Derek Henderson was jumpy and full of rage when he came home from Iraq in 2003. Over the next four years, he fought with his mother and brothers and got into trouble with the police. Finally, on June 22, 2007, he jumped off a bridge into the Ohio River. He didn't die, though, at least not right away. He tried to swim to a pole that supports the bridge and then slid under the water. He was 27 years old.
Some suicides seem preordained -- or at least planned with determination and care. That was not the case with Henderson. True, he was a mess, physically and emotionally -- and dangerous, too. He carried a box cutter in his pocket and kept a hatchet in his Mercury Cougar. Once he got into a fight at home with his brother, Garland Sharpe. The fight was so savage, Sharpe barely survived. Henderson, who was 5-foot-11 and weighed 160 pounds, reached for a 10-pound weight during the brawl. Luckily, their mother, Diana Henderson, moved it out of the way. Otherwise, says Sharpe, "I probably wouldn't be here."
Henderson was suffering from post-traumatic stress disorder (PTSD), according to medical records that his mother showed to a reporter. He had also made it clear through his conversations, remarks to therapists, and frequent, violent outbursts that he was having problems. At times, his efforts to reach out to people seemed clumsy, even childish, but the message was clear: He could not manage on his own.
Sharpe, who is 25, says that he and his brother used to play a Madden NFL video game together when they would hang out in the evenings. Once, Henderson gave his quarterback an odd name: HelpHim. "You're playing this video game, and every time you tackle him, the name comes up and it says, ‘HelpHim,' and you're like..." Sharpe trails off. "It's like a yelling. See what I'm saying?" He waves both his hands in the air, showing how his brother was asking for help, and he looks frustrated -- and heartbroken.
Police and medical records show that Henderson was given various antipsychotic medications, everything from Buspirone to Haldol, after he got back from Iraq. Yet none of the caregivers at the institutions where he was treated seemed prepared to take responsibility for him. On at least one occasion, an official at the Veterans Affairs hospital balked at receiving him in a psychiatric in-patient unit, and he was moved frequently from one institution to another. His mother, who is studying for a nursing degree at Eastern Kentucky University, says she tried to get help for him at the VA. "He wanted to be hospitalized, but they wouldn't take things seriously," she says. "I begged them, 'Please help me to help my son before something bad happens.' They thought I was goofy."
The story of Derek Henderson shows the human cost of an overburdened VA system and the tragedies that occur when the care of veterans is delayed or insufficient. It also reveals some of the inadequacies in the sprawling U.S. Department of Veterans Affairs, which is the second-largest federal agency (behind the Defense Department), and how these problems could intensify in the coming years as more and more soldiers return from Iraq and Afghanistan.
The recent failures of the VA are all the more striking because the agency has been acclaimed for its record of health care. In Best Care Anywhere: Why VA Health Care Is Better Than Yours, author Phillip Longman says the VA received a 2006 award from Harvard for "innovation in government," quoting university officials who describe it as a "model for what modern health care management and delivery should look like."
For many people who visit VA hospitals, that is the case. Veterans of wars in Vietnam and Korea, many of whom are over 60, generally receive outstanding care at the VA facilities. Yet the newer patients -- soldiers who have served in Iraq and Afghanistan -- are in their 20s and 30s and have a different set of problems. Often, they need help for psychological, not physical, problems. A study released by RAND Corporation earlier this year shows that roughly 300,000 men and women who have served in Iraq or Afghanistan are suffering from mental illness, particularly post-traumatic stress and depression. The VA has been slow to respond to their needs. Only half of these individuals have sought treatment, and they often experience severe delays or minimal care within the VA system.
The reasons for the delays at VA facilities are complex, but they are partly rooted in bureaucratic history. In the mid-1990s, the VA started to move toward a more streamlined model of health care, emphasizing the treatment of patients on an outpatient basis, and, in this way, reflected national trends in patient care. Over a 10-year period, from 1995 to 2005, according to a September 2006 Government Accountability Office report, the ratio of outpatient to inpatient stays at VA hospitals went from 29 to one to 92 to one.
Unfortunately, this shift in treatment occurred during a time when an increasing number of veterans needed psychological care. "Although the number of veterans diagnosed with PTSD doubled between 1997 and 2005, the number of clinic contacts per veteran per year declined steadily and relatively uniformly across the years," writes Robert Rosenheck, a Yale professor and director of the VA's Northeast Program Evaluation Center in West Haven, Connecticut, in a 2008 report, "Recent Trends in VA Treatment."
In addition, the number of beds for patients was reduced. In the late 1980s, according to Rosenheck, VA hospitals had 9,000 inpatient psychiatry beds. Now, there are 3,000. (He provided a deposition for a federal lawsuit filed in July 2007 by two veterans groups against the VA's former secretary James Nicholson; the suit was dismissed in June, and the veterans groups are trying to overturn the decision.) As a result, many veterans are sent back home, with a handful of prescriptions to fill, or into group therapy. In the case of Henderson and others who need individual treatment and careful monitoring, this has not been a successful approach.
In July, a 26-year-old Navy veteran, Lucas Senescall, committed suicide while under the care of the Veterans Affairs Medical Center in Spokane, Washington. He was not the only one. Another veteran, National Guardsman Timothy Juneman, was suffering from post-traumatic stress disorder after being injured in Iraq and was being treated at the Spokane VA with "several medications, including potent antidepressant, anti-anxiety and antipsychotic drugs," according to a July 21 article in The Spokesman Review. He killed himself in March. In addition, four other individuals who have visited the Spokane VA this year have committed suicide; last year, only two people did. The situation in Washington state and Kentucky, with their overburdened VA hospitals, is similar in other parts of the country. VA officials acknowledge that more veterans have been killing themselves in recent years. From 2001 to 2005, said Gordon H. Mansfield, deputy secretary of Veterans Affairs, at a hearing of the Senate Committee on Veterans Affairs in April, the number of suicides among individuals who have sought care in the VA has increased from 1,403 to 1,784. Veterans, say family members, are not getting adequate treatment.
