Private Models Improve Services to Vets

The homeless veteran – he is a historical problem we want to ignore. The sheer magnitude of the dilemma makes us feel helpless. Ragged men – and women – on the streets, haggard from sleepless nights, eyes bloodshot from too much booze or drugs. Marylanders are not strangers to this sight, because we have some 3,750 homeless veterans, about 1,700 in Baltimore.1 According to a newly released survey of the homeless, “34 percent of men who seek refuge at America’s rescue missions are veterans. The survey also indicates that seven percent of women at missions are also veterans.”2

Homeless veterans contend with problems rooted in, or intensified by, their military service. About one in three served in Vietnam.3 Chemical dependency, post- traumatic stress disorder (PTSD) and chronic physical problems plague a number of these veterans. Historically, alcohol has been considered an inherent factor in homelessness. “Those who remained homeless in the economic boom years and after World War II tended to be middle-aged male alcoholics and persons with deep emotional and psychological problems,” says researcher M. Leepson.4

Numerous studies have shown that addictive behavior and homelessness are inexorably linked. Approximately half of the veterans who are homeless have a problem with alcohol or drugs, though they are more likely to abuse alcohol than other drugs.5 Other studies affirm that many of the half-million to three million people identified as homeless in America suffer from addiction and/or mental illness. “Up to two-thirds of homeless adults suffer from alcoholism and at least half suffer from drug disorder,” according to Pamela Fischer and William Breakley.6

Addictions are at the root of homelessness and, unless they are adequately addressed, the millions of dollars spent on job training, education, housing and employment will have been for naught if the veteran is unable to stay clean and sober. So if drug and/or alcohol addiction is a core problem associated with homelessness, particularly among the veteran population, we must ask what is being done. The U.S. Department of Veterans Affairs (VA) spends $75 million to serve homeless veterans, up from $32 million just three years ago.7 The VA operates about 90 centers serving homeless vets nationwide. But freer government spending on various programs has not reduced the numbers living on the streets. Research shows that, in 1991, 29 percent of all men seeking shelter in missions were veterans. As noted above, in 1996, no fewer than 34 percent were veterans.8

Well intentioned though they are, federal programs targeted at veterans currently serve only a fraction of those in need. For vets, difficulty in accessing VA benefits and health-care services is common, as are long waiting lists for drug, alcohol and PTSD treatment. The quality of service is also in question. The performance of the VA at delivering services to homeless veterans at the local level was recently rated by clients at an average of 5.24 on a scale of one to ten.9

Personal Commitment

However, at the end of the day, one must recognize that the primary tool for recovery lies within the homeless addict – it is his personal commitment. According to Professors John Belcher and Bruce LaForge of the University of Maryland system, “The causes of homelessness lie both in social conditions and within the homeless people themselves. While our aim here is not to blame the homeless, they must assume some responsibility for their predicament.”10

A primary focus for any governmental or non-profit organization, then, should be on ending substance abuse. Nonetheless, the decision to seek treatment must be made willingly by the veteran – and committed to. Homeless veterans must be encouraged to take charge of their lives, not to live from dole check to check.

It is important, too, that policy makers understand that addictions are diseases, illnesses that are “characterized by significant impairment in the emotional, psychological, spiritual, physical and social areas that [are] directly associated with the persistent and excessive use of alcohol [or drugs]. Impairment may involve psychological or social dysfunction which interferes seriously with the patient’s mental and physical health and his adaptation to his environment.”11

Using the disease model, a framework for treatment is possible. The key, however, is that the veteran must himself be involved. Alcoholics Anonymous’ well known 12-step program is often considered to be the most reliable and orderly approach to recovery from alcoholism and other forms of addiction. AA began in 1935. It has thrived, not by creating entitlements, but by encouraging spiritual instruction and fellowship.12

But how can the current recovery system be converted into a successful strategy using the tools of personal responsibility coupled with spiritual guidance? It is the contention of veterans’ service providers that military-style discipline instills a sense of direction and pride in the recovering veteran. That is why church groups and missions can often turn a life around – because they have the ability to deny services to individuals not attempting to take charge of their lives. Unlike government entities, churches and the like can require clients to make an effort to change. A 1994 pilot program established in Maryland and Illinois called “One-Church/One-Addict” mobilized churches and other houses of worship across the country to adopt one addict each and help see that person through recovery.13 This kind of effort shows that Americans are not without heart; they ask only that their donations be used effectively for the good. When it comes to VA expenditure, they cannot be sure.

