Testimony before the New York City Council Committees on Veterans and Mental Health, Developmental Disability, Alcoholism, Substance Abuse and Disability Services

November 20, 2017

Chairs Eric Ulrich and Andrew Cohen, Council Members, and staff, good afternoon and thank you for the opportunity to speak about the City’s efforts to address the mental health needs of New York City’s veterans. My name is Samantha Kubek, and I am an Equal Justice Works Fellow in the LegalHealth division of the New York Legal Assistance Group (NYLAG), a nonprofit law office dedicated to providing free legal services in civil law matters to low-income New Yorkers. NYLAG serves immigrants, seniors, veterans, the homebound, families facing foreclosure, renters facing eviction, low-income consumers, those in need of government assistance, children in need of special education, domestic violence victims, people with disabilities, patients with chronic illness or disease, low-wage workers, low-income members of the LGBTQ community, Holocaust survivors, as well as others in need of free legal services.

LegalHealth partners with medical professionals to address the nonmedical needs of low-income individuals with serious health problems. This year, our Veterans Initiative will serve nearly 1,000 veterans in VA medical centers’ behavioral health, geriatrics, and women’s health clinics. Working closely with veterans’ healthcare providers, these “medical-legal partnership” clinics reduce veteran homelessness by preventing evictions, expand access to needed veterans’ services by upgrading bad paper discharges, and stabilize incomes for veterans with significant health needs.

Veterans from all periods of service in this country are affected by mental health diagnoses. According to the RAND Center for Military Health Policy Research, 20% of the vets who served in either Iraq or Afghanistan suffer from either major depression or post-traumatic stress disorder.[1] 26% of veterans from the Vietnam Era have experienced PTSD at some point over the course of their life, with about 15% still suffering today.[2] Many of NYLAG’s veteran clients have a mental health diagnosis, which can cause or complicate their legal issues and force them into dire situations. The connection between mental health and resulting legal problems is demonstrated to us through our work every day.

As an attorney with LegalHealth, which has legal clinics at 32 hospitals, I staff the nation’s first legal clinics for women veterans at the Bronx and Manhattan Veterans Administration Hospitals. The overwhelming majority of my clients are survivors of military sexual trauma. The federal government defines military sexual trauma (MST) as “psychological trauma resulting from a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment which occurred while the Veteran was serving on active duty, active duty for training, or inactive duty training.” The Department of Veterans Affairs stipulates that while “veterans are not granted compensation for the traumatic event itself,” they may receive “disability compensation for conditions that result from MST.” These women often come to me with diagnoses of post-traumatic stress disorder, anxiety, and major depressive disorder, among others. Women veterans are more than twice as likely as their male counterparts to experience PTSD, and sexual assault victimization is associated with high lifetime rates of PTSD in both men and women.[3] Many of these women are unable to maintain employment as a result of their diagnoses and end up struggling financially, and may end up facing homelessness.  Women veterans are three times more likely to be homeless than civilian women, and over half of homeless women veterans are survivors of military sexual trauma and have a resulting mental health diagnosis.[4]

One client of mine, a veteran who we will call Susan, came to my clinic suffering from extreme depression, anxiety, and post-traumatic stress disorder. She had been out of the Army for thirty-four years. Her mental health diagnoses stemmed from her rape during the military, and though she had tried for decades to get VA service-connected benefits for her trauma, she had been unsuccessful, largely due to the severity of her conditions. Her PTSD was such that she was unable to draft the statement needed to complete her claim and present the evidence required by the VA to secure her benefits. By working with an attorney, she was finally able to get the assistance she needed and obtain her long overdue benefits, totaling a back pay of over $60,000 and ongoing monthly payments of approximately $3,000 for as long as her disability remains—likely for the rest of her life. Unfortunately, for far too many women veterans like Susan, the legal services organizations that do this critical work do not have the capacity to meet the need, and many veterans are unable to get the services they need.

