As 1 in 3 Iraq vets seek mental health care, VA faces criticism over delays and shortages.
After six sleepless nights, Blake Uddin knew he was in trouble.
He was hearing voices and feeling "clairvoyant." A sergeant in the Wisconsin National Guard with two tours of duty in Iraq, Uddin drove himself to the Minneapolis Veterans Affairs hospital, where he expected to be admitted.
Instead, after a two-hour exam, doctors said he was not a threat to himself or others, even though they called his Guard unit and suggested he not be allowed around weapons. He was told to come back the following week.
Four days later, with the voices now telling him, "Run ... run ... they're coming," he stole a car, crashed it and spent desperate minutes rushing across four lanes of morning rush-hour traffic. Footage from an overhead traffic camera shows him stepping in front of a semi-truck slowing to keep from striking him. Then he is hit by a van and thrown 50 feet into a ditch.
A psychologist who later examined him said Uddin was experiencing "an acute, significant, psychotic break." The psychologist took the unusual step of criticizing the VA for not admitting him or giving him medication and called the VA's lack of action "perplexing."
"I'll take responsibility for it," Uddin says now of the morning last year that changed his life. "But light needs to be shed that things could have changed."
The U.S. Department of Veterans Affairs is facing unprecedented demands on its mental health system. Like Uddin, about one of every three soldiers returning from Iraq was seen in a VA facility for mental health treatment within a year of returning.
Nationally, there is growing concern that the VA is failing its mission. It's facing criticism for staffing shortages and delays in seeing veterans worried about their mental state.
"There is a serious systemic problem with access to mental health care," said Patrick Bellon, executive director of Veterans for Common Sense, which sued the VA for how it handled access to its mental health programs. "If you are in a serious mental crisis, two weeks might as well be forever."
Asked to respond, a spokesman for the VA in Washington provided a two-page summary of actions the department has taken, including increasing mental health staffing levels from 14,207 in 2006 to more than 21,000 currently and increasing screening to identify veterans who may have depression and alcohol misuse, or who have experienced military sexual trauma.
Still, a federal appeals court in San Francisco last year criticized the VA system's handling of mental health care and disability benefits, accusing it of "unchecked incompetence." It ruled that massive delays in veterans being given mental health assessments and care represented a violation of their rights to due process.
The Department of Veterans Affairs inspector general opened an investigation last year into the death of an Iraq war vet who stepped in front of a train three days after being turned away from a VA hospital in Palo Alto, Calif. In Lexington, Ky., the widow of a Marine veteran filed suit last year, claiming two VA facilities refused to provide her husband psychiatric help hours before he took his life.
Even within the VA, where more than 1.25 million veterans were treated in 2010 in a specialty mental health program, a survey last year found 70 percent of VA health care providers say they don't have adequate staff or space.
At the Minneapolis VA, mental health hires have increased 17 percent over the past five years, while the number of veterans seen by the mental health unit have risen 19 percent. Its 24-bed, in-patient psych ward averages using 10 beds and has not been full.
Instead it tries to use outpatient and other mental health resources, said Dr. Michael Dieperink, the hospital's director of mental health services. "We've never had to have a veteran who needs hospital admission have to go find a bed in the community," Dieperink said. He stressed that anyone who walks in seeking help for mental health is seen the same day, either at the clinic or in the emergency room.
Dieperink declined to discuss Uddin's case, despite a waiver from him. A VA spokesman said Uddin's case file would speak for itself.
Interviews with people involved and a review of hundreds of pages of documents, including Uddin's VA medical records provided to the Star Tribune by Uddin, show the consequences of a lost opportunity to intervene.
For the 31-year-old global studies student at the University of Minnesota, the incident stands to irreparably alter the plans he had for his life. He considered going to law school and wanted to pursue a specialty in Arab languages in the military. Now he faces four felony charges for robbery and theft and a discharge from the National Guard, which threaten his VA health and education benefits.
Uddin, who was born in St. Louis Park and grew up in Minnesota and western Wisconsin, joined the Wisconsin National Guard while still in high school. "I wanted to be a member of a team -- an elite organization."
He was deployed to Iraq from 2004 to 2005 and from 2009 to 2010, when he worked maintaining communications equipment. There were rocket attacks and indirect enemy fire at bases where he was deployed.
But he doesn't believe his experiences in a combat zone contributed to his problem, and he has not been diagnosed with post-traumatic stress disorder. Instead, in the weeks before he went to the VA for help, he felt increasingly anxious from two weeks of missed classes. He had just returned from an intensive eight-week language course in California and was facing a weekend of Guard drills and three weeks of make-up Guard duty.
