How Legal Services Help Prevent Veteran Suicides

Episode Notes

Transcript

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Jeff Staton: The social determinants, if you don’t address them, the situation just kind of worsens and worsens, kind of like a medical condition until the point it’s critical. So with Supportive Services like our Legal Services we were able to step in and assist them in staying stable so that they can also stay stable with their health and with their mental health.

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Intro: Equal access to justice is a core American value. In each episode of Talk Justice, at LSC Podcast, we will explore ways to expand access to justice and illustrate why it is important to the legal community, business, government, and the general public. Talk Justice is sponsored by The Leaders Council of the Legal Services Corporation.

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Will Gunn: Hello, and welcome to LSC’s Talk Justice Podcast. I’m Will Gunn, Vice President of Legal Affairs and General Counsel for the Legal Services Corporation, and your host for this episode. Today, we’ll be talking about how Legal Aid Services for low-income veterans can contribute to veteran suicide prevention efforts.

The most recent data places that veteran suicide rate at a staggering 57% higher than the rate for non-veterans. With the help of our guests, we will discuss the social factors that contribute to veteran suicide risk, and also look at the ways in which civil legal services can address some of the legal problems that are plaguing veterans and harming their mental health.

Today’s topic is one that hits particularly close to home for me. First, I’m an Air Force Veteran, having served 25 years on active duty, later I served as General Counsel for the U.S. Department of Veterans Affairs. And now at LSC, I focus on civil legal aid for low-income Americans.

However, my interest goes beyond my military service and other positions I have held. You see more than a decade ago, one of my longtime mentees and Air Force Veteran died by suicide while dealing with depression, unemployment and a pending mortgage foreclosure action. For all those reasons I hope you’ll agree with me that this is a very important topic to explore and I’m looking forward to hearing from our two guests.

Our first guest today is Dr. Eric Elbogen, Director of the Department of Veterans Affairs, National Veterans Financial Resource Center. Eric is also Professor of Psychiatry at Duke University. His research has often focused on veterans’ mental health and suicide risk as relates to financial problems, housing insecurity and other social factors.

We are also fortunate to be joined today by Jeff Staton. Jeff is Managing Attorney at the Legal Aid Society of Louisville in Kentucky. In his role, Jeff oversees the Legal Aid Society’s veterans programs for their service area which spans 15 counties.

Welcome gentlemen.

Dr. Eric Elbogen: Thank you.

Will Gunn: Eric, I’d like to start with you. In preparing for our conversation I kept hearing the term social determinants of health. What does that term mean and could you describe how social determinants relate to veteran suicide risk?

Dr. Eric Elbogen: Yes. I want to start off to say before defining social determinants that eliminating veteran suicide is a top VA priority, and we at the VA are working with Federal Tribal State local governments to advance a public health approach which includes looking at social determinants to suicide prevention. And before we do that, suicide is strongly predicted by mental health problems, that is a very consistent finding and if anyone listening knows someone who’s experiencing mental health issues; hopelessness, depression, please know that there is a Veterans Crisis Line, you dial 988, and press 1 or go to the website at veteranscrisisline.net.

So suicide is a mental health problem Will, but it’s also a social problem. There’s other components to it, that are the social determinants like homelessness, unemployment, financial strain and social determinants.

Now, this has been shown in the general population for a long time. So big study showed that adults with unsecured debt are five times more likely to attempt suicide.

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Other researchers looked at this National Data set, they looked at over 2,500 variables to predict what are the strongest predictors of suicide attempts in the next three years. They have listed the top 20, four of the top 20 were social determinants; employment, income and financial debt, which ranked number 7 out of over 2,500.

Will Gunn: Wow.

Dr. Eric Elbogen: It’s a problem in military and veteran populations. One study showed that nearly one-quarter of active duty soldiers within 24 hours of their suicide attempt had reported financial issues. Study we did of post 9/11 veterans show that veterans who were experiencing money management problems and had low income, they were four times more likely to have suicidal ideation. An extensive VA records analysis showed similar trends. 2023 findings show that this relates to transitioning service members. So in the first year or so after transitioning and just last year too we show that food insecurity was strongly predictive of suicidal ideation in a nationally representative study post 9/11 veterans. But they were protective factors like stable housing and employment. Those related to reduced suicidal ideation.

