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Matthew Smith (fourth from right) joins other Veterans and first responders who were recognized at an Oct. 21 college football game at California Memorial Stadium for helping the state combat wildfires. Smith helped transport supplies to field hospitals that were set up in Santa Rosa, and arranged for infectious-disease experts from UC-Berkeley to speak with patients.
October 26, 2017
By Mike Richman
VA Research Communications
Matthew Smith in Haditha, Iraq, in 2006. (Photo courtesy of Matthew Smith)
When asked how he’s doing, Matthew Smith is quick and to the point.
“I’m living the American dream,” he says. “I’m an American, and I go to college.”
Smith, a Marine who did two tours in Iraq and fought in the second battle of Fallujah in 2004, is a senior at the University of California, Berkeley. He majors in social welfare and has a grade point average of 3.66. Having battled PTSD, he is aiming for a career focused on counseling Veterans to help them overcome struggles in life.
Smith is one of nearly 3 million post-9-11 service members who have returned home. About a third of them are attending college using U.S. government benefits as part of their transition back to civilian life.
The college experience presents challenges for Veterans unlike those facing traditional students. Researchers have found higher rates of health-risk behaviors, such as substance abuse, and psychological disorders, such as PTSD, among Vets in college, compared with their peers without military experience. Studies have also cited problems for Veterans in adjusting to campus life and interacting with students.
One of the more informative studies appeared in January 2017 in the American Journal of Orthopsychiatry. The study not only identifies and elaborates on the potential difficulties that Vets face in higher education, but also makes recommendations for facilitating their successful integration. The research focuses on post-9-11 Vets.
Dr. Brian Borsari, a clinical psychologist at the San Francisco VA Health Care System, was the study’s lead researcher. He became inclined to pursue the research when he worked in the PTSD clinic at the Providence VA Medical Center in Rhode Island from 2007 to 2013.
"There's just a huge difference in life experience that student Veterans have versus students who didn’t serve."
“At the Providence VAMC, I was struck by the number of student Veterans with significant PTSD symptoms in my caseload who were trying to enroll and attend school,” he says. “I was also alarmed by the number who would drop out or do very poorly. This led me to check with a number of schools in the area to learn more about any coordinated approaches to enhancing the odds that student Veterans could succeed. I discovered tremendous variability in the services that were offered from campus to campus and the near lack of systematic research on the topic.”
He adds: “Given my previous research examining brief interventions for alcohol use with college students and my current position as a staff psychologist in VA, this seemed like a good opportunity to review the literature and highlight some pressing issues and needs for the student Veterans who were returning to campus.”
Borsari and his team reviewed 130 articles with details on Veterans in higher education. About half of the articles were peer-reviewed manuscripts. The other half appeared in government, trade association, and commercial publications.
Among the difficulties Vets could face on campus, according to Borsari and his team, is “intrusive or unpleasant” interactions with their non-Veteran peers, who may ask whether the Veteran killed someone while deployed.
“Veterans often report difficulty connecting socially with traditional students, who are less likely to have firmly established vocational, social, and family roles,” the researchers write. “Beyond the perception that traditional students are just 'kids,’ the military has been a way of life for [Veterans], and the less-structured role as a student may not be as familiar.”
Smith, for one, sometimes finds it hard to converse with others on campus and in class. At 33, he’s at least a decade older than most of the students at UC-Berkeley and has a view of the United States, the military, and global affairs that is not shared by many of his fellow students. That disconnect frustrates him.
Case in point: After more than 300 people were killed in a recent terrorist attack in the Somali capital, Mogadishu, Smith heard a student say the U.S. is responsible for doing something about the attack. Smith responded that in 1993 the U.S. engaged in a battle in Mogadishu that left 18 Americans dead and became known as “Black Hawk Down.” He believes many students who haven’t served lack knowledge of history and a sense of when it is right to carry out a military intervention.
“I didn’t experience what the American soldiers did in Somalia, but I have been shot at and blown up,” he says. “I’ve seen what it costs to try to go over there and do these interventions. Your average American doesn’t know that. They know these interventions happened. But there’s no way they could know exactly what it’s really like. Unless you really know the cost, you can’t understand it in the moment.”