One way to help this veteran population is by providing access to legal services.  Attorneys are able to act to keep veterans in stabilized apartments and assist veterans in obtaining government benefits, including VA benefits. Individuals with mental health diagnoses who are given access to an attorney are more likely to obtain positive outcomes in their cases than those who do not have access to one. When identified in a healthcare setting, civil legal problems are often detected earlier, enabling the civil legal aid community to prevent these problems before they cascade into crises, achieving better outcomes with fewer resources.[5] Evidence suggests that addressing veterans’ legal needs onsite where they receive their care helps to improve quality of life and mental health. According to a 2017 VA survey, four of the top ten unmet needs for homeless veterans involve legal problems,[6] and these social determinants impact health. For example, the American Academy of Suicidology lists legal difficulties as events that can increase the risk of suicide.[7] The benefits of legal services on veterans’ mental health extend across all types of legal matters. Child and family support services stabilize income, reduce the incidence of domestic issues and also help maintain familial bonds and structure.[8]  Representation in VA benefits and employment matters may also stabilize veterans’ income. Increasing income and access to transportation enables veterans to more easily attend their healthcare appointments (making neglect of treatment less likely) and also helps veterans maintain employment status.[9]  Finally, advance planning services also ease stressors for severely ill or elderly veterans (the latter of which is a growing population as the baby-boomer generation ages).[10]

Of particular concern is the need for housing assistance among veterans, and veterans with mental health diagnoses are particularly vulnerable.[11] As troops return from operations in Iraq and Afghanistan, the face of veteran homelessness has changed: homeless veterans are increasingly younger, female, and heads of households. Despite this, homeless veterans are still most likely to be males between the ages of 51 and 61 and to have served in the Vietnam War, and, in the next 10 to 15 years, it is projected that the number of homeless veterans over the age of 55 could increase drastically.[12]

I appreciate the opportunity to speak to the Council about this issue, and I look forward to engaging in further discussions about assisting our veterans in improving their behavioral health outcomes.

Respectfully submitted,

Samantha Kubek, Esq.

New York Legal Assistance Group

 

[1] https://www.rand.org/pubs/research_briefs/RB9336.html

[2] https://www.ncbi.nlm.nih.gov/pubmed/26201054

[3] http://www.military.com/benefits/veterans-health-care/va-finds-ptsd-affects-women-differently-then-men.html

[4] https://www.va.gov/HOMELESS/nchav/docs/HERS-Womens-Proceedings.pdf

[5] http://www.healthaffairs.org/do/10.1377/hblog20150422.047143/full/

[6] U.S. Department of Veterans Affairs, Community Homelessness Assessment, Local Education and Networking Group (June 2017) available at https://www.va.gov/HOMELESS/docs/CHALENG-2016-factsheet-508-2017-07-29.pdf.

[7] American Association of Suicidology, Warning Signs and Risk Factors available at http://www.suicidology.org/ncpys/warning-signs-risk-factors.

[8] [8] The Invisible Battlefield: Veterans Facing Health-Harming Legal Needs in Civilian Life, National Center for Medical-Legal Partnerships (June 15, 2016) http://medical-legalpartnership.org/invisiblebattlefield/.

[9] [9] The Invisible Battlefield: Veterans Facing Health-Harming Legal Needs in Civilian Life, National Center for Medical-Legal Partnerships (June 15, 2016) http://medical-legalpartnership.org/invisiblebattlefield/.

[10] Kerry J. Rodabaugh et al., A Medical-Legal Partnership as a Component of a Palliative Care Model, 13 Journal of Palliative Medicine 1 (2010); Stewart B. Fleishman et al., The Attorney as the Newest Member of the Cancer Treatment Team, 24 Journal of Clinical Oncology 2123 (2006).

[11] Approximately 40,000 veterans in the U.S. are homeless, and another 1.4 million veterans are at risk for homelessness.  FAQ about Homeless Veterans, National Coalition for Homeless Veterans http://nchv.org/index.php/news/media/background_and_statistics/.

[12] https://endhomelessness.org/resource/veteran-homelessness/