When Darren* returned to civilian life in South Lake Tahoe after five years in the Marine Corps and one combat deployment in Iraq, he knew he was not the same.
"They completely rewire you when you go to boot camp. They have to break you down and build you up into a person that goes into something like a deadly situation and they know how you'll react," said Darren.
"You go into some of these situations and you see horrible things. You watch people dying. You see kids getting killed. You see things for how they can be — how easy things can go real violent or how fleeting life is. If you miss a detail in a situation over there, it costs people's lives. That's not something you can just shut off. There is no switch. It's become a part of you, and you can't get rid of it."
Darren had issues sleeping and experienced mood swings and a sense of loneliness because he was no longer surrounded by his Marine "brothers" or anyone who really understood what he was going through. He struggled with "hyper vigilance."
"I'm aware of everything. You sit in a restaurant and you're scoping out everything and sizing up everyone as they walk in the door," explained Darren. "You hear a bump in the middle of the night, and instead of thinking it's the washing machine, you go search your entire house with a gun and make sure nothing is there and check your entire property."
He sought help with the United States Department of Veteran Affairs (VA) in Reno, and was diagnosed with Post Traumatic Stress Disorder and traumatic brain injuries.
"Their solution is to throw pills at you. I'm off all of it now … I got tired of it. Anti-depressants. Anti-anxiety medications. Bi-polar meds," said Darren. "I tried seeing a therapist and that never helped. It's a complete stranger, nodding and smiling and saying, 'How does that make you feel?' after everything you say and that just didn't work."
He found there was a generational gap in the support groups in South Lake Tahoe with a majority of veterans having fought in the Vietnam War.
"There is not really a place for younger guys of the two recent wars," said Darren.
In March, Darren's friend and fellow Marine committed suicide. Twenty-two of the men he served with showed up.
"It was the first time that we'd gotten together in a long time since we'd been in the Marines. Just talking to each other, relating to each other, and seeing how similar everyone's experiences really was, it helped a lot. To know we weren't alone dealing with the same sh*t. To know we were all together — living apart — but together dealing with it."
Over the years, Darren said he's come to terms with the new version of himself.
"I wouldn't say it's better, but I've gotten used to it," he explained. "My family has gotten more used to it."
Many veterans have stories similar to Darren's.
Around 4 million people have served in Iraq and Afghanistan, the longest sustained U.S. combat operations since Vietnam. Research shows that 10-18 percent of veterans from these wars are likely to have PTSD after they return, according to the VA. They are also at risk for depression, substance abuse and suicide.
The number of VA users with mental health issues or substance abuse disorders has increased from 27 percent in 2001 to 41 percent in 2014. The data also shows that veterans are 22 percent more likely to commit suicide than a non-veteran.
"These findings are deeply concerning, which is why I made suicide prevention my top clinical priority," said former VA Secretary Dr. David J. Shulkin last September when the department released its report. "I am committed to reducing Veteran suicides through support and education. We know that of the 20 suicides a day that we reported last year, 14 are not under VA care. This is a national public health issue that requires a concerted, national approach."
A study from National Academics of Sciences, Engineering and Medicine found that nearly half of U.S. veterans who need mental health care don't get it, while more than half of those who would benefit from treatment don't know they need it.
The report also pointed out that a majority of those who could use mental health services don't know they are eligible for them, how to access them, or even that the VA provides those services.
On Wednesday, the Senate cleared a bill that would allow veterans to see private doctors when they do not get the treatment they expected, with the approval of a VA health care provider. Veterans could also access private care when they have experienced long wait times or the VA medical centers do not offer the services they require. President Donald Trump is expected to sign it into law in the coming days.
El Dorado County has its own independent Department of Veteran Affairs based out of Placerville. They hold office hours in the South Lake Tahoe county building twice a month.
But as with the federal VA, some veterans are unaware of what the department can offer — or, despite the department's best efforts, that it even exists at a local level. Darren was unaware of it and traveled down to Reno instead.
But Lance Poinsett, county veterans service officer and a Navy veteran, says the department is busy. They field an average of 20 calls a day, and since the start of 2018, have filed 528 claims for veterans in the county.
They refer veterans to mental health professionals, provide housing assistance, and help veterans tap into education benefits.
This March, the county department signed an agreement with the nonprofit Only Kindness to boost its veteran outreach and mental health services. They hope to drastically increase their presence in South Lake Tahoe and provide more outreach to the 88 veterans that are currently homeless in the county.
"We change lives here," said Poinsett. "We had a veteran that toward the end of his life contracted cancer. We got his benefits very quickly, but he passed away last week. Now we are getting benefits for his wife. His son emailed me and wrote that his dad said it gave him hope that his country still cared about him."
Poinsett said they also are working to improve their communication with the younger veterans.
"Things are improving," said Poinsett. "The county is doing a lot. Really if veterans give us a call, we can set up an appointment, meet them, and point them in the direction they need to do."
It's not an easy job, continued Poinsett, and he can only give assistance to those that are willing to accept it.
"If you can change someone's life and improve it for the better, it makes it all worth it."
As for Darren, he wishes he knew what would help him and his fellow veterans as they transition back into civilian life.
"That's the million dollar question. I have no idea. If I knew I wouldn't be working an hourly job. I'd have a solution," said Darren. "The guys I know struggle with it. They can't hold normal jobs. Can't keep a relationship. And the ones that do, I think they just get lucky.
"But I do know it's worse if we hold it all inside. If you talk about it, at least people can know what you've been through and know who you are."
If you are a veteran struggling with mental health issues, you can call the federal Veterans Suicide Task Force to speak with health care professional at 1-877-493-1161. To speak to someone at the county's Psychiatric Emergency Services, call 530-544-2219. These lines are open 24/7.
*Darren is a fictitious name used by the Tribune for an actual veteran living and working in South Lake Tahoe. Due to the sensitive nature of mental health issues, the Tribune opted not to use his real name.