Critics blast veterans' mental health care

WASHINGTON, July 28 (UPI) -- Several Members of Congress blasted the Department of Veterans Affairs and the Pentagon this week, saying the agencies not doing enough to aid soldiers returning from Afghanistan and Iraq with post-traumatic stress disorder.

"All I hear is 'we're doing everything right.' All I hear is 'everything's fine.' Everything's not fine - we have suicides," Rep. Bob Filner, D-Calif., told a panel of witnesses from the VA and the Army at hearing of the House Veterans Affairs Committee on Wednesday. He went on to call government claims about proactive treatment of PTSD in soldiers "demonstrably false."

Post-traumatic stress disorder, an anxiety disorder, was first identified in 1980 and occurs following exposure to a life-threatening event. Symptoms can include insomnia, nightmares and depression and nervousness. The disorder is marked by both biological changes and emotional symptoms.

About 20 percent of soldiers returning from Iraq suffer from PTSD, depression or anxiety, according to Col. Charles Hoge, chief of psychology at the Walter Reed Army Institute of Research in Washington.

Hoge told hearing attendees that about 30 percent of soldiers who served in the Vietnam War developed PTSD at some point during their lives.

"Every time someone re-experiences an event or has a flashback ... the memory becomes more and more intractable, the harder and harder it is for the persons brain wiring to go around the memory," explained Lizbet Boroughs, deputy director of government relations for the American Psychiatric Association.

Rep. Steve Buyer, R-Ind., the committee's chairman, cited an "alarming" VA report that indicated the number of PTSD patients grew by nearly 100,000 from 1999 to 2004, to a total of 215,871 cases.

The key to treating PTSD is outreach, Donald Mooney, assistant director of the American Legion's Veterans Affairs and Rehabilitation Division, told United Press International. Unfortunately, "outreach hasn't been (the VA's) strong suit for the last 10 years," he said.

Though institutions such as the Bethesda Naval Medical Center in Maryland, and Walter Reed Army Medical Center in Washington, provide good services for soldiers suffering from PTSD, it often is difficult to bring help to those who need it most, said Rep. Grace Napolitano, D-Calif.

"My concern is that only those who have been identified or self-identified get help," said Napolitano, who is co-chair of the Mental Health Caucus. "Others go home and think they can deal with it. Something is wrong that we are not helping soldiers deal with it."

According to the Army's study of PTSD, soldiers are unlikely to seek professional help if they have a mental-health problem for fear of being treated differently by their peers and leaders. Hoge said the Army is continuing to research how to reduce the stigma of PTSD and ensure delivery of mental-health services.

"The culture inside the military hasn't changed that much," Mooney said. "Attitudes are not changing at the operational level as rapidly as knowledge of the condition."

In addition to reducing the stigma, the military also will attempt to expand education efforts for primary-care physicians and soldiers so they can more readily identify PTSD.

Though he suffered from physical symptoms associated with PTSD -- including high blood pressure, chest pain and erectile dysfunction -- military primary care did not identify PTSD in Capt. Michael Jon Pelkey, his widow testified.

"I think that's where my husband really lost out," Stephanie Pelkey told committee members. "They just didn't recognize the physical symptoms (of PTSD)."

A report from the VA's Inspector General indicated that wait times for appointments were underreported, Buyer said. Following his return to Germany after a tour in Iraq, Pelkey was referred by a physician to a counselor to look into his anxiety. Though he tried to attend counseling in Germany, and tried again later when he was restationed at Fort Sill, Okla., he could only receive appointments that were months away and thus did not attend.

Pelkey was not diagnosed with PTSD until he finally saw a civilian therapist outside of the base -- one week before he killed himself in November 2004, about 16 months after he returned from Iraq.

In his testimony, Michael Kilpatrick, deputy director of the Pentagon's Deployment Health Support Directorate, said soldiers receive information about mental-health problems and how to get help for them before deployment. He also said when soldiers return from deployment they are screened for mental-health issues, and 16 percent of those who received a post-deployment health assessment are referred to mental-health providers.

Thomas Berger, chairman of Vietnam Veterans of America's PTSD and Substance Abuse Committee, told UPI the pre-deployment discussions are little more than a "pep talk," and more needs to be done to inform soldiers about PTSD before they move to conflict zones.

