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Most societies consider veterans of military service a special subgroup by virtue of the sacrifices they have made and the often extraordinary risks they have incurred in defense of their nation. As a result, governments make particular benefits and services available to them and the public takes responsibility for assuring the well-being of this special group of citizens. It is thus a matter of concern that veterans are represented in great numbers among homeless Americans.
Risk Factors For Veteran Homelessness
The first national study of homelessness among U.S. veterans was based on survey data gathered in 1987. Forty percent of homeless men reported past military service, compared with only 34 percent of men in the general population. Further analyses confirmed that veterans were 1.4 times as likely to be homeless as other men, and that approximately 200,000 were homeless on any given night. By far the greatest risk of homelessness was among those who served in the post-Vietnam all-volunteer army from 1972 to 1980. These men were about four times as likely to be homeless as their non-veteran peers. In contrast, veterans in the age group that served during the Vietnam period were only 1.4 times as likely, matching the overall average. World War Il-era veterans had a slightly lower rate: They were only nine-tenths as likely to be homeless as non-veterans. These data indicate that combat exposure is not the strongest determinant of homelessness among veterans of various war eras; indeed, post-Vietnam veterans had the least combat exposure but the greatest risk of homelessness.
Rather, the key factors seem to be related to their pre-military experience and status. World War II veterans are a highly representative cross-section of their age group in the society at large. So are Vietnam veterans, partly because of deliberate policies to make the draft as fair as possible. In contrast, veterans of the all-volunteer force have been shown to have more psychiatric and substance abuse disorders than non-veterans in their age group. Many seem to have entered the military because they lacked desirable options in the civilian labor market. Moreover, negative public opinion on the Vietnam conflict made military service unpopular and recruiters could not be selective in the post-Vietnam era.
This finding was replicated in two subsequent studies, one based on data from the Shelter-night survey in the 1990 census, the other on a 1996 national survey. While the gap has diminished, veterans are still twice as likely as non-veterans to be homeless, by these measures of the 1990s. This risk is far higher than was observed among veterans of the Vietnam era and before.
Vietnam Service and Posttraumatic Stress Disorder
These findings seem counterintuitive to many homeless service providers who assist Vietnam veterans suffering from posttraumatic stress disorder (PTSD).
A number of studies have found that while there are high rates of Vietnam service and PTSD among those who are homeless, these rates are no higher than those found in non-homeless, low-income veterans. Available data indicate that among veterans, just as among other men, the antecedents of homelessness include poverty, social isolation, and substance abuse. Thus Vietnam military service does not seem to be an especially strong predictor of homelessness, although it is quite common among homeless men.
Survey data from homeless veterans themselves lend some support to these epidemiological findings. For example, among those who had always had a home previously, an average of 12.5 years elapsed between military discharge and their first homeless episode. When asked if they thought their military service had contributed to their becoming homeless, 59 percent responded “no,” 25 percent “somewhat,” and only 16 percent “very much.” When asked to name particular aspects, the most common response was not combat exposure, but that military service had increased their substance abuse.
Veterans Among Homeless Women
Between 3.1 percent and 4.4 percent or homeless women were veterans, according to data from the 1996 survey and from a large clinical program conducted in the late 1990s in eighteen U.S. cities—a program not under the auspices of the Veterans Administration (VA). This seemingly small proportion is actually quite substantial given that only 1.2 percent of all American women are veterans. Thus their statistical risk of homelessness some three to four times greater than that of their non-veteran peers and is fairly consistent across all age groups. These unexpected findings parallel those for male veterans of the all-volunteer army. Indeed, females have always served on a voluntary basis. The same factors that prompt some people to volunteer for military service—unstable family situations, few opportunities for civilian employment—may also place them at high risk of homelessness after discharge. It seems that when these veterans complete their military service, they may find themselves further cut off from social supports and thus at greater risk of becoming homeless.
The Changing Proportions Of Veterans Among Homeless Americans
National surveys conducted about a decade apart by Martha Burt of the Urban Institute provide insight into the shifting proportions of veterans among homeless American men. In these analyses, birth cohorts (i.e., samples sharing similar dates of birth) of men assessed in 1987 were compared with the same birth cohort in 1996, so that changes in the proportion of veterans in various age groups in the general population were not mistaken for changes in the risk of homelessness.
Comparing matched age cohorts, Burt found that the overall percentage of homeless men who were veterans declined by 9 percent, from 45 to 36 percent. More specifically, the figure dipped slightly in the post-Vietnam age group (from 31 to 29 percent), dropped a bit more in the age group that served during the period between the Korean and Vietnam conflicts (from 68 to 64 percent) and dropped even more significantly in the Korean and World War II-era age groups (from 75 to 65 percent). However, the proportion of veterans in the Vietnam-era age group increased slightly, from 38 to 41 percent). While encouraging overall, these data do not identify specific causes of these declines.
