Veterans' Mental Healthcare: Epidemic of Denial

My impression is that PTS and PTSD are going from an undiagnosed or underdiagnosed problem to an overdiagnosed and overtreated problem. The problem of institutionalization of the people suffering for this problem, when the best way to treat this and many other mental disease is to try hard to reinsert the person in his/her family/workplace. People need to be given help there, not in hospitals away from their home. Hospitalizing people for long terms (weeks, months) have a grave risk to make them dependent from the institution. They start behaving like the institution expect they will behave. In the rush to help and protect, people sometimes do more damage than good. The problem is that the good done is seen, but the damage is not.

As I understand how the military does it - they are not taking the institutionalization approach. We learned the hard way as long ago as WWI that approach was one that actually made the problem worse. The French and German approach which mirrors what Mirco spoke of, was much more effective for treating what was then termed "battle fatigue".

Okay John, you asked for it, you got it. My maiden post. In the current health care environment, people with mental health issues are not hospitalized unless they are in severe crisis. Nor should they be. Kat has done a really fine job of outlining the difference between PTS and PTSD and the many issues surrounding these disorders. The standard of care for PTSD includes both individual and group therapy, as well as appropriate medications (antidepressants and anxiolytics) when they are necessary. The group component is very important in helping people understand that their experience is not unique and that they are *not* crazy. Others here have also mentioned the stigma surrounding mental health issues and this is something with which our culture struggles mightily. That is one reason we are beginning to see services labeled as behavioral health. I work in the field of health psychology, which didn't exist when I was an undergrad back in the dark ages. When I am working with people, I try to help them understand that it is impossible to separate the mind from the body. Is your brain not a part of your body? Depression and PTSD should carry no more stigma that diabetes or hypertension. They are problems that need to be dealt with to lead a healthy life.

Everybody, meet my sister. Keep that in mind, too. She's my sister. Pick on me, she'll kick your butt.

And welcome to our commenter from Italy... Mirco.

Well, when we are talking about "suicide" here, we are not talking about "end of life" decisions regarding the terminally ill. Mental health is not a terminal condition unless someone absolutely chooses it. It is almost always something that can be addressed either through therapy and/or medications. Having dealt with several people with the chronic condition, usually the issue is that they either believe they are a burden on their family or they simply cannot deal with how they perceive their own behavior. Typically because it's extreme ups and downs, but also complicated by sleep deprivation, alcohol and drug abuse, family issues (which invariably occur as families try to deal with it). They can't see a way out though it is there. They can't see who they are going to be beyond what they are experiencing right that second. Most of our job is to assure them that this is not the end or the only thing they will ever experience. There is a future, even for those who experience chronic PTSD. The symptoms can be controlled and eventually recess to nothing or a minimum. There are a lot of coping skills that clinicians can teach and that people naturally have if they reach for them. Here's some thoughts on the "over diagnosed"...it happens in every medical condition, it can be "undiagnosed". Secondly, there was a time when it was "under diagnosed" and in reality, that happens today as many try to avoid the diagnosis and hide the symptoms. At this point, "over diagnosed" is not nearly the problem that "under diagnosed" is.

I know that there is the distinction to be made between PTS and PTSD, but to those affected it is a moot point if there are long waits for assistance and lack of facilities in addition to the stigma. Unfortunately, in my experience, the stigma is most fostered by the NCOs with interference, intimidation, threats and punishment. Whether this was (is) ignorance on their part or the pressures top down to train up and have sufficient personnel mission ready.... it exists. Only those [soldiers] in crisis mode (they must tell someone they are considering or have attempted suicide or violnce) are seen on an emergency basis. If a soldier is then determined to be a threat to himself or to others he is hospitalized -- but typically in a civilian facility because the services cannot afford to spend capital dollars on "housing" for mental health conditions. If they are not in crisis, they have to call and get an appointment and wait for weeks to be seen. If they are experiencing crisis symptoms (extreme anxiety, aggitation, severe depression, suicidal urges) they must go to the medical ER where they might sit for 6, 8, 10 hours before they are seen... and most soldiers in crisis leave in frustration. Self medication -- alcohol, drugs and "cutting" (self-mutilation) -- are big time among returning troops... and little is done to discover or discourage such behavior: so long as you show up at formation and pass the occasinal urine screening (and your Sgt. isn't called out to bail you out or break up a fight) -- you're good. I know that they are trying to change the culture within the services and that efforts are underway to up treatment availability in the VA system... but it's going to be a long, difficult and costly process. But it all starts with truthful answers when asked, "Have you ever ______" and the willingness to speak up and/or seek treatment when the answer is "yes".

