PTSD: Light at the End of the Tunnel?

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Mental health problems and self-destructive behavior have always been difficult subjects to discuss, let alone diagnose and cure.   Since the 2008 Rand Corporation study on Post Traumatic Stress Disorder (“PTSD”) entitled Invisible Wounds of War:   Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery,  there has been growing preoccupation with the high incidence of psychological disorders affecting military men and women serving in Iraq and Afghanistan.  According to the Rand study, it is estimated that one in five veterans suffers from some form of mental disorder.

In February of this year,  Mental Health America (“MHA”) hosted a proof-of-concept conference consisting of 35 experts to help achieve the following goal:

By September 11, 2011, all­ active duty, retired, or separated National Guard, and Reserve Operation Enduring Freedom (OEF; Afghanistan) and Operation Iraqi Freedom (OIF; Iraq) veterans, and their dependents, will have access to unlimited, free mental health counseling which meets an established nationwide standard for military-specific, trauma-informed care.

While this goal is still far from being realized, the MHA conference had what we consider to be the finest assessment of the current difficulties we have in dealing with this growing epidemic.  Because of it relevance to providing our brave warriors with access to the best treatment for PTSD, we are quoting MHA’s Key Discussion Points in their entirety.

MHA’s Key Discussion Points

  • Little has changed in the three years since the 2008 RAND study.  Approximately 18.5% of deployed personnel will experience PTSD or depression.
  • The group concurred that there are currently several significant barriers to care for military family members facing mental health challenges:
  • Lack of awareness of existing programs
    • Personal shame or embarrassment (internal stigma)
    • Organizational discrimination (external stigma)
    • Cost
    • Bureaucratic, burdensome process
    • Availability of trained expertise
    • Quality of care
    • Accessibility (phone, online, face-to-face)
    • Friendliness of initial contact
  • Passive programs whereby the military member is required to find the program and take a series of steps to receive benefits from the program are probably not adequate to fully meet the need.  Several group members felt strongly that programs needed to assertively reach out to military families to offer help.
  • One participant cited recent studies that indicate that, contrary to common belief, suicides appear to have no statistically significant correlation to deployments but occur evenly throughout the current worldwide,U.S. military population.
  • The most effective current programs empower the client to define precisely what help s/he needs and place the client in contact with “culturally competent” advisers/counselors.  There are many programs offering services that are inappropriate for the unique mental health needs of military service members and their families.
  • To have significant impact and to reach the target population effectively, programs must ensure that their representatives are “culturally competent”, that is, sufficiently familiar with the military culture to quickly establish a bond of shared life experience with the individual asking for help.
  • National efforts should focus not on developing new programs but on creating systems which lead those in need to effective existing programs.  This will require a nationwide, single-message marketing effort and a “navigator” function whereby a trained expert partners with a client to connect them with the best and most appropriate programs available within their community.
  • The availability of confidential care—within the legal constraints that mandate reporting potentially harmful behavior—is essential.  Our society in general and the military culture in particular, will not eliminate the stigma associated with mental health issues in the foreseeable future.  Thatsaid, the American public is now probably more receptive to the need for integrated care than ever before as a result of the wars in Iraq/Afghanistan.
  • Counseling must be evidence-based.  There was general consensus at the conference that the scientific community knows how to treat posttraumatic stress and its co-morbid conditions such as depression, substance abuse, etc.
  • Several in the group highlighted the need for a “navigator” to lead a military service member or family member through the maze of available resources in their communities and link that client with those programs.
  • Counselors should, whenever possible, be trauma-informed.
  • Any solution must serve military service members and their families not located within a military community or near a Department of Defense (DoD) or Department of Veterans Affairs (VA) treatment facility.
  • Community programs and services that are currently offering help must be consumer ratable in order to begin to establish a “gold standard” of care and to identify those programs that are working and those that are not.
  • There was unanimous consensus within the group that peer counseling works to establish a bond with the service person and enhance engagement, and that it should be a part of any comprehensive solution.  Specific features of an effective peer counseling network include:
    • Process to properly screen peer counselor applicants
    • Peers should be paid for their services
    • Peer specialists who are culturally competent
    • Peer specialists who are trauma-informed
    • Continuity; a sustained, trusting relationship with the client
    • Direct, clinical peer supervision and support
    • Systemic indicators to identify “compassion fatigue” among the peer counseling network
    • Near permanent client/peer assignment
    • Casual, relaxed atmosphere
    • Formal peer training and certification
    • Precise job descriptions
    • Ideally, phone or face-to-face counseling only, with an emphasis on face-to-face counseling

SFTT will be devoting an increasing percentage of its attention and resources on helping our brave warriors and their families to deal with the crippling effects of PTSD.  It is important to note that the consensus among the MHA experts that attended this conference is that “National efforts should focus not on developing new programs but on creating systems which lead those in need to effective existing programs.”   This panel of experts argues that we have the necessary resources to deal with the problem and help these brave warriors, but that we need “to establish a ‘gold standard’ of care and to identify those programs that are working and those that are not.”

