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UNEXPECTED VOICES 

CHAPTER I

“Some people didn’t say anything, and it just grew and grew inside of them. I wanted to let it out. Even now that I’m back home, and Iook at the pictures of the guys, its hard to keep from crying.”

— ARMY NATIONAL GUARD SGT. SINQUE SWALES

"When we send our young men and women into harm’s way, we have a solemn obligation not to fudge the numbers or shade the truth about why they’re going, to care for their families while they’re gone, to tend to the soldiers upon their return, and to never ever go to war without enough troops to win the war, secure the peace, and earn the respect of the world."-President Barack Obama

WE are the voice of influence for the voice-less who have lost the battle to suicide. 

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SUMMARY

Veteran suicide is currently a silent phenomenon in this country but is a preventable tragedy. Unexpected Voices is an advocacy campaign to address this tragedy by shining a spotlight on the ignored systematic benefit issues veterans face post-military service, which is often a contributing factor to veteran suicide. Our program is specifically centered on improving veteran access to mental health care by breaking down the procedural barriers and stigmas that exist. 

 

To do this we utilize our unique position between the veteran community and the entertainment community to provide a louder voice to the numerous issues veterans face in accessing and receiving adequate mental health care through the Department of Veterans Affairs. Motivated by the countless accounts of the members of our military community about their struggles in accessing care, we hope to bring about actionable change in how the Department of Veterans Affairs and the larger community treatment and care for veterans with mental health issues.

Portrait of young sad woman with anxiety
Boxer athlete sits with a drooping head

WHY UNEXPECTED VOICES?

Unexpected Voices has been selected as the project title to represent the lost voices of the veteran community, and those who have lost their fight to mental health. WE want to be their voice, echoing onward and into the nation's conscience. The name further refers to the many who speak out on the injustices that our veterans face; veterans themselves, their families, and those that care for the veteran community.  Unexpected Voices encapsulates our pursuit of creating a national conversation and therefore action to address the issues with mental health care for veterans.

THE PROBLEM

Since industrial nations have waged war against each other societies have recognized the invisible wounds that veterans of conflicts bring home. In the time of the American Civil War, they referred to it as "Soldiers Heart", during the Great War "Shell Shock" became the common name, and in the Second World War, it became known as "Battle Fatigue" or "Combat Fatigue". In modern conflicts, PTSD has come to represent the impact that traumatic experiences in military service have on a person’s mental state. 
 

Despite the long recognition of the invisible wounds veterans carry, veterans in our country continue to face institutional and societal barriers to access and receive adequate care for their mental health. Veterans have long struggled to overcome the burdensome, complicated, and bureaucratic processes required to receive benefits from the Veterans Administration. Beyond this, veterans must overcome the societal stigmas that surround mental health which create unimaginable and subsequent harmful consequences. Due to these failures, too many veterans are unable to access the care they need to live dignified, fulfilling lives in comparison to the civilians in the country they have defended. 

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stressed african american soldier with a

THE CONSEQUENCE 

The consequence of the inaccessibility of veteran mental health care due to barriers of entry is this country’s high rate of veteran suicide. 
 

According to the 2019 National Veteran Suicide Prevention Annual Report, veteran suicide occurs at a rate one and half times higher than the national rate, this is despite the rising rate of suicide in the general population and a decreasing veteran population. This statistic represents the on average twenty veterans that lose their lives to suicide a day in the United States. The high rate of veteran suicide described here is the clearest representation of the failure of the current mental health care for veterans. Our project focuses on two elements of this larger failure relating to access, the claims process for the VA and societal stigmas. 

For our nation's Veterans, the Veterans’ Administration (VA) represents the single largest health care entity and the federal government's method of providing the care due to them for their service. The VA has one of the largest budgets for federal agencies annually, receiving $68 billion to oversee the delivery of care to more than 9 million enrolled Veterans. Furthermore, the VA employs 322,030 full-time health care professionals and support staff at 1,255 health care facilities, including 170 VA Medical Centers and 1,074 outpatient sites of care of varying complexity. The sheer size, wealth, and depth that this system has should allow it to adequately care for all veterans who require services. The 9 million enrolled veterans represent about a third of the veteran population of just over 20 million in this county. That leaves two-thirds of the veteran population without VA care or not enrolled to receive VA care. The high number of veterans not enrolled with the VA occurs due to a multitude of reasons, such as some veterans not requiring care, some veterans failing to qualify for such care, others choosing not to use the VA, and some who have tried to access care but have been denied. 
Though all these reasons have their own and varied causes, we have identified the claims process as a common point of several of the reasons veterans are not able to access VA care. The claims process is a complicated, laborious, and ill-suited process that can often be the reason veterans are denied care or do not attempt to seek care with the VA. According to one study, about 30% of claims are denied, of these, they found that 60% were denied due to an error. 
Demonstrating the nature of the claims process is the current evaluation form for claims for service-connected for PTSD which provides three rows of 60 characters statement for a veteran to describe and defend their need for care due to PTSD. Though seemingly straightforward, such a small space to adequately present and explain one's PTSD symptoms and causes is challenging. This is just one form of the many that a veteran must commit time and effort to, to defend their need for care from the VA. As this limited example demonstrates our veterans face poorly designed, complicated, and challenging processes to access and secure the mental health care they need and deserve.

