Aftermath News

Associated Press | May 11, 2008

By KEVIN FREKING

WASHINGTON - Families claiming that a mercury-based preservative in vaccines triggers autism will challenge mainstream medicine Monday as they take their case to a federal court.

They seek vindication and financial redress from a government fund that helps people injured by shots.

Two 10-year-old boys from Portland, Ore., will serve as the test cases that determine whether the children and their families should be compensated. Attorneys for the boys will attempt to show the boys were happy, healthy and developing normally. But, after being exposed to vaccines with thimerosal, they began to regress and show symptoms of autism.

Thimerosal has been removed in recent years from standard childhood vaccines, except the flu shot. In 2004, a committee with the Institute of Medicine concluded there was no credible evidence that vaccines containing thimerosal caused autism.

Overall, nearly 4,900 families have filed claims with the U.S. Court of Claims alleging that vaccines caused autism and other neurological problems in their children. Lawyers for the families will present three different theories of how vaccines caused autism.

The case beginning Monday focuses on the second of those theories: that thimerosal-containing vaccines alone cause autism. Lawyers for the petitioning families said they will present evidence that injections with thimerosal deposit a form of mercury in the brain. That mercury excites certain brain cells that stay chronically activated trying to get rid of the intrusion.

“In some kids, there’s enough of it that it sets off this chronic neuroinflammatory pattern that can lead to regressive autism,” said attorney Mike Williams.

In the end, the families’ attorneys hope to convince a special master of the U.S. Court of Claims that thimerosal belongs on the list of causes for the inflammation that leads to regressive autism.

To win, the attorneys for the two boys, William Mead and Jordan King, will have to show that it”s more likely than not that the vaccine actually caused the injury.

Many members of the medical community are skeptical of the families’ claims. They worry that the claims about the dangers of vaccines could cause some people to forgo vaccines that prevent illness.

“I think that what’s so endearing to me about the anti-vaccine people is they’re perfectly willing to go from one hypothesis to the next without a backward glance,” said Dr. Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia.

Autism is a developmental disability that typically appears during the first three years of life and affects a person’s ability to communicate and interact with others. Dr. Andrew Gerber, a psychiatrists, said that medical experts don’t have a comprehensive understanding of what causes autism, but they do know there is a strong hereditary component.

Toxins from the environment could play a role, but currently, data does not support that they do, Gerber said.

Arguments are scheduled to go on throughout the month. A final decision could take several more months to occur. Claims that are successful would result in compensation taking into account lost earnings after age 18 and up to $250,000 for pain and suffering.

The families or the federal government can also appeal the decision of the special master to the Court of Federal Claims or to a federal appeals court.

While there have been about 5,000 claims relating to autism, there have been fewer than 3,000 claims for all other vaccines.

Doctors to decide who lives and who dies in coming pandemic

Who should MDs let die in a pandemic? Report offers answers

AP | May 5, 2008

By LINDSEY TANNER

CHICAGO (AP) — Doctors know some patients needing lifesaving care won’t get it in a flu pandemic or other disaster. The gut-wrenching dilemma will be deciding who to let die.

Now, an influential group of physicians has drafted a grimly specific list of recommendations for which patients wouldn’t be treated. They include the very elderly, seriously hurt trauma victims, severely burned patients and those with severe dementia.

The suggested list was compiled by a task force whose members come from prestigious universities, medical groups, the military and government agencies. They include the Department of Homeland Security, the Centers for Disease Control and Prevention and the Department of Health and Human Services.

The proposed guidelines are designed to be a blueprint for hospitals “so that everybody will be thinking in the same way” when pandemic flu or another widespread health care disaster hits, said Dr. Asha Devereaux. She is a critical care specialist in San Diego and lead writer of the task force report.

The idea is to try to make sure that scarce resources — including ventilators, medicine and doctors and nurses — are used in a uniform, objective way, task force members said.

Their recommendations appear in a report appearing Monday in the May edition of Chest, the medical journal of the American College of Chest Physicians.

