[Senate Hearing 110-89]
[From the U.S. Government Publishing Office]
S. Hrg. 110-89
HEARING ON MENTAL HEALTH ISSUES
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HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED TENTH CONGRESS
FIRST SESSION
__________
APRIL 25, 2007
__________
Printed for the use of the Committee on Veterans' Affairs
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COMMITTEE ON VETERANS' AFFAIRS
Daniel K. Akaka, Hawaii, Chairman
John D. Rockefeller IV, West Larry E. Craig, Idaho, Ranking
Virginia Member
Patty Murray, Washington Arlen Specter, Pennsylvania
Barack Obama, Illinois Richard M. Burr, North Carolina
Bernard Sanders, (I) Vermont Johnny Isakson, Georgia
Sherrod Brown, Ohio Lindsey O. Graham, South Carolina
Jim Webb, Virginia Kay Bailey Hutchison, Texas
Jon Tester, Montana John Ensign, Nevada
William E. Brew, Staff Director
Lupe Wissel, Republican Staff Director
C O N T E N T S
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April 25, 2007
SENATORS
Page
Akaka, Hon. Daniel K., Chairman, U.S. Senator from Hawaii........ 1
Craig, Hon. Larry E., Ranking Member, U.S. Senator from Idaho.... 2
Murray, Hon. Patty, U.S. Senator from Washington................. 3
Tester, Hon. John, U.S. Senator from Montana..................... 5
Rockefeller, Hon. John D., IV, U.S. Senator from West Virginia... 5
Brown, Hon. Sherrod, U.S. Senator from Ohio...................... 6
Webb, Hon. Jim , U.S. Senator from Virginia...................... 7
WITNESSES
Bailey, Tony Bailey, Father of Justin Bailey..................... 8
Prepared statement........................................... 10
Omvig, Randall, Father of Joshua L. Omvig; accompanied by Ellen
Omvig, Mother of Joshua L. Omvig............................... 11
Prepared statement........................................... 13
Attachment, newspaper articles:
Pair Help Iraq Veterans `Survive Peace'.................. 15
Grundy Center Couple Who Lost Soldier Son Visit Capitol
Today...................................................... 17
Parents Push for Soldier's Story to Continue Beyond
Suicide.................................................... 18
Family of Dead Soldier Wants Government to Do More to
Treat
Post-Traumatic Stress.................................. 22
Campbell, Patrick, OIF Veteran, Legislative Director, Irag and
Afghanistan Veterans of America................................ 24
Prepared statement........................................... 27
Best, Connie Lee, Ph.D., Senior Faculty Member, National Crime
Victims Research and Treatment Center, Medical University of
South Carolina................................................. 29
Prepared statement........................................... 31
Oslin, David, M.D., Director, VISN 4 Mental Illness Research,
Education and Clinical Center, Department of Veterans Affairs.. 48
Prepared statement........................................... 49
Kemp, Jan, R.N., Ph.D., Associate Director for Education, VISN 19
Mental Illness Research, Education and Clinical Center,
Department of Veterans Affairs................................. 50
Prepared statement........................................... 52
Resick, Patricia, Ph.D., Director, Women's Division, National
Center for Post Traumatic Stress Disorder, Department of
Veterans Affairs............................................... 54
Prepared statement........................................... 55
Ibson, Ralph, Vice President for Government Affairs, Mental
Health America................................................. 56
Prepared statement........................................... 59
APPENDIX
Female Soldiers and Sexual Trauma: Operation Iraqi Freedom (OIF),
submitted by SGT Carolyn Schapper, Virginia National Guard..... 67
HEARING ON MENTAL HEALTH ISSUES
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WEDNESDAY, APRIL 25, 2007
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 9:11 a.m., in
Room 418, Russell Senate Office Building, Hon. Daniel K. Akaka,
Chairman of the Committee, presiding.
Present: Senators Akaka, Rockefeller, Murray, Brown,
Tester, Webb, and Craig.
OPENING STATEMENT OF HON. DANIEL K. AKAKA, CHAIRMAN,
U.S. SENATOR FROM HAWAII
Chairman Akaka. This hearing will come to order. Good
afternoon, everyone. I will be brief as I am eager to hear the
testimony of the witnesses before us.
The very real truth of the war is that the toll will be
felt by servicemembers and their families for years to come. We
have focused much attention recently on the physical wounds
sustained in combat. Today, we are taking a long overdue look
at the invisible wounds, wounds which cannot be seen but are
every bit as devastating as physical wounds.
We know that many of the men and women who are currently
serving in Iraq and Afghanistan will require treatment for
mental health issues. We do not know yet if we will see the
widespread chronic PTSD that followed Vietnam. I hope we do
not, but veterans will need help readjusting back into society,
and unfortunately, many will abuse drugs and alcohol to ease
their pain. Some will commit suicide because of their pain.
Still others will quietly suffer with PTSD and the profound
wounds caused by sexual trauma.
Without question, the Administration should have been
taking the necessary steps at the start of this war to ensure
that VA was prepared for the growing demand for mental health
care. We know that the VA mental health system has long
suffered from funding cuts and long waiting lines for care.
Indeed, VA's own advisory groups and high-level officials have
pointed out the shortcomings. A former high-level official
charged that waiting lists rendered VA mental health care
virtually inaccessible. Now, we know that demand is increasing.
The latest numbers from VA indicate constant growth in mental
health, with PTSD and abusive drugs as the top two conditions.
Let me be clear about my goal. VA needs to have the finest
mental health care available. The demand is too great and the
manpower and expertise are just too broad to relinquish this to
the private sector. When partnering with community programs
makes sense, I am open to that. But I do not believe VA should
shy away from its direct responsibilities in this area.
A special thanks to our witnesses. We are so glad you are
here with us today. I especially want to say thank you to those
who are here to share personal stories. I also want to thank
our staff, who have worked hard to put this together, and
others, as well. I want to tell our witnesses that we are
deeply in your debt.
So let me, at this point in time, call on Senator Craig for
his statement.
STATEMENT OF HON. LARRY E. CRAIG, RANKING MEMBER,
U.S. SENATOR FROM IDAHO
Senator Craig. Mr. Chairman, thank you, and thank you for
focusing on this most important issue. I also want to extend a
warm welcome to our panelists today, particularly to Tony
Bailey, certainly to Randall and Ellen Omvig. We are truly
grateful for your willingness to share with the Committee your
stories and you have my deepest condolences for the loss of
your loved ones. This country owed them a debt of gratitude for
their sacrifices and their services and that debt we now owe to
you.
Just as the Committee is concerned about the bodies of
returning servicemembers, we want to be sure that those
troubled in mind by what they experienced protecting our
freedoms receive the same kind of care. We must ensure that all
are aware of their access to care and are not afraid to seek
that care.
I first made this statement in a series of seamless
transition hearings over two years ago and it remains true
today, that healing the veteran's mind is as equally important
to this Committee as healing the veteran's body. The goal is to
be sure that those with mental illness can return to live,
work, learn, and participate fully in their communities. That
means we must identify unmet needs and barriers to services or
accepting the services available.
We must identify innovative treatments and services that
are demonstrably more effective. We must improve coordination
amongst case managers and providers at DOD and at VA. And we
must focus on the desired outcome of mental health care, which
is to provide for each individual an opportunity to attain a
full and productive life through employment, self-care,
interpersonal relationships, and community participation.
These are tough goals and they require that we ask tough
questions, questions such as whether our servicemembers are
prepared to manage the stress of combat before they set foot on
the battlefield, questions such as have we created a barrier to
wellness by compensating for mental illness without requiring a
focus on recovery and rehabilitation from it? Are we setting
appropriate benchmarks to evaluate the effectiveness of
prescribed treatments?
These are very difficult questions that are going to be
required of us in taking the appropriate actions necessary. But
the price for not addressing these questions and this issue are
simply too high.
To our two witnesses, to the fathers who have lost their
sons, you know that price better than any of us. For the loved
ones attending, you know that price better than any of us.
As VA continues to implement its mental health strategic
plan and its mental health initiative, including efforts at
suicide prevention, I am committed to addressing these very
difficult questions with my colleagues, but we owe a great deal
to all of you for coming today to put a face on this issue and
for sharing with us the reality of it.
I thank you, Mr. Chairman, for convening this hearing.
Chairman Akaka. Thank you very much, Senator Craig of
Idaho, for your warm message.
Senator Murray from the State of Washington?
STATEMENT OF HON. PATTY MURRAY,
U.S. SENATOR FROM WASHINGTON
Senator Murray. Well, Mr. Chairman, thank you very much for
holding this really important hearing on mental health care
issues that are affecting our veterans. I want to thank all of
our witnesses especially today who are here to share their very
personal and very painful stories. You need to know that all of
you are speaking out for many others who can't be here, and I
and all the Members of this Committee are really committed to
using your experiences to help us help other veterans.
Mr. Chairman, we all know that going to war has a profound
effect on those who are sent to fight, and the wars in Iraq and
Afghanistan are no exception to that. As the Iraq War now
enters its fifth year, it is pretty clear that the fighting
overseas has taken a tremendous toll on the lives of our troops
who have served this Nation so honorably and on their families
who have supported them so fully.
We do know that more and more of our veterans from Iraq and
Afghanistan are seeking care for mental health care problems
when they return home. In fact, according to the VA itself,
one-third of all returning Iraq veterans who have enrolled in
the VA are seeking treatment for mental health problems. That
is a pretty astounding statistic, and tragically, it is
probably too low. We know that many of our returning
servicemembers and veterans aren't looking for care because of
the stigma surrounding treatment or because they fear that
mental health diagnosis might negatively impact their military
or civilian careers, and those veterans aren't being factored
into the VA's own statistics and all too often we are finding
those soldiers self-medicating their mental wounds.
We have also heard reports of servicemembers being shipped
back to war after doctors did recognize PTSD symptoms. Last
month, in fact, the mother of an injured soldier sat right here
at this table and told us about her son, who was not given
medication to treat PTSD because if he was, then he would be
called unfit to redeploy.
Mr. Chairman, we also know that troops are deployed
overseas for the third or now even the fourth time, a tour of
duty, and the risk of positive screening for PTSD and other
mental health care conditions increases with each deployment.
So to me, it is really clearly time for the VA to really
redouble their efforts to fight the PTSD stigma and increase
their screening, their outreach, and their treatment.