In dealing with the homeless veteran population, it is fair to ask what the major veterans’ service organizations (VSOs) are doing. A number Maryland VSOs have worked collaboratively on the personal-responsibility issue and have used military-style discipline as a way to attack the problems of addiction, homelessness – and helplessness. As a result, Maryland Homeless Veterans, Inc. (MHV), was established in February 1993 as a non-profit organization funded in part by private donations and in part by federal, state and local government agencies. The City of Baltimore acquired a five-story building that it now leases to MHV for $1 a year. The living quarters are modeled on military barracks, and residents must actively work in the living environment, reinforcing a sense of discipline. In this sense, the MHV bears certain similarities to the Caroline Center for female welfare recipients discussed in this journal.

Addiction problems have been a primary concern because “about 95 percent of the residents of MHV were former addicts. Residents are referred to MHV when undergoing substance abuse treatment at the local VA medical center. The client spends about two weeks on probation, during which time he determines whether the MHV program meets his needs while fellow residents and staff observe how well he fits in.”14 The client also continues attending AA-style 12-step meetings to help him stay free of drugs and alcohol.

There are many new organizations like MHV, dealing specifically with homelessness and its root causes. Traditional VSOs – such as the Veterans of Foreign Wars (VFW) or AMVETS – would do well to work with the newcomers. VSOs can address the issue of homelessness at the local level with minimum federal aid and still achieve maximum results. In addition to MHV, other innovative VSOs include the National Coalition of Homeless Veterans (NCHV), representing 170-plus community based veterans groups assisting the homeless. The NCHV was instrumental in establishing nationwide support for “stand-downs,” two- to three-day safe havens for homeless veterans, providing them with a temporary place of safety and security. “Stand down” is a military term referring to the time when soldiers leave the battlefield for rest and recovery. Others include the New England Shelter for Homeless Veterans in Boston, operating in a renovated former VA hospital, and the Missouri Veterans Leadership Force, which operates an employment service for homeless veterans. In Houston, concerned veterans formed a stand-down house providing transitional housing for vets. An AMVETS post in Brecksville, Ohio raised the funds necessary in 1989 to start a transition house in the Cleveland suburb. The VFW has stand-downs in Kansas City, Missouri, and recently began a national homeless veterans’ committee. AMVETS has also followed suit with a national committee. The Vietnam Veterans of America group has also recognized the problem that affects so many veterans from the Vietnam era by hosting stand-downs in the D.C. area.

A New Approach

Noting the success of community-based organizations with a significant veterans’ base, Congress in 1992 passed the Homeless Veterans Comprehensive Act (P.L. 102-590). The act established a grant program to support non-profit and public entities serving homeless veterans.

To attain the goal of reestablishing the veteran’s full civil participation, addictions must be addressed. Addicts must be challenged to change their lifestyles. MHV and other groups set forth the opportunity to changing lives locally. “For too long,” says philanthropy writer Marvin Olasky, “we have been told to prove our sincerity by writing checks or passing legislation, without too much thought about consequences. Yet, when it comes to changing lives, it’s not just the thought that counts. The good news is that we know how to do better, if we stop relying on either governmental or philanthropic bureaucracies to do the work for us.”15

Finally, the message is getting through. Now some states and organizations are undertaking efforts to revamp delivery of services. For example, Michigan Governor John Engler (R) has helped pioneer a shift in the responsibility for helping the poor from government bureaucracies to civil institutions – particularly religious ones. To care for his state’s homeless population, Engler has approved a multi-million dollar contract with the Salvation Army – a new approach to “outsourcing.” Other religious-oriented organizations have created programs designed specially for veterans. The Union Gospel Mission of St. Paul, Minnesota has an American Legion Post for homeless veterans located inside the mission that provides counseling and rehabilitation services for veterans. With the federal government scaling back its social spending, religious non-profits may become the new provider of choice for funding and delivering social programs. The enthusiasm for religion-based providers is well-deserved. Christian-based substance-abuse recovery programs, for example, reportedly boast a 70 to 80 percent success rate, whereas secular therapeutic programs report an average success rate of 6 to 10 percent.16

