May 28th, 2010
When the presenters at a Veterans’ Mental Health Training Initiative symposium last week in New Paltz, New York, played the “Raise your hand if you…” game, very few participants raised their hands to indicate that they or a family member had been in the military, or even that they were currently working with clients or patients who had returned from combat.
By and large, the people in the room–most of them social workers and other mental health professionals–had almost no experience with or understanding of the unique military culture or the special needs of veterans returning from combat. For many clinicians, attending the symposium was a first step toward developing a new kind of cultural competency as they anticipate working with military families and returning veterans, because they recognize that the need for services is tremendous.
A seminal national study by the RAND Corporation, Invisible Wounds of War, found that nearly 20 percent of the servicemen and women returning from Iraq and Afghanistan have depression and/or post-traumatic stress disorder (PTSD), and approximately the same percentage reported combat-related traumatic brain injury (TBI). Only 53 percent of those with PTSD or major depression sought care, and of those who did seek treatment, half did not receive even minimally adequate services.
The unprecedented rate of suicide among this generation of military personnel and veterans is also a devastating symptom of the untreated mental health needs of this population. At last week’s symposium, many of the presenters noted that more military personnel serving in Iraq and Afghanistan have died as a result of suicide than from physical injuries related to combat. They also reported that as many as 50 percent of female veterans and one-third of male veterans have experienced military sexual trauma.
These statistics are a clear indication that we must do more to increase access to behavioral health services and improve the quality of those services for returning military personnel and their families. At a minimum, services must be made available in the communities these veterans call home—not just through the Department of Veterans Affairs (VA) medical centers and clinics, where there are often real and perceived barriers to care for many returning servicemen and women.
Some good resources do exist for veterans and their families. At the symposium last week, we heard about the program for veterans at Samaritan Village, a long-term residential treatment program where approximately 70 percent of clients are coping with both substance use and mental health issues at the same time. And throughout the country, Readjustment Counseling Centers (better known as Vet Centers) provide veterans and their families with confidential services ranging from marital and bereavement counseling to employment and educational assistance. The centers also can help veterans navigate the VA system to file claims and receive benefits. But we need to do a better job of getting the word out about those resources, and sharing and replicating effective models and approaches.
People are sometimes surprised, at least for a minute, when I tell them that we at the New York State Health Foundation (NYSHealth) have a particular interest in the needs of returning veterans and their families. Most people assume that there are plenty of people who are working on military and veterans’ issues, and that there’s a ton of government money being poured into this area. But in fact the fit is a fairly natural one for a foundation committed to improving the health of all New Yorkers.
In New York State there are an estimated 90,000 servicemen and women who have returned from Iraq and Afghanistan and are working to reintegrate themselves into their families and their communities.
We see it as a community health issue, a public health issue, that so many veterans are returning home in need of care and services—not only for their physical wounds, but for their mental health and substance use issues as well. It’s not just the veterans themselves—their family members also require support and services. When one person in the family is called to duty, the entire family is affected. Family dynamics have probably changed during the time of deployment, and readjusting once the veteran is back home is a stressful and difficult process for everyone.
So NYSHealth has committed $2 million to support the urgent and long-term reintegration needs of returning veterans and their families, with a focus on improving access to timely primary care and services dealing with mental health and substance use.
To help us get a more detailed picture of what some of those needs are, and a more comprehensive understanding of what resources already exist, we have commissioned RAND to conduct a statewide assessment—looking at some of the same issues that it explored in its national Invisible Wounds of War study—that will include both qualitative and quantitative data about New York State. We expect to release the study later this year (sign up here to make sure you receive an e-mail alert when it’s available!), and we hope that it will serve as a road map for a range of actors in the state.
It was encouraging to see last week that so many clinicians across New York State are taking an interest in understanding the unique challenges that returning veterans and their families face. We all have a role to play in ensuring that our servicemen, women, and their families have access to the support and services they need once the veterans are back home.