We also know that the Iraq War has created challenges for
the VA to provide care for all of the veterans who are seeking
mental health care treatment, and we have known about these
problems for some time. Last year, the GAO issued a report that
indicated the VA did not spend all of its mental health care
funding that it was provided by us and that unclear directions
from the VA central office likely resulted in mental health
care funds being used for other health care priorities.
Last spring, a VA under secretary said that VA mental
health care was, he called it, virtually inaccessible because
of the long waiting lines. And then this past February, the
American Psychological Association released a report that
servicemembers and their families are not receiving mental
health care because of limited availability and difficult
access.
Our National Guard and Reserve members aren't faring any
better. These are citizen soldiers who leave their families and
their jobs to serve our Nation overseas and they often live, as
we know, in very far-away areas which makes it very difficult
for them to receive care when they come home. I hear, and I
know my colleagues do, as well, from Guardsmen and Reservists
and their families all the time about the problems they are
encountering trying to get access to the VA, and to me, that is
really unacceptable and we need to change.
Mr. Chairman, now we are hearing that Vet Centers, which
are an integral part of our VA's mental health care network,
don't have enough staff to meet the growing numbers of veterans
who are accessing these centers.
And finally, according to this USA Today article that was
just out, ``Staffing at VA Centers Lagging,'' it says that the
number of returning veterans from Iraq and Afghanistan has gone
up by more than 100 percent since 2004--100 percent since 2004,
and yet the staffing levels at our Vet Centers has only gone up
by 10 percent.
So, Mr. Chairman, we have some real challenges, and we are
making progress and I want to commend you and others for
working with us in the Senate budget to increase the number for
VA to $43.1 billion, and the money in the emergency
supplemental that is going to come to the Senate, and I hope
that the President signs, that will increase by $1.8 billion
for veterans.
But this hearing is really important for us to hear
personally about this issue of post-traumatic stress syndrome
and how we as a Committee can really start to focus on making
sure that those men and women who fight for us don't have to
fight a health care system when they come home.
So thank you very much for holding this hearing. I really
appreciate it.
Chairman Akaka. Thank you very much, Senator Murray from
Washington State.
Now I would like to call on the Senator from Montana,
Senator Tester.
STATEMENT OF HON. JON TESTER,
U.S. SENATOR FROM MONTANA
Senator Tester. Thank you, Mr. Chairman. I want to thank
Ranking Member Craig and all the other Senators that are here
today, and I especially want to thank the panel, Dr. Best, Mr.
Campbell, the Omvigs, and Mr. Bailey. Thank you very much for
being here today.
I can tell you that, as from the testimony that has already
been given and the opening statements, we have got a problem. I
look forward to each and every one of your testimonies on this
panel and the next one to help further delineate ways by which
we can fix this problem.
Tony, I have got a daughter who is 27 years old. I cannot
imagine what each one of you have been through. When the
Members of this Committee talk about us being indebted to you,
it is right on. But we have got a problem here. We have come to
this Committee to try to get the testimony and get the kind of
input necessary so we can solve this problem by working
together. And I really do appreciate the fact that you are
willing to take the time out of each and every one of your busy
schedules to talk about a subject that, for some, is very, very
difficult.
Thank you very much.
Chairman Akaka. Thank you very much.
Now I would like to call on Senator Rockefeller for your
statement.
STATEMENT OF HON. JOHN D. ROCKEFELLER IV,
U.S. SENATOR FROM WEST VIRGINIA
Senator Rockefeller. Thank you, Mr. Chairman. I almost
don't know where to start, and so I probably shouldn't, but let
me just say that for those of us who have been on this
Committee and who care about it and who understand that this
Nation has sort of a tendency--I don't hold ill will toward the
Nation, but I hold ill will toward the results--of honoring the
warfighter while the warfighter is fighting, and then the
warfighter gets hurt, visibly or invisibly or both, comes back,
and gets subject to a budget which, as Senator Murray pointed
out, is entirely inadequate because it is within the budget of
the United States as opposed to the warfighter's war, which is
subject to the loans of China, Japan, and South Korea. So one
gets everything they want, although that did not happen, but
the second definitely doesn't.
I think that you will not find a group of people around
here who approach you with more respect, more sadness, more
desire to help, more frustration, more anger at our own
government, both Democratic and Republican Administrations, it
doesn't make any difference. It seems that we never seem to
give people their due.
And then something comes along like Building 18, which in
some ways is a gift to the Nation because it tells us how
little we know, how little attention is paid to this and how
much we have to do. I don't think there is anybody on this
Committee on either side who doesn't have a heart full, a full
heart.
I know a little bit of something about suicide. I know
nothing about suicide, Mr. Omvig. It has happened in my family.
I don't know anything about it from the point of view of a
parent. I don't know what I would do. I don't know what brings
it on. I don't know if it is sudden.
I do know that I talk almost every weekend I go home to
West Virginia, which is not a big and powerful State but has
unbelievable people, and I just sit down with 12 or 13 wounded
veterans, visibly, invisibly, for 2 or 3 hours, no staff
allowed, no press--they never know that it happens, no pencils.
It is just--and then you start. And then people begin to say
things that you could never imagine that people could say
unless you were in there and the rhythm of the whole thing,
their bonding, their anger, their need to leave the room
sometimes just to vent and then come back in and join or not
join.
So I feel like Senator Murray, who has just been
unbelievable on all of these things, as have our Chairman and
Vice Chairman, but we aren't doing the job, and I think the
beauty of your being here is that finally, there is a call to
conscience on the part of the American people and I think you
have helped cause this to happen. When the American people are
really stirred and angry and emotional about a subject, they
will not take excuses.
Most Americans don't know that the Chinese, the Japanese,
and the South Koreans pay for our war. Most of them don't know
that we fail to pay for the results of that war in human terms
because it is under something called a government budget, which
is always inadequate no matter what the Administration is. It
is always inadequate.
Patty Murray talks about the mental health. There is just
so much to learn. There is so much to do. We have to start and
you have to understand that we are trying, whether we are
beginning to try or however you want to interpret it.
But take us as real people and let us make that our
beginning point, that we sit here and you sit there. It is all
a table. We are all human beings and we want things to work out
for you and people who have served and people who are hurting,
people who have passed, some people who are wounded who maybe
wish they had passed because the agony is so deep. So those are
my words.
Chairman Akaka. Thank you very much, Senator Rockefeller
from West Virginia.
Now from Ohio, Senator Brown.
STATEMENT OF HON. SHERROD BROWN,
U.S. SENATOR FROM OHIO
Senator Brown. Thank you, Mr. Chairman and Senator Craig.
Thank you. My comments will be brief. I would just echo the
words of Senator Rockefeller. I don't have the breadth of
experience he does but have seen and heard so many of these
stories and have been increasingly overwhelmed by the failure
of our government to do what it needs to do for the families of
our soldiers. We cheer them on as they go to war and do so
little in so many cases when they come back.
To take the issue of the polytrauma centers, we hear so
much about they are doing tremendous work. However, the four
polytrauma centers around the country have 48 beds among them.
Ohio State University at the medical center treats brain injury
patients in its world class facility, Dodd Hall. They have 60
beds in that one facility, 12 more than the four polytrauma
centers around the country. That tells me how very much we need
to do.
The numbers are staggering. As we know, one-third of
soldiers from the wars in Iraq and Afghanistan will seek some
kind of mental health treatment. We have not done what we
should for the next year or two or three or five. We should be
talking even more years into the future for what we need to do
for the next four or five decades and what we are going to need
to do to serve the men and women who have returned from these
two wars.
I so much appreciate the families being here and their
sacrifice and their candor and their courage, so thank you all.
Chairman Akaka. Thank you very much, Senator Brown from
Ohio.
From Virginia, Senator Webb.
STATEMENT OF HON. JIM WEBB,
U.S. SENATOR FROM VIRGINIA
Senator Webb. Thank you, Mr. Chairman. I would say to our
witnesses here that this is really your chance to talk to us.
We have a chance to talk to each other every day and I don't
want to take much time from your opportunity to discuss your
issues.
I would say a couple things. One is that I first started
working in this area in 1977 after I got out of the Marine
Corps and attended law school. I came up here as a Committee
counsel working on the Veterans Committee on the House side.
One of the constants of American history in terms of when we
send people off to war is that they do have readjustment needs
when they come back.
A lot of people are kind of surprised by that when we look
at all the films about World War II and all the rest of that.
But one of the first studies I worked on in 1977 was a National
Academy of Sciences study on these sorts of issues and 25
percent of the people coming back from World War II had similar
difficulties. Each one of these experiences has a different
pattern to it. In the Vietnam era, we basically pioneered a lot
of this post-traumatic stress research and this sort of thing.
I have been intimately involved with people who have been
serving since 9/11, a lot of it through my friends, a lot of it
through my own family. I have two daughters who are engaged to
enlisted veterans. You may know my son is currently in Iraq as
an enlisted Marine. We need to stay on these.
And I think, Mr. Chairman, what happened at Virginia Tech
last week, I think at bottom when we examine it, we are going
to see that we are not paying enough attention to these sorts
of issues in our society, issues of mental health and how to
talk about them openly and how to help people.
I am looking forward to doing what we can in these
situations and am grateful for all of you being here today.
Chairman Akaka. Thank you very much, Senator Webb from
Virginia.
I welcome the first panel. We have asked each of you here
for your personal and your particular perspective on VA mental
health care.
First, I welcome Tony Bailey. Mr. Bailey is the father of
Justin Bailey, who served as a Marine in the first wave of
troops on the ground in Iraq. Mary Kay Bailey, Justin's mother,
is here today, as well.
I also welcome Randy Omvig, Joshua Omvig's father. Randy is
accompanied by his wife, Ellen.
To the Baileys and the Omvigs, you have traveled long
distances to be here today to speak of your sons, both of whom
died far too young. You have my deepest sympathy for your loss.
You also have my gratitude for being willing to share your
stories in the hope that things will be better for other young
servicemembers.
I welcome, as well, Patrick Campbell. Patrick represents
Iraq and Afghanistan Veterans of America and served in Iraq as
a combat medic. He currently serves with the Washington, D.C.
National Guard.
Finally, I welcome Dr. Connie Best. Dr. Best is a senior
faculty member at the National Crime Victims Research and
Treatment Center at the Medical University of South Carolina
and served for 20 years in the Navy Reserve.
I want to thank each of you for being here today. I want
you to know that your full statements will appear in the record
of the Committee.
Before we move to testimony, I should tell you that I
received a submission by a woman veteran who served in Iraq
describing her service and that of other women. I ask unanimous
consent to put it in the hearing record as it provides valuable
insights on the experience of some women who have or are
serving in combat zones. That will be added to the record.
