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War Wounds of The Mind Part IV: A Warning About Troops Returning from Iraq and Afghanistan

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John E. Carey
By John E. Carey
Peace and Freedom
February 21, 2007

We are not qualified to fully assess or predict the Post Traumatic Stress Disorder (PTSD) situation of the American troops returning from Iraq and Afghanistan. And we certainly pray that each man and woman returns to the safety and security of their families without any side effects of war.

But we know now from experience that that is highly unlikely.

We would also like to hope and trust that the Veterans Administration is fully ready for the onslaught of returning PTSD impacted veterans. But reports in the media would indicated otherwise.

The VA vastly underestimated the number of PTSD cases it expected to see in 2006, predicting it would see 2,900 cases. As of June 2006, the VA had seen more than 34,000 Iraq and Afghanistan veterans for PTSD.

A top Walter Reed Army Medical Center official told Congress in September 2006 that 41 percent of National Guard and Army Reservists reported mental health concerns up to six months after deployment, compared with 32 percent of the active-duty force."Stressors may be more intense for those in the (National) Guard and (Army) Reserves, with many leaving families and jobs. Military pay doesn't equate civilian pay. When we look at the intensity of experiences, for many, this (combat duty) is a day-to-day kind of thing ... out patrolling the streets every day, looking for (improvised explosive devices)." Some, Wilson said, tire of questions on their war experiences from well-meaning co-workers, friends or family. "They may shut down further.

"This is not based on statistics, but I'd say it is very likely that we're going to see those returning from Iraq having greater symptoms and a wider range due to the nature of the combat and where (they) are stationed," Wilson said. Some of his patients who served in Iraq have told him they feel alienated after going back to their jobs. "They sense that no one is really going to understand because they weren't there."

Good News: Exposure Therapy

There is also some good news.

Traumatized US soldiers are being treated for post-war psychological disorders by going out on patrol in a computer-generated "virtual Iraq." Skip Rizzo, a psychologist at the University of Southern California, helped create the program that simulates life in the war zone for Iraq veterans suffering from conditions such as post-traumatic stress disorder (PTSD).The system uses a long-established therapeutic technique known as "exposure therapy."

One of the many veterans who have written to us on this subject is Ken Larson. We'd like to close this section of discussion by quoting him directly:

"I am currently a resident in a Minnesota Veteran's Home after having undergone treatment through the VA for PTSD and Depression which was long overdue some 40 years after the Tet Offensive which cap stoned my military career in Vietnam with a lifetime of illness.

My blog has attracted the stories of many veterans' such as myself and other sufferers from PTSD who were victimized by elements of society other than the VA system of medical and mental treatment. I, for one, became trapped in the Military Industrial Complex for 36 years working on weapons systems that are saving lives today but with such high security clearances that I dared not get treated for fear of losing my career. See:


When my disorders became life threatening, the Commission of Veteran's Affairs for the State of Minnesota, Clark Dyrud, stepped in and saw to it that I was entered into the VA System for treatment in Minneapolis. It saved my life and I am now in complete recovery and functioning as a volunteer for SCORE, as well as authoring books and blogging the world.

When I was in the VA system I was amazed at how well it functioned and how state of the art it is for its massive mission. Below is a feature article form Time Magazine which does a good job of explaining why it is a class act:


I had state of the art medical and mental care, met some of the most dedicated professionals I have ever seen and was cared for by a handful of very special nurses among the 84,000 nursing population that make up that mammoth system. I do not say the VA system is perfect. It is certainly being run better on a $39B budget than the Pentagon is running on a $494B budget."

Concern Rising: McClatchy Newspapers Issue an Alert

(Reprinted from an article by Chris Adams, McClatchy Newspapers, First Published February 11, 2007)

An investigation by McClatchy Newspapers has found that even by its own measures, the VA isn't prepared to give returning veterans the care that could best help them overcome destructive, and sometimes fatal, mental health ailments.

McClatchy relied on the VA's own reports, as well as an analysis of VA data released under the federal Freedom of Information Act. McClatchy analyzed 200 million records, including every medical appointment in the system in 2005, accessed VA documents and spoke with mental health experts, veterans and their families from around the country.

Among the findings:

" Despite a decade-long effort to treat veterans at all VA locations, nearly 100 local VA clinics provided virtually no mental health care in 2005. Beyond that, the intensity of treatment has worsened. Today, the average veteran with psychiatric troubles gets about one-third fewer visits with specialists than he would have received a decade ago.

" Mental health care is wildly inconsistent from state to state. In some places, veterans get individual psychotherapy sessions. In others, they meet mostly for group therapy. Some veterans are cared for by psychiatrists; others see social workers.

And in some of its medical centers, the VA spends as much as $2,000 for outpatient psychiatric treatment for each veteran; in others, the outlay is only $500.

" The lack of adequate psychiatric care strikes hard in the western and rural states that have supplied a disproportionate share of the soldiers in the wars in Iraq and Afghanistan - often because of their large contingents of National Guard and Army Reserves. More often than not, mental health services in those states rank near the bottom in a key VA measure of access. Montana, for example, ranks fourth in sending troops to war, but last in the percentage of VA visits provided in 2005 for mental health care.

Moreover, the return of so many veterans from Iraq and Afghanistan is squeezing the VA's ability to treat soldiers from Vietnam, Korea and World War II. And the competition for attention has intensified as the vivid sights of urban warfare in Iraq trigger new PTSD symptoms in older veterans.

