STIGMA KEEPS MANY NEW VETS FROM SEEKING MENTAL HEALTH CARE

So, S.F. VA sets up a special clinic just for Iraq War veterans that combines primary care and mental health checkups in a nonjudgmental setting.

This is a plan that should be considered at all VA hospitals. And, not just for the new vets. A unified primary care / mental health unit would help reduce the stigma of a vet having to "report" to the mental health department.

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Waiting room fills with young vets

Meredith May
Chronicle Staff Writer



Four years after the start of the war in Iraq, Dr. Karen Seal took a job at the San Francisco VA Medical Center to work in the liver clinic, treating patients with hepatitis C.

She noticed the veterans in the waiting room. Most of them were from the Vietnam era, in their 60s and older.

But over the months, the faces began to get younger. The waiting room was starting to fill with young men in their late teens and 20s, the first trickle of Bay Area soldiers emotionally and physically injured by the war.

Seal, a primary care physician, began working with them, taking their medical histories and directing them to the right care.

"At the time, I had never heard of PTSD," Seal said.

Now she knows how post-traumatic stress disorder contributes to the alcohol addiction and depression she sees in many of her patients.

She made referral after referral to the mental health wing of the VA hospital, but heard from colleagues that those initial patients never made it. It was too much of a stigma - especially in military culture - to walk across the campus to the mental health ward.

So Seal and colleagues got an idea. What if there were a special clinic just for Iraq war veterans that combined primary care and mental health checkups in a nonjudgmental setting?

There were only a few other places in the country that do such a thing - the Department of Defense has a one-stop veterans clinic in Washington, and there was a similar one in Seattle, but it took anyone from the first Gulf War to the present.

Finally, in April 2007, San Francisco VA opened a clinic just for Iraq war veterans, calling it the Operation Enduring Freedom/Operation Iraqi Freedom Integrated Care Clinic.

"Now, we see three to seven veteran men, and one or two women, a week," Seal said.

Visitors can drop in and be seen by a primary care doctor and a combat stress specialist. They are screened for post-traumatic stress, depression, alcoholism, and brain injury. If they need help readjusting into civilian life, there's someone to assist with that.

About 1 in 5 is discovered to have post-traumatic stress, but now only 15 percent miss their appointments with mental health workers.

"This job is a gift," Seal said. "To be able to tell them it's normal to jump when they hear a balloon pop or to get nervous on a crowded bus. I can tell them that a lot of their buddies are experiencing the same things."



E-mail Meredith May at mmay@sfchronicle.com.

Wonderful idea . maybe thats all it may take to get these guys to realize that what they went through is different form most of the other people but they are not different and they can live a normal life.