Health Care Happenings

Suicide in our military and veteran communities is a threat to the health of the all-volunteer force and is an issue of national security!

That was the overarching theme of a panel discussion I attended this week in Washington, DC, hosted by the Center for a New American Security. Discussions centered on the agency’s newly released report called, “Losing the Battle: The Challenge of Military Suicide.”

A very disturbing topic and the statistics that go along with the report are startling to say the least.

Suicide Statistics (approximate rates):

1% of Americans have served in the military—yet, 20% of suicides in the U.S. are former servicemembers.

1 Servicemember died every 36 hours during the period 2005-2010.

18 veterans die a day—1 veteran dies every 80 minutes.

The report tells me we have a lot more to learn, and a whole lot more to do. Suicide among servicemembers and veterans as well as in our civilian communities is a crisis that will truly require a national commitment if we intend to win the war.

Authors of the report, Dr. Margaret Harrell and Nancy Berglass provide a framework for understanding the phenomena of suicide, the obstacles for reducing suicides, and offer constructive recommendations on how the Department of Defense, military services and the Department of Veterans Affairs (VA) can address these obstacles that put the health and well-being of our force at risk.

“Eliminating suicides isn’t realistic, but we can address the obstacles,” said Dr. Harrell during the panel discussions.

“Removing stigma within the military, veteran and civilian cultures is one of the toughest aspects of preventing suicides,” said General Peter Charelli, Vice Chief of Staff of the United States Army, another participant in the panel discussions.

A stability or cohesion period for units after deployment, continuity of mental health services when members transfer, involvement of unit commanders in legal investigations, and improving coordination and data collection between the Departments of Defense, VA and Health and Human Services were just a few of the report recommendations.

The panel highlighted some of the positive steps the agencies have taken to help troops, veterans and families in crisis, but all acknowledged there is so much more that can and should be done.

Dr. Janet Kemp, VA’s National Mental Health Program Director for Suicide Prevention mentioned one of the best initiatives the agency has implemented is the Veterans Crisis Line which has fielded almost a half a million calls and is credited for saving more than 7,000 actively suicidal veterans.

Kemp went on to say, “Any veteran suicide is a lost battle, but I think we are winning the war.”

So why is the issue of suicide so important to our national security and challenges the health of America’s all-volunteer force?

Well the authors pose some interesting questions for all of us to think about:

• “If military service becomes associated with suicide, will it be possible to recruit bright and promising young men and women at current rates?
• Will parents and teachers encourage young people to join the military when veterans from their own communities have died from suicide?
• Can the all-volunteer force be viable if veterans come to be seen as broken individuals?
• And how might climbing rates of suicide affect how Americans view active duty servicemembers and veterans—and indeed, how servicemembers and veterans see themselves?”

THOUGHTS?

Yesterday, the Secretary of Labor the Honorable Hilda Solis, introduced the Trauma-Informed Care for Women Veterans Experiencing Homelessness:  A Guide for Service Providers, also known as the “Trauma Guide.”  This comprehensive guide was created to address the unique psychological and mental health needs of women veterans.  Specifically written for service providers, it’s primary goal is to improve the engagement effectiveness of the female veteran population.

Through the effort to better understand the factors which would lead women to become homeless, the Women’s Bureau at the Department of Labor conducted extensive qualitative research, which revealed that the experience of multiple traumas increases the risk of homelessness and severely impacts women veterans’ ability to re-adjust to civilian life.

Consider these facts about our growing number of military women:

Women are now 20% of new recruits, 14% of the military as a whole, and 18% of the National Guard and Reserve.  While women represent only 8% of veterans, their risk factors are rising disproportionately to their numbers.  Women veterans are at 4 times greater risk of homelessness than their non-veteran civilian counterparts.  Over the last decade, the number of homeless women veterans has nearly doubled, with a significant number having children.  Further research suggests that 81-93% of female veterans have been exposed to some type of trauma either during their service or prior to joining the military.

Thus, the experience of trauma and the subsequent impact on daily functioning can present a significant challenge as women veterans re-adjust to civilian life, and can be a risk factor for homelessness. Women veterans also have unique challenges compounded by their military experiences and multiple roles as breadwinner, parent, and spouse.

• Female veterans who are homeless have significant histories of trauma.
• Exposure to trauma impacts all aspects of daily functioning.
• Female veterans do not always self-identify as veterans.
• Female veterans often find themselves without a support network.
• Few current services exist which address and are tailored to the needs of female veterans.       

So as we seek to further understand how the experiences of trauma impact our female veterans, it is the hope that by using this guide as a framework to tailor services to women;  that providers, organizations and we in the community will be better able to facilitate the recovery and re-entry of our women.