Will Gunn: Wow, thank you. So there’s a lot of data out there.

Dr. Eric Elbogen: There is, and it supports that suicide, it’s really important to address both mental health issues and also potentially address upstream some of these social issues.

Will Gunn: I see. Jeff, how well do the factors that Eric just mentioned track with the problems that veterans bring to you and your colleagues at Legal Aid Society?

Jeff Staton: I think it tracks very closely with what we see. I would say in doing research to apply for the Sergeant Fox Suicide Prevention Grant, we saw statistics from the National Center for Medical Legal Partnerships that 60% of a person’s health is determined by those social factors that Eric mentioned; income, health insurance, housing, utilities, education, employment.

When veterans come to us we see that it’s not just one single exacerbating problem, it’s usually a lot of problems that need to be untangled. And so we need to sit down with them where they are and triage those issues to see what we can help them with and where we can get them help for other things that we might not be able to do that aren’t legal services.

One of the great things about the Sergeant Fox Suicide Prevention Grant which we kind of refer to as the Fox Grant, it has some components to it that include providing some of those services and some of those connections to Veterans beyond just legal services, help with things like utilities, emergency, housing assistance and things of that nature.

The statistics are kind of bleak and one of the things I want to talk about is a story, a client, well, the name is changed, but we will call him Vince. He’s indicative of the clients that come to us. Vince was discharged from the Army in the 1980s. He had been working for a long time, but had been having a sharp decline in his health to a point where he had a heart condition and had to be hospitalized. That happened so quickly, he wasn’t able to tell his employer and he wasn’t able to contact his employer to let them know. Once Vince was better and he went back to his employer they had terminated him because he wasn’t available or told them, so that obviously exacerbated some of the issues Vince have been experiencing with his mental health and was causing a crisis for him.

So when he came to us, you know, we talked to him about filing for unemployment and going through that process and we assisted him, but besides that in the meantime, he needed an income so we were able through the Fox Grant to help cover utilities for him for a period of time and hook him up with other Veterans Administration Services, like the HUD-VASH Program so he could stay house during this period of income insecurity. We were able to help him look at things like applying for Social Security Disability Insurance and other benefits that he could get as well as going through the unemployment process.

So we are able to triage all these issues for Vince and help him to stay housed and to prevent him from sliding further down into homelessness and exacerbating his mental health and I think that’s very important.

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These indicators, these social determinants, if you don’t address them, or the person doesn’t have a way and doesn’t know how to address them and has no help, the situation just kind of worsens and worsens, kind of like a medical condition until it’s the point it’s critical. So, with supportive services like our legal services, we’re able to step in, provide our expertise and information to the client, and assist them and staying stable so that they can also stay stable with their health and with their mental health.

Will Gunn: Jeff, in terms of the Fox Grant, and that’s VA Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program, it’s my understanding that you all first received that in 2022, is that right?

Jeff Staton: Yeah, that’s correct. Coming out of the pandemic, we had a veteran’s program and we had started in 2021 with a medical legal partnership. And basically, what we did is we worked with the Rex Robley VA Hospital in Louisville, Kentucky, and we provided an attorney and office hours within their facilities so that we could meet clients where they were, where they were coming to the VA, where VA employees would know where we were and they could send veterans to us to help with their legal issues. So we were already doing that when the Fox Grant came around, we applied for that and the thing about the Fox Grant, it was going to help us continue that work and actually, extend that work out to more veterans. So we were excited about that.

Now the Fox Grant, it’s a national program and the Fox Grant, I think we are one of the few direct recipients of the Fox Grant, they are kind of experimenting with a lot of different public health services that could include art therapy, I think there’s a program where veterans work with horses, training them, working with them, things like that so all sorts of different programs besides legal services could be under Fox. And these are again, to help veterans improve their mental health. And Fox is meant to see kind of what works, you know, what can we do out in the community and what services are going to help veterans so we can get suicide numbers down.