Another post-9-11 Veteran, Christopher Brown, concurs with Smith. Brown, a Marine who did tours in Iraq and Afghanistan and like Smith was diagnosed with PTSD, earned degrees from Western Washington University and the University of Washington.
Brown says there’s an ideological divide between Veterans and non-Veterans in college that could be dangerous to former service members with mental health conditions.
“The United States—whether we want to believe it or not—we are warriors to a degree, and we’re still in the largest wars to date,” he says. “The problem is that only 1 percent of the population is shouldering those wars.
“In the past, the Native Americans perceived their warriors as highly respected, esteemed members of the community,” he adds. “But it’s not that way today. That speaks to the tension that many Vets experience in college. That’s the underlying cause that leads them to not want to participate in discussions in the classroom. I know a lot of Veterans who have tried to have those discussions and were just overlooked and avoided. That leads to potential isolation, which can exacerbate the condition of a Vet with PTSD.”
Many Veterans in college confront mental health conditions, such as PTSD, anxiety disorders, and depression, according to Borsari’s study. It notes, however, that findings among college students are mixed as to whether those disorders occur at much higher rates in Veterans than non-Veterans. Suicide attempts and thoughts, substance abuse, and physical disabilities are also concerns among student Vets. Plus, Veteran students may still have active-duty status, leading to redeployments that cause disruptions in education, including a loss of scholarships and course credits.
The researchers also say Veterans may find logistical challenges to be “overwhelming” in the switch from military to college.
“Because a large number of [Veterans] enlist in the military as emerging adults and spend a number of years in the strict and structured environment of the military, they may be less skilled at navigating available services outside the context of the military setting,” Borsari and his team write.
These problems could include not understanding how to use services such as the Veterans Benefits Administration, which provides financial and other aid to Veterans and their dependents. They may also have trouble managing education-related finances and could be late on tuition payments.
Retention is another problem. A survey cited in the study found that 37 percent of part-time and 16 percent of full-time Veterans dropped out within nine months of enrollment. Generally, retention rates are lower among student Veterans compared with non-Vets, but factors such as the type of school and major can make it a difficult comparison.
There’s also the transition to open campus life after experiencing a more rigid military lifestyle.
“Specifically, the military often uses a standardized, stepwise, and 'hands on’ approach to teaching a skill, which is different from the more autonomous approach typically used on college campuses,” the researchers write. “Furthermore, different departments and individual professors often vary in their approaches to grading, teaching, and class requirements, whereas instruction and evaluation in the military tend to be more consistent across settings. Perhaps for these reasons, student Vets have reported that they view the campus environment as more chaotic, confusing, and less-ordered than the military environment. Adapting to this environment may result in struggles and drop-outs among student Veterans.”
As part of the study, Borsari and his colleagues recommend ways to improve life for Veterans on campus:
“Many of the qualitative interviews conducted with student Veterans revealed a desire for Veteran-only classes, Veteran online courses, lounges, orientations, and other programs,” the researchers write. “For example, learning communities, composed of groups of students sharing thematically linked experiences inside and outside the classroom, have been
proposed as a way to keep student Veterans together by incorporating a curriculum that has been adapted for their needs.”
To Keith Armstrong, a social worker at the San Francisco VA Medical Center, the recommendations by Borsari and his team are “right on.” Armstrong runs an outreach program – the Student Veteran Health Program – that assists student Veterans at more than a dozen schools in the Bay area (see sidebar).
Armstrong has collaborated with Borsari on projects related to student Veterans. He expounded on the recommendation to educate non-Veterans on the experiences of those who served.
“The lack of dialogue and understanding between those who served and those who haven’t, that chasm is larger now than it’s ever been,” he says. “There’s just a huge difference in life experience that student Veterans have versus students who didn’t serve. So anything that can break that down is a good thing. It’s also helpful for faculty and staff to get trained because many professors tend to fall on the more liberal, anti-war kind of edge of things. It’s important for them to understand what it’s like going to war on the ground and not just from an intellectual standpoint.