The VVA also submitted a statement to the committee indicating that the Pentagon's post-deployment health assessment is a two page, multiple-choice test that "is hardly a useful mental health assessment tool." The VVA statement also said soldiers lack the incentive to tell the truth about mental-health issues, because they fear that such issues could prevent their promotion -- a fear the VVA and American Legion say is well-founded.

Pelkey said perhaps the best way to detect PTSD is by developing programs to educate spouses of soldiers about the disorder, because they often are the most effective at persuading them to seek help.

"If only the military community had reached out to family members in some manner to prepare them for and make them aware of the symptoms of PTSD, my family's tragedy could have been averted," Pelkey said.

According to an American Legion report, there is a "critical shortage in the funding of VA health care."

Boroughs said most VA health centers have at least some personnel qualified to detect and treat PTSD, but "the question is, do they have enough (personnel) and do they know about some of the newer treatments?"

She added that although the VA is required to have PTSD teams in each of its 21 regions, not all do.

An American Psychiatric Association statement also said only half of all VA medical centers have PTSD Clinical Teams, and 39 of those 84 teams might not have staff assigned to PTSD duties.

Further complicating the treatment issue are concerns about handling the transition of treatment from the Department of Defense to the Department of Veterans Affairs for reservist and National Guard troops returning from Iraq and Afghanistan.

Mooney explained that most returning active-duty troops are demobilized and given time to decompress, then are debriefed and screened, but National Guard and reserve troops go directly from the field to their home reserve centers and armories.

"If they get any screening or treatment at all, it's just for a couple days," Mooney said. "There's a disconnect in the prevention services."

Berger called on state governors to also help in addressing the disparity in treatment of National Guard and reservist troops.

Kilpatrick cited an agreement between the National Guard and the VA to promote a "seamless transition" of veterans' health services from the Pentagon to the VA, but Brig. Gen. Michael Kussman, who is Deputy Undersecretary for Health at the VA, said the data are "not as comprehensive as the VA would want to provide truly seamless clinical care."

Buyer said the Army is not sharing data from its two-and-a-half-year survey of 20,000 soldiers with the VA, which also provides mental-health support. Still, Matthew Friedman, executive director of the VA's National Center for Post-Traumatic Stress Disorder said the level of collaboration between the VA and the Pentagon was "unprecedented."

A crucial way to help soldiers readjust to life after war is through the aid of communities, Berger said, explaining that employers and churches can play a significant role in veterans' lives.

"I think it's real important that it not just be the Veterans Administration (helping soldiers)," Berger said. "It takes the whole community to reintegrate the person. People need to understand the sacrifice."

A Government Accountability Office report released last February said the VA "does not have sufficient capacity to meet the needs of new combat veterans while still providing for veterans of past wars."

To alleviate the crisis, Congress may pass new legislation soon that provides an emergency $1.5 billion to the VA to fix its budget shortfall. The funding is attached to a Department of Interior spending bill that should clear the Senate before the August recess.

Legislation pending in committee, the Comprehensive Assistance for Veterans Exposed to Traumatic Stressors Act, would increase outreach to veterans and provide education to families and healthcare providers about PTSD. The bill would also require collaboration between the Pentagon and the Department of Veterans Affairs with regard to mental health treatment.

Earlier this week, the Pentagon announced plans to spend $100 million on screening soldiers returning from Afghanistan and Iraq for PTSD three to six months after they come home. The program would allow any soldier who needs help can get it. Such a program is important, Boroughs said, but she warned that PTSD often does not appear until years after war.

The Army's Mental Health Advisory Team reported last week the suicide rate for soldiers in Iraq and Kuwait fell from 18 per 100,000 in 2003 to 8.5 per 100,000 in 2004. Soldiers' morale is also improving, the report said. In 2003, about 52 percent of soldiers described morale as low, dropping to 36 percent in 2004.

Veterans groups, the VA and the Army all praise the 207 Vet Centers that employ mostly veterans to provide health services to those returning from war. Last year, the VA hired 50 veterans from Afghanistan and Iraq to work in Vet Centers, and the agency is looking at adding 50 more.

The NIMH is also piloting a program called DE-STRESS designed to test methods for reducing PTSD symptoms using Internet-based programs.

VA officials and veterans' groups also cited the success of groups embedded with combat units to evaluate and treat stress.

Ryan Holeywell is an intern for UPI Science News.