LEWISTON — Bruce Morris, an Iraq War combat veteran with 21 years in the Maine National Guard, is a little on edge these days.
So are dozens of his brothers and sisters in arms as they ponder the circumstances that led to the death of Justin Crowley-Smilek, who was shot by a police officer last month in Farmington.
Crowley-Smilek, a U.S. Army Ranger who was disabled in Afghanistan in a 30-foot fall from a helicopter was bipolar and — according to his friends and family — suffering from post-traumatic stress disorder.
He was shot and killed by Farmington police officer Ryan Rosie on Nov. 19 after Crowley-Smilek confronted Rosie with a knife outside the Farmington police station, police have said.
Morris said he attended group counseling with Crowley-Smilek at the Lewiston Veterans' Center. Morris considered Crowley-Smilek a friend.
Those working to manage their own war-related issues have been left questioning how things went so tragically wrong and what can be done going forward to keep other combat veterans from facing similar fates and circumstances, Morris said.
"How is this allowed to happen?" said Morris, 40, a Poland resident and Edward Little High School graduate.
He said that besides not knowing all of the details of what went down the morning Crowley-Smilek was killed — the shooting remains under investigation by the Maine Attorney General's Office — vets know they may never get the full truth behind his death.
"Every story has two sides to it," Morris said. "But in this case, one side is dead and we will never know that side."
More than anything, Morris said, he wants to raise awareness of the difficulties combat veterans, especially those with mental health problems, face as they try to regain their civilian lives.
Morris is not alone. Others, including law enforcement leaders, state lawmakers and mental health experts seem to agree that more must be done to better prepare Maine's communities for increasing numbers of combat vets returning home as the wars in Afghanistan and Iraq wind down.
20 percent screen positive for PTSD
According to a widely cited 2008 Rand Corp. study, nearly 20 percent of Iraq and Afghanistan veterans screen positive for PTSD after returning from combat. Veterans who have served multiple tours increase their chances of developing PTSD with each tour, according to a 2009 report issued by Iraq and Afghanistan Veterans of America.
The final report of the President's Commission on Care for America's Returning Wounded issued in 2007 revealed "56 percent of active duty, 60 percent of reserve component and 76 percent of retired or separated service members say they have reported mental health symptoms to a health care provider."
In Maine, an estimated 39,000 veterans are receiving medical care from the Veterans Affairs department.
Of them, 9 percent (3,500) have a primary diagnosis of PTSD, while another 3 percent show PTSD as their secondary diagnosis. That means 12 percent (4,680) of veterans are being treated for PTSD as either a primary or secondary ailment, according to Jim Doherty, a spokesman for the state's primary VA hospital at Togus.
Doherty said the Togus hospital has three people administering that caseload and getting those individuals connected to the right mental health care providers.
He believes Maine has the capacity to handle the treatment needs of its vets with PTSD, but a bigger issue may be the vets who are not seeking treatment, Doherty said.
Many don't seek available help
Outreach to them is often challenging because of the stigmas attached to PTSD and mental health issues, he said. Many veterans who could benefit from treatment don't ask for it, Doherty said, but the VA system is designed around the vet first asking for care.
Not all veterans with symptoms of PTSD need intensive case management, Doherty said, adding that the VA does a lot of outreach to veterans, including sending a pamphlet describing services to every veteran who has returned to Maine from a war zone.
The pamphlets come with a letter from the governor welcoming veterans back home, he said. That service began in 2003 or 2004.
Troops are also debriefed upon their return home, and a big part of the debriefing focuses on recognizing the problems associated with returning to civilian life after time in combat, Doherty said. He said they are encouraged during those debriefings to share the information with others.
Vets still frustrated with VA
Still, Morris said, accessing the care vets need via the VA is often challenging and frustrating. Calls to the VA usually result in being patched through a confusing automatic phone tree, "and more often than not you get a voice mail," he said.
He said for a vet in crisis looking to talk to someone other than a 911 dispatcher or a suicide-prevention hot-line worker, that only adds to the anger and frustration that comes with PTSD.
Visits to Togus often are not any better for him, he said. Signs on walls tout the focus on the veteran, but Morris said he feels like little more than a number. "And I could have a trail of people tell you the same stories."
Vietnam vets have been dealing with the frustration for 40 years, Morris said. "You would think after 40 years the VA would figure out how to streamline itself a little more, but now history seems to be repeating itself."
New laws may help
Several state lawmakers in Maine have or currently are making an effort to help veterans and others who suffer from mental health problems and their families.
One piece of legislation signed into law by Gov. John Baldacci in 2010 provided families, friends, law enforcement and health care providers a new avenue allowing them to seek court-ordered treatment plans for people suffering from mental illnesses.