For more information please go to www.dol.gov/wb

On Thursday, during opening remarks at a Senate Veterans Affairs Committee hearing on “VA Mental Health Care:  Closing the Gaps,” Chair Patty Murray (D-WA) made some startling opening remarks that really brought home to me the realities of almost a decade of wars and the challenges facing not only the VA and the Pentagon here and now, but the long-term ramifications for our country and the servicemembers and veterans and their families who sacrificed so much.

Murray started the hearing with 3 sobering points:

• “1/3 of veterans returning from Iraq and Afghanistan who have enrolled in VA care have post-traumatic stress disorder (PTSD),
• On average, 18 veterans kill themselves every day, and
• The difficult truth is that somewhere in this country, while we hold this hearing, it is likely that a veteran will take his or her own life.”

                                                    Wow–What a Wake-Up Call!

Two of the major challenges facing VA are–lack of mental health providers and access to quality, evidenced-based care in a timely manner–same issues, just a different day, a different hearing.

While VA has done much to address these issues, they continue to struggle with closing these gaps. 

One wounded warrior testified to having contacted his VA medical center to reschedule a counseling appoint in order to come to the hearing.  The staff told him they could change the appointment but he’d have to wait 4 months to get in again.

The spouse-caregiver of another wounded warrior testified also that it’s a 24-7 effort to personnally care and coordinate the services her husband needs through the VA: 

“It took months to navigate the [VA] bureaucracy…there is a mental health crisis going on and the system is failing these warriors…” 

MOAA is grateful for the Committee’s leadership efforts in keeping these issues on the radar scope. 

And, we appreciate the progress and investments made by the VA and DoD to close the gaps in wounded warrior care. 

Our Association will do all we can to keep these invisible wounds visible so our troops, veterans and their families don’t become casualties of the very systems responsible for their care.

You too may have your own sobering stories or experiences with with the VA.  We are always happy to hear your stories. 

Read more this week in MOAA’s Legislative Update on the hearing and a summary of the House Veterans Affairs Subcommittee hearing onVA’s caregiver assistance program.

On Tuesday the Defense Health Board met here in Washington DC to discuss several findings and to review an interim report on Psychotropic Mediction and Complementary and Alternative Medicine.  The Defense Health Board is a Federal Advisory Committee to the Secretary of Defense.  It provides independent scientific recommendations on matters relating to operational programs, health care policy development, health research programs and requirements for the treatment and prevention of disease and injury, and the delivery of health care to DoD beneficiaries.  It is a board comprised of the country’s top leaders and medical specialists.

One of the charges of the group was to examine the prescription practices and psychotropic medication use of troops and to take into account the context of specific military-unique challenges that might impact the well-being and psychological health of Service members.

One of the key findings was that was identified was that our troops experience a plethora of sleep problems and issues.  This is not suprising when you consider that troops in combat zones must maintain themselves in a hyper-vigilent state and are under constant pressure to perform as needed.  Under these circumstances it must be very hard to relax and take a “power nap”.  Think how you feel when you do not get a good nights rest….now imagine that multilplied over an extended period in austere conditions. 

The problem of sleep (and rest) was reflected in the pharmacy data studied.  Sleep medications are the predominant prescription psychotropic drug used in theater.  Specifically the drug Ambien was identified as the most popular.  There also appears to have been a trend towards an increased use of psychotropic drugs in theater over the past three years.

Recognizing that good sleep is the foundation of good health and troop readiness, one of the recommendations that will come out sometime in the near future will be the establishment of a Task Force on Sleep. This Task Force will be essential to identify emerging scientific findings and define the best operational and medical practices to optimize our troops readiness and performance.  One promising area is to explore alternative treatment strategies such as accupuncture and other mindfulness practices which can be employed to reduce combat stress and pain.

As sleep and adequate rest are of the utmost importance, we can look forward to a lot more focus and study in this area and hopefully some advances in treatment.

