“Once you meet the people who are coming back, you get very involved,” says Marcia Valenstein, M.D., an associate professor of psychiatry. “You realize how much we’re asking from these people and their families.”
Valenstein is also a clinician and researcher at the Veterans Administration Ann Arbor Healthcare System, where many physicians hold a joint U-M faculty appointment. Because of her considerable experience with peer interventions there, Valenstein was asked to help write the application for WBV funding and has been instrumental in devising and implementing a program called Buddy-to-Buddy under the initiative’s auspices.
“The whole premise was that no one can be a more credible source of both support and overcoming the stigma around asking for help than another veteran who’s been there,” says John Greden, M.D., the Rachel Upjohn Professor of Psychiatry and Clinical Neurosciences and executive director of the U-M Depression Center, where the program is housed.
Helped considerably by Major Robert Lagrou, a member of the National Guard who was also a child psychiatry resident at the U-M, the Depression Center and psychiatry department — and Michigan State University, a frontrunner in such efforts — had been talking with the Michigan Army National Guard about what kind of programs might be most helpful to them. The guard expressed a particular interest in peer outreach and linkage. Valenstein was already involved in a project within the VA where people who were in treatment for depression are enlisted to support each other in addition to receiving their regular treatment. “The new initiative applied the same soldier-to-soldier concept in a new way,” she says.
There are two tiers of “buddies” in the system.
Buddy Ones are individuals within each returning unit who are trained in communication skills and recognizing signs of difficulty, and charged with staying in regular contact with seven to 10 of their comrades. “The thought was that these were the people they deployed with, know well, and trust most,” says Valenstein. “Their buddies check in on how they’re doing in the same way you might check in on a friend who has had a difficult experience.”
If there are, indeed, signs of trouble, the returnee can be referred to a number of resources, including a Buddy Two, one of a group that’s also known as Volunteer Veterans. Buddy Twos receive intensive training in interviewing techniques and how to access resources. They can maintain confidentiality because they are not affiliated with the National Guard or governed by its chain of command.
These volunteers aren’t required to have served overseas or in combat, but the overwhelming majority of them have, according to Brandon Brogan, the Buddy-to-Buddy program coordinator. “Soldiers returning from Iraq and Afghanistan are far more likely to open up to those who know what it’s like to come home and try to transition back,” he says. Brogan knows whereof he speaks. He’s an ex-Marine who served three tours of duty in Iraq.
“I got out a little over two years ago and know what it’s like to return home and try to create a life out of nothing,” he says. “I was pretty much on my own. I did a fair amount of research to make sure I knew where to go to get my GI bill started and how to get VA medical care, but it was quite time-intensive and not everyone is able to do that.”
While buddies are briefed on the availability of a range of services from housing to employment, encouraging veterans to seek assistance with psychosocial difficulties carries an added degree of complexity.
The military has a stigma regarding mental health, Brogan says, and this is a way of breaking down that stigma. “The leadership in the military sees the issues and will admit they’re there, but getting guys on the ground level to admit they have a mental health issue is a completely different thing.”
“What we would hear from people was, 'If you haven’t been there, you don’t get it,’ ” says Greden. “If you can find the right soldiers — people they identify with, people they served with — the simple message is, 'You’re not alone, treatment works, it’s a sign of real strength to get help. I would like to help you do that. I’ll even go with you. Let’s do it.’ ”
According to Brogan, they have definitely found the right group of veterans.
“We have a fantastic group of volunteers that go above and beyond any expectation,” he says. “It’s humbling to see the work these guys do. A lot of them are Vietnam veterans who definitely weren’t supported when they got home, and they’re dedicated to seeing that doesn’t happen to these veterans.”
That dedication includes attendance at monthly drill weekends, which both Brogan and Valenstein cite as a major step forward. Once guard members see the volunteers on a regular basis, they get to know them as interested, concerned citizens who are knowledgeable about resources. They have credibility in advance of any need for their assistance.
“We had to develop trust with the Michigan Guard before we could have the volunteer veterans go to the drill weekends,” says Valenstein.
The long-standing link between the U-M and the VA is an obvious one, and it began to take on an added dimension when Greden got a phone call from Fred Wilpon, a Michigan alumnus and donor. “I think we actually talked on a Saturday,” says Greden, “which is an indication of how much someone cares about a topic.”
Wilpon and others interested in the problems being faced by returning veterans had visited Walter Reed Army Medical Center in Washington. He came away impressed by the sophisticated care that patients were receiving for their physical injuries, but distressed at what he saw as the despair and demoralization among those who were coming back with “invisible injuries” — post-traumatic stress disorder, depression, suicidal thoughts, sleep disturbances.
“The VA is a wonderful system that’s delivering terrific care,” Greden says, “but not everyone can access a VA facility, some are not eligible, and some prefer to go outside the VA for care. The idea was to get some of the interested universities who had expertise in this area to start working together with the VA to really jump into this.”
WBV was launched late in 2008 with funding from several organizations, including the McCormick Foundation and Major League Baseball Charities. Later, funding was supplemented by the Department of Veterans Affairs. Of the initial universities to receive WBV grants, Michigan chose a path that led to the Buddy-to-Buddy program. “Michigan’s belief was that addressing stigma issues was necessary before you could get people into treatment programs, no matter how effective those programs were,” says Jane Spinner, who oversees the veterans project for the Depression Center. “We chose to help address those challenges through the peer-to-peer approach, using military culture to help change the culture. This program fit well with the expertise of our faculty and our Depression Center mission.”
The team members recognized that even though many troubled returnees were isolated in terms of access to services, their problems did not exist in isolation, nor could they be addressed that way. Strong Families, in effect a support program for supporters of soldiers, was created to focus on that need.
“We’re doing a more intensive parenting intervention for the military service members who have young children because the impact on children is particularly worrisome,” Spinner says, “and we saw that the reintegration challenges faced by military families are just as significant as those of the returning veterans.”