Characteristics Of Homeless Veterans And Non-Veterans
By many measures, veterans differ little from non-veterans among homeless populations. Veterans tend to be older, better educated, and have more days of recent employment than non-veterans. On the other hand, they have somewhat more severe alcohol problems—but similar levels of drug and psychiatric problems. A study of the military records of clients treated in non-VA homeless case management programs (those not requiring VA eligibility) found that 6.9 percent had received bad conduct or dishonorable discharges, more than triple the general rate of such discharges (1.8 percent). Not surprisingly, homeless veterans had less successful military service than other veterans. Nevertheless, it is notable that in every era, homeless and non-homeless veterans are equally likely to have served in combat —with about 30 percent receiving fire during that service.
Services For Homeless Veterans
While homeless veterans receive assistance from many programs, the federal Department of Veterans Affairs bears special responsibility for addressing their needs, both through its mainstream health care and benefit programs, and through a nationwide network of specialized services. Like their housed peers, homeless veterans may be eligible for compensation for medical and psychiatric conditions precipitated by military service, for pensions, and for other education and housing benefits. As a result of their extreme poverty, they almost always qualify for free medical services at VA centers throughout the United States. Surveys have found that 24 percent of general psychiatry VA inpatients were homeless at the time of admission, as were almost 50 percent in inpatient substance abuse programs.
Since 1987, the VA has sponsored two major specialized programs. The Domiciliary Care for Homeless Veterans (DCHV) program based on VA’s longstanding residential treatment units provided 5,500 episodes of care at thirty-five VA medical centers nationwide in 2001. The Health Care for Homeless Veterans (HCHV) program had contacts with 57,854 veterans at 134 VA medical centers in the 2001 fiscal year, and provided 5,093 episodes of residential treatment through contracts with commitment providers. Although they differ in several respects, both programs involve five core activities. First, both have outreach functions, identifying veterans among homeless persons encountered in shelters, soup kitchens, and other community locations. Second, they offer team psychosocial assessments to determine the needs of each veteran, and to give priority to those who are most vulnerable. Third, they make referrals for medical and psychiatric inpatient and outpatient treatment. Fourth, both provide time-limited residential treatment, the DCHV in domiciliaries (and the HCHV in community-based halfway houses. Fifth, they offer follow-up case management, as budgets permit, to help veterans identify resources to facilitate their community integration.
Increasingly, these programs have formed partnerships with community providers, with the VA offering health care services and its partners, funded through both contracts and grants, providing transitional housing services. Treatment outcomes in these partnerships show that while contract residential treatment is linked with improvements in housing, psychiatric status, substance abuse, employment, and social support, it also costs more than treatment though it is limited to outpatient service provision.
To further enhance these core programs and to establish a full continuum of care, the VA has expanded its housing, financial support, and rehabilitative functions by collaborating with state and local providers—and with other federal agencies such as the Social Security Administration (SSA) and the Department of Housing and Urban Development (HUD). A VA-SSA joint outreach program showed that veterans were more than twice as likely to receive SSA benefits at joint program sites as at control sites.
Moreover, receipt of SSA benefits resulted in improved housing outcomes and subjective quality of life measures, with no increase in alcohol or drug use. Similarly, a rigorous three-year experimental evaluation of the HUD-VA Supported Housing (HUD-VASH) program showed HUD-VASH veterans had 25 percent more nights housed than a standard care group and 36 percent fewer nights homeless (excluding institutional care in hospitals or jails), although there were no significant differences between treatment groups on any measures of psychiatric or substance abuse status or community adjustment.
Veterans Service Organizations (VSOs)
Since the Civil War, veterans have joined to create large, independent advocacy and support groups, such as the Grand Army of the Republic, the American Legion, and the Veterans of Foreign Wars. Many of these VSOs have become prominent forces in American life and have promoted efforts to assist homeless veterans, often by making donations that support national VA programs.
The growth of homelessness among veterans has also stimulated the development of numerous smaller groups, many adopting a nonprofessional, “veterans helping veterans” philosophy. In 1990, an umbrella organization of such service providers, the National Coalition for Homeless Veterans (NCHV), was formed. With an estimated 200 chapters, the NCHV has formed partnerships with the VA as well as with state and local governments.
Toward Eliminating Veteran Homelessness
While the stated goal of VA and many non-VA service providers is the total elimination of homelessness among citizens who served and sacrificed for their country, progress toward achieving this goal is limited. While hundreds of thousands of veterans have been assisted through these programs, and robust evidence demonstrates that program participation is associated with improvement in multiple life areas over the course of treatment, it does not seem likely that homelessness among veterans will be eliminated independently of a broad solution of the tragedy of homelessness in society as a whole.
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