BILOXI, Miss. (AP) — Donna Anderson sees the system from the inside, and she sees problems.
As a case manager at Keesler Medical Center, the retired Army nurse sees "the struggles the local servicemen and women" endure when they make the transition from active duty to civilian status.
She works with both active-duty and retiring soldiers. But most problems she sees lie with National Guard and Reserve returnees.
"There was some disparity in them being able to find or hold their jobs when they got back due to their physical or mental health issues," she said, "and there were delays getting their Veterans Affairs benefits. They would go long periods of time without having income."
After watching their struggles, Anderson founded Combat Wounded Veterans of South Mississippi (CWVSM) in 2011 to help all wounded veterans with emergency financial needs such as house payments, car payments, food and clothes.
"These guys are struggling. There needs to be a bigger support group," said Roger Sibley, executive director of the nonprofit. "They are trained in the military to be strong and that it is a sign of weakness if they come forward and sat 'Hey look, I'm struggling with what happened over there and dealing with this.' "
Reserve and Guard members have increasingly been sent to front lines along with active-duty service members since 9/11 to fill gaps across all five military branches. The Army National Guard, which is the largest non-active force, made up half of the combat brigades in Iraq at one point in 2005 during Operation Enduring Freedom. Just last year, the Army announced it would deploy more Guard and Reserve units to round out active-duty units.
Nationwide, 51,000 National Guard members returned to civilian life in 2016 after deployment. Each year about 265,000 service members transition out of the military. But they return from deployment and go straight back to civilian life, without the same sense of community and resources as those on military bases.
They suffer the same effects of combat and deployment — stress, PTSD, alcoholism, depression — as active-duty members after deployment. But Reserve and Guard members are not full-time employees— they attend drills one weekend a month and serve two more weeks per year, taking time away from their normal jobs.
And the way in which they earn benefits, such as education credits and health care access, is different from active-duty and depends on voluntary deployments. Legislation introduced by South Mississippi's U.S. Rep. Steven Palazzo seeks to reduce, if not eliminate, inequities between the two classifications.
"Regardless of what segment of the military you come from, these issues are real," Sibley said.
The Department of Veterans Affairs and the Department of Defense has been aware for years that there is an invisible barrier that prevents some service members from successfully transitioning back to civilian life.
Transition programs were "inconsistent across all the military services" prior to the 2011 Vow Act, said Margarita Devlin, executive director of the VA's Benefits Assistance Service. The act created a "consistent standardized curriculum" across all services to help ensure everyone would get the same information to help their transition. The act also made the training mandatory.
The Mississippi National Guard's Yellow Ribbon program provides service members with information before they deploy and when they return.
The 155th Armored Brigade Combat Team and 106th Brigade Support Battalion recently held a Yellow Ribbon at the Mississippi Coast Coliseum in Biloxi for members of those units that will deploy to the Middle East in June.
For two days, 1,300 soldiers from 12 companies had access to representatives from 26 organizations that provide support services. Soldiers and their spouses met, listened to speakers, and were able to break out into sessions covering different aspects of deployment.
"They do all these Yellow Ribbons, it's just a bunch of PowerPoint slide shows," said Richard Parker of Pascagoula, who deployed to Iraq and Afghanistan with the Mississippi Guard. "When you ask a question they give a vague answer, or the VA will send you to a website that doesn't always have the answer or is hard to navigate."
Parker left the Guard in 2016 after being injured in Afghanistan.
"They run through it and they don't really sit down and explain the ins and outs of the whole process," he said. "And for people with memory issues, severe TBI (traumatic brain injury) or PTSD, we're not always understanding what they're trying to say. They're throwing all this information out there at once and you're cutting us loose.
"I think they could have done better."
"Nobody likes a death by PowerPoint presentation," said Sgt. First Class James Huffman who has served in a support unit with the 155th since 2001 and is a part of the Yellow Ribbon staff. "That's where it was going and we looked at it and said 'this is not working, this is not efficient.'"
The new approach for the state's National Guard is to give soldiers an overview and have representatives of support organizations on hand to answer questions.
Preparing for transition is hard because service members don't realize what life is going to really be like until they get "on the other side," said Devlin.
She said it's hard for them to absorb information because they don't know what's coming.
"There's so much information that they feel like they are overwhelmed," said Devlin.
The VA is constantly revamping their program, she said, so service members can "see the relevance to their own life." The latest revamp rolled out April 2.
The department also created Transition and Care Management program for post-9/11 veterans "to face the challenges of multiple deployments, being reintegrated into the community and transitioning," said Biloxi VA program manager Larry Parker.
"The program intention was to help transition those veterans into VA care," he said. "There wasn't the best hand-off between DoD (Department of Defense) and them coming back into the community."
A report published in February by Clinical Psychology Review found that because so much emphasis is put on veterans with PTSD, the stress of transition is being overlooked.
In combat, service members have to "flip a switch to become cold and heartless," said Army veteran Casey Kennedy of Biloxi. "We're trained to do that, but when we come back we're not re-trained to not think the same way."
But there are indicators that problem is being addressed.
The VA created a Welcome Kit in February to help veterans learn about their services.
The Mississippi National Guard launched the MS National Guard Outreach Services support app in January 2017. It is a comprehensive source for service members and their families to use on either Android or Apple devices
"It's a challenge to meet them where their needs are, to be where they are, to be able to provide them the information in a format that is helpful," said Larry Parker of the VA.
A key finding in a 2013 National Academy of Sciences report said "Numerous programs exist to respond to the needs of returning OEF and OIF active-duty personnel, veterans, and family members, but there is little evidence regarding their effectiveness."
"I'd like to see the providers do a better job of educating the veterans on how they can make adjustments to help themselves," Parker said.
"Nobody's really taking that personal interest and sitting down with them and having that conversation," he said.
"That's where we can do a better job."