A veterans mental health clinic in Mililani is looking to change how veterans and their families come home from war.

The Steven A. Cohen Military Family Clinic at Child &Family Serv­ice in Mililani is trying to reach veterans who have traditionally been unable to access care, as well as put an emphasis on caring for families.

It’s part of the Cohen Veterans Network of Clinics started by billionaire hedge fund manager and New York Mets owner Steven Cohen, whose son enlisted in the Marine Corps and fought in Afghanistan. Though he returned unwounded and without major mental trauma, he told his father there was a crisis of mental health among veterans and their families.

The network officially launched in 2016 with four clinics and has since grown to 21. The Mililani clinic opened in September 2020. Though the network will see veterans of any conflict, its focus is on those who enlisted after the Sept. 11, 2011, terrorist attacks.

“The reason why we focused on post-9/11 veterans is we don’t want to wait until they become homeless or unemployed or destitute or chronically mentally ill or struggling with substance use,” said Dr. Anthony Hassan, a veteran who serves as CVN’s president and CEO. “Trying to get upstream on this was really important to (Cohen).”

Unlike the Department of Veterans Affairs, CVN clinics accept veterans who left the military with a dishonorable discharge or “other than honorable” discharge — known as “bad paper.” These veterans often struggle to access benefits. The clinic also will see individuals who may not have been able to complete training due to injuries or other reasons and who would not normally meet the legal definition of a veteran.

“If you serve one day in the military, regardless of your discharge status, regardless if you deployed or not, you served this country. You raised your hand, you wanted to give back and so we want to give to you,” Hassan said. “We wanted to make sure that they didn’t fall through the cracks just because they maybe had a bump in the road.”

During his time in the military Hassan served in both the Army and Air Force, including deployments to Iraq. As a mental health officer, he eventually oversaw large-scale military substance abuse and family advocacy programs in the Pacific.

He told the Honolulu Star- Advertiser that in the years since leaving the military he’s had a chance to reflect on mistakes the military made in misdiagnosing and even punishing troops struggling with mental illness, including the ways he himself may have contributed.

“Maybe I ended up administratively separating someone when they should have been medically boarded,” Hassan said. “Maybe their negative behavior was a result of PTSD or depression, maybe their drug use was a way to cope with their nightmares and trauma.”

Oahu is unique in having bases from each military branch as well as a large number of residents who are veterans, both transplants and kamaaina. Since opening, the Mililani clinic has seen over 700 patients.

“I expect this to be one of our busiest clinics where they’re seeing 1,000 to 1,200 patients a year,” Hassan said. “I worry that we got to keep up with that demand. But we’ll work on it. We’ve got resources. We’re not going anywhere. We’ve invested a lot already.”

The post-9/11 generation is smaller than previous generations of veterans due to its all-volunteer nature.

Until President Richard Nixon put an end to the draft in 1973, any adult male in America or its U.S. territories could be called to serve. But ever since the military has increasingly drawn recruits from intergenerational military families, fewer Americans have personal connections to overseas conflicts, ties to service members or knowledge of military life.

Veterans of recent wars have reported particular difficulties integrating into society and feeling as if the country was apathetic about the wars they fought.

Straddling the divide between military and civilians have been National Guard troops and reservists. Both the federal government and state governors have used National Guard units for everything from fighting in overseas conflicts, natural disaster response, search-and-rescue operations and emergency pandemic services.

Janet Covington, director of the Mililani clinic, said the strain has isolated citizen- soldiers who struggle to explain their experiences to friends, neighbors and coworkers who lack military experience.

“They came back to a community that didn’t really understand what deployment meant, they didn’t really understand what the needs of that person were,” Covington said. “They went back into their regular full-time job doing something very different from being in war.”

Covington said another unique factor for post-9/11 veterans has been the number who make it home.

Recent conflicts pale compared to previous wars in the number of deaths, in part due to medical advances. Veterans of recent conflicts saw intense combat and at times survived injuries that veterans of previous wars would never have survived.

“You have major chronic pain from injuries that were sustained, a lot of (traumatic brain) injuries that can affect behavioral health,” Covington said. “This is a lot of combination of injuries that really do impact the well- being of these veterans.”

A MAJOR emphasis of the clinic is getting family members of veterans involved in treatment.

“We identify with the entire family because we believe that if we can get in front of the family, there’s a good chance we’re gonna get the veteran in the door as well,” Hassan said.

In Hawaii, that means an awareness that a veteran’s ohana may not look like a traditional family.

“A family member is anybody who the veteran says is a family member,” Covington said. “In Hawaii we have hanai relatives … ; if the veteran says ‘this is a family member, they’re important to me and they need help,’ or ‘we as a family need help,’ (then) they’re a part of the group that we’ll help to support.”

Operating in Hawaii has other challenges. Rent is incredibly expensive and the high cost of living puts strains on staff and patients alike.

The clinic uses a mixture of health insurance reimbursements as well as grants to pay for treatment for patients who can’t get coverage. Hassan readily says the clinic is a money- loser and that it can function only due to Cohen’s funding.

“No business in outpatient mental health care could survive in Hawaii (or) in most of America, and that’s why we have a mental health crisis in America today,” he said. “It’s a perfect storm and we’re trying to calm that storm by being present in Mililani.”