These stories sparked the interest of SFTT.[recreading=5]
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
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.
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.
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.”
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.
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.
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?
Dr. Charles Hoge, the U.S. Army’s senior mental health researcher at Walter Reed Hospital from 2002 to 2009 and now advisor to the Army Surgeon General, wrote an interesting piece for the Huffington Post in which he effectively dismissed the idea that there might be lingering effects from mild traumatic brain injury (“TBI”). This article appears to have written to place the US Army “spin” on earlier report from the New York Times that a US Army survey of 18,000 soldiers suggested that 40% of returning soldiers had “experienced at least mild TBI.” Could it be that our antiquated military helmets should have provided better protection to prevent these cases of TBI?
While Dr. Hoge recommends that we should honor these brave but impaired heroes, he goes on to argue that there is no easy clinical or pychological explanation to determine the degree of TBI. In fact, he goes on to suggest that we re-label these conditions to produce an “AC” or Army-Correct version. According to Dr. Hoge, “medical and mental health professionals can better educate their warriors about combat physiology, and not make everything so clinical. Instead of ‘trauma,’ ‘injury,’ ‘symptom’ or ‘disorder,’ they can try using words like ‘experience,’ ‘event,’ ‘reaction’ or ‘physiological responses.’ That doesn’t minimize the importance of medical terminology, especially in guiding effective treatment, but it also acknowledges the warriors’ need for validation of their own experiences.”
This callous “spin” suggests that if we call the symptoms or evidence of TBI something else such as Post Traumatic Stress Disorder (“PTSD”) then we have a psychologically treatable “reaction” to high levels of stress rather than a physical ailment. This is sophistry at its best.
Many have long argued that our troops need state-or-the-art liners and self-adjusting padding inside military helmets to cushion or dissipate the energy of a hit that lessen the sudden movement of the head that causes concussions. Why can’t our brave soldiers be afforded the same level of protection that we give to NFL and college football players? The technology is available if only the US Army would care to look rather than staunchly defend the safety of current military helmets.