THE HOMELESS FRONT


The Oklahoma City VA Medical Center, one of the larger Oklahoma City organizations dealing with the homeless, reported that Iraq and Afghanistan veterans now make up almost 20 percent of the homeless veterans they serve
story by Juliana Keeping
photos by Chris Landsberger

At the height of his Army career, Tulsa native Titus Jacobs traversed hostile Baghdad streets, updating complex maps used to guide U.S. military assaults.

Injured in a bomb blast and haunted by a close-range firefight on a crowded street, the staff sergeant returned home from that 2004-05 deployment a different person.

By 2012, the preacher’s son with a linebacker’s build, always quick with a joke and a story, could no longer shake the demons of war. He spent nights in his car in Walmart store parking lots.

Thirteen years after America went to war in Afghanistan, and later Iraq, the number of veterans from those two conflicts now living on the streets is beginning to surge.

Locally, the Oklahoma City VA Medical Center, one of the larger Oklahoma City organizations dealing with the homeless, reported that Iraq and Afghanistan veterans now make up almost 20 percent of the homeless veterans they serve. It’s a sharp increase from 2012 when such veterans represented just 9 percent of those seeking services at the VA.

Lenny Vile, the director of the center’s homeless program, said his office worked with 188 Afghanistan and Iraq veterans in 2013, up from 88 in 2012.

Dan Straughan, director of the Homeless Alliance, another large Oklahoma City organization working to end homelessness, considers the rising numbers of those seeking help a harbinger of even greater homelessness to come among the estimated 2.5 million veterans who served in Iraq and Afghanistan.

“We’re on the very front end of that wave, and that’s what we’re worried about,” Straughan said.

A 2013 study by the U.S. Department of Veterans Affairs found that as many as four percent of post-9-11 veterans could find themselves homeless within five years after leaving service.

Experts attribute the recent rise, in part, to the nature of injuries suffered by many Iraq and Afghan veterans. Those include the invisible wounds of traumatic brain injury and post-traumatic stress, which can go undiagnosed for years. Between 10 percent and 20 percent of Iraq and Afghanistan vets have suffered a brain injury, according to the advocacy group Iraq and Afghanistan Veterans of America. Traumatic brain injury is thought to worsen the effects of post-traumatic stress, another malady that the VA estimates afflicts 11 percent of Afghanistan veterans and 20 percent of Iraq veterans.

Today, Jacobs, 40, lives in an Oklahoma City apartment paid for through the VA. He is working to start anew after fighting the effects of post-traumatic stress and a worsening brain injury that smothered the life he once knew. War took his marriage, his home and hurt his relationships with his four children. It took homelessness for him to fully address the depth of the problems threatening to snuff him out.

“It was a wake-up call,” Jacobs said.

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Soldiering on

Jacobs grew up hardscrabble in north Tulsa, “’cross the tracks,” he said. The son of a Baptist preacher and a homemaker, the family struggled financially. Jacobs said he and his brother learned to fend for themselves at a young age to keep from going hungry. The Army was a way out, a way to get paid, a way to dine on “Uncle Sugar’s dime.”

“What drew me to serve? I like to eat,” Jacobs said, laughing.

He enlisted in 1992. He married his high school sweetheart. He served in combat units, moving his family to a new post every few years and deploying to South Korea and Bosnia. When home, he loved to hunt and fish and take his kids to carnivals, fairs, the beach and sporting events.

In 2004, he landed at Fort Bragg in North Carolina, which Jacobs said molds a man to believe he is invincible, that nobody but God is greater and that the body can do anything the mind wills.

“I believed all the hype,” he said.

From there, he deployed to Iraq with the 18th Airborne Corps.

On his second day in country, seconds after Jacobs stepped out of a trailer that served as his living quarters to use the restroom, a rocket-propelled grenade destroyed the trailer.

The blast damaged major nerves in his back, tore cartilage in his shoulder and left Jacobs with a traumatic brain injury that would go undiagnosed for years.

Drawing upon the tough-guy Army mentality he had always embraced, he popped Motrin like candy and soldiered on.

During his tour, Jacobs was part of a small team who traversed Baghdad and other cities throughout Iraq completing topographic surveys of critical infrastructure and updating military maps. Small arms fire, mortar attacks and improvised explosive devices were part of the work day. Still, he loved the job. He was good at it.

Titus Jacobs finishes getting ready before leaving to go to the Veterans Affairs Hospital in Oklahoma City.

“If I said it was there, you best believe it’s there,” he said.

But, over time, that first blast took a toll. Jacobs said his mind seemed to slow down. He couldn’t think as clearly as he had before. Tasks he’d always completed with ease — like writing daily reports — became drudgery.

“I used to hop and pop,” he said. “I’d do a lot of calculations. I could turn angles in my head. After I got blown up — you might ask me what two plus two was. I’ll give you an answer. It just might be a delayed reaction.”