Last week I had the privilege on behalf of MOAA, to sit down for an interview with RADM Karen Flaherty at Navy Medicine’s Headquarters in Washington DC. RADM Flaherty is the Director for Wounded Ill and Injured for the Navy. …
Here are excerpts from our interview:
Beasley: Admiral thank you for taking the time this morning to talk about what Navy Medicine and the Marine Corps are doing to care for our wounded service personnel coming back from Iraq and Afghanistan.
Flaherty: First, Congress and the American taxpayers were very generous. The Services received Congressional funds of over $200M for new projects directed to the following key areas: access to care, surveillance, quality care, and transition coordination care. At Navy Medicine we have put Programs put in place which are targeting resilience. We know that the number of deployments can adversely impact resiliency. We have put together programs in partnership with civilian academic institutions such as UCLA and have developed our signature program “Project FOCUS” headed by Dr. Patricia Lester. This is a research program set up to work closely with the family system to examine the stressors experienced by the family as it undergoes multiple deployments. Children are a focus as well as the whole family unit. We know that families undergo stress when they experience 4 to 6 deployments. The Navy Surgeon General and Navy Medicine have always been focused on the family with our concept of family centered care. So we naturally began with looking at the family and their network of support and infrastructure to determine what they will require in terms of their abilities to succeed in managing the stress. This has been a very big focus area for us. Initially, we started Project FOCUS with the Navy Special Warfare community. To understand what we need to have in place. The program has been very well received.
Beasley: Navy also takes care of the Marine Corps. Can you comment on the support for the Marine Corps?
Flaherty: Along with the Navy, we have the Marine Corps in fully in our sights and mind when we put programs in place. They are a bit different and we tailor programs and provide them to where and when the Marines deploy and where they are located. We work closely with the Wounded Warrior Detachment in Quantico and with Headquarters Marine Corps here in Washington.
Beasley: It was noted by several of our panelists during our (MOAA’s) recent Wounded Warrior Symposium, that there exist differences between the Services in the manner with which they handle transition care. Can you comment on this observation?
Flaherty: First, each service has a unique culture and identity. When the Marines look at their warriors they view them as “Marines for Life”. They have numerous programs such as the Semper Fi Fund, which directly support the Marines and their families. They also take a more holistic approach. I would like to note though that one service’s model is not better than the other. But there are different models. The Marines very quickly developed the Wounded Warrior Regiment (WWR) model. The WWR provides and facilitates assistance to Wounded, Ill and Injured Marines and Sailors attached to Marine Units, and their family members, throughout the phases of recovery. The WWR is a single command with a strategic reach that serves the total WII force: Active Duty, Reserve, Retired and veteran Marines. The Wounded Warrior Battalions East and West are located at Camp Lejeune and Camp Pendleton. Detachments include major Military Treatment Facilities and VA Polytrauma Centers. The Regiment Headquarters is in Quantico VA. The WWR provides non-medical care management with a personal touch. Their assets include: Family Support Staff; Chaplains for spiritual support; Recovery Care Coordinators to assist with transitional issues; VA liaisons; Clinical Services Staff to assist with care coordination and TBI/PTSD outreach education and much more. The Marines truly take care of their own. You can find out more at their website at www.woundedwarriorregiment.org
Beasley: The VA and DoD have just held a joint Mental Health Summit here in DC with the objective of identifying where gaps are between the two departments with respect to transitioning service personnel. Based upon your experience with the VA can you comment on this from your perspective?
Flaherty: First, the transition needs to be smooth and we need to partner when ever and where ever we can. In a perfect world it would be ideal to have the joint electronic record which could be initiated on the battlefield and to follow through until VA rehabilitation. But this is a few years out and we have work to do before this happens. Our energies must be focused on building the relationships and partnering connections and encouraging people in the support of each other. We will get there. Whenever we can forge partnerships and relationships at the hand offs and connections between the two systems, this will benefit the sailor and Marine and their families.
Beasley: What can the Military Service Organizations such as MOAA, and the other advocacy groups do to assist in the military’s efforts with the Wounded Ill and Injured?
Flaherty: I think you all are doing a magnificent job! You all live in the communities where these young men and women are coming home to. I think the recognition of the commitment they have made and the help with the smooth reintegration for these men and women is where you can and do help. You help celebrate what these people have done and the more you can allow them to tell their stories the better – as this is therapy. We rely on you as critical partners in this.
Beasley: Thank you Admiral for all that you and your team are doing.
Flaherty: Thank you for helping get the word out and for all of your support.

Last year at the SILVERDOCS documentary film festival one of the films entitled Does Your Soul Have a Cold? caught my attention in part due to curiosity with the title and part conjecture about what it might entail. Come to find out it addressed the cultural stigmatism associated with mental health in an interesting way.

 
With men’s health month, the MHS Blog posts signs of depression highlighting studies showing that boys don’t cry, but are often depressed. While it may be true that men are often the last to seek help or self-identify with symptoms of depression,  these traits are not unique to the male population; rather, they readily cross age, gender, and cultural lines.

Given the current ops tempo and activations affecting our men and women in uniform along with the increased stress incurred by their spouse or significant other and family members as well as our retired servicemembers and their families, this topic bears repeated mention to ensure all are fully aware of how to seek help for self or others.

That being said, anonymous self-assessment screenings for Depression, Alcohol, PTSD, Bipolar Disorder, Generalized Anxiety Disorder, and the Parent Version of the Brief Screen for Adolescent Depression are available 24/7 online at www.militarymentalhealth.org. Additional anonymous self-assessments screenings are available for Depression or Alcohol by phone at 877-877-3647. Finally, these screenings are just that screenings and are not intended to take the place of a clinical evaluation.

Please pass the word.