Nobody blames the medication -- at least not entirely. Instead, family members say the problem lies with the type of care, or lack of it, that patients receive within the VA system. Staffers at VA facilities are often harried and overworked, and they rely more heavily on prescription medication than they did in the past. "We've medicalized the war," says Bobby Muller, president of Veterans for America. "Pharmacology was not the preferred way back in the Vietnam era, but that's all we do today."
The VA's Rosenheck seems to agree. "There's much less psychotherapy going on, and people are relying more on pharmacotherapy," he said in his deposition. "Eighty percent of the PTSD patients take medications in a given year. We didn't have medications so much in the past."
VA officials say they are trying to accommodate the soldiers who are returning from the Middle East. They have started a suicide hotline and added 3,800 new mental-health staffers over the past two and a half years, bringing the total up to nearly 17,000. In addition, says VA spokesman Jim Benson, funding for mental-health services has increased from $2 billion in 2001 "to a projected amount of over $3.5 billion this year."
For some veterans, it is too little, too late. Derek Henderson's brother is standing in a doorway of their grandmother's house in Louisville. His mother sits on a couch. An air-conditioning unit hums, and the mood is relaxed, even sleepy -- a world apart from the rage and violence the family experienced with Henderson in their midst.
It had not always been that way. As a child, Henderson did well at school and used to write science-fiction stories, says his mother. She takes out a sheet of paper, a Young Authors Awards Certificate, that he had received from The Courier-Journal in 1991. After he came back from Iraq, she says, he was different. "Kind of angered," she says, shaking her head. "Short-fused."
Henderson enlisted in September 1998, according to an Army spokesman, and became part of the 106th Transportation Battalion out of Fort Campbell, Kentucky, a battalion that provided support for the Army's 101st Airborne Division. He served in Afghanistan in 2001 and in Iraq in 2003, working as a forklift operator, and he was awarded an Army Good Conduct Medal and a National Defense Service Medal. He received an honorable discharge on Oct. 31, 2003. By then, he was back home and telling his mother about the horrors he had seen -- though the details were hazy. He said he had watched a pregnant U.S. soldier shoot herself in the stomach, killing herself and the baby, his mother recalls. (A Pentagon official who tracks suicides of active-duty service members says he has no record of a pregnant soldier killing herself.) He talked about Iraqi children who carried weapons. "He just said it was sad," she recalls. "He didn't want to have to shoot any kids."
On at least one occasion, he broke furniture in a fit of rage. Another time, he jumped out of a moving car, according to an Emergency Psychiatry Evaluation drawn up by a VA Medical Center staffer, and "told his mom he is facing a battlefield." She tried to get him hospitalized, and a judge agreed that he needed help, ordering a 60-day involuntary stay at the VA hospital. Henderson entered the facility. A week later, he was out -- with a prescription for Buspirone and a VA appointment scheduled for noon on Dec. 18. He never made it there.
The day before, he got into an argument with his mother in the parking lot of Norton Audubon hospital, where she was working as a nursing assistant, and tried to hit her with his car. "Then he got out and took a knife and hacked his left wrist and it was just dangling," she says. Sitting on a couch in the living room, she slams the side of her hand into her wrist. She tries to show what he did with a twelve-inch blade and the damage he inflicted on himself. That evening, he was taken to University of Louisville Hospital with a sliced artery. A week or so later, staffers tried to get him admitted to the VA hospital, but they were at first unsuccessful. He was "not accepted at VA inpatient," according to the facility's "Patient Progress Notes" from Dec. 31.
The director of Louisville VA Medical Center, Wayne L. Pfeffer, sent the Prospect a written statement on Aug. 27, 2008, in which he said he could not address "patient information specific to Mr. Henderson's care." Nevertheless, said Pfeffer, he extends his condolences to the family. He explained that more than 1,800 veterans of the conflicts in Iraq and Afghanistan are currently receiving care at the facility and that "timely, responsive, and compassionate care for every veteran that entrusts us with their care is our top priority."
Eventually, Henderson was placed at the VA. He spent time there, as well as at University Hospital and Central State, a psychiatric facility in Louisville. (A Central State spokeswoman said she could not speak about his stay at the hospital or even if he had been a patient.) In several reports, therapists describe his remarks about suicide and the "jokes" he made about hurting people. Whether his aggression was directed at himself or others, it did not seem lighthearted. In a Jan. 8, 2004, University Hospital report, for example, a staffer writes, "Patient states: I need embalming fluid."
Sharpe, who works with mentally disabled adults in Louisville, says his brother was given antipsychotic drugs, but no one seemed all that interested in what the medication did. "It was almost like he was a lab rabbit. 'Oh, he's sick. Let's see if this drug works,'" he recalls. "They just gave him pills. As far as checking in on him or sending anybody out [to] check on how he's doing, they didn't do anything at all. At the VA, they really turned their backs on us."
"My son did his five years," his mother says, "and after he was honorably discharged, his worth diminished."
Sharpe says a stranger showed up at his brother's funeral and said she had watched him jump in the Ohio River. "This woman says he tried to swim his way out, and that did me no good. I don't think he wanted to die. The [video] game pretty much showed how he felt: HelpHim. My intention is to have the story out there. It's an epidemic, and people are hush-hush about it."
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