On that August Friday, Uddin said he packed a bag, sure he would be admitted, and sat for hours in the parking lot of the Minneapolis VA, worried how seeking mental help would affect his military career. He was later asked if he was feeling suicidal. "No," he would tell a doctor. "But I didn't want it to get to that point."
The VA's notes on the visit describe Uddin as hearing voices, suspicious of others and believing he was possibly clairvoyant. He was given instruction about the onset of psychotic symptoms and stress management and was told to come to the emergency room if his symptoms got worse. Doctors' notes said he denied feeling suicidal but was anxious about upcoming Guard duties.
Doctors contacted his unit with a request that he be excused from weekend drills. His commander agreed but said Uddin would be expected to show for the three weeks of makeup duty.
"The veteran did not want medication fearing that it would negatively impact his professional [military] standing," the VA's notes said. The visit lasted from 4 p.m. until 6:12 p.m.
Uddin reported to the armory in Eau Claire on Monday. Still unable to sleep that night, scared something was going to happen to him, he retreated to one place he knew people would be in the middle of the night: Wal-Mart. After an hour walking the store, he sat in the parking lot before deciding he needed to go back to the VA hospital. He left a note for his commanding officer and drove back to the Twin Cities. That act, considered absence without leave, is why he is facing possible discharge, he said.
Frantic on a highway
Uddin's recollection of what happened next is pieced together from police reports, doctors notes and traffic camera video. He remembers making coffee at his apartment. He would tell doctors he believed agents were coming for him because he had lied on a security application. The voices told him he was going to be raped as punishment. Another voice told him to run.
Bypassing the ease of his front door, he climbed out the window of his Inver Grove Heights apartment, ran past his own car and headed toward the parking lot of the Inver Hills Community College. He remembers getting into a car and driving.
He had actually tried to steal two cars in the parking lot that morning. But one driver accelerated and Uddin kept hanging on to the car as he drove away. A woman putting her books in her backseat looked up to see Uddin sitting in the driver's seat. He told her: "I had to do this."
Minutes later, Uddin pulled her car onto the side of Hwy 52. Video shows his next frantic two minutes as he grabs at several passing cars in the northbound lane, then hops the median, running in front of four oncoming cars before stepping in front of the slowing semi. Uddin then jumps back into the center lane, where a van, swerving to try not to hit him, knocks him 50 feet. He broke several ribs and his right shoulder.
Uddin remembers a voice telling him to dive in front of a car because it was his only chance of not being captured.
"I remember trying to just get in front of a car, and when it missed me, I was upset," he said. "I think I was trying to kill myself."
Uddin faces trial in July for the carjackings. He was evaluated by a court-approved psychologist, who determined that he shows signs of schizophrenia and that he should not be held legally responsible for his actions that day. The psychologist, Ernest Boswell, also was critical of how the VA initially handled Uddin.
"It is somewhat perplexing to this examiner that more consideration was not given to an inpatient plan or more time devoted towards helping the defendant understand the advantages of taking anti-psychotic medication that evening," Boswell wrote in a 24-page evaluation. "If Mr. Uddin had been started on appropriate medication, the events of 8/23/11 would likely have been attenuated, if not prevented."
John Baker, Uddin's attorney in the criminal case, said Uddin's situation is similar to the 2007 suicide of Iraq war veteran Jonathan Schulze, which prompted criticism of the St. Cloud and Minneapolis VA. Schulze's death initiated reforms in the VA's suicide prevention programs.
"If you peel away the layers, nothing has really changed," Baker said.
A month after Uddin's incident, Dr. Charles Dean, a psychiatrist at the VA who saw Uddin that initial Friday, wrote an addendum to the original report. While Uddin "seemed a bit irritable at times" and was hearing voices, the doctor said there was no signs of "conceptual disorganization" or suicidal behavior.
"In our interview there was no evidence that such events would transpire, other than the stress he was feeling," Dean wrote.
Uddin, who has completed a VA outpatient mental health program after experiencing another episode, takes responsibility for what he did that day, but also believes his unit commanders in the Guard should have been more sympathetic and the VA more proactive.
"The military has this big thing where they say they're trying to fight the stigma of mental health," he said. "They say it takes the strength of a soldier to seek help for mental health. Well, I did that."
Mark Brunswick • 612-673-4434