Chairman Akaka. Mr. Bailey, will you please begin with your
testimony.
STATEMENT OF TONY BAILEY,
FATHER OF JUSTIN BAILEY
Mr. Bailey. Mr. Chairman and Members of the Committee, I
would like to tell you about my son who died on January 26,
2007, at the West L.A. VA Hospital. He was 27 years old and
Justin was seeking treatment for PTSD and drug abuse.
Justin joined the Marine Corps in December 1998,
approximately 6 months after graduating from high school.
Justin was in the infantry and was due to separate from the
Marines in January of 2003, but was involuntarily extended due
to the impending war. Justin was with the first wave of troops
that arrived in Iraq when the war started in 2003. He fought in
Nasarija and returned to Camp Pendleton in June of 2003.
While Justin was in Iraq, he sustained an injury to his
groin. He underwent two different surgeries about 6 months
apart. In between these surgeries, he waited around, basically
doing nothing, until he was discharged in April of 2004. After
his discharge, Justin still complained of pain from his
injuries and he was diagnosed with PTSD. He began taking
prescription drugs that were prescribed by the VA and were not
monitored. He was also using illegal drugs.
In November of 2006, Justin checked himself into the West
L.A. VA Hospital. According to his medical records, Justin went
in taking Xanax and a pain medication and 2 weeks later was on
Xanax and four other different prescription drugs. Justin had
been on Xanax since 2004. We were later told by the medical
staff after Justin's death that Xanax is inconsistent with the
treatment of PTSD. Justin's pain medication had been changed to
methadone, which received an FDA alert in November of 2006 and
had been highly publicized due to its addictive and
unpredictable nature.
After 2 weeks in the hospital, Justin was sent to the
domiciliary, which is described by the VA as a residential
substance abuse treatment program. On the night of January 26,
I learned that Justin was being taken to the ER at the
hospital. He had just received his new prescriptions the day
before and now he had died of an apparent overdose of his
prescription drugs.
Looking back, I was very happy for Justin that he made the
decision to get help and that he was going to the VA for help.
I assumed that being a large VA facility, that they would be
the best equipped and would have the best experience with PTSD
and related drug abuse issues. I was wrong.
Despite warnings from friends, family, and notations in his
medical records that Justin had a tendency to over-medicate
himself on prescription drugs, the L.A. VA Hospital determined
that after a mere 2 weeks at their hospital, that he had the
ability to self-administer his medication.
Two days after Justin died, my wife and I visited the
hospital and were greeted with a total lack of sympathy and
faced bureaucratic hassles to get basic information. And
despite the VA's touting of its electronic medical records, we
were sent on a wild goose chase throughout the hospital looking
for Justin's records. We met with his medical staff. They
indicated that Justin had missed several of his PTSD
appointments but they did nothing but reschedule a new
appointment. They should have made face-to-face contact with
him. Patients with PTSD and substance abuse are notoriously
difficult to reach.
We left the hospital with unanswered questions. We went
from place to place and got nowhere. I can only imagine what a
veteran with mental illness would go through.
Other than some classes required by the domiciliary
program, it functioned as a residential facility, and while
many veterans need a place to stay as they are transitioning to
civilian life, Justin was there primarily for drug treatment
and he needed more.
I will tell you that after our experiences with the
hospital, they are making some changes, including reducing
dosages, surprise inspections, increased weekend staffing. It
is my hope that these changes will remain in effect and that
these changes will occur
systemwide.
I cannot express the emotion that I feel over Justin's
death and the thought that all of this could have been
prevented. I don't believe that this facility is equipped to
deal with PTSD and drug abuse problems, which are so prevalent.
I believe with some veterans, that there is a lag between the
return from war and their acknowledgement and/or diagnosis of
PTSD and we have yet to see our VA hospitals overwhelmed with
mental illness from this war.
It would help to increase the budget of the VA hospitals,
but not before a thorough evaluation of these facilities is
conducted. Adding money to facilities that have systematic
issues is not going to increase their effectiveness.
When I spoke to Justin on the Sunday before he died, he
said, ``Dad, I know this is my last chance and I want to get
better.'' He was very positive about what he was going to do
when he got out of the program. He had plans for his career and
wanted to do something with his life. His stepmom and I were
very happy for him, and for once in a long time, we had hoped
that he would be able to lead a happy and healthy life.
Thank you for allowing me to speak to you today.
[The prepared statement of Mr. Bailey follows:]
Prepared Statement of Tony Bailey, Father of Justin Bailey
Mr. Chairman and Members of the Committee:
I would like to tell you about my son, Justin Bailey, who died on
January 26, 2007, at the West LA VA Hospital. He was 27 years old.
Justin was seeking treatment for PTSD and drug abuse.
Justin joined the Marine Corps in December 1998, approximately 6
months after graduating from high school. He was in the infantry and
was due to separate from the Marines in January 2003, but was
involuntarily extended due to the impending war. Justin was with the
first wave of troops that arrived in Iraq when the war started in 2003.
He fought in Nasarija and returned to Camp Pendleton in June 2003.
While Justin was in Iraq, he sustained an injury to his groin. He
underwent two different surgeries at the Naval Hospital at Camp
Pendleton about 6 months apart. In between surgeries, he waited around
basically doing nothing until he was discharged in April 2004.
After his discharge, Justin still complained of pain from his
injury, and he was diagnosed with PTSD. He had trouble sleeping,
nightmares, and short term memory loss. He began taking prescription
drugs that were prescribed by the VA. Over approximately the last two
and a half years, the VA prescribed the following different drugs:
alprazolam (xanax), diclofenac, quetiapine fumarate, buspirone,
benztropine mesylate, aripiprazole, hydrocone, acetaminophen,
olanzapine, hydroxyzine pamoate, divalproex, magnesium hydroxide,
clonazepam, lithium carbonate, trazodone, prazosin, bupropion,
levalbuterol tart, lorazepam, oxycodone, omeprazole, ibuprofen,
doxepin, amitriptyline, temazepam, mirtazapine, and methadone. It
doesn't appear as if the drugs were monitored effectively and in my
opinion he was given drugs and sent on his way instead of being
properly diagnosed and treated. He also began using illicit drugs.
In November 2006, Justin checked himself into the West LA VA
Hospital. According to his medical records, Justin went in taking xanax
and hydrocone for pain, and 2 weeks later was on xanax, buproprion and
trazodone, which are antidepressants, prazosin, and methadone, which he
was given for pain. Justin had been on xanax since 2004. We were later
told by medical staff after Justin's death that xanax is inconsistent
with the treatment of PTSD. Justin's pain medication had been changed
to methadone, which received an FDA alert in November 2006 and has been
highly publicized due to its addictive and unpredictable nature. The
FDA alert explained the risks of methadone and cautioned the medical
community to ensure that the benefits of prescribing methadone outweigh
the risks.
After his 2 weeks in the hospital, Justin was sent to the
domiciliary, which is described by the VA as a residential substance
abuse program.
On the night of January 26th, I learned that Justin was being taken
to the ER at the hospital. He had just received his new prescriptions
the day before. And now he had died of an apparent overdose of his
prescription drugs.
Looking back, I was very happy for Justin that he made the decision
to get help and that he was going to the VA for help. I assumed that
being a large VA facility they would be best equipped and would have
the most experience with PTSD and related drug-abuse issues. I also
assumed that Justin would only receive his prescriptions in small
individually controlled dosages. I was wrong.
Despite warnings from friends and family and notations in his
medical record that Justin had a tendency to over-medicate himself on
prescription drugs, the LA VA hospital determined that after a mere 2
weeks at their hospital that he had the ability to self administer
medications. The day before he died, he was given five different
prescriptions in dosages of 14, 15 and 30 days.
Two days after Justin died, my wife and I visited the hospital and
were greeted with a total lack of sympathy and faced bureaucratic
hassles to get basic information. And despite the VA's touting of its
electronic medical records, we went on a wild goose chase throughout
the hospital looking for Justin's records.
We met with his medical staff. The PTSD professionals indicated
that Justin had missed several of his PTSD appointments, but they did
nothing but reschedule a new appointment. They should have made face-
to-face contact with him. Patients with PTSD and substance abuse are
notoriously difficult to reach. They also indicated that although they
knew that Justin had problems with over-medicating on prescription
drugs, they had to listen to the patient when it came to his care. And,
they told us that Justin had not seen a psychiatrist since being in the
domiciliary. He had been there approximately 6 weeks already, and a
psychiatrist had not yet been assigned to him. We found it disturbing
that the primary care physician and RN continued to give Justin
prescriptions that he had been prescribed in the hospital, without
evaluating him to see if the drug interactions were OK or the drug
treatment was even effective.
We left the hospital with unanswered questions. We went from place
to place and got nowhere. I can only imagine what it must be like for a
veteran with mental illness. Every office that we visited seemed to act
independently without knowledge of what others were doing. There was
obviously inadequate communication between offices and medical staff,
but yet that seemed to be the norm and didn't concern the people that
we spoke to. The only communication network that did seem to function
well in this hospital was the communication to the organ donation
people. I received a phone call 4 hours after my son died at 2:30 in
the morning in which I was asked questions about the condition of my
son and specifically about his eyes.
Other than some classes required by the domiciliary program, it
functioned as a residential facility. And while many veterans need a
place to stay as they transition to civilian life, Justin was there
primarily for drug treatment, and he needed more.
I will tell you that after our experience with the hospital, they
are making some changes, including reducing dosages, surprise
inspections, and increased weekend staffing. It is my hope that the
changes will remain in effect and that these changes will occur system-
wide.
I cannot express the emotions that I feel over Justin's death and
the thought that all of this could have been prevented. I don't believe
that this facility is equipped to deal with PTSD and drug abuse
problems, which are so prevalent.
I believe with some veterans, there is a lag between their return
from war and their acknowledgment and/or diagnosis of PTSD, and we have
yet to see our VA hospitals overwhelmed with mental illness from this
war. I have a concern that our Iraqi veterans with mental illness will
give up on our VA hospitals, because of the complexity and apathy. We
can do better than that. We send them to war to fight for our country
and it is our responsibility to take care of them when they return.
It would help to increase the budgets of the VA hospitals, but not
before a thorough evaluation of these facilities is conducted. Adding
money to facilities that have systemic issues is not going to increase
their effectiveness.
