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May 25, 2007Topic
of this update is specifically about As we head into the Memorial Day Weekend, it is important to remember the contribution of the courageous soldiers in Iraq and Afghanistan and in all our prior wars. I am honored to have a father who served bravely for the United States in World War II. We should provide our returning veterans with dignity and respect. Unfortunately, we are failing many veterans through a lack of a comprehensive response to their mental health needs. There is a crisis in our country today regarding the lack of accessible mental health services for veterans.. This update is dedicated specifically to the issues of veterans and mental health issues. Included is the recent testimony from MHANYS before the Assembly committee on Mental Hygiene and Veterans Affairs as well as an article taken from NPR on an investigation they did about mental health issues in Fort Carson in Colorado. New York must develop a comprehensive response to the needs of veterans with mental health issues. MHANYS along with several other organizations has helped set the stages for a framework for change. On May 23rd, the Assembly Mental Hygiene Committee and Veterans Committee held a joint hearing on the issue of Mental Health and Veterans. MHANYS had an opportunity to provide testimony on this important issue. I give a great deal of credit to Assembly members Peter Rivera and Felix Ortiz for holding these hearing and asking very pointed questions about how we can respond to the crisis of returning veterans. Several speakers provided some significant clinical information about Post Traumatic Stress Disorder (PTSD) and how we can be more responsive as a system to the PTSD needs of veterans and other trauma related issues. The most moving speaker was a veteran who had recently returned from Iraq who shared his compelling story about how it is like to live with PTSD and the lack of care he has received throughout the process. In our testimony, I shared several recommendations that were both global and specific to New York. I spoke about the need for funding to train non profit agencies in treatment of trauma related issues and the special needs of returning veterans. Also, we spoke about the need to develop a core curriculum in New York on training trauma for all military personnel. Helena Davis, the MHANYS Deputy Director, has been using her expertise to work on the development of such a curriculum. I know that several MHA affiliates have been working on curriculum development as well. Additional, specific recommendations related to New York include development of a better response to the co-occurring needs of veterans, suicide prevention money specifically geared to veterans, priority in the SPOE process for veterans in the public system, funding for Parents with Psychiatric Disabilities who are veterans, recognition of the needs of the 15% of women currently at war in Iraq and Afghanistan and finally a strong public awareness campaign in New York about the stigma of mental illness. Several of the speakers on Wednesday talked about that stigma. Whether you are a veteran, a child, an adolescent or an adult, the stigma of mental illness is still pervasive. We must do something in New York to change that mindset. Listed below is the Assembly testimony: I would first like to thank Assembly members Rivera and Ortiz for holding this hearing on mental health services for New York State veterans. I would especially like to acknowledge the work of Assembly member Rivera. Public hearings like the one being held today highlight why he is so dedicated to helping individuals with psychiatric disabilities across New York State. My name is Glenn Liebman and I am the CEO of the Mental Health Association in New York State. We have 30 affiliates across New York which represents 54 of the state’s 62 counties. Our organization is comprised of affiliates that provide services, trainings and educational programs across the breadth of New York State. We are also very involved in many different advocacy issues and in the positive transformation of the mental health system. An area in which we have become involved in recent years is around issues of veterans returning from Iraq and Afghanistan and the impact to the mental health of these individuals and their families When the war in Iraq began, no one had any inkling as to how many thousands of American soldier and families would be impacted. The nature of the wars have produced unanticipated impacts on soldiers due to the ever-increasing intensity of civil war and anti U.S. insurgents, extended tours of duty, and the number of soldiers who are serving their second or third tours. According to a survey published in Marine Corps Times in April of 2007 in which 1320 soldiers were surveyed as well as 447 Marines, it is clear that there is a significant mental health impact for individuals serving extended tours and those going back for a second and third tour. It was found that on a second, third or fourth deployment, 27 percent screened positive for mental health issues, compared to 17 percent of first time deployers. And 22 percent of those in-theater for six months or more screened positive for mental health issues, compared to 15 percent of those who have been there fewer than six months. There was also an increased rate of suicide among Army combat veterans. The rate of suicide for combat veterans was 16.1 per 100,000 compared to 11.1 per 100,000 for non deployed soldiers. All of the foregoing has set the stage for a tidal wave of need for returning veterans now and in the future. The number of soldiers returning home with acute psychiatric symptoms increases exponentially as the chaos in Iraq and Afghanistan increases. As we have seen in recent months, the Veteran’s Administration (VA) procedures are far too cumbersome and staffing is too sparse to attend to the immediate physical and psychiatric needs of returning soldiers. In addition, the V.A. has had to cut services to families that are struggling to maintain an even keel with a family member in harm’s way. The situation is a no-win for soldiers, their families, their communities and the country as a whole. The conditions at the battle front are such that many more soldiers than anticipated are exhibiting acute psychiatric symptoms such as major depression, anxiety