Asheville’s mental health support for area veterans

The 20 years that Kevin Mahoney served in the U.S. Air Force might sound like a dream deployment for some.

Mahoney, who lives in Asheville, joined at 24 and trained as a cryptolinguist in Arabic and Farsi. The Air Force deployed him to the Middle East and the Persian Gulf. He was able to travel extensively, and he says his bags were always packed. The job — monitoring and translating messages to gain military intelligence, which afforded him security clearance  — involved an incredible amount of pressure.

The Air Force honorably discharged Mahoney on Sept. 17, 2000, and he returned to his wife in Augusta, Ga. “Things were great for about two months,” he says. And then his adjustment to civilian life turned south.

“When I came out, I was not a well person,” Mahoney explains. “Within two years of discharging, I was homeless. I had lost my marriage, lost family.”

Depression that began during his service deepened in civilian life. He couldn’t sleep; he was hypervigilant. (Today, he recognizes those behaviors as symptoms of post-traumatic stress disorder.) Mahoney self-medicated by abusing his four prescriptions for psychiatric drugs — a mix of antidepressants, benzodiazepines, sleeping pills and stimulants — as well as illicit substances.

“I was a shell living in a shell,” he says. He survived two attempts to take his own life.

Without stable housing for four years, Mahoney squatted, sometimes forgoing electricity. He’d hoped to gain  employment in the defense industry, but his mental health struggles made security clearances difficult. He couldn’t hold a steady job. “I spent four years in the wilderness, basically, homeless and destitute,” he says.

Although he recalls the sharpest contours, like abusing drugs and being unhoused, this chapter of his life mostly remains a question mark. “I don’t remember a lot of it, to be honest, because I was so deep in depression, PTSD and insomnia,” Mahoney says.

Following years of living on the streets, in 2005 Mahoney began his “discovery” — he prefers the word to “recovery,” as it means gaining self-knowledge — and took a new direction in his life. He moved to Western North Carolina in 2008 and began working in community crisis support. Today he’s living a different dream, working as a peer support specialist at the Asheville-based Mountain Area Health Education Center. He primarily works with people without housing.

Among his roster of clients are four veterans.

‘You’re supposed to be tough’

Although Mahoney’s experiences are extreme in some ways, other veterans have shared his struggles.

And many older vets haven’t been aware of the long-term ramifications of psychological trauma related to their service, nor has there been encouragement to explore the topic.

“Talking about your mental health issues related to military service is not welcome, no matter what they say about it,” says Bruce Carruthers of Waynesville. “You’re supposed to be tough and macho and not supposed to discuss what these experiences have done to you.” Among Vietnam veterans like him, 30% are estimated to have had PTSD in their lifetime, according to the U.S. Department of Veterans Affairs.

Moe Davis, a retired Air Force colonel who lives in Asheville, says when he joined the military in 1983, a referral to mental health services was stigmatizing and could be used punitively by higher-ups — “more to shame the individual than to try to get them help,” he says. He recalls the slur “nutjob” being used. By his retirement in 2008, however, Davis says the military “did a better job of recognizing there are scars you don’t see.”

Previous generations spoke of soldiers experiencing shell shock or battle fatigue; today, the mental health community has a greater understanding of PTSD. Says Tim McElyea, director of the Veterans Restoration Quarters at Asheville Buncombe County Community Christian Ministry, “Especially if you’re a combat veteran, that’s not a natural circumstance you’re put in … and you have to cope with that.” (McElyea was deployed in combat in Operation Desert Storm, serving in Kuwait and Saudi Arabia.)

And Heath Smith, who served in the Marine Corps infantry from 1999-2004 and currently directs Buncombe County’s Veterans Services, agrees that today’s military is more educated about risks to mental health. Leaders also provide more education to the troops: Before his discharge, he recalls attending a weeklong class about reviewing his veteran benefits and how to access mental health services.

Asheville’s Department of Veterans Affairs hospital, the Charles George VA Medical Center, offers multiple avenues for mental health support. Its behavioral health department has an outpatient clinic providing psychiatric and psychological treatment, including services for families and couples. An inpatient psychiatry unit focuses on treatment of serious mental illness, such as bipolar disorder and schizophrenia. That unit works closely with the VA’s Psychosocial Rehabilitation and Recovery Center, which helps veterans develop skills to live good lives while experiencing serious mental illness.

The Charles George behavioral health team includes social workers, clinical pharmacists and peer support specialists, and a monthlong treatment program is available for those with substance abuse disorders. The VA website notes that all VA health care facilities offer same-day help for behavioral health, and veterans may even qualify for services without enrolling in VA health care.