When I spoke to Justin on the Sunday before he died, he said,
``Dad, I know this is my last chance and I want to get better.'' He was
very positive about what he was going to do when he got out of his
program. He had plans for his career and wanted to do something with
his life. His step-mom and I were very happy for him and for once in a
long time, we had hope that he would be able to lead a happy and
healthy life.
Thank you for allowing me to speak to you today.
Chairman Akaka. Thank you very much, Mr. Bailey.
Now, Randall Omvig.
STATEMENT OF RANDALL OMVIG, FATHER OF JOSHUA L. OMVIG;
ACCOMPANIED BY ELLEN OMVIG, MOTHER OF
JOSHUA OMVIG
Mr. Omvig. Ellen and I would like to thank you for the
opportunity to address the Senate Veterans' Affairs Committee.
We have submitted two newspaper articles from the Des Moines
Register and the Waterloo Courier from Iowa for your
examination. We also hope that you have had time to look at
Josh's memorial Web site, which was created by Josh's aunt,
Julie Westly. This site was created to help others with as much
information as we could find on PTSD, post-traumatic stress
disorder.
There is no way we could go through in 5 minutes the events
leading up to and the day Josh took his life in front of his
mother. We would like to voice our strong support of the Joshua
Omvig Veterans Suicide Prevention Act, S. 479, reintroduced by
Senator Harkin and Senator Grassley. This bill has Josh's name
on it, but it represents so many men and women before and after
Josh who were unable to live with the physical, mental, and
psychological effects of their service.
One of the most important issues we see in the past and
today is the way we are bringing our troops back, regular
service and especially the National Guard and Reserve units who
are going back to civilian life. Josh's company went from Iraq
to Thanksgiving dinner with their families in less than 1 week.
One or 2 weeks of decompression or defusing is not enough.
This, however, is more the rule than the exception. A few days
later, Josh was back to his civilian job.
All the troops know how to fill out the form asking if they
are having any problems. They know if they say yes, they will
be held back, won't be able to see their families and loved
ones. The one thing they have been thinking and dreaming about
is the homecoming and they won't do anything to delay that.
Josh's company was put on a 90-day call-up period when they
got back, whereby if they were needed, they would be called
back to active duty. During this time, there is no drill, no
contact with the people he spent such an intense time with.
There was no one around him to talk over things with. After a
week or two of being home, reality starts to set in. Things are
not the same.
Why didn't Josh and so many others seek help when they got
back? We train our soldiers well, mentally and physically, to
handle any situation that comes up, to survive, the ``I can
do,'' ``I can handle it'' attitude. When we would ask Josh how
he was doing, it was, ``I am OK. I can handle it.'' When we
hear that now, we know there is a soldier that is having
problems.
Josh wouldn't tell us very much about what he did in Iraq.
He had to sign secrecy papers that they would not say where
they were or what they did. Josh tried to keep his promise.
Little things here and there in conversations would come out.
He would tell us, ``We couldn't tell anyone.'' How can you seek
help if you couldn't tell anyone what his service experiences
were? And we have heard this from other veterans, too.
When Josh got back, he was always sick with some type of
upper respiratory or gastrointestinal problem. We finally got
him to go to our family doctor, who he was friends with. We
told him to talk to her about some of the problems he was
having. She later told Ellen to get him some help. We tried to
get Josh to go to the VA hospital, but he wouldn't go. He said
it would affect his military and personal career. We told him
we would set up an appointment with a private doctor, but he
said the Army would find out. We even told him that we would
set up an appointment under our name so the Army wouldn't find
out. He couldn't believe we would really do such a thing. It
wasn't right.
It is usually a crisis or a tragedy that brings the veteran
to see that they can't handle it alone and they need help, or
the family that finally pushes the situation of seeking help.
This is why it is so important to have the appropriate support,
training, and counseling for family members before their
soldiers come home. This will help them to understand the
changes that may happen, what to look for, where to go for
help, what action can be taken to help their soldier.
We received the present information families get before
Josh got home. Give them space. Don't push them to talk. Give
them time to acclimate. It didn't work. Peer training and
counseling is needed to help the veteran and their families.
The VA delivery system, presentation, and implementation of
mental health and psychological services hasn't changed much.
It is still mainly up to the veteran and their family to
identify the problem and go seek help.
There is still no comprehensive prevention program during
the defusing or decompression time to start dealing with the
emotional and psychological effects of their service, to
provide group peer counseling, training, coping mechanisms, and
strategies.
The first counseling of Josh's company had come at the
first drill after Josh's death. They brought in chaplains and
counselors to have group and private sessions, to talk over
what happened with Josh. Something amazing happened. The
conversation went from what happened to Josh to what troubles
some of the other soldiers were having. Some of them went on to
get more counseling and treatment after that.
We feel the decompression time should take place after the
soldiers have left to see their families. After the experience
of homecoming and being with their families, the soldier will
be able to deal with the paperwork and assimilation training to
civilian life. When back home, we must assure that there are
accessible, timely services, education, and outreach programs
for the veterans and their families.
The day after Josh's suicide, the Grundy Center Police
Department and Fire Department had a defusing time where a
professional counselor was brought in to help them cope and
deal with what happened that day. Do we as a Nation take the
same humanitarian measures for our troops who have served for
us for months in a combat area? Are we providing our military
men and women with the appropriate services to help them
assimilate back to civilian life? Are we providing them with
what they need to survive the peace?
Ellen and I have to say, no, not at this time.
We can and we must do more. This is no time to bury our
head in the sand, to take a defensive posture, to try and
justify or explain the problems of the past. It is time to make
a major process check in the implementation of preventative
programs. Research has proven that if treated early, the chance
of coping with mental and psychological problems is better and
may keep them from going to the chronic stage.
We have and we will have brave men and women serving for
us. It is our duty to see that they receive the best services
possible so they can once again have good lives. As we see it,
they are the ones who have actually earned this right.
[The prepared statement of Mr. Omvig follows:]
Prepared Statement of Randall Omvig, Father of Joshua L. Omvig
Ellen and I would like to thank you for the opportunity to address
the Senate Veterans' Affairs Committee. We have submitted two newspaper
articles from the Des Moines Register and the Waterloo Courier from
Iowa for your examination. We also hope you have had the time to look
at Josh's memorial Web site, http://joshua-omvig.memory-of.com/
about.aspx which was created by Josh's Aunt, Julie Westly. This site
was created to help others with as much information as we could find on
Post Traumatic Stress Disorder (PTSD). There is no way we could go
through in 5 minutes the events leading up to and the day Josh took his
life in front of his mother.
We would like to voice our strong support of the Joshua Omvig
Veterans Suicide Prevention Act, S. 479, reintroduced by Senator Harkin
and Senator Grassley. This bill has Josh's name, but it represents so
many men and women before and after Josh who were unable to live with
the physical, mental and psychological effects of their service. The
major points of the bill are the following:
1. De-Stigmatizing Mental Health
2. Training of employees and other personnel on suicide and suicide
prevention.
3. Family education and outreach.
4. Peer support program.
5. Health assessments of Veterans
6. Counseling and treatment of Veterans
7. Suicide prevention counselors
8. Research on the best practices for suicide prevention among
Veterans.
9. Substance abuse treatment
10. 24-hour mental health care.
11. Telephone Hotline.
One of the most important issues we see in the past and today is
the way we are bringing our troops back, regular service and especially
the National Guard and Reserve Units who are going back to civilian
life. Josh's company went from Iraq to Thanksgiving dinner with their
families in less than a week. One or two weeks of decompression or
defusing is not enough. This however, is more the rule than the
exception. A few days later Josh was back to his civilian job.
All the troops know how to fill out the form asking if they are
having any problems. They know if they say yes they will be held back
and won't be able to see their families and loved ones. The one thing
they have been thinking and dreaming about is the homecoming and they
won't do anything to delay that.
Josh's company was put on a 90 day call-up period when they got
back whereby if they were needed they would be called back to active
duty. During this time there is no drill, no contact with the people
who he had spent such an intense time with. There was no one around for
him to talk over things with. After a week or two of being home reality
starts to set in, things are not the same.
Why didn't Josh and so many others seek help when they got back? We
train our soldiers well, mentally and physically, to handle any
situation that comes up to survive. The Can Do, I Can Handle It
attitude. When we would ask Josh how he was doing it was ``I'm OK, I
Can Handle It.'' When we hear that now we know there is a soldier
that's having problems.
Josh wouldn't tell us very much about what he did in Iraq. They had
to sign secrecy papers that they would not say where they were or what
they did. Josh tried to keep his promise. Little things here and there
in conversations would come out and he would tell us we couldn't tell
anyone. How could he seek help if he couldn't tell anyone what his
service experiences were. We have heard this from other veterans too.
When Josh got back he was always sick with some type of upper
respiratory and gastro-intestinal problem. We finally got him to go to
our family doctor whom he was friends with. We told him to talk to her
about some of the problems he was having. She later told Ellen to get
him some help. We tried to get Josh to go to the VA hospital but he
wouldn't go, he said it would affect his military and personal career.
We told him we would set an appointment with a private doctor but he
said the Army would find out. We even told him we would set up an
appointment under our name so the Army wouldn't find out, he couldn't
believe we would really do such a thing it wasn't right.
It is usually a crisis or tragedy that brings the Veteran to see
they can't handle it alone and they need help or the family that
finally pushes the situation of seeking help. This is why it is so
important to have the appropriate support, training and counseling for
family members before their soldier comes home. This will help them to
understand the changes that may happen. What to look for, where to go
for help and what action can be taken to help their soldier. We
received the present information families get before Josh got home.
Give them space, don't push them to talk, give them time to acclimate--
it didn't work. Peer training and counseling are needed to help the
Veteran and their families.
The VA delivery system, presentation and implementation of mental
and psychological services hasn't changed much. It is still mainly up
to the Veteran and their family to identify the problem and go seek
help. There still is no comprehensive preventative program during the
defusing or decompression time to start dealing with the emotional and
psychological effects of their service. VA and DoD need to provide
group peer counseling, training, coping mechanisms and strategies.
The first counseling Josh's company had came at the first drill
after Josh's death. They brought in chaplains and counselors to have
group and private sessions to talk over what happened with Josh.
Something amazing happened. The conversation went from what happened to
Josh to what trouble some of the other soldiers were having too. Some
of them went on to get more counseling and treatment after that.
We feel the decompression time should take place after the soldiers
have leave to see their families. After the experiences of homecoming
and being with their families, the soldier will be able to deal with
the paper work and assimilation training for civilian life. When back
home, we must assure that there are accessible, timely services,
education and outreach programs for the veterans and their families.
