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Frontline Report   |    
The Helping Heroes Bridge Program for Veterans
Alexander de Nesnera, M.D.
Psychiatric Services 2008; doi: 10.1176/appi.ps.59.12.1475
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Dr. de Nesnera is associate medical director at New Hampshire Hospital, Concord, and associate professor of psychiatry at Dartmouth Medical School, Hanover, New Hampshire. Send correspondence to Dr. de Nesnera at New Hampshire Hospital, 36 Clinton St., Concord, NH 03301 (e-mail: adenesne@dhhs.state.nh.us).

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The recent conflicts in Afghanistan and Iraq have led to an increase in conducting psychiatric evaluations and treatments for returning veterans and National Guard personnel. A unique program to support this effort was developed by psychiatrists in New Hampshire with input and support from various federal, state, and private agencies, as well as from individuals. This program could serve as a template for other states as they determine what services are needed for their returning veterans and National Guard personnel.

The Helping Heroes Bridge Program is a voluntary program developed and run by psychiatrists providing free evaluations, assessment, and temporary care to veteran and National Guard personnel who need access to psychiatric services and who are eligible for these services but reluctant to obtain them or not able to obtain them in a timely manner. This program allows individuals the opportunity to meet with a psychiatrist on a temporary basis to begin a process that will lead them to treatment (if needed) in the Department of Veterans Affairs (VA) or another system. This program allows individuals to connect with civilian psychiatrists as a first step toward obtaining the services and treatment that may be necessary to resume leading a productive life.

The challenge in developing this program centered on getting various constituent groups working together to allow this program to evolve. Seven psychiatrists volunteered to be the clinicians meeting the individuals. All psychiatrists were Dartmouth Medical School faculty and worked at New Hampshire Hospital, the only state psychiatric hospital in New Hampshire. Having all physicians in one area allowed for easy communication and coverage between them. The VA hospital psychiatric staff provided information that allowed civilian psychiatrists access to key resources within the VA system, enabling the sharing of this information with veterans during the initial evaluation. The New Hampshire National Guard Adjutant General's office ensured that this program was available to National Guard personnel returning from service overseas. The New Hampshire Department of Health and Human Services, New Hampshire Hospital administration, and members of the New Hampshire legislature all worked together in providing legislative, administrative, and legal support to bring this program to fruition. The New Hampshire State Veterans Council and the Veterans Centers were all informed of this program and participated in informing veterans about the program and its potential benefits.

Individuals seeking treatment were urged to call a number that allowed them access to one of the volunteer psychiatrists, who then scheduled a meeting time with the individual. Further assessments would determine whether family involvement was also necessary. Scheduled sessions were limited to five, with a plan for rapid referral to the appropriate federal or state agency for follow-up care.

The results of this one-year program were interesting. Initially, in 2006 there were 20 to 30 inquiries for information about the program. Many calls were from family members expressing concern about their loved ones who had returned from combat and seeking advice about how to get their loved ones to seek help. Most veterans and National Guard personnel did not come for an assessment but were willing to receive information about how to obtain care within the VA or other system. It is unclear whether this information was used effectively and whether recipients considered it helpful. Among those returning from combat, there was a sense of reluctance to meet with the psychiatrists. The stigma of seeking treatment for a supposed mental health problem may have limited the referrals.

Despite this program's limited impact, its development led to an open discussion among a number of groups caring for veterans and National Guard personnel, which led to further assessment of services that are provided to this vulnerable population in our state. All parties felt this effort to be very productive, and the discussions helped to strengthen the communications among agencies, legislators, and private citizens caring for these men and women. This program allowed individuals to initially seek services from civilian psychiatrists, an option that some individuals may find less stigmatizing than seeking services through the VA. The ultimate goal was to provide another venue for service personnel to use, furthering the goal of helping the maximum number of people in need of treatment to obtain the care that they deserve. This program allowed psychiatrists to be seen as leaders in providing mental health care to our homecoming armed services men and women. Psychiatrists (and their psychiatric societies) in other states should consider developing similar programs and should intensify efforts to overcome the stigma associated with seeking treatment.

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