“If a mass casualty critical care event were to occur tomorrow, many people with clinical conditions that are survivable under usual health care system conditions may have to forgo life-sustaining interventions owing to deficiencies in supply or staffing,” the report states.

To prepare, hospitals should designate a triage team with the Godlike task of deciding who will and who won’t get lifesaving care, the task force wrote. Those out of luck are the people at high risk of death and a slim chance of long-term survival. But the recommendations get much more specific, and include:

_People older than 85.

_Those with severe trauma, which could include critical injuries from car crashes and shootings.

_Severely burned patients older than 60.

_Those with severe mental impairment, which could include advanced Alzheimer’s disease.

_Those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes.

Dr. Kevin Yeskey, director of the preparedness and emergency operations office at the Department of Health and Human Services, was on the task force. He said the report would be among many the agency reviews as part of preparedness efforts.

Public health law expert Lawrence Gostin of Georgetown University called the report an important initiative but also “a political minefield and a legal minefield.”

The recommendations would probably violate federal laws against age discrimination and disability discrimination, said Gostin, who was not on the task force.

If followed to a tee, such rules could exclude care for the poorest, most disadvantaged citizens who suffer disproportionately from chronic disease and disability, he said. While health care rationing will be necessary in a mass disaster, “there are some real ethical concerns here.”

James Bentley, a senior vice president at American Hospital Association, said the report will give guidance to hospitals in shaping their own preparedness plans even if they don’t follow all the suggestions.

He said the proposals resemble a battlefield approach in which limited health care resources are reserved for those most likely to survive.
Bentley said it’s not the first time this type of approach has been recommended for a catastrophic pandemic, but that “this is the most detailed one I have seen from a professional group.”

While the notion of rationing health care is unpleasant, the report could help the public understand that it will be necessary, Bentley said.
Devereaux said compiling the list “was emotionally difficult for everyone.”
That’s partly because members believe it’s just a matter of time before such a health care disaster hits, she said.

“You never know,” Devereaux said. “SARS took a lot of folks by surprise. We didn’t even know it existed.”

The state’s juvenile prisons, group homes for the disabled, and state schools for people with mental disabilities all came under fire last year for reports of widespread physical and sexual abuse.

Dallas Morning News | May 4, 2008

By EMILY RAMSHAW

AUSTIN – Patients with severe mental illness are committed to Texas’ state psychiatric hospitals to be protected from themselves. Instead, some are suffering vicious abuse from the very caregivers hired to look after them.

And dozens more have participated in brutal beatings at the psychiatric hospitals since 2005, employee disciplinary reports show – using chokeholds, headlocks and threats of violence to restrain the patients under their watch.

In all, 72 employees across Texas’ 10 state mental hospitals have been fired in the last three years for allegations of physical abuse, according to a Dallas Morning News analysis of state personnel records. Hundreds more have been terminated for other violations, the records show, from sleeping on the job to over-medicating mentally ill patients.

State officials say there will always be some reports of abuse and neglect in an institutional setting. And they say they take any allegations of mistreatment seriously. But the records show that as in other state-run facilities, abuse and neglect are systemic.

The state’s juvenile prisons, group homes for the disabled, and state schools for people with mental disabilities all came under fire last year for reports of widespread physical and sexual abuse. The state psychiatric hospitals, like other systems for vulnerable Texans, are chronically starved for cash, advocates of more state funding say, and services at the local level can’t keep up.

“You get what you pay for,” said Rep. Garnet Coleman, D-Houston, who has bipolar disorder. “When you financially dumb something down, you make services cheap, something’s got to give. Unfortunately, it usually ends up being a mentally ill or disabled Texan.”

Officials with the Department of State Health Services, the agency that runs the psychiatric hospitals, say abuse and neglect are “absolutely not” pervasive – and verified cases are actually dropping.

In the last two years, they confirmed 15 “Class I” cases – the most serious abuse. On average, investigators substantiate 5 percent of the more than 2,000 allegations they examine annually. And 90 percent of patient deaths since 2005 were attributed to natural causes, agency spokesman Doug McBride said. Five were suicides, and none were the result of abuse.