disorders and especially post traumatic stress disorder. The more quickly returnees receive proper treatment for their symptoms, the more quickly they will recover. When these symptoms go untreated, they become much worse and other problems such as addiction, domestic violence, homelessness and traumatized families result. Issues of Post Traumatic stress disorders (PTSD) are particularly prevalent among veterans. It is estimated that one in every five Iraq war veterans has PTSD. That number has increased in recent years. Traumatic events such as combat greatly increase a person’s risk of suicide. For those veterans who have PTSD as a result of combat trauma, it appears that the highest risk of suicide is in veterans who were wounded multiple times or hospitalized for a wound. The intensity of the trauma and the number of times it occurs may influence suicide risk in veterans with PTSD. Another factor in suicide and PTSD with veterans is combat-related-guilt. Many veterans experience extreme guilt about acts committed during times of war. In addition, medicating symptoms from PTSD with alcohol and drugs when treatment is not available greatly increases the risk of suicide. The issues of women in the military and PTSD has in many ways been unique to this war. Approximately 15% of the troops that are fighting in Iraq and Afghanistan are women. This is unprecedented in United States history and has greatly impacted many issues including PTSD. Many women in the military are single parents and readjustment is very difficult. If this individual also has PTSD than re-bonding with a child as a parent becomes even more difficult. Unfortunately, the military’s mental health system is not currently equipped to handle the needs of returning veterans. According to the American Psychological Association, more than three out of every ten soldiers meet criteria for a mental disorder, but far less than half of those in need sought help. Sometimes, the report maintains, it is due to the stigma of the illness, but other times it was simply because the services were not available or easily accessible when needed. The report also stated that there are high vacancy rates and huge ‘burn out’ for mental health professionals in the military. Four out of ten active duty licensed clinical psychologist slots are not filled in the military. In addition, one third of army mental health personnel reported high ‘burn out’. In the area of PTSD, it is estimated that only 10 to 20 percent of the military’s mental health experts are trained to help those with post-traumatic stress disorder. How is it possible that when we recognize that PTSD is the mental disorder that impacts over 25% of returning veterans, we have a) such limited resources and b) mental health personnel in the military are untrained in treating PTSD. That is a national disgrace. These problems translate into generations of untold suffering for those involved and untold cost to communities in terms of increased cost for Medicaid, justice and welfare systems. In other words, this is not just a military problem, it is a social problem. More over, this is an ethical problem in that our volunteer soldiers and their families have made huge sacrifices for our country and they should be entitled to timely, adequate, appropriate assistance to recover and resume their lives at home. We could sit back and say, ‘Let the V.A. handle it” but the truth is that the V.A. will not be able to do this alone. Our courageous soldiers and their families deserve to have the most comprehensive mental health services that are available. Recommendations Therefore, we would like to make the following recommendations:
In The News: Gaps
in Mental Care Persist for Fort Carson Soldiers Corey Davis was a machine gunner in Iraq; he was featured in NPR's December 2006 investigation on mental health care at Fort Carson. He told NPR that he began "freaking out" after he returned to the base; when he sought help at the base hospital one day, he says he was told he'd have to wait more than a month to be seen. Gen. Robert Mixon says the Army will take disciplinary action against supervisors who mistreat soldiers with mental health problems.
Those stories sparked ongoing investigations of the post, including one by a bipartisan group of U.S. senators and another by Pentagon officials. Early this year, commanders at Fort Carson responded by launching what they described as an important new program: They required every leader, from sergeants up to generals, to attend a training course on how to spot and help soldiers who potentially have post-traumatic stress disorder. Officials say more than 2,200 leaders have taken the course so far, most of them early this year. But during a recent return trip to Fort Carson to see whether conditions for troubled soldiers had improved, the most significant changes appeared to be rhetorical. More troubling is that independent mental health specialists who work with troops told NPR that Fort Carson's heralded new training course might even make things worse. And it seems as though the commanders' stated goal of helping every soldier conflicts with the military's demand for discipline. Officials at the base say they've been trying to teach leaders about the importance of mental health problems linked to combat since the United States invaded Iraq, but the workshop is the most important new strategy designed to make sure that every leader gets the message. Treat Troubled Soldiers, or Discipline Them? On the face of it, the training program seems like a good step. "One of the things that's extremely important in our jobs is minimizing the stigma associated with PTSD," the director of Fort Carson's medical center, Dr. John Cho, told dozens of supervisors at a recent session. He told them that NPR's reports had taught the base that there were "a number of sergeants" who "did not allow their soldiers to come to our hospital" to get proper psychiatric treatment. In fact, during a previous visit to the post, NPR spoke with a half-dozen sergeants who expressed contempt for soldiers with PTSD. They said such soldiers were "weak," called them "s—-bags," and said they didn't belong in the Army. In the new workshop, a psychiatric nurse, Laurel Anderson, led the audience through a presentation of about 40 minutes designed to get leaders with those types of views to change. "Combat