“Educating faculty and staff on students who served and getting students who didn’t serve into more dialogue, letting them ask dumb questions, that’s all super helpful because it helps to create a more inclusive environment,” he adds.
Meanwhile, Matthew Smith is thriving academically and socially at UC-Berkeley. In addition to academics, he serves as president of the Cal Veterans Group, which provides professional, academic, and other resources to ease the transition of the school’s Veterans from military life to higher education.
After graduation, he wants to counsel aging Veterans on issues such as suicide prevention. VA data say 65 percent of all Veterans who died from suicide in 2014 were 50 years of age or older, and that nearly 50 percent of Veteran suicides that year were at least 60 years old.
“I’m from Atlanta, where the politics are 180 degrees different from UC-Berkeley and the township of Berkeley,” he says. “And so I’ve become a better person. I’ve challenged some of my own personal beliefs by coming here. I definitely have gotten way more patient with some of these kids when hearing some of the stuff that comes out of their mouths. I’ve also learned a lot from these kids because they’re smart. The professors are amazing.”
Keith Armstrong, a social worker at the San Francisco VA Medical Center, understands that many student Veterans with mental health issues, such as PTSD, begin their journey in higher education at community colleges. He believes such problems can make it daunting to tackle the demands of a four-year school.
Armstrong runs the Student Veteran Health Program (SVHP). The endeavor assists student Vets at four community colleges in the San Francisco Bay area in VA health care enrollment, social work and mental health services.
He established SVHP in 2010 at the City College of San Francisco, which today has two full-time VA clinicians on campus. The program also assigns VA staff to the College of the Redwoods, Napa Valley College, and Skyline College.
SVHP also oversees the Bay Area Student Veteran Leadership Council, which involves at least 15 colleges and universities in the region, including the four primary community colleges. The council relies on student Veteran leaders from two-year, four-year and graduate schools who are studying business, law, and medicine. It aims to improve the student Veteran experience by providing a forum for the leaders to share advice, such as how best to run a student Veteran club or how to work with a college administration.
According to Armstrong, SVHP served as a model for the creation of the VA program Veterans Integration to Academic Leadership (VITAL) in 2012. VITAL, in part, helps connect Vets to their local VA medical centers for physical and mental health assistance. The initiative now has programs at 23 VA medical centers in the U.S. At least one employee from each VA facility is assigned to provide mental health and outreach services at schools in that respective area.
The Student Veteran Health Program is part of VITAL.
“We provide mental health work and social services and evidence-based psychotherapy services at our four primary schools,” he says. “But what we’re really driven by is providing services that make the VA relevant to student Veterans and their day-to-day life. The idea is that our program is really the face of VA. We want to make sure that when a student Veteran comes in with a question or an issue, if we can’t answer it we can link them with somebody who can.”
Armstrong says VA medical personnel with SVHP are authorized to prescribe drugs at the City College of San Francisco, which has about 1,000 student Veterans. He says that service isn’t provided, for example, at Napa Valley College, which has 200 student Veterans. At the four community colleges, social workers and psychologists provide treatments such as prolonged exposure, a form of cognitive behavior therapy designed to treat PTSD, he says.
“We provide services including helping to get folks enrolled,” he says. “We also get them appointments at a VA medical center when they first walk in to make sure that they’re really hooked in to VA care. And we do a speaker series, in which we run monthly presentations in the student Veteran lounge on topics of interest to student Veterans, ranging from learning about VA benefits to suicide prevention.”
Armstrong is also a professor at the University of California, San Francisco. He co-authored the book “Courage After Fire for Parents of Service Members: Strategies for Coping When Your Son or Daughter Returns from Deployment.”
He hopes the Student Veteran Health Program pays off down the road when Vets enter the workforce.
“While we’re providing services to student Veterans, we want to make sure that there’s an opportunity for them to give back to the community that they’re embedded in,” he says. “It’s important to be communicating to the general public that our Veterans are not all broken people that we need to pity. In fact, they’re going to be the people who are going to be leading our country.”
—Mike Richman
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