The Kentucky statistics, we outpace the region and veteran suicides, it’s 33 veteran suicides per 100,000 people compared to 31 for the southern region and about 32 for the nation. So it’s a little bit higher. So I think it was a good program for us to do in Kentucky and for our service area. It was also able to expand, like I said, the services we could offer to more veterans and our outreach into some of the more rural counties besides just serving the VA center in Louisville. So we were able to meet up with other community partners. We were able to start going to the Jefferson County Veteran Drug Court where we could also access clients. We’re in the process of starting that same program in Hardin County, which is one of the more rural counties in our service area. But the thing about Fox that was so great is these other components that Fox had that most of the time when we do legal services, we’re just doing the legal services, so if a client has an eviction issue, we can’t pay their rent for them for that short emergency time and keep them housed. We can go to court with them but there’s not a monetary solution. Fox actually offers that. They had emergency housing assistance in their grant, transportation assistance, child care assistance, and some other assistance that could actually, we could use along with the legal services to keep the client and the veterans stable where they were, which I think was very important and kind of a unique opportunity for us.

So I think that’s worked really well. I think the other things work really well is these connections that we’ve made in the community with other providers to help veterans, not just veteran administration folks but lots of other programs throughout our service area. For instance, there’s a veteran tiny house village, which services veterans in Shelby County we’re able to meet up with them, and we can get referrals for legal services for their folks. And there are other programs like that.

Will Gunn: Well, it sounds like the program is a real force multiplier and enables you to do things that you wouldn’t be able to do otherwise due to funding constraints.

Jeff Staton: Yeah, that’s correct.

Will Gunn: Eric, LSC’s 2021 Justice Gap Report found that consumer issues having to do with things like debt as well as income maintenance are two of the biggest issues that veterans report facing. What sorts of resources does the National Veterans Financial Resource Center provide or recommend for veterans with these and other financial issues?

Dr. Eric Elbogen: Well, the National Veterans Financial Resource Center, and it’s FINVET for short, it was funded just last year by the VA Office of Mental Health and Suicide Prevention. And our mission is to empower veterans to take charge of their financial well-being and our vision that we’ve come up with is that we want every single veteran in the United States to earn more money, save more money, and protect their money by taking advantage of financial tools and resources. So that’s actually What FINVET is going to do, we’re going to connect veterans and their families to financial tools, financial education, financial resources for five different areas of financial well-being, and that those overlap with the ones that you just talked about and also what Jeff talked about.

Number one, meeting basic needs. Home, food, auto, clothes, utilities. Two, managing money, budgeting, savings and discount, financial planning. Three, increasing income, work, benefits, investing. Four, lowering debt and bills, debt management. Medical debt, legal assistance. Five, the last one, protected money, making sure the veterans are not preyed and avoid scams and secure banks.

And so I think there’s going to be a list that we provided of resources that are available to veterans that we’re going to have on our soon to be launched FINVET website that will be on the va.gov website soon enough. But in the meantime, here’s a few programs that would be really important for veterans to know about. In the last year, the Veterans Benefits Banking Program has actually started a new program to allow veterans to get and access free credit counseling session or financial counseling session, and those are by accredited financial counselors, and that’s a new program that’s available, and if someone, a veteran is experiencing debt, they can call that number or go to the website and sign up for that resource.

There’re others that are available though too, HUD, Housing and Urban Development, actually has a number of housing counselors and housing counseling agencies, but they provide free financial counseling and budgeting as well. A number of veteran service organizations, not only provide free assistance to veterans with veteran’s benefits, but some of them also have accredited financial counselors. So that’s really important to know. If you don’t know this yet, there is a list of hundreds of discounts for veterans posted at the VA. There’s a number of government programs, low income, home energy assistance, and affordable connectivity programs, so you could lower your bills and have low cost Wi-Fi for earning money, Not only the VA programs like compensated work therapy or veteran readiness and employment, but the Department of Labor has over 2,000 American job centers. And they each have veteran representatives at them. You type in your zip code and they’ll show you they’re all around 25 miles square radius where you live. They prioritize veterans for job training, job search assistance, resume writing.

Lastly, meeting basic needs, VA homeless programs, there’s a homeless program. 1-877-424-3838. If you have urgent need to access homeless services, and then dialing 211 is the United Way, you could get emergency assistance, housing, food, clothes, car, utilities, expenses. Those are just some resources that we’re going to be able to provide in a very user friendly, veteran centered format on our FINVET website.

Will Gunn: Well, Eric, it sounds fascinating to me that you’re in a unique position as a researcher, that you’re able to research the problem, but also as being head of FINVET. You’re able to provide very practical solutions for people that you may be researching or that you are trying to address through your research.