“Keep in mind there are about 7,400 employees, 18,000 patient admissions and probably hundreds of thousands of staff-patient interactions in a year,” Mr. McBride said.

State officials acknowledge that the psychiatric hospitals are stressful environments; there are times, Mr. McBride said, when employees “do not handle a situation appropriately.” But they say the rules for reporting abuse and neglect are stringent – and confirmed cases of physical and sexual abuse are reported to police.

And they balk at the suggestion that conditions bear a resemblance to the state schools for people with mental disabilities, where the U.S. Justice Department has intervened twice in recent years.

The state psychiatric hospitals, which have about 2,500 patients daily, had 137 confirmed abuse cases in 2007. The state schools for people with disabilities, which have twice as many residents, have an average of 300 confirmed abuse cases per year.

But some advocates fear the mentally ill patients may face greater risks. Patients of the psychiatric hospitals are largely indigent, transient and not connected to their families, so they have few allies as they bounce through the mental health system.

“It’s a population that’s easy to abuse because they’re not on the radar in any way,” said Richard Hansen, a Texas mental health advocate who was chemically restrained, shackled and beaten to the point of broken ribs years ago while suffering from bipolar disorder in a New York mental hospital.

But there are few alternatives, advocates say, because smaller community-based services are as strapped as the state system.

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The medications have side effects which accelerate mental decline, triple the risk of stroke, and double the chances of premature death.

Telegraph | Apr 28, 2008

Ministers should step in to stop inappropriate prescriptions of powerful antipsychotic drugs for Alzheimer’s patients, an influential group of MPs said today.

Up to 105,000 people with dementia in Britain are wrongly being treated with the drugs, which are used to control behavioural symptoms such as aggression, they claim. Research has shown that the medications have side effects which can accelerate mental decline, triple the risk of stroke, and double the chances of premature death.

They are intended for psychotic patients suffering from delusions, paranoia and hallucinations. Yet the drugs continue to be used as a first resort to address the challenging behaviour of people suffering from Alzheimer’s disease and other types of dementia, according to the MPs. A report from the all-party parliamentary group (APPG) on dementia demanded Government action on the problem and urged the National Institute for Health and Clinical Excellence (Nice), the health watchdog, to carry out a review.

The report, A Last Resort, points out that no audit or regulation of such prescriptions exists. Jeremy Wright, the group’s chairman, said: “Antipsychotics can double risk of death and triple the risk of stroke in people with dementia, (can) heavily sedate them, and (can) accelerate cognitive decline.

“The Government must end this needless abuse. Safeguards must be put in place to ensure antipsychotics are always a last resort. We need to include families in decisions, give people with dementia regular reviews, and equip care staff with specialist training.”

The inquiry was told that 150,000 people with dementia were prescribed antipsychotic drugs in British care facilities. Psychiatric experts said 70 per cent of these prescriptions were inappropriate.

Neil Hunt, the chief executive of the Alzheimer’s Society, said more than 70 per cent of dementia patients exhibited challenging behaviour.

“More often than not this is an expression of unmet need, not a symptom of dementia, and there is no excuse for reaching for the medicine cabinet,” he said.

Associated Press | Apr 26, 2008

By PAUL ELIAS

SAN FRANCISCO - A top-ranking official at the Department of Veterans Affairs defends the agency’s treatment of disabled veterans and denies the agency has tried to cover up the number of veterans committing suicide.

Dr. Michael Kussman, a department undersecretary for health, testified during a trial in San Francisco federal court that will determine whether the VA is shirking its duty to provide adequate mental health care and other medical services to millions of veterans.

The two veterans groups suing the VA want U.S. District Court Judge Samuel Conti to order the agency to dramatically improve how fast it processes applications and how it delivers mental health care, especially when it comes to preventing suicides and treating post-traumatic stress disorder.

The groups contend that veteran suicides are rising at alarming rates in large part because of VA failures. In court, plaintiffs’ lawyer Arturo Gonzalez clashed Thursday with Kussman over how to compile and report the suicide rates.