Fighting words

Months into his deployment, Jacobs was beginning to slip. Then, he collapsed.

He was in a soldier’s face, chewing him out, when Jacobs said he felt himself fall. A soldier mistakenly yelled that Jacobs had been shot.

Jacobs said it was like his mainframe had malfunctioned; He’d gone blank. He could think, but nothing else worked.

“That’s what happens to me sometimes. If I get stressed out or overexcited, I short out,” he said.

The Army sent him home to Fort Bragg to recover from his back and shoulder injuries. His commander also saw that Jacobs showed symptoms of PTSD — he was on edge, withdrawn and emotionally numb. But when the commander ordered Jacobs to meet with Army psychologists, Jacobs said he was offended.

Despite efforts by the military and the VA to reduce the stigma associated with mental illness, denial and shame surrounding conditions like PTSD and depression are still deeply ingrained in the military culture.

Experts attribute the recent rise, in part, to the nature of injuries suffered by many Iraq and Afghan veterans. Those include the invisible wounds of traumatic brain injury and post-traumatic stress, which can go undiagnosed for years.

“The stigma of going to see a psychiatrist or psychologist — you just didn’t do that in the military,” Jacobs said. “If you were labeled crazy, they made you pay.”

Jacobs rejected the idea that he had PTSD or was disabled. His traumatic brain injury was still years from being diagnosed. In time, traumatic brain injury would be recognized as the signature injury of the wars in Iraq and Afghanistan. Given that brain injuries often are incurred in traumatic experiences, the two often coexist. People suffering from both conditions can be hard to diagnose because so many symptoms, such as anger, irritability and depression, can overlap. Only in recent years has research focused on the intersection of the two injuries and recent studies suggest that traumatic brain injury can increase the potential for post-traumatic stress disorder, according to the National Institutes of Health.

Jacobs didn’t know any of that. If he had, he would have tried to shake it off rather than address his deepening problems, he said.

“Disabled — that was a fighting word,” he said.

Army doctors felt differently.

In 2006, Jacobs received a medical discharge. His Army career was over.

Hitting bottom

In the civilian world, Jacobs soon got a job at the U.S. Postal Service. He delivered mail, but struggled with the work and sometimes found it overwhelming.

He started drinking to cope with the stress.

“I was screwing up bad,” he said. “My supervisor should have fired me. She had mercy.”

Depression and substance abuse — common among soldiers returning from deployment — are major contributors to homelessness and suicide, said Terry White, the director of the state Mental Health Department.

Jacobs walks down the hall way at the Veferans Affairs Hospital in Oklahoma City as he attends his PTSD group counseling.

Although they represent only about 8 percent of the state’s population, veterans account for a quarter of all suicides in Oklahoma. Veterans also are overrepresented in the homeless population. The stigma surrounding mental illness is especially troubling because the longer veterans wait to seek treatment, the harder those conditions become to treat, White said.

Eventually, Jacobs left the Postal Service job.

At home, the once-outgoing Jacobs isolated himself. No longer able to tolerate crowds, he lost interest in the things that once brought him so much joy — like being outdoors and going places with his children.

“All of my interests changed,” he said. “I began to be withdrawn.”

Still, he wanted to contribute. Jacobs took a leadership role at a large nonprofit that ran community programs to address hunger and poverty, experiences that shaped his youth. But the stress made his post-traumatic stress disorder and brain injury symptoms worse.

Night terrors were frequent. He didn’t want to leave the house. Jacobs was emotionally numb, so much so that when people closest to him died, like his best friend, who died in an Iraq bomb blast, he couldn’t bring himself to cry.

In 2006, Jacobs went to a VA Health Center near Fort Bragg for help. There, he encountered bureaucracy and missteps that he said delayed treatment. Then, between 2006 and 2011, doctors prescribed Jacobs as many as 21 medications at a time. It wasn’t until the family moved to Macon, Ga., and he sought help at a different VA facility that Jacobs said doctors noticed that six prescriptions were for the same medication.

It was in Georgia, in 2011, six years after his return from Iraq, when a different VA care team sent him to an inpatient treatment program and diagnosed him with a traumatic brain injury, he said.

Over time, that first blast took a toll. Jacobs said his mind seemed to slow down. He couldn’t think as clearly as he had before. Tasks he’d always completed with ease — like writing daily reports — became drudgery.

It was also in Georgia that his wife, after 19 years of marriage, told Jacobs she couldn’t take it anymore and filed for divorce. Jacobs holed up in a condominium across town, lost track of the days and stopped paying his bills. Evicted, he occasionally stayed in hotels, but mostly lived out of his car, parking at Walmart stores overnight and taking “bird baths” in the stores’ restroom sinks.