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Dr. Eric Elbogen: Well, actually, in 2007 I started running money management groups for veterans at the VA. So it’s actually veterans who’ve inspired me and working with them for over a decade on money management, and that, and the research and beginning to have an opportunity to try to get this information, like what we just listed out to veterans and every time I hear a veteran, it’s like, “Oh, I didn’t know that, that’s really so helpful.”  That’s really one way in which we hope that this National Veterans Financial Resource Center will help veterans and their families.

Will Gunn: Outstanding. Now, you mentioned something that really resonated with me. You threw out a phone number. Here in the DC area, I take the Metro from time to time, and I used to take it every day. As I will go in, I confront veterans from time to time, holding up signs that says, “I’m a homeless veteran” and “Please, please help.” Of course one way to help perhaps is to give a contribution that’s often what was desired in that immediate moment, but I’ve also seen situations and been in situations where I’ve been able to provide information about how to access services that can — I suppose you could use the story about you give man to fish, he eats for a day, you teach him how to fish and he eats for a lifetime. So with that in mind, can you throw out that number again and tell us what we can do or what we can expect if a vet, if we or a veteran were to call that number?

Dr. Eric Elbogen: Yeah, it is 1877-424-3838, and this is for services for veterans who are homeless but it’s also for veterans who might be at risk of homelessness. Jeff, you mentioned HUD-VASH, those are some of the programs. There are a lot of different homeless programs, there’s a whole array of them that veterans can access by calling that number.

Will Gunn: Thanks, really appreciate that. Now Jeff, I want you to talk about some of the challenges that you encounter providing legal service to the veteran community and some of the solutions that you see.

Jeff Staton:  I think piggybacking a little bit off what Eric said, you know, there’s some really great services that the Veterans Administration has put out there and organizations where people can go and get some of these needs that they have met. I think one of the issues that we’ve seen particularly in the Fox Suicide Prevention Grant is veterans tend to have a lot of trust issues. Sometimes they don’t have the best relationship with government agencies or necessarily feel like they’re going to get what they need. Veterans also that comes to us with suicidal ideation maybe or some mental health issues going on, they also feel like they shouldn’t be asking for help, that they should be able to be able to deal with these problems that they have on their own and it would be admitting weakness or defeat if they were to say I need this help or where is this help at, or you know, help me access this help. So they tend to want to remain very self-sufficient and sometimes, when we’re just meeting the clients and you know, some of the times they’re in a mental health crisis along with what the legal issues they have are, so you have to be very sensitive in talking to them about that. I think one way we tried to address that is we actually have a very good staff. We have a veteran’s attorney who was himself a longtime veteran in the army. He was in the military police corps in the judge advocate general’s office. He also worked as a Headmaster at Forest Hills Military Academy in Kentucky. He helped found that and he was President of the Lyman Ward Military Academy in Alabama, so a lot of experience and expertise with veterans and what veterans’ issues are. Our paralegal also had a lot of experience in a different vein. Our paralegal also went to law school now, but he was a paramedic in New York City for some years including during 9/11. So he has a lot of good experience and expertise in dealing with people that are in crisis and I think that’s important to have when you have someone that’s coming to you and they have suicidal ideation when they’re talking about how they’re going to kill themselves and how do you deal with them in that moment, and then also stay with them and help them through some of these problems that need to be triaged.

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Will Gunn: You know, one thing that strikes some people as strange is that when you look at VA regulations and such, there are people that have served in the military but due to their character of discharge, they’re not eligible for VA services. So that can play a major role. Is there anything that you all do in those situations, for those veterans that may have left the military other than honorable conditions?

Jeff Staton: Yes. We do take cases with veterans for discharge upgrades to try to help them so that they can get the benefits that they need. Then we also help them obtain veteran benefits that we think they’re entitled to. That’s a big part of the process that we do and what we look at. Another thing about having an experienced veteran who’s also an attorney and well aware of how those systems work and how to navigate them, I think a lot of times for people, anybody, not just veterans in this situation, it’s always nice to meet somebody that can say, “Hey, here’s what you should do. Here’s where you should go. I’m going to help you.” Sometimes that can just make all the difference in that person’s life and we have clients that have told us that’s what we’ve done for them.

