Article: National Council Testimony on Post-Traumatic Stress

On May 16, 2007, Linda Rosenberg, President and Chief Executive Officer of the National Council for Community Behavioral Healthcare testified before the House Committee on Veterans Affairs as a participant in the PTSD Health Care Symposium.

After Ms. Rosenberg introduced herself and described the National Council, she pointed out that Operation Iraqi Freedom [OIF] and Operation Enduring Freedom [OEF] are unique in their heavy reliance on the National Guard and Reserves who compose a large percentage of our fighting forces. Reserve forces alone make up as much as 40 percent of U.S. forces in Iraq and Afghanistan and, at one point, more than half of all U.S. casualties in Iraq were sustained by members of the Guard and Reserves. She went on to say that "these operations are also unique in their reliance on repetitive deployments".

She went on to point out that the incidence of mental disorders among returning soldiers can only be described as alarming. Fully one-quarter of returning veterans are reporting symptoms consistent with PTSD, according to DOD data released earlier this month. Also strikingly high, are prevalence rates for major clinical depression and anxiety disorders. She notes that according to the Washington Post an Institute of Medicine study on PSTD referred to fears that returning troops will produce a " tidal wave" of PTSD cases.

Ms. Rosenberg hastened to add that from a clinical perspective, it's important to note that all three of these conditions-PTSD, clinical depression and anxiety disorders - often co-occur in the same individual, which gives rise to major treatment challenges. Added complexities include co-occurring substance abuse disorders and the strong social stigma still associated with mental illnesses. In many instances fear and shame combine to delay initial access to treatment which means that veterans do not seek mental health care until their symptoms have become acute-or they are in psychiatric crises. She further stated that she was "struck by the recent testimony of Colonel Cameron Ritchie, M.D., a U.S. Army Psychiatrist and the former Chief Forensic Psychiatrist of the Walter Reed Health Care System, before the Senate Mental Health Caucus some weeks ago. Col. Ritchie stated that the prevalence of mental illnesses is particularly high among soldiers who have experienced multiple deployments."

She went on to say that there can be no question that the U.S. Department of Veterans Affairs is THE world leader in recognizing and successfully treating PTSD. She said "furthermore, the National Council strongly believes that the VA's research and treatment capacity in this critical area must be both preserved and substantially expanded".

Ms. Rosenberg added that she is very proud to report that-when called upon-National Council members have stepped up to the challenge of providing intensive mental health services to our fighting men and women. She cited several examples from around the country where outpatient VA clinics have engaged in innovative service partnerships with CMHCs to address the needs of the unexpectedly large number of veterans who require often intensive mental health services. She said that in almost every instance, the target patient population includes mostly National Guard members and Reservists living in rural areas far from existing VA facilities. The most prominent example is in Montana. There the VA Montana Healthcare System has contracted with all four Community Mental Health Centers in the state to initiate care for veterans requiring outpatient services. The individual case rate is identical to that paid if the National Guard member had received mental health care in the VA system. Moreover, the individual VA clinics have total control over all referral processes. While Montana has a relatively small population despite its immense size, it is astounding to note that just in 2006 alone, National Council member agencies served over 2,100 veterans with service related mental illnesses.

She then went on to describe the VA-community mental health agency relationships in South Dakota and western Washington. She said "What's interesting about all of these partnerships is that family support services are a required component". These services are provided to families of veterans as well as to families of deployed service personnel. National Council members also make every effort to ensure that all services delivered to veterans are culturally competent. In many cases peer counseling is a key part of any service plan developed for a veteran.

In conclusion, Ms. Rosenberg said that the innovative service partnerships are an adjunct to the VA's outpatient service network-and each individual partnership was developed to address the unexpected circumstances we now confront. She then said "Given the mental illness prevalence rates that I cited just a few moments ago, the National Council strongly supports a nationwide contract initiative funded at $100 million targeting only National Guard members and Reservists living in rural areas.