But Smith suggests that military culture at large still needs improvement. “Veterans of my generation, there’s probably a little bit more access to that care,” he says. Particularly in the all-male infantry in which he served, however, “there’s still that stigma around it. … You suck it up and you move on.” The VA reports that up to 20% of veterans from operations Iraqi Freedom and Enduring Freedom experience PTSD in any given year.

And tragically, PTSD is associated with a higher risk of suicide, a problem particularly prevalent among veterans. Over 17 veterans per day died by suicide in 2019, according to the VA, and the suicide rate among veterans was 50% higher than in the general population.

Bucket lists

Mahoney lived near Fort Gordon in Georgia after his deployment, but he didn’t turn to its VA services for help. The VA there wasn’t forthcoming with assistance either, he says. As a result, he felt isolated and disconnected. (He remains unconnected to VA services today, he says.)

In some ways, his experience is the opposite of what veterans tell Xpress is the case in WNC. Buncombe County is home to 18,000 vets, says Smith. He suggests that the comparatively high number of veterans in an area without a military installation — at roughly 8.2% of adult residents, Buncombe’s veteran population exceeds the national average of 7% —  is due to the popularity of the Charles George hospital.

Charles George is the largest facility in the WNC VA Health Care System, which also comprises the Franklin Community Based Outpatient Clinic, Hickory CBOC and Rutherford County CBOC. Altogether, more than 46,000 veterans use the WNC VA’s services, says Vance Janes, a spokesperson for the system.

The hospital was consistently rated a four- or five-star facility in federal assessments prior to the elimination of the ratings system earlier this year. Charles George ranked particularly highly in patient satisfaction and wait times. “Folks drive past their VA hospitals a lot of the time to come to ours,” says Smith.

Carruthers, the Waynesville Vietnam vet, uses Asheville’s VA for treatment related to his service-connected permanent disability, a cardiac condition resulting from his exposure to Agent Orange (a toxic herbicide the military sprayed in Vietnam, Laos and Cambodia from 1961-71). He says the care at Charles George is as good as or better than the private health care he received after a cancer diagnosis in 2014.

“All the providers who run the VA are trained in issues that veterans have,” says Carruthers, who retired about a decade ago after 30 years working  at VA facilities around the country. “They know how veterans feel about things. A mental health provider will understand the reluctance of someone coming back from Iraq or Afghanistan to talk about it.”

Listening to what veterans say they need is crucial, says Elizabeth Lima, chief of Whole Health Service at Charles George VA. Her team’s strategy, she explains, is to “[expand] the conversation from ‘what’s the matter with you?’ … to ‘what matters to you?’”

Diabetes, chronic pain, PTSD and chronic obstructive pulmonary disease are the top issues Lima’s patients face.  But coaching veterans to look at the bigger picture beyond health alone, she continues, is the start of making positive lifestyle changes.

“What’s on your bucket list?” Lima asks veterans. Their responses are usually what she calls “the four Gs”: grandchildren, going places, God and golf. Most patients at Charles George VA are 60 years old and older, she says, and the promise of ticking items off their bucket lists is key to setting goals like smoking cessation or dietary improvement.

Experiences within the VA system vary based on a veteran’s income, disability and other factors. Smith, who says he refers 90% of the calls he receives at Buncombe’s Veterans Services to the Charles George VA, says that  veterans are frequently unsure about their eligibility for benefits. “Whether they’re a peacetime veteran or a combat veteran,” he says, “they should always contact our office. It can’t hurt to check in on what you may be eligible for.”

‘Take care of us’

Occasionally, Mahoney says, he misses the adrenaline-packed chapter of his life in the military. “I get really nostalgic — almost a physical longing for it sometimes,” he recalls. But he reminds himself how good his life is now: a job he loves, an apartment, a cat.

Today he says he no longer takes psychiatric medications. His depression and PTSD haven’t manifested in several years, and he cares for himself by practicing Pilates and yoga, going for long walks and listening to spiritual podcasts, like “On Being” by Krista Tippett.

There is no one-size-fits-all approach to veterans’ health care, and it can take the proverbial village: a composite of VA care from the professional medical community, nonprofits like ABCCM, peer support specialists like the role Mahoney holds at MAHEC and 12-step groups.

“I appreciate your thanks,” Mahoney says, with regards to appreciation for his service. “But take care of us, rather than just thank us.”

If you are a veteran in crisis, or concerned about one, the Veterans Crisis Line at 800-273-8255 is free, anonymous, confidential and staffed by VA professionals.