For instance, VA Secretary James Peake told Congress in a Feb. 5 letter that 144 combat veterans of Iraq and Afghanistan committed suicide between October 2001 and December 2005.

But Gonzalez produced internal VA e-mails that contended that 18 veterans a day were committing suicide. Kussman countered that the figure, provided by the Centers for Disease Control and Prevention, included all 26 million veterans in the country, including aging Vietnam veterans who are reporting an increased number of health problems.

Kussman said Thursday that suicide prevention was a VA priority and that the agency instituted new measures in the past 18 months, including training its workers to identify suicidal patients and establishing a 24-hour suicide hot line for veterans.

Court documents given to the judge by Gonzalez showed that 2,508 veterans called the hot line in March, the busiest month so far.

“People are using it,” Kussman said. “It’s a good thing.”

Gonzalez also asked Kussman to explain several e-mail chains among agency officials that discussed an unwillingness to share suicide statistics with CBS News, which was preparing a story on the subject.

“I don’t want to give CBS any more numbers on veterans suicides or attempts than they already have — it will only lead to more questions,” wrote Everett A. Chasen, chief communications officer in a March 10 e-mail to several VA officials.

On Monday, the first day of trial, an e-mail message written in December by Dr. Ira Katz, the agency’s mental health director, was given as evidence. It alerted Kussman and others that 12,000 veterans under VA care were attempting suicide a year.

“Is this something we should (carefully) address ourselves in some sort of release before someone stumbles on it?” the e-mail asks.

Katz also reported that of the average of 18 military veterans who kill themselves each day, four to five of them are under VA care when it happens.

Three Democratic senators, including Sen. Daniel Akaka of Hawaii, chairman of the Veterans Affairs Committee, called for Katz’s dismissal this week.

“I disagree with the premise that there was some effort to cover something up,” Kussman testified Thursday. “We don’t obfuscate.”

Instead, Kussman said, there’s concern about how suicide rates are compiled among the nation’s 26 million veterans.

“It’s been hard to track exactly,” said Kussman, who noted that only 5.7 million veterans are under VA care.

The trial is scheduled to last another week; there was no testimony Friday. The judge is hearing the case without a jury.

UPI | Apr 20, 2008

OTTAWA, April 20 (UPI) — The suicide rate among Canadian soldiers doubled from 2006 to 2007, military figures indicate.

The Canadian Broadcasting Corp. reported Sunday that the suicide rate among military personnel is triple that of the general population.

In 2007, the number of suicides among regular and reserve members of the Canadian Forces rose to 36, the highest in more than a decade. The average number of suicides among Canadian Forces military members for both active duty personnel and reservists between 1994 and 2007 was 16 per year.

In 2006, the number of suicides among members of the military rose to 20 and then increased to 36 the following year.

Dr. Greg Passey — a former military psychiatrist and head of a post-traumatic stress disorder clinic in Vancouver, British Columbia — said the increase in military suicides is “disturbing” but not surprising.

“We’re now a number of years into that mission and the frontline, the combat soldiers, and even the support staff are having to do multiple tours,” he said.

Only half of vets have sought help for depression, post-traumatic stress

MSNBC | Apr 17, 2008

About 320,000 U.S. soldiers have suffered brain injuries in fighting in Iraq and Afghanistan, a new study estimates.

WASHINGTON - Some 300,000 U.S. troops are suffering from major depression or post traumatic stress from serving in the wars in Iraq and Afghanistan, and 320,000 received brain injuries, a new study estimates.

Only about half have sought treatment, said the study released Thursday by the RAND Corporation.

“There is a major health crisis facing those men and women who have served our nation in Iraq and Afghanistan,” said Terri Tanielian, the project’s co-leader and a researcher at the nonprofit RAND.

“Unless they receive appropriate and effective care for these mental health conditions, there will be long-term consequences for them and for the nation,” she said in an interview with The Associated Press.

The 500-page study is the first large-scale, private assessment of its kind — including a survey of 1,965 service members across the country, from all branches of the armed forces and including those still in the military as well veterans who have left the services.