Will Gunn: Outstanding. Finally, if you both could highlight at least one piece of advice or information that you would like to share either with veterans who might be listening or people who provide veterans services, if you could do that, what advice would you like to share? Eric, how about you?

Dr. Eric Elbogen: Well, one, there’s this light bulb that went off of veterans who were telling me about this, and actually, our research ended up showing this too. What they told me is that when they were in the military, they actually had a lot of these social protective factors. They had housing stability. They had employment. They had social support. They had money to cover basic needs that were present when they were service members and active duty but not necessarily present after they left the military. So one veteran said, “It’s like the carpet was swept out from under me. I suddenly had to pay my first light bill, you know, do a budget for the first time. I had to create a resume and try to find a job. I had to find my own social support network and have enough money to cover basic needs.” So what the light bulb for me was is that, and you know, for people who are veterans or people providing veterans services, helping veterans get those social protective factors, like improving financial being can actually be seen as critical part of community success for veterans after they leave the military. So job retraining, vocational rehabilitation, income support, housing assistance, financial education, debt management, could actually supplement mental health treatment as an upstream approach for preventing suicide in veterans. One thing is focusing with the financial part, focusing on one dimension is not going to be enough. So income support might help but if veterans are getting scammed out of their money, this is one of the things that FINVET is going to be trying to do is to help veterans learn the skills to protect themselves from cybercrime, identity theft and veteran-specific scams. Then they could still risk, even if they have income support, they might still risk eviction or debt. So the FINVET, National Veterans Financial Resource Center, we’re really hoping that linking veterans to financial tools, resources indefinitely will be linking to LSC. Having, providing education about these different areas of financial well-being will hopefully be an upstream approach to prevent a reduced risk of suicide in veterans.

Will Gunn: Great. One comment that comes to mind from my perspective is that I’ve had a lot of people that have approached me, who’ve expressed interest in providing housing for veterans who are homeless or who are at risk of homelessness, but what I hear you saying is that beyond say, being housed there may be opportunities for policymakers or for nonprofits or for government to come in and meet those other areas of need that are out there besides again, having a roof over the veteran’s head.

Dr. Eric Elbogen: Yeah, and I think there are, and this is one of the things. Our website which can actually link to 18 different government organizations where there’s already interactive financial literacy, trainings and games that the FDIC has created and the Department of Labor in their American Job Centers and the housing counselors, they’re called housing counselors, but they also provide other support for budgeting and financial counseling. So that’s exactly right.

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Will Gunn: Outstanding. Jeff, how about you, is there a piece of advice or information that you’d want to share with veterans or for others who are in the business of providing services to vets?

Jeff Staton: I think I would say it’s more something we learned as an organization and that’s with veterans, you can’t fake it. You have to really beat them where they are physically and mentally on their own terms and start there, and you really have to recognize their humanity. The comment I would make is you know, veterans have given a lot to serve and protect our country, and it’s a disservice to them not to be able to provide access to justice or the justice system when they need it and denying them that access to justice kind of flies in the face of everything they have done to fight for our country and what our country is supposed to stand for.

Will Gunn: I really appreciate that. One of the things that I hear or that comes to mind when you say that in meeting veterans where they are comes with respect to women veterans. There’s been research out there showing that asking a woman who has served whether or not she is a veteran is not the most effective way to find out whether or not she served in the military just because of maybe not clear understanding among everyone in terms of what that term “veteran” and actually means. So asking, “Have you served in the military,” is a better way of finding that out and getting to where that person actually is. So I appreciate it. So I want to thank both of you, Jeff, Eric, this has been a great conversation and I want to really thank you not just personally or for LSC, but also for what you’re providing to the veterans’ community. For our listeners, if you would like more information on veterans, civil legal needs, you can find it at LSC’s Veterans Task Force Report on our website at lsc.gov. Thanks again to our guests and thank you for tuning in to this episode of Talk Justice.

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Outro: Podcast guest speakers’ views thoughts and opinions are solely their own and do not necessarily represent the Legal Services Corporation’s views, thoughts or opinions. The information and guidance discussed in this podcast are provided for informational purposes only and should not be construed as legal advice. You should not make decisions based on this podcast content without seeking legal or other professional advice.

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