs, or my 4 county Veterans' Agency being there, or contacting 5 me to let me know how they could help. 6 Since the civilian workers on post couldn't 7 work late, I ended up spending Christmas Eve at 8 Fort Bragg, which had completely emptied out for the 9 holiday. 10 I finished my out-processing the next day. 11 After a flight to Syracuse, and a 3-hour bus 12 ride back to Latham, I was finally home. 13 But while my body was home, my mind wasn't 14 where I wanted it to be. 15 The dreams, the hypervigilance, the anxiety, 16 the anger, the stress of readjusting to a life that 17 kept going while I was gone, quickly became a 18 problem. 19 My wife and family immediately noticed how I 20 had changed, but, I was lucky, because I noticed it 21 too. 22 Fortunately, for me, I have a great support 23 system of family and friends. I availed myself of 24 the V.A.'s resources. 25 It helps, but it hasn't been easy. 1 And aside from the personal challenges of 2 dealing with PTSD, I believe there still exists 3 institutional and bureaucratic impediments to 4 helping service members who suffer from it. 5 First, and foremost, PTSD is, figuratively, 6 still a four-letter word. 7 It carries with it a stigma that discourages 8 those who have it from seeking help. 9 This is especially true in military culture 10 which necessarily cultivates the warrior ethos: 11 A warrior is strong, unaffected by battle, and 12 immune to the inhumanity of war. 13 Conversely, PTSD is a sign of weakness, to be 14 denied and stuffed away in the deepest recesses of 15 one's mind where it cannot affect the warrior's 16 ability to fight on. 17 The problem with this tragedy is, that while 18 one can discipline one's self to compartmentalize 19 these thoughts and feelings, they do not go away. 20 They fester like an infection that is 21 ignored, becoming ever more malignant, until 22 eventually overwhelming their host and causing an 23 inability to function normally. 24 Still, many veterans will try to suppress 25 their symptoms because of their belief that society 1 finds them distasteful; and, because, to admit one 2 has a problem, is to admit that which is most 3 distasteful to a warrior: weakness. 4 But before we were warriors, we were 5 human beings. 6 Veterans need to be encouraged, from all 7 circles, to seek help. 8 They need to know that PTSD is a normal 9 response to abnormal circumstances; 10 They need to be informed of every resource 11 available to help them, from every federal, state, 12 and local agency; 13 And, they need to know, that without that 14 help, they will have difficulty continuing the 15 mission. 16 There are numerous individuals who have 17 dedicated their professional lives to helping 18 veterans who suffer from PTSD. 19 I believe that, as legislators, it is your 20 responsibility to ensure that they have the 21 staffing, the training, and the resources to 22 accomplish their mission. 23 Without them, we, as warriors, cannot 24 accomplish ours. 25 I appreciate you bearing with me, gentlemen. 1 I just sort of wrote that from the heart 2 because it's how I feel about my own personal 3 situation. 4 I know everybody's experiences are different. 5 I appreciate your service to our country. 6 And, certainly, I greatly appreciate your 7 willingness to utilize this Committee, and its 8 resources, to help those veterans who need the help 9 that we desperately need. 10 It's my hope, that all these efforts, and 11 I've heard from many of the speakers today, there 12 are certainly enough people who want to get the job 13 done. 14 And I feel as though, all it takes is the 15 resources, because we have the will. 16 SENATOR MCDONALD: Joel, your presentation 17 was outstanding. 18 JOEL ABELOVE: Thank you, sir. 19 SENATOR MCDONALD: And we're grateful for 20 your service. 21 And, you and myself and Senator Zeldin, and 22 so many people here, are military people. 23 Sometimes, when you speak up, they get you to 24 volunteer, whether you like it or not. 25 We're volunteering you to help us out. 1 You're a local person that lives, literally, 2 across the river from here. 3 JOEL ABELOVE: Yes, sir. 4 SENATOR MCDONALD: So this is something -- 5 and I know you have to make a living, and all that 6 kind of stuff, but this is something that you, 7 obviously, have your heart in the right place. 8 And, like Senator Zeldin, you're a young 9 veteran that -- a recent veteran. 10 So, we're going to come back and utilize that 11 heart, and that brain, to help out these veterans 12 today. 13 JOEL ABELOVE: I hope so, sir. I look 14 forward to it. 15 SENATOR ZELDIN: I think, not only your 16 testimony is a fitting way to end this hearing, but 17 your last couple of sentences were a fitting way to 18 end the hearing. 19 You're saying that you believe, that, as 20 legislators, it's our responsibility to ensure that 21 there's a staffing and training, resources, to 22 accomplish this mission. And without them, the 23 warriors cannot accomplish it. 24 So, I think that it's really the duty. 25 There are 212 legislators here in Albany, and 1 a governor. It is our duty, to do what we can to 2 help. 3 And, thank you, as well, for your service. 4 JOEL ABELOVE: Thank you, sir. 5 SENATOR ZELDIN: I want to say, thank you, to 6 everyone that traveled from Suffolk County. 7 Suffolk County is actually the home of the 8 single highest population of veterans in the entire 9 state of New York. 10 We're very proud of our veterans. 11 And, I'm very honored, and proud, of the fact 12 that so many traveled so far to be here. 13 For all of you watching at home, that last 14 public service announcement, if anyone ever needs 15 any help, the phone number is: 1-800-273-8255. 16 Press "1." 17 Maybe you're calling for yourself, a loved 18 one, a business associate. 19 There's a website for the V.A., at: 20 VeteransCrisisLine.net. 21 You can also text it to: 838255. 22 We're here, not only to help you, 23 individually, but, to figure out what we can do as a 24 state, to finally address post-traumatic stress 25 disorder. 1 So, thank you, everybody, for your 2 participation. 3 SENATOR MCDONALD: Thank each and every one 4 of you. 5 Drive carefully. It's snowing out. 6 Help your neighbors. 7 There's nothing better than to help your 8 neighbors. 9 Thank you. 10 [Applause.] 11 (Whereupon, at approximately 1:20 p.m., 12 the public hearing, held before the New York State 13 Senate Standing Committee on Mental Health and 14 Developmental Disabilities, concluded.) 15 16 ---oOo--- 17 18 19 20 21 22 23 24 25