Its results appear consistent with a number of mental health reports from within the government, though the Defense Department has not released the number of people it has diagnosed or who are being treated for mental problems. The Department of Veterans Affairs said this month that its records show about 120,000 who served in the two wars and are no longer in the military have been diagnosed with mental health problems. Of the 120,000, approximately 60,000 are suffering from PTSD, the VA said.

Veterans Affairs is responsible for care of service members after they have left the service, while the Defense Department covers active duty and reservist needs. The lack of information from the Pentagon was one motivation for the RAND study, Tanielian said.

Problems affect more than 18 percent of troops

The most prominent and detailed military study on mental health that is released is the Army’s survey of soldiers at the warfront. Officials said last month that it’s most recent one, done last fall, found 18.2 percent of soldiers suffered a mental health problem such as depression, anxiety or acute stress in 2007 compared with 20.5 percent the previous year.

The Rand study, completed in January, put the percentage of PTSD and depression at 18.5 percent, calculating that approximately 300,000 current and former service members were suffering from those problems at the time of its survey, which was completed in January.

The figure is based on Pentagon data showing over 1.6 million military personnel have deployed to the conflicts since the war in Afghanistan began in late 2001.

The Gazette | Mar 18, 2008

By Cindy Hadish

In about the time it takes to toast your bread, someone in America develops Alzheimer’s disease. By mid-century that time will be cut by more than half.

A report released Tuesday shows an estimated 10 million baby boomers — one out of eight — will develop the progressive brain disorder.

Up to 5.2 million Americans have the disease.

“It’s not an aging issue,” said Kelly Hauer, executive director of the Alzheimer’s Association East Central Iowa Chapter. “It’s a public health issue.”

In just two years, Iowa’s population of Alzheimer’s patients is predicted to grow from 65,000 to 69,000, according to the report, issued by the Alzheimer’s Association.

With 70 percent of Alzheimer’s patients living at home, the disease touches not only those afflicted, but their families and caregivers.

Last year, 95,733 Iowa caregivers provided more than 82 million hours of unpaid care for someone with Alzheimer’s or other dementia, valued at $874 million.

“It’s a tough job,” said Kathy Good, 61, of Cedar Rapids, whose husband, David Good, also 61, developed early onset Alzheimer’s at age 56.

A district court judge, David Good lost even simple abilities, such as finding the right word for “toothbrush.”

Kathy Good considers the couple lucky. Friends take her husband out to lunch or the YMCA. She has some flexibility in her job as a social worker. They have financial stability.

That’s not the same for everyone.

A bill in the Iowa Legislature would address the needs of Iowans living with Alzheimer’s and their caregivers.

Senate File 2341 calls for a county-by-county review to determine services and future needs of people with Alzheimer’s and other forms of dementia, and address availability of caregiver services.

Another component of the bill addresses training for people who work in care facilities and those who care for an Alzheimer’s patient at home.

Tuesday’s report showed:

l Alzheimer’s is the seventh leading cause of death nationwide and the fifth-leading cause of death for those over age 65.

l Every 71 seconds, someone in America develops Alzheimer’s disease; by midcentury someone will develop Alzheimer’s every 33 seconds.

l By 2010, almost one-half million new cases of Alzheimer’s will occur annually; by 2050, there will be almost 1 million new cases each year.

l Women are nearly twice as likely as men to develop Alzheimer’s disease (17 percent vs. 9 percent) basically because women live longer.

l One in six women and one in 10 men age 55 and older can expect to develop Alzheimer’s disease in their lifetime.

Hauer said death rates from diseases such as stroke and breast cancer are declining as research money goes toward finding treatments and cures, but Alzheimer’s deaths continue an upward trend.

“We’ve got a disease that doesn’t have a cure,” she said. “With our graying state … now is the time to develop an effective blueprint to deal with this disease.”

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Alzheimer’s cases may quadruple by 2050

A memorial website was set up within hours of Miss Randall’s death

Police fear internet cult inspires teen suicides driven by a desire to achieve prestige by having a memorial website set up in their name.