THE SOLUTION 

We believe that there are key changes that can be made to reduce the burden on veterans to receive mental health care and therefore preventing veteran suicide. Our solutions to some of the issues identified are:

•    Reform the initial claims process forms for service-connected mental health. Reformed entry form and process should place the burden of proof onto the VA rather than the veteran, or at least reduces the undue burden that many veterans face in having their claim accepted, particularly relating to mental health as an invisible wound which often is more difficult to demonstrate. 
•    Influence society views on mental health issues so that one recognizes the importance of treatment and removes the stigma associated with mental health care. The stigmas around mental health care can often lead to the individual not seeking care, by removing these we can make sure we are a healthier society, including our veterans.

 

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World mental health day concept. Green a
World mental health day concept. Green a

THE RESPONSE 

To advocate for the changes we are seeking we provide a louder voice for Veterans Mental Health Care by highlighting the issues with the current system that are commonly known and either accepted or ignored.  We provide a louder voice by cultivating relationships with influential members of the community to raise the profile of the issues faced by the veteran’s community to national media and the public.

 

In so doing the attention and therefore action of congress will be ensured, as their constituents and the national media call for action to address the deficiencies present in the current Mental Health Care for Veterans.

By providing a voice to the voiceless we seek to end the ultimate result of failed mental health care, veterans suicide.
 

STAKEHOLDERS

Across the many groups, three have been identified as the main stakeholders for this project, the veteran community, the federal government, and the media. Each of these groups has a vested interest in the project and will play a key role for the project, keeping it accountable, on target, and contributing to its success.

Image by Doug Keeling

VETERANS

The most important stakeholders for Unexpected Voices are veterans themselves and the community that surrounds them. The changes we are seeking are designed to benefit the community and provide veterans with support to live fulfilling dignified lives in their country. To help ensure that our work represents this community and is continually working toward bettering outcomes for it we are committed to engaging with it throughout the project. In part, this engagement will help to ensure that the project does not create more of a stigma or a misconception about mental health and the veteran community.  Further, we recognize the key role that veterans and their support community play in overcoming aspects of mental health for other veterans. The veteran community and those that surround them are vital in the success of Unexpected Voices as the population we are working to help and as key actors in the success of the project's ability to affect change. 

GOVERNMENT

The second stakeholder group that will play a pivotal role in this project is the federal government, particularly the legislature and Veterans Administration. These two groups are those whose role is to oversee, fund, and direct the federal care for the nation's veterans. As such they will be vital in any permanent and institutional changes, we are seeking within how veterans access federal mental health care. The bipartisan legislation introduced by Senators Jon Tester and Jerry Moran in 2019 to connect more veterans with mental health care, demonstrates how actionable change can occur within the federal government regarding veteran health care. Overall, the government as a key stakeholder has an important role to play in the project, that of end actor and facilitator of the reforms we seek.

NATIONAL MEDIA

The final key stakeholder for Unexpected Voices is the national media, whose coverage and platform will serve as the primary vehicle for raising the voice of the veteran community as we seek to do. The national media will also play a key role between Unexpected Voices and the government, serving as a conduit of information and a means of creating public pressure. Further, this stakeholder will allow our work on destigmatizing mental health care to be spread across the nation, beyond the tight-knit veteran community. Though the last of the stakeholders discussed the national media plays a vital role in the success of Unexpected Voices and its ability to affect the important change we seek. 

BE THEIR VOICES

I was furious. I have never been shot at in my civilian life. I have never been blown up in my civilian life. I haven't lost an "adopted" child to a suicide bomber in my civilian life. And I haven't had to listen to a man's death over the Med-Evac frequency in my civilian life. All those things happened during my year in Iraq, but my PTSD is probably just related to my years working at UPS or something?

OPERATION IRAQI FREEDOM VETERAN 

It took two years and nine suicide attempts for DJ to finally get help through the VA system. He has had plenty more deplorable doctors; one shrieked at me how, “That’s the VA way. If you don’t like it, leave,” when DJ had a life-threatening reaction to a medication. Now, when I advocate for DJ’s and other’s care, I remember her lesson that near-fatal medical policies are the VA way. Instead of leaving, though, I do my best to make sure poor treatment at home doesn’t kill soldiers who survived deployment.

WIFE OF OPERATION ENDURING FREEDOM VETERAN

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