The day after Josh's suicide, the Grundy Center police department
and fire department had a defusing time where a professional counselor
was brought in to help them cope and deal with what happened that day.
Do we as a Nation take the same humanitarian measures for our troops
who have served for us for months in a combat area? Are we providing
our military men and women the appropriate services to help them
assimilate to civilian life? Are we providing them with what they need
to survive the peace? Ellen and I have to say ``No'' not at this time.
We can and must do more!
This is no time to bury our head in the sand, to take a defensive
posture, to try and justify or explain the problems of the past. It is
time to make a major process check to implement preventative programs.
Research has proven that if treated early the chance of coping with
mental and psychological problems is better and may keep them from
going to the chronic stage. We have and will have brave men and women
serving for us. It is our duty to see that they receive the best
services possible so they can once again have good lives. As we see it,
they are the ones who have actually ``earned'' this right.
______
[From the Des Moines Register, May 12, 2006]
Pair Help Iraq Veterans `Survive Peace'
(By Jennifer Jacobs)
Grundy Center, IA.--The secrets that troubled veterans confide to
Randy and Ellen Omvig weigh heavily on their shoulders.
Their son, Joshua, a 22-year-old Iraq veteran, was so anxious to
clear his mind of the trauma of war that he killed himself in front of
his screaming mother. A Web site they created in his memory: http://
joshua-omvig.memory-of.com/About.aspx has become a whispering wall of
sorts, a safe place where other soldiers confess their silent
suffering.
``It's been hundreds a day--so many heartbreaking stories,'' Ellen
Omvig said, holding on her lap the note her son left, explaining his
own torment. ``It's like the same story over and over again, just
different names, different towns. A lot of them will make you cry,
there's so much pain.''
The Omvigs, of Grundy Center, will be at the State Capitol Rotunda
today with Congressman Leonard Boswell and Gen. Wesley Clark, who will
speak at 3:30 p.m. on the need for better services for troops with
post-traumatic stress disorder, returning from Iraq and Afghanistan.
``You know the phrase you've got to be careful of?'' Randy Omvig
said. He paused, his breathing ragged. ``When they say: `I'm fine. I
can handle it.' That means: `I'm having trouble.' ''
It took 4 months for the Omvigs, who are intensely private,
churchgoing Republicans, to agree to share Josh's story publicly.
Randy Omvig, a wrestling coach with a rock-like stature and stoic
personality, nearly skipped his son's funeral in December because, he
told himself, he couldn't have everyone see him break down. His wife
has been unable to work full time since a semi hit her car 8 years ago,
and these days she is even more fragile.
``The time to help Josh is over,'' Randy Omvig said, and this time
his bass voice was unwavering.
``But we can't ignore the others. They're coming back here safe.
We've got to help them survive the peace.''
messages of torment
The messages come in the dead of night, from insomniacs who tell
the Omvigs that they nurse a deep need to be alone. They trust no one
but their combat buddies. They can't kick the flashbacks and
nightmares. They lose their temper at work. A few have admitted they
expect to divorce soon. Some have lashed out with their fists. Some say
getting drunk seems to be their only relief.
And some have felt the scratch of rope around their neck or the
chill of a gun muzzle on their head.
``Instead of killing themselves, they'd rather re-enlist and get
shot,'' said Josh's aunt, Julie Westly of Sioux City, who helps the
Omvigs keep up with the 15 to 50 e-mails that arrive daily from
soldiers and families in Iowa and elsewhere. ``They'd rather die with
honor,'' Westly said.
That was Josh's plan, his family said. He thought diving back into
the war zone would ease his restlessness--and spare some other soldier
from being separated from family.
The kid known as the joker who cracked everyone up barely cracked a
smile after he got home in November after 11 months of high-level
security work north of Baghdad.
Josh, who was with the U.S. Army Reserve 339th Military Police
Company of Davenport, said he felt honored to defend his country, and
he knew why he had to do the things he did. But he was never able to
recover from them.
``He'd say, `Mom, I don't want you to hate me,' '' Ellen Omvig
recalled, her eyes red and tired behind delicate glasses. ``I'd say,
`How could we hate you? You were in the war.' ''
Every time he left the house, he hugged his parents fiercely and
said he loved them.
Unable to sleep, he would work himself into exhaustion, pulling
double shifts as a security guard in the skywalks of Des Moines before
driving 90 miles to Grundy Center. Then he'd hide out in his bedroom,
playing war video games with loud music in his headphones.
At least his hands had stopped shaking. For a while, he couldn't
button his clothing or grasp items in his pockets. He'd see something
on the side of the road and for a few seconds his racing heart told him
it could be a bomb. He was startled by sudden movements, like a bird
landing on a stop sign.
a final note
The shaking stopped, but the hyper-vigilance didn't. And his mood
worsened.
He refused to go to counseling. He was certain the Army would find
out, and that there would be repercussions. He figured that with his
symptoms, his goal to be a police officer was ruined.
Four days before Christmas, Josh went out drinking. A friend whose
car had slid into a ditch in Black Hawk County called him for help, and
Josh was arrested for first-offense operating while intoxicated.
When he got home in the morning, he shaved, changed into his desert
uniform, and told his mom the recruiter had asked him to tag along to
meet some possible recruits.
Ellen Omvig detected nothing unusual about his behavior, and told
him she was going to hop in the shower. Josh casually handed her a
note, saying, ``You can read it later,'' and walked out the door.
``Mom & Dad,'' she read. ``Don't think this is because of you. You
did the best you could with me. The faces and the voices just won't go
away.'' He's re-enlisting, she thought.
`` . . . I will always love you. Josh.''
She sprinted after him, figuring she could persuade him not to sign
anything until he talked it over with his father.
And then the realization hit her, and she was yelling for Josh to
stop, stop, stop, stop. She fumbled for the locked door handle of his
pickup, grabbed the side-view mirror, pleading.
``Terry's coming,'' Josh told her. ``He'll take care of it.''
Ellen Omvig saw the handgun. As supervisor of his security crew,
Josh was permitted to carry one.
She was screaming, and Josh kept telling her she didn't understand.
His battle buddy had been killed, he said.
His parents aren't sure how he knew that. Maybe he got a letter.
Neither parent has entered his bedroom since he died.
Josh kept repeating that he should have been there taking care of
him. He had to be with him now. He said he'd been dead ever since he
left Iraq.
``His eyes were just dark, and it was like he wasn't really
there,'' Ellen Omvig recalled, her hands hugging her sides, not
touching the tears sliding down her face. ``I said, `No! Your dad's
counting on you to take care of me if anything happens to him.' And
that's when he broke and the pain and the anguish was so clear and he
said, `How can I take care of you when I can't take care of myself?' ''
Then a squad car rolled up, Ellen Omvig said. Josh had telephoned
police officer Terry Oltman and asked him to be at the Omvig house in
10 minutes. Josh, a reserve officer and volunteer firefighter, knew
every cop in town. ``Go!'' Josh ordered his mother.
Oltman was shouting for Ellen Omvig to get away, but she wouldn't
leave her son, and Josh angled his head so the bullet's path wasn't
aimed at his mother.
That was December 22, 2005.
helping the living
It never hit Ellen and Randy Omvig until later that Josh's problems
were classic symptoms of post-traumatic stress disorder. After posting
information at http://joshua-omvig.memory-of.com, they've heard from
military families worldwide who say the problem is extensive.
``It's a terrible thing,'' Ellen Omvig said. ``There are a ton of
things that can be done so that people can live with it and at least
put it on the back burner in their lives instead of letting it be the
driving force in their lives and being permanently disabled.'' The
Omvigs think the U.S. military isn't doing enough to address veterans'
mental health or to ease the stigma of getting treatment.
Officials with the Veterans' Administration and Department of
Defense said they have taken steps to offer more mental health
services, but servicemembers are not always receptive to that.
A Government Accountability Office report issued Thursday states
that of returning troops found to be at risk for PTSD, 88 percent were
not referred by government health care providers for further help.
``We're not political one way or another about should we be over
there, should we not be over there,'' Randy Omvig said. ``We hear
they're on a `humanitarian mission.' There must also be a humanitarian
mission when they get home. We can't let another generation suffer the
way the Vietnam generation suffers.''
Now the Omvigs write to politicians and military officials,
applying pressure. When Boswell's office called Wednesday, they agreed
to come to the Capitol.
``I'm willing to talk to anybody I have to,'' Randy said. ``This
isn't going to end in a year.''
______
[From the Waterloo-Cedar Falls Courier, May 12, 2006]
Grundy Center Couple Who Lost Soldier Son
Visit Capitol Today
(By Dennis Magee)
Grundy Center.--Randy and Ellen Omvig will go public this afternoon
with their grief. They would rather not.
``Truth be told, we'd rather go fishing,'' Ellen said.
But then, many things in their life are not as they would wish.
The couple's son, Josh, killed himself in December. He was 22 years
old and a veteran of the war on terrorism. He managed for about a year
after his return to Iowa.
Randy and Ellen Omvig blame post-traumatic stress disorder for
their son's death. As the name suggests, the psychological condition is
triggered by horrific events that overwhelm a person's ability to cope.
In a series beginning Saturday, the Courier will examine issues
related to post-traumatic stress and what the disorder will mean to
soldiers, their families and the state of Iowa.
The Omvigs will appear at 3:30 p.m. in the State Capitol Rotunda
with Rep. Leonard Boswell, who will talk about proposed legislation.
Boswell, a Democrat representing Iowa's 3rd District, will appear with
Gen. Wesley Clark, a onetime and possibly future Democratic candidate
for president.
Boswell served for 22 years in the U.S. Army and completed two
tours in Vietnam. He is expected to talk about House Resolution 1588, a
bill introduced by Rep. Lane Evans, D-Illinois in April 2005, but still
stuck in the first stages of the legislative process! The measure calls
on the Federal Government ``to improve programs for the identification
and treatment of post-deployment mental health conditions, including
post-traumatic stress disorder, in veterans and members of the armed
forces, and for other purposes,'' according to a Web site maintained by
the Library of Congress. The bill also suggests a requirement to study
factors that decrease the likelihood of developing chronic post-
traumatic stress disorder related to combat.
The [bill] is backed by more than 100 congressmen, almost
exclusively from the Democratic side of the aisle, but including Rep.