He tried to enroll in a veterans homeless program, but found it had a two-year waiting list. He couldn’t wait that long.

Jacobs had lost 40 pounds by the time a fellow veteran invited him to stay in a spare room at his house.

“If he hadn’t scooped me up, man … ” Jacobs shakes his head. He doesn’t finish the sentence.

He sobered up.

“I was broke,” he said. “Alcohol costs money. I had to ask myself, ‘Would you rather eat or drink?’ I chose to eat. Me and food been friends for the last 40 years.”

After 20 years away, it was time to come home to Oklahoma. Army pension money paid for the move.

In early 2013, he arrived in Midwest City to stay with his father.

Digging out

Soon after, Oklahoma City VA Medical Center staff helped Jacobs find a home through a program that provides homeless vets with a housing voucher and long-term intensive care, including inpatient treatment programs that Jacobs said allowed him to finally address the full range of war-related problems in his life.

“They shake the nest to see how many demons you got,” he said.

In one type of therapy, for example, he told of an incident during his deployment over and over. He wrote it down. He recorded and listened to it. The retellings drew out memories and emotions he’d suppressed for years. He couldn’t stop crying — for the friends he lost, the things he saw. He cried for the death of his best friend, his mother, brother, grandmother and favorite aunt. His night terrors worsened. Everything was coming back. It had to, so he could finally move forward.

“It broke the ice,” he said. “Then, pretty much, unthawed everything, allowed it to float to the surface.”

At 6:30 a.m. on a recent Thursday, Jacobs readies for a group session with about a dozen other Iraq and Afghanistan veterans suffering from post-traumatic stress. He irons a shirt in his home office in his small, tidy northwest Oklahoma City apartment. He keeps his medications in a small kitchen cabinet, pill bottles stacked two high. When he takes medications each day, he starts at the top right and moves counterclockwise. On occasion, he still suffers the symptoms of his injuries. He’ll write a check, put it in an envelope to be mailed and then forget about it for weeks.

He leaves two hours early for his 9 a.m. therapy appointment. Before parking at the VA Medical Center, he circles the facility once, checking for potential threats, just like he did during his deployment. It makes him feel safe. He does the same thing, he said, before he parks to shop for groceries or other appointments. He used to circle the VA three or four times, he said. He’s proud he’s got it down to just once.

“I’m always late,” he said.

In the canteen, Jacobs orders two platters of biscuits and gravy and jokes with a cafeteria worker. The second plate isn’t for him, he tells her. It’s for a friend — in case she got the wrong idea.

That friend is a young Iraq vet who has just completed a three-month in-patient treatment program.

Over breakfast, Jacobs feeds the young veteran information he wished he’d had when he started looking to the VA for help. What to get first, who to see, who to avoid — how to utilize the system.

“You got things workin’ for you man, you gonna be OK,” Jacobs tells the man. They share a laugh and a handshake. “Just listen to what I’m telling you.”

After the morning’s appointments, it’s time for school work. Jacobs is enrolled in a professional studies program for network management at Southern Nazarene University in Bethany.

That evening, students discuss management techniques. Jacobs sits at the ready with a high-tech pen that records the lecture and transfers notes electronically to his new laptop.

Post-It notes, gel pens and highlighters are neatly arranged in a black case. He is a lively contributor to a discussion about paradigms — the models, patterns and shared assumptions that shape our view of the world.

Service members who return from war face “paradigm paralysis,” Jacobs tells the class. They struggle to adjust to rules of the civilian world.

Before parking at the VA Medical Center, he circles the facility once, checking for potential threats, just like he did during his deployment. It makes him feel safe.

“It’s hard to adapt,” he says. “A lot of guys go into that paralysis. They start digging in.”

Jacobs is digging himself out.

His experiences are emblematic of the newest homeless veterans. They may sleep on the couches of family and friends, stay outside or in a car, or patch together some combination of shelter that doesn’t include a permanent mailing address. They grapple with depression, substance abuse, post-traumatic stress and, in some cases, the lingering effects of a traumatic brain injury. Some veterans are unable to stop moving; life has become a never-ending patrol.

The new homeless veteran is on U.S. soil, but may feel they’ve never really returned from war.

Almost a decade after his return from Iraq, Jacobs only now is beginning to feel at home.

Sitting at his dinner table, facing his apartment door as he always does, Jacobs said he is grateful.

Why?

He takes deep breaths in and out.

“At the end of the day, as long as I can do that, I’m good to go,” he said.

He recently began a job helping homeless veterans at VA Hospital.

“I’m at a place right now where I’m learning to accept what happened,” he said. “I’m learning to accept how they treated me. I don’t want to reopen wounds. I feel like I’m healing. For right now, I’m just happy to be alive, to know I can pick up the phone and call my kids, and know I can go see them whenever I want to.”

“I got my life. I’m living. I walked away.”