stress should be viewed as a combat injury," she told them, clicking through slides. PTSD is "a bona fide psychiatric disorder." But as she progressed through the slides, Anderson's message seemed confusing. On the one hand, she told them several times that "admitting to a mental health problem is not a character flaw," and that "it's not OK" for soldiers to not get proper help. As leaders, she told them, "Do not ignore the warning signs — excessive drinking, marital problems, domestic abuse, suspected drug use, declining work performance. Make sure you are aware of those signs and symptoms. They are often the first ones." In fact, studies from past wars predict that 20 percent to 25 percent of troops with PTSD might abuse alcohol or drugs, and that significant numbers might commit domestic violence and other destructive behaviors. But, on the other hand, Anderson then seemed to minimize the problem. "The fact is," she declared, "most soldiers who have PTSD do not beat up their families, they do not take drugs – they just don't do that. The Army is always going to be a disciplined organization with no room for that kind of conduct. The truth is, the Army has one mission: Kill the enemy. Its mission is not long-term care." Reinforcing Negative Views of PTSD? NPR sent the audio and slides from the entire training workshop to four mental health specialists who work with troops and their families; they all denounced the program. At best, they said, it's so boring and dry that it's unlikely to change anybody's mind. "I would be worried that it would turn them off," said Dr. Stephen Xenakis, a retired brigadier general who used to supervise all the Army's medical centers in the southeastern United States. "I would say [the training] is a failure," another psychiatrist, Dr. Judith Broder, told NPR. Broder runs a network called The Soldiers Project, which includes more than 100 therapists in California and New York who offer free services to troops and their families. After listening carefully to the lecturer's choice of words and tone of voice, and analyzing the slides, Broder said the training could actually reinforce leaders who feel that soldiers with PTSD deserve to be punished. If the critics heard any "mixed messages," they were "inadvertent," said Dr. Stephen Knorr, the chief of Fort Carson's mental health center. He added that the training would reach leaders even if it were boring, because whenever commanders call soldiers into an auditorium and tell them " 'this is important stuff, we've got to take care of our soldiers, we've got to take care of each other,' it has a tremendous impact." New Reports of Punishment for Mental Anguish There are other signs that the climate at Fort Carson hasn't changed as much as the commanders say it should. Five soldiers who spoke to NPR during a previous visit to the post had similar, troubling stories: They had been falling apart, psychologically, since they came home from the war. Their supervisors had been punishing them and, in some cases, taking steps to kick them out of the Army. The soldiers' medical and personnel records corroborated their accounts. Commanders at the base would not talk to NPR about the soldiers, citing medical privacy. Commanders also stressed that it's unrealistic to expect every leader at Fort Carson to change as a result of the new training on PTSD. Still, the base commander, Gen. Robert Mixon, insisted that he'll punish leaders who mistreat soldiers who are troubled. "We expect leaders to support soldiers' getting care and treatment without bias," Mixon said. "And if we see evidence of bias, we will take disciplinary action against the leaders." Mixon said the Army has already held some leaders "accountable." But Mixon's right-hand man, Command Sgt. Maj. Terrance McWilliams, said, "No, we have not taken disciplinary actions." McWilliams said he has merely "reprimanded" a few leaders "verbally." As McWilliams explained his approach to running the post day-to-day, he shed light on the dilemma that seems to be causing controversy around Fort Carson. The training sessions on PTSD teach leaders that some of the most common side symptoms include "excessive drinking, marital problems, domestic abuse, suspected drug use, [and] declining work performance," but McWilliams insisted that he'll punish soldiers who misbehave in those very ways — even if the Army's doctors have diagnosed them with disorders like PTSD. "We have an obligation to maintain good order and discipline," McWilliams said. "We just can't … say that 'my experience in Iraq or Afghanistan is a justification as to why I broke the law' " — including military rules. Mental health specialists who work with PTSD patients say that Fort Carson's policy in effect punishes many soldiers for their illness — because a minority of soldiers with PTSD do act out in destructive and even illegal ways. 'We Can't Fix Every Soldier' The Pentagon's message is clear: Assistant Secretary of Defense William Winkenwerder told NPR last year that the military's goal is to heal every soldier who comes back from the war with emotional problems, or at least heal the soldier enough to return to active duty or live a good life outside the military. But Knorr has written a memo warning commanders that trying to save every soldier is a "mistake." "We can't fix every soldier," Knorr's memo states. "We have to hold soldiers accountable for their behavior. Everyone in life — besides babies, the insane, and the demented and mentally retarded — has to be held accountable for what they do in life." Knorr's memo, which he posted on his office bulletin board, also warns commanders not to make another mistake: "Procrastination on discipline and separation." Translation: Officers should get rid of troubled soldiers, quickly. "From a commander's standpoint," Knorr explained, "a staff sergeant may have 30 officers in his platoon, and he has to get them trained and ready and working on a cohesive team. If he has one or two soldiers who are not showing up for work, showing up intoxicated, using illicit drugs, or going AWOL, that soldier with the misconduct problems is dragging behind the whole platoon — and they don't have time for that." NPR recounted Knorr's comments for Dr. Xenakis. "It really saddens me" to hear that policy, Xenakis said. "It's inhumane." |
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