Jim Leach, a Republican from Iowa. Boswell signed on as a co-sponsor
May 9 of this year. Last legislative action on the bill came April 25,
2005, when it was forwarded to the House Subcommittee on Health.
During a recent interview, the Omvigs talked about their reluctance
to become public figures--and their commitment to do so.
Burying their heads and hearts would be easier and safer than
speaking out.
``But it wouldn't have been just to Joshua,'' Randy said.
``Or to anybody,'' Ellen added.
The couple view their participation with trepidation.
``Exciting is not the word we think of. Frightening is the word we
speak of to each other,'' Ellen said Thursday.
Not of anyone or anything in particular. Or of the probable media
horde and crowd.
``We feel ill-suited, not qualified, to speak on the behalf of
others,'' Ellen said. ``I do not have the right words to explain how we
feel.''
She has a powerful message nonetheless.
______
[From the Waterloo-Cedar Falls Courier, May 13, 2006]
Parents Push for Solider's Story to Continue
Beyond Suicide
(By Dennis Magee)
First in a series
Grundy Center.--He always intended to be a policeman. To get
there--with his parents' guidance--Josh Omvig became a soldier.
``He was a nice young man,'' Ellen says.
A mother's pained love.
``He was a pretty straight arrow,'' Randy says.
A father's wounded joy.
They knew Josh experienced combat in Iraq as an Army reservist. By
connecting the dots, they concluded their son probably participated
vigorously. Too late, they realized the person they got back from the
war on terrorism was not the young man they sent.
Sadly, they say, post-traumatic stress disorder was only a vague
concept until they saw Josh's world unravel.
``In retrospect, we probably should have pushed harder,'' Randy
says.
His tone conveys little confidence the couple actually believe they
could have saved their boy. As they see it, odds weighed heavily
against their son.
``I keep thinking about it,'' Randy says. ``But it was a no-win
situation for Josh.'' The soldier told his mother once he died in Iraq.
But he kept living for another year.
burning desire
Josh, a former Boy Scout with a newspaper route, wanted to join the
military early. His parents refused to sign paperwork required of a 17-
year-old and made him wait.
`` `It is an adult decision. It is 7 years of your life,' '' Randy
remembers telling his son.
Later, the couple insisted their son investigate several branches
of the armed forces before making a commitment. And they helped.
``Josh was pretty focused,'' Randy says.
He enlisted with the 339th Military Police Company based in
Davenport.
``When he signed up they hadn't been activated in more than 30
years,'' Randy says.
The choice was logical for an aspiring policeman or sheriff's
deputy.
``He figured the best way to get some experience was to go into the
reserves,'' Randy says.
Josh graduated a semester early from Grundy Center High School.
Within 2 days he was training at Fort Leonard Wood in Missouri.
The company deployed to Guantanamo Bay, Cuba, guarding suspected
members of al Qaida. But Josh was not yet ready. Meanwhile, he enrolled
in law enforcement courses at Hawkeye Community College.
``But sitting in the classroom was kind of tough on him,'' Randy
says.
Josh seemed to enjoy much more the ride-alongs he arranged with
sheriff's deputies in Tama, Grundy and Hardin counties.
``He liked the action part of it,'' Randy says.
Josh started working for a security company in Des Moines and
became a supervisor. He moved to Altoona.
In 2003, the soldiers in the 339th--back from Cuba--and Josh and
his parents anticipated what lay ahead.
``They kept telling them all summer, `You're going to be activated
real soon . . . ,' '' Ellen says. ``That went on for months.''
Josh got ready, had his teeth checked and deposited DNA samples
with the military. Officials activated the 339th once again in December
2003 and the company deployed to Iraq in February 2004.
The soldiers' mission included guarding people and enemy munitions.
They at times also protected convoys. Shifts were 15 hours long. Their
camp at one point was mortared daily.
Temperatures inside tents exceeded 100 degrees at night, Josh said,
and soldiers resorted to flea collars on their beds and around ankles
to stop the pests. But that didn't work too well, Ellen says, because
the toxic chemicals irritated the soldiers' skin.
``It was pretty rough conditions for them,'' Randy says.
At the time, the couple didn't know where their son was. They later
learned he served in the Sunni Triangle, a region northwest of Baghdad
and home to many of Saddam Hussein's most loyal followers.
The 339th worked out of a ``forward operating base,'' according to
the Omvigs. There were no showers and only sporadic electrical service,
Josh said. Telephone reception was poor and calls were frequently
interrupted.
Soldiers in the company encountered close combat in urban
conditions. Josh mentioned tall buildings crowding streets narrower
than H Avenue where his parents lived in Grundy Center. Gunmen would
pop up in windows a few feet away from convoys. Josh indicated a
handgun might have been more effective than the grenade launcher he
manned.
Josh never talked about killing anyone but said the 339th came
under fire. He was usually in the company's lead vehicle and ``he was
their best shot,'' Randy says.
The couple received one letter from their son in 11 months. Josh
later said he was firing off notes every month. Josh also occasionally
skipped opportunities to call home, at least in part to allow fellow
soldiers with spouses and children access to available phones.
``Another reason was he said it was too hard talking to us,'' Ellen
says.
break in the action
In early September 2004, Josh returned to Grundy County for a few
days of rest and relaxation. He found little of either, according to
his parents.
``He shook for 3 days,'' Randy says.
He remained vigilant and seemed unable to let down his guard.
``He was in pretty bad shape when he got back,'' Randy says.
The effects were apparent enough that others noticed. One of Josh's
first desires was a meal at McDonald's. While there, the family
encountered a veteran of the Vietnam War.
The older man saw the jitters and addressed Josh.
`` `I know. It will get better. Thank you for your service,' ''
Ellen remembers the man saying.
Josh only shared information about Iraq in one or two-sentence
fragments at a time. But as they spent time together, his parents
learned driving presented perceived threats to the veteran. Deer along
the road. Headlights in the rear view mirror. Ordinary items, like
culverts, that to Josh represented hiding places.
``His head was on a pivot,'' Randy says.
While home, Josh withdrew periodically from family festivities.
`` `You've got to forgive me. But I can't be around people too
much,' '' Ellen remembers him saying.
But he was glad to be in Grundy Center.
``He kept saying, `I'm so happy to be home,' '' Ellen says.
Randy remembers Josh taking time to smell flowers and touch leaves
still hanging on trees. He talked little about what he had experienced.
Peace eluded Josh, especially at night.
``Of course, you heard him. The bad dreams,'' Ellen says.
Their son would call out while sleeping, usually ``No'' or ``Stop''
or some other military command.
``He didn't really want to go back. But he didn't want to leave his
buddies either,'' Randy says.
Josh fulfilled his obligation. He returned to Iraq after about 10
days.
``We just got him pretty well rested and fed,'' Ellen says.
The couple was concerned. Looking back, they realize they witnessed
the serious effects of combat-stress reaction.
`` `I'm fine. I can handle it. I've got it under control,' '' Ellen
remembers Josh repeating several times.
``I didn't know enough,'' she adds.
``And he was putting on a pretty good act for us,'' Randy says.
headed home
Josh completed his tour of duty in Iraq on his 21st birthday in
November 2004. He later told his parents the company expected to spend
3 weeks in Kuwait. At another point, Josh believed he would be at Fort
McCoy in Wisconsin for 3 months.
In reality, the soldiers were in Iowa within a week.
As the Omvigs explain the transition, Josh ``went from fifth gear
to first gear'' in a few days.
For many troops returning to the United States, the fastest way out
is the preferred path. Though sick, Josh declined an opportunity to
visit the infirmary in Wisconsin.
Randy explains a soldier's option at that point.
``Do I say yes and have to stay, or do I say no and go home to my
family? ''
When he arrived in Iowa, the next day was Thanksgiving. On Friday,
Josh returned to work in Des Moines.
Ellen and Randy knew their son was suffering. Josh, however,
continued to assert he could handle the situation. He expressed concern
that talking with an Army counselor, admitting a mental health issue,
conceding he needed help would damage his career.
``We even tried to get him to go get private help that we would pay
for,'' Ellen says. ``He said, `Nope. They will find out.' ''
Ellen suggested seeking therapy by using an assumed name. Josh
rejected the idea, shocked his mother might condone lying.
The specifics about what troubled their son and to what extent
remained a mystery.
``You get short conversations,'' Ellen says. ``Loving and kind. But
short.'' Other veterans later told Randy and Ellen that Josh at times
appeared to want to discuss something. The veterans did not press the
issue, giving the soldier space to proceed at his pace. Josh inevitably
let the moments pass, the veterans said.
The security firm put out pink slips and Josh was out of work. He
moved into his parents' home in Grundy Center and--still considering a
career in law enforcement--enrolled at Ellsworth Community College.
While waiting for classes to begin, Josh commuted to a part-time
job in Des Moines. At one point, he shared a conversation with his
father, notable because of its length and content.
`` `Dad, I just want to be happy like you,' '' Randy remembers.
Josh repeated the thought several times.
An aunt, Julie Westly of Sioux City, and others in the family also
knew about Josh's ``deep, deep depression.''
``We all encouraged him to get help. But he was so afraid because
he thought his career would be over,'' Westly says.
Weeks played out, and casual observers in Grundy Center might not
have noticed any change in Josh. He started helping as a crossing guard
for the elementary school, setting out stop signs. He volunteered with
the Grundy Center Fire Department, bounding out of the Omvigs' home
when his pager sounded.
``He loved it. He loved to help people,'' Randy says.
Getting up in the night for an emergency hardly seemed an
inconvenience.
`` `Well I don't sleep anyway, Mom,' '' Ellen remembers him saying.
Josh altered his career goal slightly. He still wanted to be a
policeman, but in a small community.
``Mostly, he wanted to be happy,'' Randy says. ``I knew what he
meant.''
Besides restless nights, Josh experienced flashbacks. Unfamiliar
sounds sparked an undeniable urge to examine his parents' property--in
military terms, to secure the perimeter.
Ellen and Randy know Josh would circle their lot. He may have gone
farther into the neighborhood.
``I don't know. We didn't follow him,'' Ellen says.
Josh occasionally shared thoughts that his mother did not
understand.
`` `I don't want you to hate me,' '' she remembers him saying.
At the time, Ellen interpreted the comment as a reflection on tasks
performed in combat. Attempts to reassure that she would never hate her
son were only marginally effective.
`` `What you had to do over there is what you had to do to
survive,' '' Ellen remembers saying.
Josh admitted another problem.
``He talked about hearing voices, seeing faces,'' Randy says.
