Addressing veterans' mental health

It's fitting that the US dedicates a day each year to honoring veterans, but ensuring that veterans get the care and services they merit is year-round work. In recent years, we've seen the federal government increase recognition of, and resources for, the mental health conditions that many veterans suffer from. Yet, as US Representative and combat veteran Charlie Rangel points out in a USA Today column, we haven't done enough:

In the United States, suicide has become the seventh leading cause of death for men and the fifteenth for women. Every year, there are nearly a million suicide attempts. I am especially alarmed that veterans account for 20% of all suicides. Nearly eighteen veterans and one active-duty soldier take their lives each day. This is simply unacceptable.

Rangel recognizes some new and successful programs developed by the Department of Veterans Affairs: AboutFace, the Veterans Crisis Line, and Make the Connection. He also recommends, and has promoted legislation to address, mandatory Transition Assistance Program counseling for all soldiers and sailors returning home and relaxing restrictions on delivering telemedicine across state lines.

In September, Tina Rosenberg of the NYT Fixes Blog delved into some of the many different therapies available to help veterans struggling with post-traumatic stress disorder. She also reported on the scope of the problem, and the resources devoted to it:

According to a recent report by the National Academy of Sciences’ Institute of Medicine, since 2005, the Pentagon and the V.A. have greatly increased funding for PTSD research. The V.A. has added 7,500 full-time mental health staff members and trained 6,600 clinicians to do cognitive processing and prolonged exposure therapies. Starting in 2008, all large V.A. clinics were required to have mental health providers onsite. The V.A. also added more centers that offer free, confidential counseling. Mobile centers bring counselors (themselves combat vets) to rural areas where other counseling is scarce.

All this effort however, is falling short. Only about 10 percent of those getting mental health care in the V.A. system are veterans of Iraq or Afghanistan — a vast majority of those treated are still Vietnam veterans. But some 2.4 million soldiers have been through Iraq and Afghanistan. The RAND Corporation’s Center for Military Health Policy Research did a telephone survey of vets from these conflicts and found that one-third were currently affected by PTSD or depression or report exposure to a traumatic brain injury — and about 5 percent had all three. RAND also found that only half of those who reported symptoms of major depression or PTSD had sought any treatment in the past year.

In the Washington Post, Jim Sheeler has an excellent portrait of Army Lt. Col. David Cabrera, "believed the first military social work officer killed in action by enemy fire." The colleagues and patients (both official and unofficial) who talked to Sheeler expressed gratitude and admiration for Cabrera -- and seem to agree with Cabrera's belief that deploying to combat zones gives therapists an important perspective and helps them earn their patients' trust. If you only click through to one Veterans Day article make it this one; just make sure you have tissues handy.

Mental health services often get insufficient attention and resources in the US, and improving them is an ongoing effort. We owe it to the men and women who've put themselves in harm's way to serve this country to get it right.

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