JACKSONVILLE BEACH, FLA. - Adam Fuller credits a simple, one-word command - and a black Lab mix named J.D. - for helping to save his life.
"Cover," he tells J.D., sitting to his left in a grassy field next to a park playground. The dog calmly walks to Fuller's right, then sits facing backward. Were someone coming up from behind, he'd wag his tail. The signal quells the sense of threat that plagued Fuller after serving in Afghanistan, that at one point had him futilely popping medications and veering toward suicide.
"Yes!" he praises J.D. as four women watch closely. They, too, are veterans with post-traumatic stress disorder, here to be trained and to leave with canine support of their own. All seem to appreciate the strategy behind "cover," as their goateed instructor demonstrates with J.D. "I wouldn't be here without him," Fuller says.
Every month, a new cycle of training begins with yet another class of veterans in a program run by the northern Florida K9s for Warriors. The 7-year-old nonprofit is one of dozens of organizations offering "psychiatric service" dogs to address the military's mental health crisis - enabling desperate vets to function in society, proponents say.
Yet even as success stories allow these groups to briskly expand, their approach faces growing scrutiny from researchers and debate among veterans groups, politicians and the Department of Veterans Affairs. At issue is whether the dogs truly help, what they should be trained to do and who should pay for them.
The VA has covered veterinary care for service dogs that help physically disabled veterans for more than 15 years. It has declined to do that for PTSD service dogs, however, citing a lack of empirical evidence for their therapeutic value. The agency is conducting a $12 million multi-year study on the topic, even as it opposes legislation that would require it to pay for dogs in a separate pilot program.
"The numbers are startling on veteran suicides, and this is working," said Rory Diamond, a former federal prosecutor who quit to become chief executive of K9s for Warriors, where he had been providing pro bono legal services.
On a table in the organization's cheery lobby these days is a flier that says "research proves" the dogs save lives. A recent first-of-its-kind study at Purdue University used standard questionnaires to assess PTSD symptoms and other aspects of mental health among 141 K9s for Warriors applicants, half teamed with a service dog and half on a wait list. Those with dogs showed significantly lower levels of post-traumatic stress, depression and social isolation, with higher levels of psychological well-being.
Still, says lead author Maggie O'Haire, an assistant professor of human-animal interaction, the study is preliminary, and more research is needed on how service dogs might fit into treatment plans. "There is so much political agenda behind this topic," she said.
O'Haire now is conducting a clinical trial with money from the National Institutes of Health.
"We really want to know the answer," said Patricia Dorn, director of VA's rehabilitation research and development service. "We want to know for the veterans and the public at large."
Dogs long have helped people
Dogs have served humans for millennia, often as hunting and herding partners. But not until World War I were they trained to as guides for the blind. Service dogs now prompt deaf people when a doorbell rings, retrieve pills for people in wheelchairs and alert people with diabetes to blood sugar spikes.
Psychiatric service dogs are forging a new frontier, and their mission blends task-oriented service with emotional support. While the dogs paired with veterans with PTSD commonly are trained to wake them from nightmares and to "block" the space between their owner and another person, advocates also laud their ability to soothe a panicking vet and provide companionship and a tail-wagging reason to get out of the house - if only for walks.
"Being able to go to a store - and not just hate it and drop everything and walk out - is phenomenal," said the 29-year-old Fuller, a K9s for Warriors graduate, as the women he was helping to train did laps with their dogs beneath the park's tall pines.
But even among psychiatric service dog providers, from well-established charities to small start-ups, there's disagreement about what dogs should do.
The accrediting Assistance Dogs International published its first standards for training and placing PTSD dogs with veterans in January, after two years of heated discussions about how much mental health experts should be involved, which commands the animals should be taught and other issues, said Sheila O'Brien of America's VetDogs, who headed the process.
The standards reject commands for a dog to search for an enemy or threat - something VA study dogs are trained to do - or to guard. Though ADI did not shun other "panic protection" commands, including "cover" and "block," those are also controversial.
"Our philosophy is that the dog is a bridge between his environment or her environment," said Cynthia Crosson, a psychiatric social worker and consultant for dog provider group NEADS, where she helped develop the nation's first service-dog program for veterans with PTSD a decade ago. "We feel that blocking kind of enables the symptoms rather than helps them cope with the symptoms."
Some veterans disagree. At K9s for Warriors, which works with a dozen veterans a month, stories are common of those who were scared to leave their houses or were gripped by anxiety in public - until they had a dog at their side trained to provide a sense of space or surveillance.
On its 8-acre campus, the veterans spend every moment with their assigned animals. They stay in apartments on the grounds, and they're even encouraged to share the queen-size beds with their dogs. Practicing commands is crucial, the organization teaches, but so is bonding.
Dogs better than pills
About a third of K9s for Warriors' graduates "drop the leash" over time, using their dogs less and less for service. Another third expect to stop after their first dog dies. Only that last third wants to have service dogs for life.
"Is that causing a harm?" Diamond asked. "The worst thing that's happened is, they have a well-trained dog. There are worse crutches, and VA is handing out a lot of them - like prescription drugs and opioids."
Most of the group's canines come from shelters, with a small number of purebreds donated by breeders.
Those that pass temperament tests are schooled at the campus by professional civilian trainers and spend months learning basic obedience and commands.
The dogs that do well - valued by that point at $27,000 - are paired with veterans, who learn to handle their dogs from vets who have completed the program. The other dogs are adopted out.
Cross, a floppy-eared black Lab mix, was one of the shelter mutts - nothing like the fluffy golden retriever that Tammie Gillums pictured when she headed to K9s for Warriors last summer.
Gillums had been an Army human resources officer, a job she did not expect would expose her to trauma during a tour in Kabul.
She was wrong a few times over, with one suicide blast throwing her off her chair during duty in a guard tower. Seared into her mind was the image of the bomber's detached head.
Gillums, a 39-year-old mother of six in a blended family, came home in 2008 with crippling migraines. She couldn't sleep or concentrate. She started lengthy therapy with a VA psychologist and psychiatrist and at one point was on a half-dozen prescription drugs. She stayed home whenever possible.
One thing made the difference, she said. Cross. Their relationship "is some type of magic."
On a recent Friday, Cross rested at her feet during her African-American history class. She accompanied Gillums on a shopping errand, then to a medical appointment.
While waiting in line at a Starbucks, Gillums quietly told Cross to "block," putting space between her and a middle-aged man next to her.
"Cross," said Gillums, "is my anxiety medication now."