Ellen pressed her son on one occasion about what he meant.
``He said Iraqi people.''
bad to worse
Josh had an ally in Iraq. Ellen and Randy know him only as Ray.
The soldiers were assigned to each other as battle buddies during
boot camp because they were standing in line together.
``They ended up good friends,'' Ellen says.
Toward the end of December, Josh apparently learned Ray had been
killed in Iraq. The soldier's death followed unfortunately close to the
funeral for Jimmie Kitch, Ellen's mother.
On December 21, Josh went out drinking, an uncharacteristic event,
according to his father and others.
``I've never seen him drink a beer,'' Westly says.
At some point during the evening, Josh's truck and another vehicle
went into a ditch along Orange Road and got stuck in snow. Josh and the
other driver left the area. When they returned in a third car with two
other people, a police officer from Hudson and Black Hawk County
sheriff's deputies were at the scene.
According to their report, the deputies smelled alcohol on Josh's
breath and he failed two of three field sobriety tests. They arrested
Josh for operating a vehicle while intoxicated.
Josh got out of the Black Hawk County Jail at 9 a.m. Ellen
remembers by 11 he was home in Grundy Center. It was a Thursday.
He shaved and put on his desert fatigues. He said he wouldn't be
going to work. At the time, Ellen remembered a conversation about
visiting a friend and didn't think anything unusual. There was also
mention of helping a recruiter talk with prospective young men and
women, which Josh had done in the past.
He asked his mother for their pastor's telephone number. And a
sheet of paper. He wanted to write a few things down.
Ellen tore a piece out of a spiral notebook, shearing off one
corner. Josh said the damaged page was good enough. Ellen remembers her
son's demeanor as calm.
Josh later handed his mother a note and went out a back door. Ellen
read the words but didn't understand. Josh described joining his
buddies. She at first thought that meant re-enlisting, a possibility
Josh had entertained.
She went after him.
``I wanted him to talk to his dad,'' Ellen says.
``Then it finally hit her what he was talking about,'' Randy adds.
Josh was in his truck. The doors were locked. Ellen pleaded with
her son to not do what he was contemplating. Her appeals turned to
screams.
Ellen did not [know at] the time Josh had already called a friend,
police officer Terry Oltman. He asked Oltman to stop by the house in a
few minutes.
Seeing what was developing, Oltman ordered Ellen away from the car,
she remembers. Ellen refused to leave her son.
Josh raised a handgun and fired a single shot. He turned his head
slightly to avoid possibly injuring his mother.
``I just can't believe how much can happen in one minute,'' Ellen
says.
Father and mother want information in their son's suicide note held
privately. Save for the closing thought:
``I will always love you. Josh.''
postscript
The family buried their soldier with help from the U.S. Army
Reserve 339th Military Police Company. Josh Omvig was 22.
``He thought it would get better because he was home,'' Westly
says. ``And it never got better. It got worse.''
Josh told his mother once he died in Iraq. But he kept living for
another year.
______
[From the Waterloo-Cedar Falls Courier, May 13, 2006]
Family of Dead Soldier Wants Government to Do More
to Treat Post-Traumatic Stress
(By Dennis Magee)
Des Moines.--He served in Iraq. He came home. Then Army Spc. Josh
Omvig killed himself. His parents blame post-traumatic stress disorder.
Only reluctantly did Randy and Ellen Omvig agree to share their
son's story.
``We already live with what happened to Josh,'' Randy says. ``Every
day.''
``And night,'' Ellen adds.
Friday afternoon--against their impulse to maintain private lives--
the couple was near center stage in Iowa. They participated in a press
conference organized by Rep. Leonard Boswell, a Democrat seeking re-
election in Iowa's 3rd District. Gen. Wesley Clark, a onetime and
possible repeat Democratic candidate for president, also addressed a
small crowd and a few television cameras.
The Omvigs sat in the State Capitol Rotunda in the front row,
introduced late in the hour-long event. Hearing the words ``he took his
own life'' moved the couple near to tears.
``We know our deep feelings will never replace Joshua,'' Boswell
said.
The event served as both campaign stop for Boswell and an
opportunity for the candidate to address the Federal Government's
response to its returning soldiers.
``We're trying to stir up a little tension. Others are, too,''
Boswell said.
Specifically, he said, the time for action on House Resolution 1588
is well-past. The measure would boost benefits for veterans and address
issues related to post-traumatic stress disorder.
Rep. Lane Evans, D-Illinois, introduced the bill in April 2005.
Boswell signed on as one of more than 100 co-sponsors last week.
``I didn't want to come out here and tell you I support it if I
wasn't on it,'' he said.
The last action on the bill was referral to the House Subcommittee
on Health toward the end of April 2005.
``I can't believe they've had that for more than a year,'' Ellen
Omvig said.
Boswell suggested part of the hang-up is related to the cost, a
notion he rejected.
``And we can't find the money? In the United States of America?
It's absurd,'' he said.
He also emphasized the bill's intent to strengthen cooperative
efforts between the U.S. Department of Defense and the U.S. Department
of Veterans Affairs.
Clark later attacked President George W. Bush, saying the
administration needs ``to get its priorities right.''
The retired four-star general, who was severely wounded in Vietnam,
also shared his experience with life after combat. Nine years after his
service in Southeast Asia, Clark said he experienced flashbacks.
``It takes a long time for these feelings to surface and for
veterans to be able to vocalize what they went through,'' he said.
``I was lucky. I didn't suffer much,'' Clark added.
Josh Omvig did.
The young man from Grundy Center suffered through nightmares,
difficulty sleeping, involuntary shaking, physical health concerns,
intrusive memories and a sense that he must be hypervigilant to
supposed dangers.
``He never was well,'' Ellen says.
She and her husband witnessed their son's struggle for about a
year. They and other family members tried to intervene but their
suggestions were rejected. Josh was in a place--had been to a place--
his parents could not reach.
``We always thought we had a pretty good rapport, that he could
tell us anything,'' Randy says. ``But he couldn't tell us about that.''
Toward what turned out to be the end, they attached a name to
Josh's condition--post-traumatic stress disorder.
``We didn't associate it with Josh until he started talking about
the voices and faces,'' Randy says.
``Nobody gave us any reason to know about it,'' Ellen adds.
Josh used a handgun to end his pain. His parents buried him in
December. He was 22.
``It's hard to just get up in the morning,'' Randy says. `` . . .
As a matter of fact, it's getting harder. The numbness is wearing
away.''
The couple's other son is in the Army. Their daughter is in high
school.
``People ask, `How can you go on?' I have other children,'' Ellen
says.
In their grief, the Omvigs sensed a need early on to address issues
they believe vitally important to soldiers and their military families.
Randy's sister, Julie Westly, created a Web page devoted to her nephew
and to post-traumatic stress disorder.
``We tried to research post-traumatic stress disorder and it was so
hard to even find out what it was called,'' Westly says. ``I was
searching for `military suicide' and it took a good week to even find
out it even had a name.''
Their sad experience spawned what the family says will be an
extended commitment to spreading the word about post-traumatic stress
disorder.
``What we can do for Josh is over. But we don't want what we went
through to happen to any other families,'' Randy says.
But it apparently is, though the extent of the problem is difficult
to quantify. The National Veterans Foundation, a private nonprofit
organization, reports at least 65 soldiers and 32 Marines have taken
their own lives, either while serving in Iraq or after returning to the
United States.
``It's the worst thing for any parent--to see your child die--let
alone suicide,'' Westly says.
help needed
Josh's parents have a short list of items they maintain returning
troops deserve.
Guarantees those who seek medical care, physical or
mental, do not face reprisals in their military or civilian careers.
One of Josh's stated reasons for not seeking counseling was fear an
admission he needed help would damage his professional life.
Transition periods between active duty and their return to
civilian lives.
``We want to make sure the troops coming back have time to
decompress, have this down time,'' Randy says.
The Omvigs stipulate the time should be spent on ground that troops
consider safe. A month in Kuwait will not serve. The transition, in
their view, would be most effective on U.S. soil. But not in their
homes and hometowns, either.
Intact units until ultimate release from duty.
The Omvigs advance--and research supports--the notion that soldiers
should be surrounded by their colleagues. After returning to home bases
or reserve centers, soldiers should be required to check in
periodically and maintain contact with other troops.
Mandatory counseling with fellow soldiers with similar
backgrounds.
Veterans tell the Omvigs they prefer to talk with people who
understand conditions on the battlefield.
``Because they won't talk or listen to someone who hasn't been
there,'' Ellen says.
That includes relatives, including parents and spouses.
``Their family is the one safe place that hasn't been affected by
their service,'' Ellen says.
Home is a good place, set aloft on an idealistic pedestal.
``They don't want it to change that. . . If they tell you anything,
it will soil it,'' Ellen says.
Information for families.
The couple also believes spouses and parents should receive more
training on how to cope with returning soldiers. Information on how to
recognize symptoms and treatment options should be readily available.
``They don't prepare the families for what comes home,'' Ellen
says.
role model
The Omvigs draw comparison to how soldiers in World War II returned
from Europe or the Pacific--on very slow ships over the course of weeks
and months. And all the while, the troops were surrounded by fellow
fighting men and women, who knew the score on the battlefield.
``You had a chance to wind down. There was nothing from the outside
world you had to deal with. Indeed, there was no way you could,'' Ellen
says.
The Omvigs adamantly resist entering the debate about the war in
Iraq. The Web site in Josh's honor refers only to his life, offering
hundreds of resources related to post-traumatic stress disorder. There
are also dozens of links to additional Internet sites they believe
veterans and their families will find helpful.
Those who would argue the merits of the conflict should go
elsewhere.
``This is not the platform or the forum for that discussion,''
Ellen says. The after effects of combat cross boundaries between
countries, between political parties and between religious convictions.
The political arena is relevant to the Omvigs for one reason only:
They want state and Federal legislators to address issues related to
post-traumatic stress disorder.
``This is isn't politics. This is humanitarian,'' Randy says.
If government officials continue to deploy military units,
including guardsmen and reservists, they should also prepare for their
return.
``OK. Take him as a citizen-soldier. But how are you going to bring
him back as a citizen? '' Randy asks.
``From the Revolutionary War on down, the attitude has been, `Buck
up. Be tough. Deal with what you've got,' '' Ellen adds. ``But that
doesn't work.''
The Omvigs understand proposals to hold soldiers longer, to provide
mandatory therapy sessions, carry a price tag But, they reason, paying
now will cost less than paying later.
