The DoD and VA are combining the best of Western medicine – treatment methods such as natural language processing and prolonged exposure therapy – and alternative approaches and mind/body skills in treating both TBI and PTS. Both the VA and DoD have experimented with the use of service dogs to help PTS patients recognize and stave off symptoms such as panic attacks, flashbacks, elevated heart rate and blood pressure, or nightmares. Naval Hospital Camp Lejeune recently implemented a PTS treatment plan called Integrative Restoration (iRest), an approach rooted in meditative yoga.
Individually, these approaches offer an encouraging look at the future of mental health care for service members and veterans, said René Campos, the retired Navy commander who takes the lead on health care issues for the Military Officers Association of America. But they’re only first steps.
“They’re really trying to look at alternative medicines or therapies, along with the traditional treatment regimes that have typically been used to treat PTSD [post-traumatic stress disorder], and even TBI, to help people manage their lives,” Campos said. These new treatments, however, are not generally available to service members or veterans, but remain confined to pilot settings – what Campos calls “pockets of excellence.”
Barriers to Care
Cheryl LeClair conducts Integrative Restoration (iRest) with Petty Officer 3rd Class Patrick Haslett on June 23, 2011, at the Second Wind Eco Tours building in Swansboro, N.C. LeClair, whose husband suffered TBI on deployment a few years back, became a full-time yoga and iRest instructor to help active-duty service members and combat veterans cope with post-traumatic stress free of charge. U.S. Marine Corps photo by Sgt. Bryan A. Peterson
The quality of mental health care at both military and VA facilities has been demonstrated by studies (including the 2011 RAND study, “The Cost and Quality of VA Mental Health Services”), to be, overall, as good or better than that provided by private health care plans. But Terri Tanielian, the RAND senior social reasearch analyst who co-edited “Invisible Wounds of War,” said this cutting-edge care is still not reaching all who need it, due to three primary challenges: a nationwide shortage of trained mental health professionals, a related inconsistency in the quality of care across mental health settings, and a persistent stigma among service members and veterans against seeking help for psychological injury.
“I think that there have been tremendous efforts made to address those issues,” said Tanielian, “but we still need to get at some of these underlying systemic challenges.”
The enduring warrior-culture stigma against acknowledging psychological injury remains one of the most significant barriers to mental health care for troops and veterans. It has persisted for two reasons: first, a practical concern that mental health treatment might have career repercussions, and second, the belief that the need for mental health care might be viewed as weakness. The Pentagon has, over the past several years, worked to eliminate the first fear, taking several concrete steps to emphasize that one’s ability, rather than a history of seeking mental health care, will determine a service member’s career path. In recent years, the DoD and VA have launched significant efforts to battle the idea that health-seeking is weakness, with their Real Warriors and Make the Connection campaigns offering multimedia testimonials and public service announcements. While these efforts are praised for their good intentions, there’s no evidence yet to determine how well they are working to reach their audience or change existing attitudes.
The shortage of trained and qualified mental health professionals, and the resulting inconsistencies in mental health care quality in underserved areas, affects the entire nation. In September 2012, the Department of Health and Human Services estimated that in order to adequately serve the mental health needs of all Americans – to achieve a population-to-practitioner ratio of 10,000 to 1 – the nation needed 15,259 additional mental health practitioners.
Among service members, and especially veterans, this shortage is acutely felt. PTS and TBI treatments require frequent visits with professionals. But the government’s response to this shortage has, by many accounts, been confusing. The VA announced in April 2012 that it was hiring 1,600 additional psychiatrists, psychologists, social workers, and other mental health clinicians – a staffing increase of about 10 percent – in order to reduce long wait times. On Aug. 31, when President Barack Obama announced at a public appearance at Fort Bliss, Texas, that he was signing an executive order directing the VA to hire 1,600 mental health professionals and 800 peer support counselors, it wasn’t clear whether these were the same 1,600 hires announced in April, or whether the two announcements amounted to 3,200 new mental health professionals working for the VA.
Neither Campos nor Tanielian, experts who often communicate with the Pentagon and VA on mental health issues, understood which was the case, and both expressed uncertainty about where they were going to come from, given the existing nationwide shortage, and who was going to pay for their services, given federal budget constraints.