Improving Treatment for Recent Veterans Suffering from PTSD & TBI
With thousands of new veterans experiencing Post Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI) symptoms in the weeks, months and years after returning from Iraq and Afghanistan, Senator Gillibrand has a comprehensive plan to bolster monitoring and treatment for men and women in uniform and new veterans. Senator Gillibrand’s legislative agenda focuses on getting the bureaucracies at the Department of Defense (DOD) and the Veterans Administration (VA) to coordinate more effectively and work to address the stigma associated with mental health treatment by pushing for enhanced screening and better access to mental health providers.
According to estimates from a Stanford University study, PTSD and other mental health illnesses can be expected to affect upwards of 35 percent of all veterans of the wars in Iraq and Afghanistan. But despite the far reach of PTSD and TBI on service members and recent veterans of Iraq and Afghanistan, there remains much more to do to provide quality treatment and combat the stigma associated with mental health disorders.
Estimates based on data from the RAND Corporation indicate that nearly 8,000 recent veterans from New York suffer from PTSD, more than 7,000 suffer from TBI, and more than 4,000 suffer from both. The RAND Corporation estimates that 20 percent of Iraq and Afghanistan veterans suffer from PTSD, 19 percent suffer from TBI and 7 percent suffer from both afflictions.
READ the county-by-county report estimating how many recent New York veterans suffer from PTSD and TBI.
Senator Gillibrand’s New Efforts to Improve PTSD and TBI Treatment for New Veterans:
1. Improve Coordination Between Defense Department and VA
Although problems still remain, the Defense Department has recently made significant strides to improve the screening and treatment of cases of TBI within its ranks. However, many of these improvements have not been translated into a coordinated approach for veterans leaving active duty and entering VA care. For example, the VA and DOD currently have no shared interoperable definition of what even constitutes TBI cases, making it difficult to ensure veterans are immediately receiving effective treatment when they transfer to the VA. Establishing correct identification of TBI is critical to ensuring the right treatment. In a letter to Defense Secretary Robert Gates and VA Secretary Eric Shinseki, Senator Gillibrand is urging development of a coordinated approach to identifying and treating Traumatic Brain Injury. Additionally, Senator Gillibrand is expressing concerns over the increased reliance on psychotropic medication to treat TBI, which has nearly tripled, increasing from approximately 100,000 prescriptions to more than 300,000, with no clear evidence as to its effectiveness.
Senator Gillibrand’s full letter to Secretaries Gates and Shinseki:
Dear Secretary Gates and Secretary Shinseki:
First, I want to commend both of you on your aggressive efforts in identifying Traumatic Brain Injury as the signature wound to our American service members who have valiantly served our great Nation in Overseas Contingency Operations in Iraq and Afghanistan. The steps that you have taken to establish a Federal Recovery Coordination Program is to be commended. Clearly, it is America’s responsibility to ensure that our joint war-fighters are able to recover from their injuries, gain access to the finest rehabilitation services available, and reintegrate into society to pursue a normal fulfilling life after their service.
At a strategic level these efforts are commendable. However, I believe much more work needs to be done to ensure that this visionary alignment occurs not only between the Secretaries involved, but also at a patient centered, customer service level, integrated between all three branches of service and with Veterans Affairs. Ultimately, alignment strategies will serve to increase efficiency in the delivery of health care services, remove redundancy, and relieve the financial responsibilities by embracing cost sharing methodologies between both departments.
I am particularly concerned that after nine years engaged in Overseas Contingency Operations we still do not have a referenced, functional and interoperable definition of Traumatic Brain Injury. Is there a definition that is in development? This definition should of course reflect tri-service input, but also should be integrated between the services and interoperable with the Veterans Affairs Health Care System. The Department of Veterans Affairs will be responsible for the health care of our service members who are released or retired from active duty with a disability. It only seems reasonable that Veterans Affairs should be considered an equal partner and have a voice at the table. In my meetings with veterans across New York, it often seems that this is the weakest link in the delivery of timely and efficient health care.
Another area of concern which could be aided by improved coordination is the significant increase in prescriptions for Psychotropic Medications. It was identified at a recent hearing on military health that in the earlier years of this decade, approximately 100,000 prescriptions were given for the treatment of psychological health issues and suicide associated with mild Traumatic Brain Injury. However, in the later years this number has grown to over 300,000 prescriptions. Are there non-pharmaceutical interventions available that could be explored to address this issue? In particular, we must ensure that a heavy reliance on prescription drugs is not used as a stopgap measure in lieu of effective treatments over the long-term. This issue in particular validates the need to bring Veterans Affairs as an equal partner in developing a synchronized delivery of quality health care to our service members.