SFTT is committed to that effort and over the next several months will begin unrolling a national resource center to our brave warriors find the support they need and, most importantly, deserve!

If you would like to help, consider becoming a member of SFTT.

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Brain Injuries: Back Walking Forward

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There is a growing public awareness that many returning veterans from wars in Iraq and Afghanistan suffer Post Traumatic Stress Disorder (“PTSD”) and other brain-related injuries. Some studies suggest that, perhaps as many as 1 in 5 veterans, suffer from PTSD. In fact, 8 servicemembers commit suicide each day as a result of these disorders.

The US Army and other services are aware that servicemembers with and caring inviduals are gathering forces to apply lessons learned in treating civilians with traumatic brain injury (“TBI”) and PTSD and helping our brave heroes reclaim their lives. 

SFTT, under the leadership of Eilhys England, has recently formed a medical task force to help determine “best practices” in helping to deal with this growing crisis.  Over the next several months, SFTT will be sharing the findings of our medical task force and lessons learned from an exciting program called Warrior Salute that we are jointly sponsoring with the CDS Warrior Salute Center in Rochester, New York. We are pleased to report that 7 servicemembers are now enrolled in this program.

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PTSD: A Needs Assessment of New York State Veterans

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Editors  Terry L. Schell and Terri Tanielian  of the Rand Corporation have recently issued a Technical Report for the New York State Health Foundation which chronicles some of the mental health challenges faced by returning veterans in New York State.  “The study found substantial elevated rates of post-traumatic stress disorder (PTSD) and major depression among veterans. ”  The Technical Report to the New York State Health Foundation from the Rand Corporation may be read online (or downloaded).  A report  summary is provided below.

“Mental health disorders and other types of impairments resulting from deployment experiences are beginning to emerge, but fundamental gaps remain in our knowledge about the needs of veterans returning from Iraq and Afghanistan, the services available to meet those needs, and the experiences of veterans who have tried to use these services. The current study focuses directly on the veterans living in New York state; it includes veterans who currently use U.S. Department of Veterans Affairs (VA) services as well as those who do not; and it looks at needs across a broad range of domains. The authors collected information and advice from a series of qualitative interviews with veterans of Operation Iraqi Freedom (OIF)/Operation Enduring Freedom (OEF) residing in New York, as well as their family members. In addition, they conducted a quantitative assessment of the needs of veterans and their spouses from a sample that is broadly representative of OEF/OIF veterans in New York state. Finally, they conducted a review the services currently available in New York state for veterans. The study found substantially elevated rates of post-traumatic stress disorder (PTSD) and major depression among veterans. It also found that both VA and non-VA services are critically important for addressing veterans’ needs, and that the health care systems that serve veterans are extremely complicated. Addressing veterans’ mental health needs will require a multipronged approach: reducing barriers to seeking treatment; improving the sustainment of, or adherence to, treatment; and improving the quality of the services being delivered. Finally, veterans have other serious needs besides mental health care and would benefit from a broad range of services.”

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PTSD: The Unintended Consequence of War

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Almost daily, we receive reports of the devastating impact of PTSD (Post Traumatic Stress Disorder) on our men and women in uniform and the terrible side-effects on their families and friends.   The US Army is aware of the terrible cost of PTSD as evidenced by the 2010 US Army Report on Health Promotion, Risk Reduction and Suicide Prevention.

Many publications suggest that the origins of PTSD are unknown as evidenced by this recent commentary from a government organization: 

“The cause of PTSD is unknown, but psychological, genetic, physical, and social factors are involved. PTSD changes the body’s response to stress. It affects the stress hormones and chemicals that carry information between the nerves (neurotransmitters). Having been exposed to trauma in the past may increase the risk of PTSD.”

While this may be true, there does appears to be a clear linkage between PTSD and the effects of increasing IED (improvised explosive devices) attacks on US and Allied military forces serving in Afghanistan.   While many believe that PTSD is a psychosomatic discorder, it is becoming increasingly clear that concussion-like head injuries are contributing to PTSD and its debilitating physical and mental consequences.    The US Department of Veteran Affairs estimates that between 11% and 20% of veterans who have served in Iraq and Afghanistan may have PTSD.   If so, this is an alarming number – almost of epidemic proportions.

SFTT has long argued that ill-fitting military combat helmets afforded little protection to our men and women in uniform.  The US Army has been painfully aware of this problem for sometime as evidenced by their decision some years ago to implant sensors in helmets to track trauma related injuries.    Recently, we have been told that a “simple tweak” in the amount of padding in combat helmets would reduce head trauma injuries by 24%.    Why did it take so long to realize we had a serious problem?  More importantly, how long will it take our procurement process to get better protective gear to our troops in the field.