Heh. That last part is good training. I still do that now and then. And watch for good ambush positions along the highways. It's how you *react* that matters. What's going on inside the head that matters. Good perspective, though. It's one of the things I've actually been hammering Gun Owners of America about - their major argument against the NICs change for Brady Checks has been that vets with PTSD will get denied. Aside from being misleading - it's damn dangerous among the vets who need help.

Thanks for the above website -- very informative for the worried mother who thinks anything unusual means "my baby has PTSD". Said baby, 6 ft. tall and 200 lbs., doesn't welcome the mothering.

"1) They aren't going to be the same when they come back" Might there be a different, better way to say this?

I know that they are trying to change the culture within the services and that efforts are underway to up treatment availability in the VA system... but it's going to be a long, difficult and costly process. But it all starts with truthful answers when asked, "Have you ever ______" and the willingness to speak up and/or seek treatment when the answer is "yes".

Addressing the first part last, I would like to say that, beyond talking bout it as if it was a regular process that we need to discuss, it might be more easily acceptable if we put it in terms that our service members are familiar with. for instance: being mission ready. I had a similar, long conversation at Blackfive. Both soldiers, NCOs and officers need to be aware that being mission ready, in all respects, both physical and mental, are important in order to insure the safety of the soldier in question, the soldiers they serve with and the successful completion of mission. Unfortunately, as I noted there, being able to physically assess someone for mission readiness is easier than assessing their psychic readiness. You can use quantitative assessments for physical conditions. You can use your eyes to see. But the psychic evaluation of "mission readiness" is about paying attention, knowing the soldiers and using our intuition. And, being overly cautious in stating someone has it or doesn't could create a different risk. In regards to available services, upon reading information available, it is apparent that we are basing the funding and addition of services based on a study from 2005. Where this issue is coming to a head right now is that we have had over 175k troops serving in Iraq during some of the heaviest combat. That means that there is a greater number at risk than any 2005 study can assess and recommend for. that goes the same for Afghanistan where, right now, combat and attacks are up significantly for the year. Our problem lies in the several aspects: 1) No one could know in 2005 that more troops would be sent than have been sent on average. Thus, no one could no the added burden. The same goes for the post 2003 invasion. Who could know how long it would go on? but, you would think we had learned our lessons from the past (we're not really that good at it). 2) Our budgeting practices. In order for certain programs to be funded, there must be some very specific numbers and assessment tied to it. These take time and, of course, invariably are based on old data. We are not very quick or flexible with this process. It's meant to protect against abuse, but, based on our spending on this compared to other things, it does appear under represented and under appreciated. 3) Our budgeting practices based on number two and then being presented as the budget for the next year well in advance of that year, leaves little room for that flexibility. It is why we need to be more proactive in reviewing programs and requesting the passing of bills within the entire year to insure these services get proper attention and funding as they are needed, not somewhere down the road.

Unfortunately the numbers reported on PTSD are most likely very low as they rely on people seeking help. Men are far les likely to seek treatment for mental health issues than their female counterparts thus skewing the numbers. As far as the medical proof of PTSD, it is becoming irrefutable as pre-test, post test data of brain scans is conducted. We are seeing changes a decrease in the mass of the hippocampus post stressful event which leads to poor emotional regulation, memory difficulty, etc. Now that they are able to target how the brain is effected, the good news is that the guess work on treatment decreases and they should be able to create more effective interventions.

kat-missouri... just by way of info, soldiers in excess of the 13 beds requiring intensive (in patient) hospital treatment at benning are sent to a civilian facility in columbus, ga... and there are anywhere from 50-75 soldiers at that facility 365 days a year with a constant population (which includes those soldiers who have found basic training too stressful)... and the rumor is that the cost is near $1000 PER DAY PER SOLDIER... but at least the approved "head count" and payroll for Martin Army Hosp. is on budget.