Telegraph | Jan 23, 2008

By Nick Britten and Richard Savill

Detectives fear a bizarre suicide craze is sweeping through teenagers in a small town fuelled by chat on social networking sites after seven friends took their own lives.

As well as the deaths during the last 12 months, several more have attempted suicide and police fear they are being driven by a desire to achieve prestige by having a memorial website set up in their name.

Many of the victims had their own web pages on the social networking site Bebo, which they spent hours on each day. After their deaths a special site is set up where friends can leave messages, photographs and videos.

Police have visited the parents of every member of a 20-strong group who they are most worried about warning them to keep a close eye on their children.

The latest victim is Natasha Randall, 17, who was found hanged at her family home last Thursday. Within 24 hours two of her friends had tried to kill themselves. One 15-year-old girl was on a life support machine yesterday while the other, also 15, was recovering after slitting her wrists.

Police, who are investigating a possible suicide chain, fear the teenagers think it is “cool” to have an internet memorial site and are killing themselves to achieve kudos among their peer group.

Within hours of Miss Randall’s death, a tribute site called “R.I.P. Tasha” had sprung up with photos, videos and messages. It has 345 members been viewed more than 2,100 times.

Her death follows those of Gareth Morgan, 27, Liam Clarke, 20, Thomas Davies, 20, David Dilling, 19, Dale Crole, 18, and Zachary Barnes, 17. Like Miss Randall, all lived in and around Bridgend in south Wales and all are being linked.

Miss Randall was in her first year on a Care and Childhood Studies course at Bridgend College. Her stepmother, Katrina, said the teenager spent hours every day on her computer using the name “Wildchild”.

She said: “The police have been and taken Natasha’s computer away to help with their investigation. This has come as a shock to all of us. We’re just too upset to speak about it, her dad especially.”

Thomas Davies’ mother, Melanie, 38, said: “It’s like a craze - a stupid sort of fad. They all seem to be copying each other by wanting to die.

“I think the problem is they do not know how to speak like adults about serious issues like this. They can speak to each other on the computer but do not know how to express their emotions in other ways.

“He did go on Bebo and apparently he had a page on there. He must have discussed his other friends dying on there because it had upset him.

“Like most parents, I have no idea how to get on these sites or what other kids are talking about. But I would warn other parents to beware and to keep a close eye on their children.”

A police source said: “Parents should keep a close watch on what their children are doing on the internet and what they are talking about.

“It’s often easier for them to disclose their real feelings on a computer rather than face to face with an adult or even their friends, and social networking sites are the ideal way to do that.”

Madeleine Moon, Bridgend MP, has met with senior police officers to discuss Bridgend’s alarmingly high suicide rate. The Bridgend and Glamorgan Valleys Coroner, Phillip Walters, has also raised his concerns and a special “task force” has been set up in the town to investigate the problem.

Consultant psychiatrist Tegwyn Williams, director of mental health services for the NHS Trust, said: “Unfortunately there’s a culture where men don’t tend to talk about how they feel. It comes to the point where they can’t see any way out.

“The key is to break down the stigma attached to suicide in the community so that people aren’t afraid to talk to someone of they feel depressed.”

It comes after the deaths of three teenagers in a suicide pact in a small village in Northern Ireland in the summer.

AP | Jan 20, 2008

By ERIN McCLAM

LEEDS, Mass. - Peter Mohan traces the path from the Iraqi battlefield to this lifeless conference room, where he sits in a kilt and a Camp Kill Yourself T-shirt and calmly describes how he became a sad cliche: a homeless veteran.

There was a happy homecoming, but then an accident — car crash, broken collarbone. And then a move east, close to his wife’s new job but away from his best friends.

And then self-destruction: He would gun his motorcycle to 100 mph and try to stand on the seat. He would wait for his wife to leave in the morning, draw the blinds and open up whatever bottle of booze was closest.

He would pull out his gun, a .45-caliber, semiautomatic pistol. He would lovingly clean it, or just look at it and put it away. Sometimes place it in his mouth.

