After a five year military career that included deployments to Kosovo in 2001 and Iraq in 2003, Kris Skinner returned to civilian life with physical injuries sustained over the course of the war.

But just as debilitating — and potentially deadly — to Skinner and many other veterans, including those who never saw combat, are the mental and emotional wounds that can manifest during their transition into civilian life.

One in ten Los Angeles County veterans have considered or made a plan for suicide, according to a survey last month by the USC School of Social Work’s research center on veterans and military families.

The USC survey follows an August report released by the Orange County Health Care Agency, which found that an average of 42 veterans committed suicide in Orange County each year between 2009 and 2011, more than any other group surveyed.

Nationwide, an estimated 22 veterans die by suicide each day and more than half of those suicides are soldiers who were never deployed to a combat zone.

Yet, in Southern California and throughout the country many veterans are not going to the Department of Veterans’ Affairs (VA) for mental health services, leaving the task of reaching out to and providing long-term care to veterans and a patchwork of local services and private nonprofits.

A Painful Struggle

After he returned from Iraq in 2004, Skinner began working at Morgan Stanley as a financial adviser. But his ongoing struggle with a gastrointestinal illness he contracted while in Iraq eventually led to him losing his job and having to move in with his parents.

“I was so sick from the physical issues, I was waiting to die. I didn’t want to live anymore and join the rat race for a paycheck — the lack of camaraderie and brotherhood; no one cared about each other. There was no purpose,” Skinner said.

“I had stopped socializing. I didn’t work. I was in my early 30s and thought that I was some broken veteran and…that I was going to die on my parents couch.”

Struggling with difficulty sleeping and feelings of anger, hopelessness, fear, anxiety and depression, Skinner reached out to the VA, where he had been treated for his physical illness. He was told to attend group therapy and prescribed several medications.

“There is nothing in this world that would be worthwhile enough to make me go through that again,” Skinner said of his VA experience.

He began to rack up debt seeing private practice therapists, until a friend referred him to a non-profit group called Soldier’s Project, which provides free counseling, psychological and support services for veterans.

In addition to counseling, Skinner’s psychologist, an unpaid volunteer, helped him fight for a full disability rating with the VA and secure a home loan to purchase a condo. Now he works for an organization called Ride 2 Recovery, which encourages mental and physical rehabilitation for veterans through group cycling.

“If I didn’t have my family and Soldier’s Project, I would be dead – without a question. I probably would have taken my life a number of years ago,” Skinner said.

Healing ‘Moral Injuries’

Soldier’s Project, which works with veterans in Southern California and across the country often gets referrals directly from the VA, said Dr. Judith Broder, one of the organization’s founders.

Broder explains that a person might be driven to attempt suicide as the result of an accumulation of many issues over time — feelings of isolation, helplessness, and worthlessness.

“Many feel like, based on what they’ve seen and done, that they really can’t talk to anyone, because to talk to anyone they love would injure them, by revealing the horrors they’ve gone through,” Broder said.

Broder says many also struggle with “moral injuries,” or the experience of witnessing or taking part in a situation that “goes against the most deeply held moral principles of our civilization.”

“People often feel as if they themselves are evil, and bad. Many soldiers feel as if they are somehow responsible for all that has happened,” Broder added.

That isolation can make it hard for veterans to reconnect with families, religion, friends or community, says Evan Fewsmith, a psychologist and the director of a Mission Viejo-based group called Strength in Support that provides a range of free services to veterans, including family therapy.

In addition to the impact on spouses, parents and children while a soldier is deployed, Fewsmith says it’s common for them to feel helpless when a veteran comes home but can’t reconnect.

“Often families feel a mixture of abandonment, guilt, powerlessness, and grief because they can’t reconnect with their loved one. People can take it personally…how can you not if you feel that you’re no longer loved?” he said.

Some organizations representing military families are reporting increased incidents of suicide among family members of veterans. Currently, the military does not track rates of suicide among military families.

