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Beasley Best Community of Caring

This quarter, Beasley Best Community Of Caring is focusing on helping our veterans who have served our country; we’re also paying tribute to their families.

We’re working with Home Base, a national organization that provides mental health services for Veterans who have served our grateful nation. Home Base is a collaboration between the Boston Red Sox Foundation and Massachusetts General Hospital; it is based in Boston, with a division in Southwest Florida, and provides extensive mental health and wellness support for vets and their families.

Home Base has provided mental and brain health care and support for more than 20,000 Veterans and military families over the past decade and established the nation’s first private sector center of excellence for the invisible wounds of war.

This week, we have an interview with Retired Brigadier General Jack Hammond, who is the Executive Director for Home Base. General Hammond has advised President Obama’s Commission on Military Compensation and Retirement Modernization and delivered remarks at the White House Veterans and Military Family Mental Health Conference. Hammond also advised President George W. Bush’s Warrior Wellness Alliance, Secretary Bob McDonald’s My VA Advisory Committee, Governor Mitt Romney’s Homeland Security Advisory Council, and Governor Charlie Baker’s Healthcare Transition Team & Veteran Advisory Council.

General Hammond simultaneously commanded two separate Battalions in Iraq, and as a General officer, he led a multi-national NATO Task Force in Afghanistan. His military awards and decorations include the Distinguished Service Medal, two Legion of Merit Medals, the Bronze Star Medal, two Meritoriously Service Medals, five Army Commendation Medals: one for Valor, two Valorous Unit Awards, the Combat Action Badge, the French Medal of National Defense, and the Bulgarian Medal of Mission Support.

As impressive as his military career is, we talked to him about returning from the battlefield and helping others to do the same.

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Home Base uses the term “the invisible wounds of war.” Can you discuss that term? 

Sure. The invisible wounds of war are primarily comprised of mental health and brain injuries associated with combat service. And that can happen in the form of brain injury from concussive injuries; from the impact of things hitting you. Or, from the concussive injury associated with the sound waves from a blast, called “blast injuries.” Folks have been receiving traumatic brain injuries, the concussive type, since the beginning of time.

Then, there is the mental health side, when you look at the trauma associated with combat. It wasn’t really until the 1980s that post-traumatic stress was identified as an actual injury. And it really wasn’t until the 2000s that people looked at the concussive effect of a traumatic brain injury and the type of damage it can cause to your body.

It’s kind of remarkable when you think about it. They gave names to what they called “soldier’s heart” in World War I, and  “battle fatigue” in World War II. There were all these euphemisms that were used, but nobody ever looked at it as an actual injury; no one really looked at novel ways to try and develop treatments.

As I began my work at Home Base in 2012, I met with some of the world’s leading experts on these issues. And frankly, there are a lot of them at Mass General at Harvard. And it’s not just [great] because it’s Harvard. It’s because they’ve made significant investments in this area.

You mention trauma and post-traumatic stress; I imagine that some veterans who come home have a hard time processing the things they saw in combat. 

The long-term effect of not receiving adequate treatment has equated to losing 30,000 post-9/11 veterans to suicide. We’ve had three million men and women raise their right hand and join the military since 9/11 just to safeguard this nation. But the cost of freedom is very high. Of those three million, 1.8 million have a permanent disability of some kind. A significant portion of them have mental health injuries. 30,000 have killed themselves. And if you flip the dial, we lost 7,070 to direct combat, but 30,000 to the mental health injuries associated with combat because of the lack of adequate treatment.

Was this ever something that was counted after other wars? Obviously, people coming back from Vietnam had lots of psychological issues as well. Back then, were we counting how many people died by their own hand due to mental health issues?

The short answer is: nobody was keeping track of this because, as I said, they didn’t even consider it an “injury” until the 1980s. Prior to that, there was a social taboo on suicide: nobody talked about it. Families didn’t talk about it. Doctors didn’t talk about it. They just said that someone “died suddenly.” There were all sorts of religious implications that were very troubling and frankly, the person was gone. Their families already have enough problems and now they’ve got this religious stigma. They’ve got to deal with it.

I have delivered the news on one of these self-inflicted gunshot wounds. And you’ve probably seen on TV when they do those casualty notifications where the officer is in a dress uniform and they show up at a house and knock on the door. I had to deliver that one time and it was a self-inflicted gunshot wound to the head. I could not make the mental leap that it was suicide. But the father knew, and he literally fell apart. And his greatest worry was, how will that affect his son in the hereafter? Thankfully, I brought a priest with me who was able to calm him down and explain to him that the Catholic faith had shifted its stance [on suicide]. If somebody takes their life: they momentarily lost their mind and they can’t be held accountable. But that’s nowadays. Back then, there was no such forgiveness. And so nobody talked about it. So, the long answer to your question is: no one tracked these.

So, how did you go from the battlefield to your current role: helping soldiers to come home?

