Military Mental Health Care Update

The VA and Pentagon are on the cutting edge of mental health care – but struggling to shoulder the burdens imposed by two long wars.

By Craig Collins - December 28, 2012

new Mental Health Center at the Palo Alto Veterans Hospital in California

Iraq war veteran and VA patient Chris Hurt walks the labyrinth in the large recreation courtyard at the new Mental Health Center at the Palo Alto Veterans Hospital in California, June 18, 2012. The center is a 90,000-square-foot facility with 80 beds, including 20 acute psychiatric beds. The center is part of a nationwide push by an already-strained VA system that is gearing up to cope with the mounting flood of veterans returning home from the Iraq and Afghanistan war theaters. Photo by Dan Honda

Coincidentally, Chiarelli’s interview was posted the day after a DoD/VA announcement that they were jointly investing more than $100 million in research that would lead to better diagnoses and treatments for TBI and PTS.

A greater investment in long-term studies may help the VA and Pentagon more efficiently target their resources. One of the reasons Chiarelli is so passionate about brain injury research is that he believes some troops have been wrongly diagnosed with PTS. It’s not unheard of for troops to feign symptoms in order to qualify for medical retirement, especially since troops with PTS receive an automatic 50 percent disability rating – a status that enables them to receive TRICARE coverage for life. As the Army sorts out the Fort Lewis scandal, it’s still not clear which evidence-based criteria will be used to arrive at a final rating for soldiers who have received at least two conflicting diagnoses.

Gen. Peter Chiarelli destigmatizing behavior health issues

Gen. Peter Chiarelli, Army vice chief of staff, responds to a question at a Pentagon press conference where he outlined the Army 2020 Generating Health and Discipline in the Force, Report 2012. “I think we have begun the process in the Army of destigmatizing behavior health issues. That to me is absolutely critical. People who need help, get the help that they need. I think we’ve [been able to do this with the help of] commanders and leaders at all levels,” he said.

The VA’s own research partnerships are leading the way, meanwhile, in identifying biomarkers in the brain scans of PTS and TBI patients – the kind of concrete evidence clinicians have been looking for to guide them through the process of diagnosis and treatment.

Such empirical results may also one day help to reduce or eliminate the military stigma associated with mental health care: If the psychological and cognitive difficulties associated with PTS and TBI can be pegged to visible anomalies in a brain scan, why should anyone feel any “weaker” than he or she might feel in seeking treatment for a broken limb?

The VA’s medical research program, one of the largest in the world, combines the expertise and resources of numerous public and private partners. Out of necessity, it seems, the future of mental health care for service members and veterans will involve similar partnerships, such as those being pioneered by DoD and the NICoE.

Tanielian hopes these efforts will produce evidence-based solutions that work. “First, I think you need to ask the question: ‘Are these effective solutions?’” she said. “It’s wonderful, the plethora of nonprofits and community-based organizations that want to deliver services to veterans and help their families in some way, and have been able to get funding from foundations or corporations.” In order to progress beyond these isolated pockets, however, much work lies ahead: integrating these programs to make sure they meet the same standards, and making sure they’re sustainable. “Progress has been made,” Tanielian said, “and it should be acknowledged. But it’s been slow, and it’s yet to really have a demonstrated impact. We need to continue to focus on these issues.”

This story was first published in The Year in Veterans Affairs & Military Medicine 2012-2013 Edition.