Finding Meaning in Post-Military Life

The transition to civilian life also sparks a fundamental question for a veteran about their self-worth and identity in civilian society, says Anthony Hassan, a 25-year military veteran and the director of the USC research center on veterans and military families.

“The depression, mental health problems, it’s just not the combat. It’s about life. ‘Who am I? Jeez. What’s wrong with me?’” Hassan said. “’I get out here and realize it’s been 60 days and I don’t have a job, and I’m living with my in-laws and they aren’t too happy with me’ – it’s stressful, it creates depression and isolation.”

According to the USC report, which surveyed 1,350 Los Angeles county veterans, 8 in 10 veterans left the military without a job, expecting to quickly find meaningful employment, and 40 percent left unsure of where they would be living.

Although the military does have a course for people transitioning out, Hassan says many soldiers aren’t listening, don’t think they will need the advice, or underestimate the challenges to returning to civilian life.

“Many veterans are making around $37,000 a year in civilian jobs versus $50,000 or $60,000 a year [in the military],” Hassan said. “A lot of this is about self-worth and identity. Those questions go away, but it takes time to process without those structures you used to have.”

Private organizations and community clinics, often working in conjunction with local governments, have emerged to fill the gap in mental health and support services for transitioning veterans, who often don’t know where to go for help.

The Orange County Veterans Service Office currently provides free counseling by clinicians who are veterans themselves at college campuses and other locations. These services are mostly short-term efforts to connect with veterans and eventually refer them to places where they can get long-term care.

But despite the clear need, reaching out to veterans is not easy, said Fewsmith.

“At the start, we naively thought we could offer free services and they’d line up. But [veterans] are emotionally disconnected, very suspicious, guarded and isolated, they don’t ask for help,” said Fewsmith.

Instead, the organization organizes weekly golf outings and activities, where veterans can be part of a social network and mentorship program that encourages them to seek counseling and therapy. They recently opened a satellite clinic at Santa Ana College.

Trouble Trusting the VA

In addition to a lack of trust in the quality of care and responsiveness of VA services, many veterans are reluctant to access VA medical or mental health care because they worry military records of seeking mental health assistance will hurt their job prospects, especially if they are interested in careers in law enforcement.

And long VA wait times can further deter veterans who are already discouraged from seeking help by social stigma and military culture, and who won’t reach out a second time, Fewsmith said.

Asked to comment on the situation, VA spokeswoman Gina Jackson said the agency is committed to the health and well-being of veterans and pointed to recent initiatives to increase mental health resources such as the introduction of pilot collaborations with community mental health providers and an increase the number of VA staff.

Jackson said the VA has seen a 61.4 percent increase in budget requests for VA mental health and approximately 40 percent increase in the number of patients since 2013.

“…Rates of suicide among those who use VHA services have not increased and that outcomes among those at risk for suicide who get care in VA have improved,” according to a January report by the agency.

Advocates like Broder and Fewsmith say their nonprofits give veterans immediate attention and uninterrupted, unlimited counseling for both them and their families, services the VA can’t be counted on to provide.

But Hassan says the problems facing veterans are too big for any one organization, whether it’s the VA or a private group, to handle. He hopes the USC report will prompt a local discussion about how to better coordinate between local government and private entities.

He also recommends more proactive initiatives that encourage soldiers to have a plan before they leave the military, including on-base recruitment or job training and earlier discussions about the transition to civilian life.

Skinner, who now organizes cycling marathons for other veterans, says cycling has helped him recuperate physically and bond with other veterans struggling with the same issues.

He says he’s confronted every day by the numbers of veteran suicides, an intimate struggle that he wonders if he himself will ever shake.

“Not another day passes that I wonder what would happen if I get sick again or struggle mentally again,” Skinner said. “I can only imagine what other veterans are dealing with. The same thing, or far worse.”

You can call the Veterans Crisis Line at 1-800-273-8255.

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