I made the decision to retire from the Army after my last deployment to Afghanistan. I was the commanding general for Kabul province in Afghanistan, and after thirty-one years and several deployments, I really felt it was time for me to hang up my boots and try something new. And as I was looking at different options, I was approached by someone who let me know that the Boston Red Sox and Mass General Hospital were looking for somebody to lead this program [Home Base], and that really captured my interest. I taught at Boston University for years and I was considering that, but I always planned on working with veterans organizations and I had already done that a bit.

But this is this really caught my attention. Because back in 2002 and 2003, I had back-to-back deployments with Afghanistan and Iraq and came back with my own issues, and I, unfortunately, didn’t get any assistance or medical clinical assistance until about 2006 and 2007. It almost wrecked my family, and it almost wrecked me.

If you keep walking around with an injury or an illness and don’t get the medical attention you need, it only gets worse and worse. In my case, I was fortunate that I got the care I needed and I was able to rally. And I stayed in the Army for another five or six years and went through another combat deployment. And I had all the skills and the tools in my toolbox to stay healthy. And really, that’s what you need: that clinical assistance to keep yourself healthy. You know, good mental health is the same as good physical health.

I imagine that the transition — coming back home after being in combat overseas — must be so strange. You’re going from living in a combat zone to living in a house or an apartment. If you’re married and have kids, the daily tasks like taking out the garbage or taking the kids to school, I imagine, might seem mundane. 

You go from being in the most high-performing environment you can imagine where it is, literally, kill or be killed each day. If you don’t bring your A-game and they do, it’s “game over.” And so when you go from this type of environment and then all of a sudden you’re in America… it’s a big transition. And so post-traumatic stress is really your body’s normal reaction to being placed in an abnormal situation.

There are obviously transition issues from going from being at the most peak performing opportunity of your life to kind of a quiet, more sedate routine kind of life… that can be boring. When you’re overseas, you’re really pining to be home with your family and your friends and enjoying life. But when you get home and you’ve been home for a little bit and you hear what’s going on, since we’ve got troops still engaged overseas… there are all sorts of psychological issues associated with that. You find yourself kind of wanting to be back over there with the team, fighting, and doing what we perceive as good things for people, and protecting the country.

So, yeah, there’s a lot to it. One of the programs that we developed a couple of years ago was focused on our special operations team members: Green Berets, Delta Force members, Navy SEALs, those types of warriors, and they show up after 15 to 20 combat deployments. They’ve known nothing but war for two decades. Many of them have for 10 years or 12 years lived a cycle of: come home for three months, get deployed for five months, retrain, go back overseas again in various kinetic environments. So you can imagine that’s just not a normal lifestyle. And when you try to turn it off, it’s not so easy.

Whether you come home to a white-collar job or a blue-collar job, it must be such an adjustment.

What’s interesting is, growing up in the ’60s and ’70s, I met a lot of guys that were World War II veterans, and they were the postmen, the milkmen. That might seem mundane. But I talked to some of these guys and they had literally been to hell. All they wanted was peace and quiet, you know what I mean? They just wanted to find some peace in their life. But on the flip side, there are some that really look to overachieve when they come back.

There’s a great guy from Mass General, former Navy SEAL. He got out of the military, went to Harvard Medical School, became a doctor, became a surgeon, and after he finished that, he decided he wanted to be an astronaut and he’s now an astronaut. So he went from being a Navy SEAL to a Harvard doctor to an astronaut. I had the honor of knowing a young man who was a triple amputee and he became a doctor. A lot of people would say you couldn’t do that and 20, 30 years ago, you probably couldn’t. But he had the desire to move forward. And, you know, he’s not “disabled.” He just has different abilities and he’s able to work them. He’s obviously not going to be a surgeon with one hand because you do need two. But it doesn’t mean he can’t be a doctor. In any case, a lot of these men and women just go on and do amazing things. Some of them can get stuck in an awful rut and they get in that downward spiral because they come home and have a bad transition out of the military. They were carrying a lot of weight, a lot of mental weight from war and their experiences.

It’s really an interesting phenomenon because only one out of four young American men and women of military age meet the minimum requirement to be a private in the United States Army. So 75 percent do not meet the minimum requirement; they’re screened out for mental health issues, physical injuries or limitations. Legal issues, criminal violations or education. So, of the pool of people that we select from, it’s the top twenty-fifth percentile of the American population because they’re the only ones that meet that minimum requirement. And so they’ve been screened for mental health injuries. But even then, they’re now two or three times more likely to take their life after service based on the mental health injuries they’ve sustained.

Well, thank goodness for you guys, and I’m sure you’re making a big difference. I know you’re not the only organization that does it, but I’m just glad that there are organizations that recognize these issues and are dealing with them and trying to help. Anybody who voluntarily goes overseas to fight for our country should never have to contend with homeless or having no support.