Prior to that, the only way to get a court to order a treatment plan was if they were an "imminent threat to themselves or others." That threshold usually meant an involuntary commitment at an inpatient mental health facility.
Former state Sen. John Nutting, a Leeds-based Democrat, co-authored the bill with former state Sen. Peter Mills, a Cornville-based Republican.
Nutting said that if the family of Crowley-Smilek, the veteran killed in Farmington, had been advised of the measure, they might have been better-equipped to compel the veteran to get help.
Under the law, a nine-member treatment team including a psychologist, a psychiatrist and local police work with the patient on an ongoing basis.
The system allows team members to petition the court again and have a person committed to an inpatient facility if the person stops following a prescribed program of treatment, including refusing to take prescribed medications.
"I can't help but think it may have helped them avoid this tragedy," Nutting said. "His own family knew he was spiraling downward."
Crowley-Smilek's parents said that despite their son's repeated interactions with the VA, local police and courts, he was never advised of the 2010 law.
“It kind of floored me that neither the police or the DA or the judge or the VA were aware of it, either,” said Crowley-Smilek's father, Michael Smilek.
Mills said the 2010 measure was a small step forward for families who previously had no other recourse in helping a loved one whom they were watching suffer from mental illness.
He said he couldn't guess whether the law would have worked for Crowley-Smilek, but Mills did say Maine, which became the 44th state to enact such a measure, was far behind others when it came to dealing with mental health patients who ended up committing crimes and then found themselves in the court system.
"It's not an instant solution by any means," Mills said. "But it is designed to make it easier for citizens and relatives to intervene in a person's care and on their behalf. It is set up so it was something short of putting somebody in an institution while legally compelling people to respond to outpatient treatment."
The Maine Legislature has always leaned toward protecting individual liberties, so it's a complicated balancing act crafting laws that allow an individual's rights to be restricted, Mills said.
"In Maine, the law is very balanced toward the rights of the individual, even if they are deluded," he said.
People have always had the right to check themselves into inpatient care for psychological or substance-abuse problems in Maine, but one of the double-edged swords of mental illness is in the very nature of mental illness, Mills said. This is especially true of the way PTSD can affect brain function.
"Who wants to go into a hospital if they don't think they're sick?" Mills asked. "If they lack the insight to know they are sick, this law at least said they must submit to outpatient treatment. It's an in-between order. You can stay outside the hospital as long as you comply with reasonable treatment conditions."
Mills said crafting those types of laws is extremely difficult, given the rights issues they involve.
"Our laws are not very flexible," he said. "There are not a lot of tools at the disposal of the family and the police."
Police lack training resources
Training and educational resources for law enforcement officers is another area where Maine could improve, according to several local police chiefs who spoke on background, noting that they didn't want to be second-guessing the incident in Farmington without a final report from the Attorney General's office.
Several said they get as much training for as many officers as their budgets will allow. They said many officers have been trained in crisis intervention to better respond to those with mental health issues. Even so, an officer must make life-or-death decisions, often in a split second, they said.
Robert Schwartz, executive director of the Maine Chiefs of Police Association, said departments in Maine are well-aware of the emerging issues with war-damaged veterans and PTSD. He said some training has been available from the Maine National Guard in recent years to help police interact with combat veterans who may be suffering from psychological issues.
But funding constraints can prevent all police departments in Maine from getting that training.
Maine National Guard Adjutant Gen. John Libby has been at the forefront of getting law enforcement better-prepared, Schwartz said, but training takes time and money, which most departments are running short on.
"We can always do a better job," Schwartz said.
He said to the best of his knowledge, there is no ongoing training program to help police officers deal with veterans.
He said Rosie, the officer who shot Crowley-Smilek, likely had little choice. "But it appears, unfortunately, that the police officer is taking the brunt of this."
The only real villain, Schwartz said, is the lack of political will to change the laws to allow earlier intervention and to provide adequate resources, both on the treatment side and on the training side for law enforcement.
"I've run into a department recently where you have a chief with four officers and three or four reserve officers and his training budget is set by the selectmen at $1,000 — and they tell him that's plenty for training." Schwartz said. "That's not plenty for training."
He said that if state and federal grants were made available for that type of training, his organization would be among the first to apply for them.
"I don't think you will find a department or police officers anywhere that aren't wanting more training," Schwartz said. The demands on the beat cop to be all things to all people have never been greater, he said. But with the right resources and training, he believes, "we could probably develop a decent protocol and some decent procedures."
For vets like Morris something as simple as having a police officer who is a veteran and trained in recognizing and understanding how PTSD works would be an improvement. The shared experiences of veterans usually fosters better communication.
"A vet talking to a vet is just always so much easier," Morris said.
Staff Writer Terry Karkos contributed to this report.