Psychologist Profile

"Stand down." In the military, it's a command to a combat unit to move out of a war zone to a safe place to regroup. In San Diego, it's an annual three-day campout with a similar goal: a time and place where the city's homeless veterans can rest and rehabilitate from the isolation, danger and uncertainty of living on the street. For the past 25 years in July, 1,000 homeless veterans have come to the encampment event on the grounds of San Diego High School near Balboa Park. They can shower, get a haircut and pick up new clothes. They can share meals with fellow veterans, visit physicians, attend support meetings and meet with veterans' benefits experts and employers. The event is supported by more than 3,000 volunteers from local military bases, hospitals, veterans' agencies and businesses who want to reconnect these vets with society and each other.

The Stand Down program is the brainchild of clinical psychologist Jon Nachison, PhD, a former U.S. Army soldier who created the first event in 1988 through Veterans Village of San Diego (then called Vietnam Veterans of San Diego) with its director at the time, Vietnam veteran Robert Van Keuren. Nachison was clinical director at the organization then and noticed how many of the veterans they were working with had no address on their paperwork.

"Up until this point, nobody in America was talking about homeless veterans, so Robert and I started talking about it," says Nachison, who will accept a presidential citation from APA President Donald N. Bersoff, PhD, JD, for his work with homeless veterans at this year's annual convention in Honolulu, July 31–Aug. 4. "We wanted to send a message to the community that there are veterans on the street, and more than people realize."

Thanks to Nachison's efforts, that message has extended far beyond the San Diego community. The San Diego Stand Down has inspired similar events in 200 U.S. cities and was profiled on "60 Minutes" in 2010.

Homeless veterans account for 13 percent of the U.S. adult homeless population, according to the National Coalition for Homeless Veterans, even though veterans make up only 7 percent of the general population. The U.S. Department of Housing and Urban Development estimates that on any given night, more than 62,000 veterans are homeless. And despite the Obama administration's commitment to end homelessness among veterans by 2015, the number of young homeless veterans is increasing. In 2010, 12,700 veterans of the Iraq and Afghanistan wars were homeless. It's a trend that Nachison is noticing at Stand Down as well.

"More and more young men and women are ending up homeless even more quickly than the Vietnam generation did when coming back," says Nachison.

Crossing to safety

Nachison designed Stand Down to evoke memories of serving in the U.S. military, a time when most of these men and women experienced a strong sense of pride and accomplishment. Veterans bunk in single-sex tents named Alpha, Bravo, Charlie, Delta and so on, using the military phonetic alphabet. A stage draped with camouflage netting stands at the center of a 30-tent horseshoe. Volunteers check veterans' service numbers at the front gate and assign each veteran to a 25-person tent where they assemble their cots.

The military structure is there "to put people in kind of an altered state" away from their lives panhandling on the street or going from agency to agency looking for help, says Nachison. In clinical terms, his goal is to move these men and women through Abraham Maslow's needs hierarchy in three days. "There's a young Marine or soldier in there, and I want to draw that person out. I want to get that kid back in here, the one who could do anything," says Nachison.

The first day of Stand Down is devoted to helping veterans address their most basic needs — food, sleep and shelter. It's also when veterans bond with tent-mates with whom they will share meals and close quarters for the next few days.

"Being homeless is not like a Victor Hugo novel," says Nachison. "The camaraderie is healing to people who have been isolated and alone for a long time."

“There’s something that’s happening here that people want to be part of,” says Stand Down founder Dr. Jon Nachison. “I try to bear in mind that this event is for volunteers as well — it’s a chance for them to find the best person in themselves for three days.”

On days two and three, Nachison and his volunteers direct veterans to various tents and stations where they tackle tougher issues identified on their "dance cards," such as the need for medical help or career coaching. One popular station is Stand Down's homeless court, where a San Diego Superior Court judge hears veterans' cases related to outstanding warrants and other infractions. After persuading the judge to participate, Nachison launched the station in Stand Down's second year. It was the first of its kind in the United States. Today, it draws around 50 lawyers to help veterans prepare their cases pro bono and has inspired other pop-up homeless courts nationwide.