That’s exactly it. Nobody’s looking for any parades or pats on the back when they come home. They know what they signed up for. But there is an implied trust, a sacred trust between the soldiers that serve this country and the government, that if they are injured, we’ll do everything we can to make them whole again, to the best of our ability. And if they get killed, we will care for their families. And that’s something that goes back as far back as the American Revolution.

After World War I and World War II, that’s when they created the VA and said, “We’ll make sure we take care of them.” It’s just that they were ill-prepared. But they just haven’t made good on the promise. And that’s why we’ve needed a lot of private sector organizations like Home Base to step up and leverage the resources of the private sector to bring them to bear on these challenges. And we’ve come up with some amazing solutions. It’s easier for us: we’re smaller, more nimble and private and we can just go right to academia to try new ideas, so we’ve been able to create a lot of great new programs.

A lot of the people who enlist are the toughest of the tough, and that’s who we want to be defending us. But do you find that to be a barrier? Like, if you tell a veteran, “You need some help to readjust, you’re struggling,” do you get negative reactions, like, “Hey, I’m not the kind of person who sees a ‘shrink?'” 

Yeah. I mean, that’s one of the primary issues and challenges we have. We take folks that are self-starters, the type of people that play hurt. Anybody that’s played sports in their life knows: if you injure your finger, you tape two fingers together, you finish the game. That’s the type of people that come into the service, especially in our ground combat units, where the rubber meets the road. And we do train them to play hard.

There are two categories that we talk about. One is when you’re hurt. One is when you’re injured. So if you’re hurt, you suck it up. That means you play while you’re hurt. You’re on a patrol: you can’t flag a cab. You’ve got to keep going. You got to push through the pain. If you get a minor wound in the middle of a fight, you don’t just lay down. You keep fighting because your life could depend on it, and the lives of your team.

But if you’re injured, that’s a more serious thing where you’re going to compromise the ability of the team to do their mission. So if you fracture your ankle or you get shot to the point where you’re significantly injured, you require medical attention.

The problem with these mental health injuries is, you walked off the battlefield. We’ve all seen friends that have been blown up and taken off the battlefield with amputations or serious significant wounds. So when we go back to the term that we started with at the beginning of this conversation, “the invisible wounds”… the invisible wounds are a challenge because nobody sees them. And if you went out on patrol with 10 people and eight people came back and two were shot, those are the wounded guys. You don’t consider yourself “wounded.” And if the other eight guys or eight gals came back and they appeared to be OK, they’re not going to say “Hey, I’m not feeling it right now. I’m feeling some conflicted feelings. I’ve got some psychological stuff going on.”

You’re a part of a team and you don’t want to let anyone down. They’re presumably doing OK, but they may or may not actually be OK. That’s the challenge because everybody puts up this false front and pretends to be OK. But they’re not. When they come through the program, in the initial survey questions we ask them, “How are you doing with your mental health, your PTSD? Do you have it?”

And almost to a person, it’s: “No, I’m good. I don’t have any PTSD.” And almost every one of them actually does have some level of PTSD. Then they’ll say, “Well, no, no, I told you, I don’t.” The doctor will say, “Well, I’m not asking this time. When we look at your musculoskeletal injury and we look at your minor traumatic brain injury, we’re telling you what you have. If you trust us on this physical stuff, you really need to trust us that you do have some PTSD. But by the way, we can help you with it.”

They all ask, “What do I do?” And they’ll get enrolled in care. And frankly, they do extremely well because they commit to the course of treatment, they’re all in. And if they do that, they usually end up quite well. It’s not a “brain swipe” where we just wipe their memory and it all goes away. But we deconstruct what went on. A lot of it is guilt, survivor’s guilt. You know what I mean? You know: you lost a friend. They’ll ask themselves, “Could I have done something differently?” Or, “Was it my fault?”

And they’ll learn to put the blame with the person that pulled the trigger. We’ll tell them, “You didn’t do it,” but we’ll work through that with them and we’ll give them the tools to deal with this stuff so that they can have a productive life and they can manage their own health, just like everybody else does.

What do you want the general public in America to know about veterans who are coming home from combat?

Well, I think the most important thing for people to realize about our warriors when they come home, is: they’re not broken. A lot of them are just injured. Military life is pretty rough and you can get hurt. The problem is some of these injuries linger on, because they don’t get the care they need. And if you know somebody that’s come home and they’re not doing well, you really need to encourage them to get help and get the care they need because we’re self-reliant people. We train our warriors to be self-reliant. If they twist an ankle, they duct tape it, and they keep moving on. You’ve heard the miraculous stories of someone getting shot and they keep fighting because frankly, they have to. I mean, that’s war, right? But when you come home, you’ve got to get the help you need. And there’s a lot of wonderful places, not just Home Base, but there’s a lot of great places out there that can care for you. They’ve got to come in and get the help they need, and if they can get the help they need, they can reclaim their life and have a wonderful life. And I think that’s what we all owe them as Americans.