"We can't do both jobs at once within current resources," a committee of VA experts wrote in a 2006 report, saying it was concerned about the absence of specialized PTSD care in many areas and the decline in the number of PTSD visits veterans receive.

"There are VA facilities that were fine in peacetime but are now finding themselves overwhelmed," said Steve Robinson, government relations director of the Washington, D.C.-based advocacy group Veterans for America. "So they're pitting the needs of the veterans of previous wars against the needs of Iraq veterans."

While the debate in the VA about the level of its psychiatric care is often frank, the public assurances of top officials are oddly optimistic. "Mental health is a very high priority of ours," VA Secretary Nicholson said last March. "The VA possesses - this will sound boastful, but ... as we used to say back home, it ain't bragging if it's true - but we have the best expertise in post-traumatic stress disorder in the world. ... So we are ramped upward, and we have a terrific cadre of experts in that area, and we are adequately funded to deal with it."

"We feel very well poised to meet the needs," said Antonette Zeiss, a VA health official who's helping to oversee the mental health system, in a November interview with McClatchy Newspapers.

Soldiers coming home today walk into a VA health system that's nothing like it was when veterans returned from World War II, Korea, Vietnam or even the first Gulf War.

The change began more than a decade ago, when the agency decided to move away from focusing on high-cost inpatient hospital care and toward outpatient clinics that could tend to veterans' primary care needs. In addition, the VA scrapped its organizational structure and created about 20 networks, more than 150 hospitals and - as of today - more than 800 outpatient clinics. The new system would provide "easier access to care and greater consistency in the quality of care," the VA said in a March 1995 report.

Its committee of experts, however, said that specialized mental health services were declining and that the VA's use of unadjusted dollars in an era of high inflation in medical costs rendered its annual reports "meaningless."

At the same time, the VA began treating many more people for mental health ailments, so the amount spent has plummeted from $3,560 per veteran in 1995 to $2,581 per veteran in 2004 - even before correcting for inflation.

In the past two years, the VA has committed more money to mental health care and brought services to previously underserved areas. But it's also changed its accounting system, so it's difficult to compare spending after 2005 with that of prior years. What does this all mean for veterans?

It means that veterans receive fewer visits to mental health professionals, on average, than they did before. Between 1995 and the first half of fiscal 2006, for example, general psychiatry visits for those in the mental health system dropped from an average of 11.7 a year to 8.1 a year per veteran, according to VA data.

VA experts said the system already was straining to provide veterans with what they needed before the United States attacked Afghanistan in October 2001. "Even before the war in Afghanistan," Matthew Friedman, a top VA mental health official, told Congress in 2004, "VA PTSD treatment capacity had been overtaxed."

The VA's mental health experts started pushing for specialized PTSD programs in all medical centers in the 1980s. Top VA officials agreed "in concept" that it would be a good idea. But in 2005 and 2006, despite telling Congress that it was setting aside an additional $300 million for expanding mental health services, such as PTSD programs, the VA didn't get around to spending $54 million of that, according to the Government Accountability Office.

McClatchy reviewed two dozen mental health measures, based in part on an analysis of every inpatient and outpatient visit in the VA health system. Among the findings:

" Some veterans get in for visits far more than others. The average number of visits per veteran with PTSD ranged from 22 in the Hudson Valley, N.Y., medical center and clinics to a low of 3.1 in Fargo, N.D. The national average was 8.1.

" Some VA medical centers spend far more on mental health care than others. In Connecticut, it was an average of $2,317 for each veteran's outpatient psychiatric care. In Saginaw, Mich., it was $468.

" Some veterans get in quickly. Others wait. At the Loma Linda, Calif., VA network, only 39 percent of new mental health patients were able to get appointments within 30 days, the VA's standard. In other networks, 90 percent or more did.

" Once they're in the door, so me veterans get visits of 75 to 80 minutes, while others get 20- to 30-minute appointments, the shortest psychotherapy appointments listed in the system. Asked about the disparities, the VA's Zeiss said: "It's true there are disparities. ... Disparity is a part of health care. ... I can tell you that the data you're looking at we're looking at too, and we're using it to make decisions about how to close the gap and ensure a standard of care nationally."

The VA's top mental health services official, Dr. Ira Katz, added that variation in mental health measures wasn't necessarily good or bad. It could reflect different strategies being tried in different states. As for the wide variation in spending per veteran on mental health care, Katz said it could be explained by the presence of special programs in various medical centers. There's a national PTSD research center at the Connecticut VA, for example, that inflates spending figures there.

The VA has begun to pump more money into local clinics to ensure that they begin to provide mental health treatment.

More on PTSD

Post-traumatic stress disorder is an anxiety disorder that can occur after a person lives through a traumatic event, such as military combat.

Not every combat veteran will get PTSD. But those who do can become easily startled and irritable, and they often feel that they are on guard. They might constantly relive a life-threatening event through flashbacks or nightmares, which often trigger intense feelings of fear, helplessness and horror. Others may isolate themselves or try to numb their memories with drugs or alcohol.

People with PTSD suffer more unemployment, divorce or separation and spousal abuse than people without PTSD.

Source: Department of Veterans Affairs National Center for PTSD

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John E. Carey is the former president of International Defense Consultants, Inc.
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