Stand Down offers time for reflection as well. Organizers hold a "recovery hour" each day, where veterans can choose to attend support groups including Alcoholics Anonymous, Narcotics Anonymous or Triple Threat meetings for former combat veterans struggling with drugs, alcohol and post-traumatic stress disorder. There are also workshops on stress reduction and appointments with psychologists and psychiatrists for vets who want to talk one on one.

Representatives from local substance abuse treatment facilities and recovery programs are also onsite to recruit people for beds. In the medical tents, veterans see podiatrists, dentists and general practitioners and can take a shuttle to and from a local hospital for minor outpatient surgeries. Optometrists provide eye exams and can fit new glasses on the spot. Veterans' children — any veteran can bring his or her dependents — can play games and do arts, crafts and other activities in the children's tent, where Nachison's wife, Sharon, volunteers.

In the evenings, Stand Down transforms into a music festival, with local bands and musicians performing for free and veterans and volunteers dancing in the grass.

"Jon had to beg people to perform in the beginning," says psychologist Victor Frazao, PhD, who has volunteered as a tent leader for Stand Down for 10 years. "Now he has to turn people away. Once people have done it, they want to come back."

Volunteers return home each evening, while local active-duty military stand guard all night to offer a sense of security to participants, many of whom are used to sleeping during the day because they don't feel safe sleeping at night. Nachison sleeps in a camper in the parking lot.

A dynamic event

Like the musicians, volunteers such as Frazao serve only once before they are hooked. Many schedule their vacations around Stand Down, which requires a week of setup before gates open. One such volunteer is "60 Minutes" producer Henry Schuster, who returned as a volunteer with his two teenage sons in 2011 after spending three days documenting the event in 2010. Other volunteers hail from veterans organizations throughout the country that are doing reconnaissance on how to host a Stand Down in their city.

More than 3,500 people volunteered for the 2012 Stand Down alone, but Nachison is the heart of the program, say its volunteers.

"Jon is the head of the table, wherever he goes," says Ron Stark, a retired Navy submarine sonar technician who is Stand Down's logistics coordinator. Since Stark started volunteering with Stand Down in 1995, five of his former Navy shipmates have sought shelter at Stand Down and only one of them is still homeless today. Stark credits the program's success to Nachison's steadfast commitment to making Stand Down not about charity, but about bringing out the best in the veterans who attend.

"It's clear to him that each person who comes needs to be their own superhero," says Stark.

To keep Stand Down dynamic, Nachison, who works full time as chief of psychology at Bayview and Paradise Valley Hospital in San Diego, welcomes almost every type of professional who wants to pitch in. Over the years, he's added artists who give workshops on drawing and creative writing, massage therapists, acupuncturists and a local psychologist, Edith Eger, PhD, who survived Auschwitz, to speak to the veterans about resilience.

"There's something that's happening here that people want to be part of," says Nachison. "I try to bear in mind that this event is for volunteers as well — it's a chance for them to find the best person in themselves for three days."

Nachison is most proud of the fastest-growing volunteer segment: former Stand Down participants. Hundreds of regular volunteers are alumni of the program who are no longer homeless, "and there are more and more every year," he says.

One volunteer, U.S. Marine Corps veteran James Vicente, says that when he came to Stand Down he had already tried "every program under the sun" to get his life back on track. "Stand Down was the only thing that got me out from the under the bridge club," he says.

Alumni recently started the National Stand Down Alumni Association, which provides a year-round support system for homeless veterans.

At the end of each Stand Down, volunteers and participants join hands around the field for a graduation ceremony while bagpipes play.

By then, no one can tell who is a volunteer and who is a participant, says Nachison. Many participants have been matched with a local treatment or follow-up program. Others haven't figured out their next step yet, and many of those same men and women will be back the following year.

"Not everyone gets it in the first few times," says Nachison. But plenty of others do. "I can't explain it without sounding self-serving, but there is some kind of a magic that happens that is transformative to everyone there," he says. "It really feels like this place where miracles can happen."