“I don’t know what to do anymore,” his wife, Anna, told him one day. “You can’t be here anymore.”

Peter Mohan never did find a steady job after he left Iraq. He lost his wife — a judge granted their divorce this fall — and he lost his friends and he lost his home, and now he is here, in a shelter.

He is 28 years old. “People come back from war different,” he offers by way of a summary.

This is not a new story in America: A young veteran back from war whose struggle to rejoin society has failed, at least for the moment, fighting demons and left homeless.

But it is happening to a new generation. As the war in Afghanistan plods on in its seventh year, and the war in Iraq in its fifth, a new cadre of homeless veterans is taking shape.

And with it come the questions: How is it that a nation that became so familiar with the archetypal homeless, combat-addled Vietnam veteran is now watching as more homeless veterans turn up from new wars?

What lessons have we not learned? Who is failing these people? Or is homelessness an unavoidable byproduct of war, of young men and women who devote themselves to serving their country and then see things no man or woman should?

For as long as the United States has sent its young men — and later its young women — off to war, it has watched as a segment of them come home and lose the battle with their own memories, their own scars, and wind up without homes.

The Civil War produced thousands of wandering veterans. Frequently addicted to morphine, they were known as “tramps,” searching for jobs and, in many cases, literally still tending their wounds.

More than a decade after the end of World War I, the “Bonus Army” descended on Washington — demanding immediate payment on benefits that had been promised to them, but payable years later — and were routed by the U.S. military.

And, most publicly and perhaps most painfully, there was Vietnam: Tens of thousands of war-weary veterans, infamously rejected or forgotten by many of their own fellow citizens.

Now it is happening again, in small but growing numbers.

For now, about 1,500 veterans from Iraq and Afghanistan have been identified by the Department of Veterans Affairs. About 400 of them have taken part in VA programs designed to target homelessness.

The 1,500 are a small, young segment of an estimated 336,000 veterans in the United States who were homeless at some point in 2006, the most recent year for which statistics are available, according to the National Alliance to End Homelessness.

Still, advocates for homeless veterans use words like “surge” and “onslaught” and even “tsunami” to describe what could happen in the coming years, as both wars continue and thousands of veterans struggle with post-traumatic stress.

People who have studied postwar trauma say there is always a lengthy gap between coming home — the time of parades and backslaps and “The Boys Are Back in Town” on the local FM station — and the moments of utter darkness that leave some of them homeless.

In that time, usually a period of years, some veterans focus on the horrors they saw on the battlefield, or the friends they lost, or why on earth they themselves deserved to come home at all. They self-medicate, develop addictions, spiral down.

How — or perhaps the better question is why — is this happening again?

“I really wish I could answer that question,” says Anthony Belcher, an outreach supervisor at New Directions, which conducts monthly sweeps of Skid Row in Los Angeles, identifying homeless veterans and trying to help them get over addictions.

“It’s the same question I’ve been asking myself and everyone around me. I’m like, wait, wait, hold it, we did this before. I don’t know how our society can allow this to happen again.”

Mental illness, financial troubles and difficulty in finding affordable housing are generally accepted as the three primary causes of homelessness among veterans, and in the case of Iraq and Afghanistan, the first has raised particular concern.

Iraq veterans are less likely to have substance abuse problems but more likely to suffer mental illness, particularly post-traumatic stress, according to the Veterans Administration. And that stress by itself can trigger substance abuse.

Some advocates say there are also some factors particular to the Iraq war, like multiple deployments and the proliferation of improvised explosive devices, that could be pulling an early trigger on stress disorders that can lead to homelessness.

While many Vietnam veterans began showing manifestations of stress disorders roughly 10 years after returning from the front, Iraq and Afghanistan veterans have shown the signs much earlier.

That could also be because stress disorders are much better understood now than they were a generation ago, advocates say.

“There’s something about going back, and a third and a fourth time, that really aggravates that level of stress,” said Michael Blecker, executive director of Swords to Plowshares,” a San Francisco homeless-vet outreach program.

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