Monday, February 12, 2007

Support the Troops by Supporting Mental Health Services for Veterans

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Chris Adams at McClatchy has a lengthy piece about the grossly inadequate and inconsistent treatment received by veterans who are suffering from post-traumatic stress disorder (PTSD):

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 Reserve troops. 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 yesterday's 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-based advocacy group Veterans for America. "So they're pitting the needs of the veterans of previous wars against the needs of Iraq veterans."

All too often, this is the result:

In the small town of Grundy Center, Iowa, Randy and Ellen Omvig keep a large plastic freezer bag. Inside is a piece of torn paper with "Mom & Dad" written at the top.

When she first saw it in December 2005, Ellen thought it was a Christmas list from her son Josh, who had just walked out the front door.

Then she read the words:

"Don't think this is because of you," it said. "You did the best you could with me. The faces and the voices just won't go away."

The note indicated Josh's imminent suicide and went on to apologize for the pain he would cause. He said he had just received a driving-while-intoxicated charge - a surprise since he rarely drank. "This kills all hope of becoming a police officer that I ever had," he wrote.

By the time Ellen realized what the note was about, she ran outside. Josh was getting in his truck. She grabbed the side mirror, yelling hysterically that he would have to run her over before driving away. He yelled back, about a friend who had been killed in Iraq.

"Your battle buddy would not want you to die," she screamed.

"Mom, you don't understand," he said. "I've been dead ever since I left Iraq."

Josh shot himself in the head a few seconds later, as a police officer - and close friend - pulled up. His case made local headlines and has since become the inspiration for legislation in Congress to better prevent veteran suicides.

Josh Omvig had been a happy kid who signed up for the Army Reserve the day after he turned 18. He spent an intense 10 months in Iraq and then suddenly was home again. In the space of six days, he went from serving in Iraq to sitting at his family's Thanksgiving dinner table.

In the 13 months that followed, it was clear that Josh had changed. His parents urged him to get help. But he was convinced that showing up at the VA would go on his record, costing him a career in the military and law enforcement.

The Omvigs believe the nation faces a cascade of mental health problems.

"There are so many Joshes coming back now," Randy Omvig said.
In many respects, the Omvigs' story is remarkably similar to that of the Bowmans', whose son Tim killed himself on Thanksgiving Day in 2005.

It's impossible to know what goes through the mind of any suicidal veteran, or whether VA care would have made a difference. But as he tries to rebuild his life without his son, Mike Bowman is convinced that even a little care would have been better than none.

Tim Bowman joined the National Guard after Sept. 11 but before the Iraq war.

He was a charming jokester, a small-town kid who played musical instruments in high school, attended some junior college and then went to work in his family's electrical business in Polo, Ill.

He left for the war on March 4, 2004, his 22nd birthday.

Over the next 12 months, his assignments varied, but among them was helping patrol Route Irish, the treacherous airport highway. He told his father about having to bag body parts.

In his communications back home, Tim became an expert at withholding the details of his reality. He did open up once, however. Home for a short leave, Tim and his father stopped for a beer after a softball game. They got into their deepest conversation about the war and even talked about an episode in which Tim, as the last line of defense, said he was forced to shoot at a car - with a family inside - that had failed to stop at a checkpoint.

"He was really quiet as he told me - not at all the normal Tim," his father said. (His commander at the time said he is unaware of any incident like Tim described. Tim's father said Tim may have been involved in a shooting and "assumed the worst in his state of mind.")

At the end of his leave, Tim didn't want to go back to Iraq, but he didn't not want to go back, either. More than anything, he couldn't stand being away from his unit.

He returned home for good in March 2005. His deployment had included some mental health screening, but he told his father that it was "a joke." Soldiers coming off months of active duty would say anything during the screenings. "All they wanted to do was get home," his father said.

That was a feeling shared by Tim's commander in Iraq, Maj. Mike Kessel of Mahomet, Ill., who recently retired after 21 years in the Army National Guard. Two months before his unit returned home to Illinois, Kessel urged his bosses to change the demobilization process by letting the soldiers go home briefly before returning for health screening.

"I knew we were going to have problems," Kessel said. But his proposal was rejected.

"We got off the bus, we had a five-minute ceremony, and, boom, we were released," he said. "We didn't come back to drill for 110 days. Suddenly, your support system is gone. We had 120 people in 70 communities spread across five states."

In a 2004 study, nearly two-thirds of soldiers and Marines who met the criteria for mental health problems felt that seeking help would harm their careers, that they would been seen as weak, that superiors might treat them differently. One VA report from 2006 said that "any effort to reach out to these veterans and their families will face enormous obstacles"; it also said that the current system "follows an attitude of `ask, but don't tell.'" While every returning soldier is asked four important PTSD-related questions, "no one seems to expect them to answer truthfully."

Tim came home and tried to dive back into his life, working his electrical job and volunteering at the fire department. He'd be pleasant one minute and flip out over mild annoyances the next.

"I don't feel right here," Tim admitted during a rare candid conversation with his sister Michelle. "I'm spending too much time in the bar," he added.

Tim took a six-week National Guard assignment to help with the Hurricane Katrina recovery. His family said he relished the structure of the unit. He even began talking about the possibility of going back to Iraq.

"What better place for a soldier to die," he told his father one night.

In November, Tim scheduled an appointment with the VA. His father wasn't sure what it was for - mental issues, or perhaps follow-up for a hand injury that Tim had suffered in Iraq.

The night before Thanksgiving, Tim had a great conversation with his father and his sister. He seemed his old, jovial self. His family now believes that by then he already knew what he was about to do.

The next day, Tim didn't show up for an extended-family Thanksgiving dinner. They called and called. Finally, Mike Bowman decided to see if Tim was at the family business. He found him on the floor, shot but still breathing.

Tim died two hours later.

At Tim's funeral, Kessel, his commanding officer, found that several other soldiers were having mental troubles, too - and having trouble getting into the VA.

"They were told, `We can't get you in for six months,'" Kessel said. "We started pulling a bunch of strings and making lots of noise, and then people started listening.

"But it was one soldier too late."

In the thousands of blog posts written by war supporters urging Americans to "support the troops" and insisting that the only way to support the troops is to support the war, I don't think I have ever seen even one post about the suicide rate of returning soldiers as well as soldiers still in the field -- unless it was a post intended to dismiss the seriousness of the problem. I don't recall a single post that wrote with sympathy, much less horror, about the mental torment of returning troops, or the lack of appropriate services to address the emotional and psychological problems of soldiers who have seen and done things they cannot forget, or live with. How many bloggers on the right will proactively, and not as a defensive retort, even mention, much less write about, this McClatchy article? I am betting none.

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