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Stand For The Troops

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Soldiers For The Truth has become Stand For The Troops. Our new name reflects exactly what we do on behalf of all concerned  Americans—stand for the troops—and more specifically, stand for our frontline troops, our young heroes who stand tall for us and our country out at the tip of the spear.   

 Our mission remains the same: to ensure that America’s frontline troops get the best available personal combat gear and protective equipment, including body armor and helmets. In fact, the military has been testing helmet sensors in Afghanistan for well over two years to evaluate the effect of IED attacks on our troops while the attacks continue to escalate with little being done to provide our warriors with more adequate head protection.   The sorry result is a near epidemic of troops suffering from traumatic brain injury (“TBI”) and post traumatic stress disorder (“PTSD”) from their service in Afghanistan and Iraq. 

While senior military officials acknowledge that PTSD is a serious and growing problem, diagnosis and treatment remains disjointed, not to mention that admitting to the disorder on record seem to be a career stopper.  Meanwhile new stories break daily about veterans taking their own lives or behaving erratically despite desperate pleas by the families, friends and fellow service members to the chain of command for more easily available, more effective treatment. 

As part of Stand For The Troops’ expanded mission, we’re mobilizing a task force of eminent medical professionals to evaluate existing PTSD treatment within the military and general communities so that a comprehensive, targeted, more effective treatment protocol can be established and offered for the benefit of our warriors. For too long the military has allowed frontline troops to resume active duty while suffering from this debilitating condition—all too often resulting in devastating consequences for both our brave warriors and their loved ones.  

 We as citizens have a responsibility to Stand For The Troops and not allow PTSD—and TBI—to be the legacy of the war in Afghanistan.

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Staying in touch with the Discarded

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On long holiday weekends, warriors not deployed check on one another since they normally have a weekend pass or time off – and this past Labor Day was no exception.   The phone will ring, you see the caller ID nickname you assigned to someone you shared a foxhole with not long ago, you always stop what you’re doing and answer it.  “Have you heard …”, “…you doing alright …”, “… remember the time we…”, “…let me know if you need anything…”.  It goes on like that for however long it takes.  The kids ask afterwards “Who was that?”  You tell them, “RANGER 9”.  They know who that is.  They laugh, remembering the stories about this particular grizzled First Sergeant.  Over time these calls are more infrequent and you miss them — because no one at home understands your silence.  They try, but they don’t get it. 

So the phone buzzed today, the caller ID said CANCER GIRL.  Diagnosed at 22, she’s been fighting for her life for the past 18 months. The last time I heard from her she was having difficulties with her chain of command:  her landlord wouldn’t allow her to break her lease to move onto post and be co-located to the chemo drip and the chain of command never fixed the problem.  Instead, it took a determined and brave case manager to work her magic, but she told me afterwards she felt discarded.   She used the same sentiment this go round as well.  She’s off treatment for the time being and she has a new chain of command, but she’s still dealing with a host of issues and doesn’t have a clear status from the Physical Evaluation Board.

 Seems like it was only last week that the New York Times broke the story on how Warrior Transition Units (“WTU”) were “Warehouses of Despair.”   I asked her then if anything reported was true at her WTU.  “Absolutely.”  But that was this past April, more than four months ago, soon after which the Army started to spin and shifted the issue from “warehouses” to a few bad and despairing apples complaining to the press.  The Surgeon General relied on favorable ratings from recent Wounded Warrior satisfaction surveys to assuage any public outcry.  Then there were visits from  senior Defense and Army leaders to Warrior Transition Units and the fix was in.  In fact, the Surgeon General officially closed the case via a press briefing placing the fault inside Joe’s rucksack as sometimes due to soldiers entering service already mentally flawed with pre-existing conditions.  As a result, this put them at risk for successfully completing effective treatment or for obtaining essential services when they find themselves assigned to a Warrior Transition Unit. Plus, it greatly complicates, if not nixes altogether, getting fairly compensated for service-connected disabilities.

 “I feel like I don’t exist here.  It’s as if all of us here are on the Island of Misfit Toys.  We feel discarded.” “Has it gotten any better at the WTU?”  “No, it’s worse.” “What can I do?” “There’s not much anyone can do for us.  After all the dog and pony show visits, I thought it would return to business as usual, but it actually got worse.  The visits and what they said afterwards made it look like it was our fault for complaining and ever since then, the leadership believes they have a license to do anything.  And the other day, a classic TBI effects and PTSD crackup case that we thought for sure would rate a 70, 80, or 90% came back at 20% because he had a pre-existing condition before he entered the Army.”  “Let me guess, ADD?”  “Yes, Attention Deficit Disorder.” I tried to cheer her up, “But the surveys said everybody assigned to a WTU was as happy as a shiny whistle.”  “Yeah right, you know what we do with those surveys?” “No, what’s that?”  “We discard them, just like they do us.”

What could I say after that?

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