What can be done to provide better services with less funding? That is the challenge for the future. “Government has a big role to play in social tasks – the role of policy maker, of standard setter, and to a substantial extent, of paymaster. But as the agency to run social services, it has proved almost totally incompetent. Many social-sector organizations will become partners with government. The relationship between the two has yet to be worked out – and there is practically no precedent for it…. [T]he work is only beginning.”17 So says Peter Drucker, the well known management consultant and professor of social sciences at Claremont Graduate School.

Clearly, non-profit organizations are well equipped to deliver the necessary services to veterans – while demanding self-improvement in return. Veterans’ social services may best be delivered on a contractual basis, administered at the local level by groups with both expertise and commitment. The situation of the homeless is a national disgrace, and it can only be solved with a national focus on the issue led by the major veterans groups.

Identifying the problems is easy. Crafting solutions, however, is a formidable task. Here, the government and the major, established VSOs are unlikely to be able to fix the problem alone (though there is a role for government to play). Maryland and other policy makers should recognize the successes of local, values-based operations like MHV. They should seek to encourage its success.

Mr. Devine is a Crofton-based veterans’ advocate. He has worked in veterans’ homelessness since 1989. He is a staff member of the U.S. House Veterans’ Affairs Committee. The views expressed here are his alone and do not necessarily reflect the views of the chairman or members of the Veterans’ Affairs Committee.

End Notes

[Top] 1. Maryland Homeless Veterans, Inc., Baltimore, Md., unpublished data sheet, dated November 21, 1996, p. 4.

[Top] 2. PR Newswire, “One in Three Homeless Men at Rescue Missions are Veterans, New Survey Shows,” news release dated November 8, 1996.

[Top] 3. From data in National Coalition for the Homeless (NCH), Heroes Today, Homeless Tomorrow? Homelessness among Veterans in the United States (Washington, D.C.: NCH, 1991).

[Top] 4. M. Leepson, The Homeless: Growing National Problem (Washington, D.C.: Editorial Research Report, 1982).

[Top] 5. NCH, Heroes Today, Homeless Tomorrow?

[Top] 6. Pamela J. Fischer and William Breakley, “Mental Illness and Substance Abuse in the Contemporary Homeless Population,” unpublished paper submitted at the Professional Symposium, Recent Findings and New Approaches to the Treatment of Mental Illness and Substance Abuse, Tulsa, Oklahoma, 1988.

[Top] 7. Michael Janofsky, “Center for Homeless Veterans Offers Balm for the Wounds Within,” New York Times, March 10, 1996.

[Top] 8. PR Newswire, “One in Three Homeless Men at Rescue Missions are Veterans.”

[Top] 9. NCH, Heroes Today, Homeless Tomorrow?

[Top] 10. John R. Belcher and Bruce LaForge, “Homeless Need More than Just a Place to Stay,” (Baltimore) Sun, December 1, 1996, p. 6F.

[Top] 11. From data provided by the American Medical Association.

[Top] 12. Michael Liimatta, A Guide to Effective Rescue Mission Recovery Programs (Kansas City, Mo.: International Union of Gospel Missions, 1993), p. 1.

[Top] 13. Laurie Goldstein, “Program Calls on Churches to ‘Adopt’ Addicts,” Washington Post, Feb. 23, 1994, p. A6.

[Top] 14. Charles Williams, “Maryland Adopts Model for Homeless Veterans Program,” DAV Magazine, Sept./Oct. 1996, p. 13.

[Top] 15. Marvin Olasky, “CPS: The Key to Effective Compassion,” Progress & Freedom Foundation American Civilization, Vol. 1, No. 7, July 1995.

[Top] 16. Amy L. Sherman, “Cross Purposes: Will Conservative Welfare Reform Corrupt Religious Charities?,” Heritage Foundation Policy Review, No. 74, Fall 1995.

[Top] 17.17. Peter F. Drucker, “The Age of Social Transformation,” Atlantic Monthly, November 1994.

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