Your mutual strategic vision is admirable and once integrated, health care delivery between the three branches of service and Veterans Affairs at all levels would be transparent and clear to our men in uniform. It will increase the efficiency of health care delivery, ensuring that all of our returning service members have access to effective care and treatment, and the resultant cost saving strategies will allow valuable resources to be applied to other areas vital to our national security.
I request your vigilance on these issues, and look forward to any information that you can present regarding an integrated and interoperable definition of Traumatic Brain Injury and associated non-pharmaceutical treatment protocols. American service members deserve the very best and most expeditious care available in addressing this serious and potentially lifelong healthcare issue.
2. Embed Mental Health Providers with National Guard and Reserve Units
Guard and Reserve units have proven to be particularly susceptible to PTSD as a result of multiple deployments and the struggle to readapt to civilian life. In the first four years in Iraq and Afghanistan, more than half of suicides of former service members occurred among Guard and Reserve veterans. To provide these troops with consistent access to mental health treatment, Senator Gillibrand is cosponsoring legislation to embed a mental health professional with every Guard and Reserve unit to build the trust of troops and their families and help identify the onset of mental injuries. Based on a successful pilot program with the California National Guard, this measure has been proven to increase access to mental health treatment and reduce the stigma associated with seeking help, almost doubling the percentage of Guard troops independently seeking mental help without referral from a military clinic or leadership.
3. Establish Long-Term Screening and Care
The Defense Department has made significant progress in the past few years in developing screening evaluations to identify cases of PTSD upon service members return from combat. However, Senator Gillibrand has heard from many veterans who have found that because of the slow onset of PTSD symptoms, a one-time screening upon return from deployment is not always adequate to identify a case. As a result, Senator Gillibrand is writing to Charles L. Rice, Assistant Secretary of Defense for Health Affairs, pushing to develop recommendations on how to best capture later onsets of these illnesses, such as by requiring an additional screening 6 or 12 months after a service member returns from combat, a proposal that would also help address the stigma of checking oneself in for treatment by making it a standard element of post-deployment reintegration and recovery.
Senator Gillibrand’s full letter to Assistant Secretary Rice:
Dear Secretary Rice:
I want to thank you for your efforts to address a serious health care issue facing our Armed Forces, PTSD. In particular, the development of an effective Post Deployment Health Assessment to screen for potential cases of PTSD upon a service member’s return from combat has become an essential tool in ensuring that our men and women returning from missions overseas receive prompt and effective treatment for this illness.
However, as I have met with constituents across the State of New York, I am particularly concerned as to the follow-up procedures for the identification and management of PTSD after a service member has separated from active duty, and transitioned into civilian life. Since PTSD can present as a transient, temporary, or permanent condition, and can develop months or even years after a service member’s military experience, how does the screening and assessment process work and how do you ensure that no one who separates from active duty loses access to the military health care system? In particular, it appears that although the vast majority of returning service members now receive an assessment upon their return from overseas, there is no effective way of capturing cases whose onset occurs after their return from service.
In particular, I urge you to consider the possibility of implementing a second assessment six or twelve months after a service members return. This would ensure that our returning soldiers, sailors, airmen and marines who have experienced trauma in their service, but whose symptoms may not have developed until after their return would still be captured by screening, and provide an opportunity for these men and women to receive appropriate treatment and care for their mental health wounds. Additionally, many of these veterans who develop cases of PTSD after their return may be reluctant to seek out appropriate medical care, and implementing such an assessment could help neutralize the stigma that these wounded warriors face while attempting to recuperate and prepare either for a return to service or reintegration into civilian life.
Implementing such an additional screening will necessarily require enhanced coordination between the Defense Department and Veterans Affairs, and I am separately advocating with the respective Secretaries to urge new efforts to coordinate care across agencies. As your senior leadership is beginning the integration process at a strategic level, I recommend that you begin to explore avenues of integration at the policy and implementation level, for example, by ensuring that information collected from Post Deployment Health Assessments are passed on to the VA.
The joint warfighter deserves the very best treatment services available. We must ensure that this treatment is not only effective, but is made fully available to all of our returning service members. I look forward to working with you to ensure that all of these brave men and women are receiving the care and treatment they need.