``Can we afford to have these people--who served so heroically--to
have problems for the next 10, 20, 30, 40, 50 years? '' Randy asks. ``.
. . How much is it going to cost in the future if they can't be
productive citizens, if they can't hold a job? '' They also cite as
possible--even likely side effects--alcohol and drug abuse, divorce and
child abuse. And suicide.
According to the National Veterans Foundation, the post-traumatic
stress disorder cases treated within the Veterans Administration system
increased by tenfold within the last year. More than 16,000 veterans of
Iraq and Afghanistan already carry the diagnosis.
``We're expected to be humane to the rest of the world. Well how
about being humane to these soldiers?'' Randy says.
Ellen and Randy, however, view the public stance their taking as
``a necessary evil.'' Dealing with their grief privately is the
preferred course.
``That's really what their goal is, to get the word out,'' Westly
says.
Burying their heads and hearts would be easier and safer than
speaking out.
``But it wouldn't have been just to Joshua,'' Randy says.
``Or to anybody,'' Ellen adds.
Josh's Web site on at least one occasion attracted a hurtful
comment about his abilities and courage--and though they state no
political viewpoint--about the family's sense of patriotism.
Five months after their son's funeral, the Omvigs and Westly are
speaking out anyway. They want others to know about the danger to
soldiers posed by post-traumatic stress disorder.
``We are ready to make a lifelong commitment to this, until it
doesn't exist any more,'' Westly says. ``We don't want to see this
happen to any other families.'' Ellen says the family has no choice.
``We know now. We've been enlightened. It's our responsibility.''
``So now it's your responsibility,'' Ellen adds to those who hear
her words.
``There's other families. There's other moms.''
Chairman Akaka. Thank you very much, Mr. Omvig.
Patrick Campbell?
STATEMENT OF PATRICK CAMPBELL, OIF VETERAN,
CONGRESSIONAL LIAISON, IRAQ AND AFGHANISTAN
VETERANS OF AMERICA
Mr. Campbell. Thank you very much for having this
opportunity to speak. I am here with the Iraq and Afghanistan
Veterans of America and I am not the only Iraq veteran here. If
I could have the other Iraq veterans in the crowd please stand
up. I know there are at least four of them here.
[Applause.]
Mr. Campbell. They might not be standing because they are a
humble group.
The system that the Department of Veterans Affairs employs
to treat servicemembers with mental health issues suffers from
a fundamentally fatal flaw. It is a system that waits. It is a
system that waits for a servicemember to acknowledge that they
have a problem. It is a system that waits for a servicemember
to ask for help. The system is broken and we must fix it before
we lose this generation of heroes.
I know everyone in this Committee has heard the statistic
that one in three Iraq veterans and one in nine Afghanistan
veterans will suffer a mental health problem as a result of
their service. As you have heard here today, every statistic
like this represents both a name and a tragic story.
I am here to tell you what my counselor at the D.C. Vet
Center told me on my very first counseling session when I
finally admitted that I had a problem a year later. No one goes
to war and comes home the same person they were before they
left, no one.
In preparation for this testimony, I exhibited a classic
symptom of post-traumatic stress disorder, denial. I wrote this
whole entire testimony wanting to talk about someone else
because I was too embarrassed to admit to you, even though I
have done it numerous times, that I personally have post-
traumatic stress disorder. I have been diagnosed. I wrote this
testimony about someone else because it was easier to tell
their story than my own. I am still going to tell theirs
because I think his is better, but I know that I am fooling
myself when I think that I am healed.
I did use this as an opportunity to talk to my brothers who
I patrolled with in Iraq. What I found not only disturbed me,
it scared me. Two years later, there is a picture in each of
your folders. The Alpha Company Killas, my brothers, are now
struggling to find their place in the world. From my lieutenant
all the way down to the gunners, no one has been spared. I
heard stories about strained marriages, ruined engagements,
methamphetamines, alcohol, and sleepless nights. These are just
some of the stories.
I want to talk about the icon of this war, the gunner, the
guy who has to make life or death decisions every day. Three
out of our four gunners are suffering from severe post-
traumatic stress disorder and substance abuse. The fourth one
is on active duty because he could not stand the idea of being
surrounded by civilians. All of them desperately need help but
are too proud to ask.
One story in particular breaks my heart. We call him
Manimal, and he is the picture on the bottom, half-man, half-
animal. He has a smile like Clark Kent, a contagious hearty
laugh, and a deadly right hook. He is a simple giant who the
kids loved in Iraq. On more than one occasion while we were
serving in Iraq, a car would come too close. They would either
ignore or not hear the warning shots and Manimal would have to
do his job. On three or four occasions, I saw Manimal put a
hundred rounds in a car, because when it came down to choosing
between us and the unknown face in the car coming toward us, he
was the most loyal friend you could ever possibly have.
I remember finding Manimal in the corner of a tent one day.
He was sitting by himself. He never sits by himself. He is the
center of attention. I said, ``Hey, Manimal, what is up?'' He
started talking, but he never made eye contact with me. He
said, ``I saw that bullet hit that man in the chest. I saw his
face as he lost control of the car. I watched that car hit the
wall as we drove by. I couldn't say anything because--well,
because we just kept on driving.'' This man watched this man
die that he just shot and we just kept driving.
As a medic, I had to make life and death decisions when an
emergency arose. Manimal had to make them every time we got on
the highway. When he got home, he never could keep a job for
more than 2 weeks. He couldn't stand being told what to do by
an 18-year-old who never saw what he saw. He drank too much and
once was caught, got a DUI and had his license suspended. He
would call me late at night, usually at two or three in the
morning, just to talk, to talk to someone whom he trusted.
Finally, I was able to work with Manimal and we decided a
profession for him. He would become a medic like myself. He
finished the EMT class and passed the test, which was a bit
step for someone who never graduated high school, only to be
told because he didn't have his driver's license, he couldn't
start his job. As he waited to start his job, he spent all his
money on a woman who said she loved him, but when the money ran
out, so did she.
Now a man who finally found his path after coming home is
still being held back by his past. Currently, he is living on
his mother's couch, still drinking too much, and is up to his
ears in debt. And the last phone call--he has been calling me.
He called me seven times in the last month asking for the phone
number on how to volunteer to go back to Iraq. He will not stop
calling me because he says to me it is the only way he can get
out of debt and Iraq is the only place that makes sense. It is
the only place where he can be someone again.
Manimal has a GED and I go to law school. We have very
different backgrounds, but we are so incredibly similar. We
both got home and we drank too much. We made impulsive
decisions. We shut the world out and tried to fill that gaping
hole in our souls with women. We are both too proud to ask for
help and too scared to admit that we have a problem. Two years
later, the only difference between Manimal and I is the fact
that I have a friend who intervened and said, ``I will not be
your friend anymore unless you go get help, because you are not
the man I knew. You are not the man who I was friends with.''
Sadly for Manimal, his support network collapsed under the
weight of his problems.
The answer to the problems that Manimal and I face require
face-to-face counseling. Every servicemember who comes home
from a combat zone deserves this. Only then will we be able to
remove the stigma and fear of asking for help. Don't
misunderstand me. The soldiers will complain, just like a kid
complaining about taking a bath after playing in the dirt all
day. Everyone knows we just need to do it.
Now, just getting into the door is not enough. We need to
make sure that once they get in that door, they spend more time
in the counseling room than they do in the lobby waiting for
help. As Senator Murray already said, the USA Today article
says the number of Iraq veterans who are using the Vet Centers
has almost tripled and the staff has only increased by less
than 10 percent. We must fully staff these facilities.
Lastly, Manimal only has a few months left to enroll in the
VA to be treated for conditions that potentially can be related
to his combat service, such as his readjustment issues. The 2-
year eligibility window is unrealistic and confusing for a
National Guard soldier who thinks that being in the Reserves
means that they are not a veteran, especially those who are in
a unit that are planning on redeploying in a couple months. A
5-year eligibility period would let our servicemen and women
have the opportunity to settle back into their lives before
they start losing their benefits.
I am sorry I didn't tell you my personal story, but I
appreciate you listening to what little pieces I did tell you.
Thank you for listening to Manimal's story, and I know Manimal
is at home watching this right now. Thank you, Manimal, for
letting me tell yours because it was much easier to tell yours
than it was to tell mine.
I have been here for a year. I have been doing this job for
a year and I can tell you that we, as a Congress, and we, as a
veteran community, have come a long way. I appreciate that we
are speaking first, the people who have had to pay the price of
this war. I know that each one of the veterans sitting behind
me, especially the ones who wouldn't even stand up, and the
veterans watching this right now, they are counting on you
because they will never ask for help. It is not in our culture.
We have got to get the help to come to them. Thank you again.
[The prepared statement of Mr. Campbell follows:]
Prepared Statement of Patrick Campbell, OIF Veteran,
Legislative Director, Iraq and Afghanistan Veterans of America
Mr. Chairman and Members of the Senate Committee on Veterans'
Affair, on behalf of the Iraq and Afghanistan Veterans of America
(IAVA), thank you for this opportunity to address, ``The VA's response
to the mental health needs of today's veterans.''
My name is SGT Patrick Campbell and I am a combat medic for the DC
National Guard, an OIF vet and the Legislative Director for the Iraq &
Afghanistan Veterans of America. IAVA is the Nation's first and largest
organization for veterans of the wars in Iraq and Afghanistan. IAVA
believes that the troops and veterans who were and are on the front
lines are uniquely qualified to speak about and educate the public
about the realities of war, its implications on the health of our
military, and its impact on national security.
Everyone on this Committee has heard the statistic that one in
three Iraq veterans and one in nine Afghanistan veterans will suffer
from a mental health problem as a result of their service. Every
statistic like this represents a name and a heart wrenching story. I am
here today to tell you what my counselor at the DC Vet Center told me
in my first session, ``No one goes to war and comes home the same
person they were when they left.''
The system that the Department of Veteran Affairs employs to treat
servicemembers with mental health issues suffers from a fundamentally
fatal flaw. It is a passive system. It is a system that waits. It waits
for servicemembers to acknowledge that they a problem. It is system
that waits for servicemembers to ask for help. The system is broken and
we must fix it before we lose this generation of heroes.
In preparation for this testimony, I decided that rather than
searching my heart for another dark shadow to bring into the light, I
would use this as an opportunity to check in with my 20 brothers from
Iraq. What I found not only disturbed me, but scared me. Two years
later with redeployments looming on the horizon, the once proud Alpha
Company Killas are now struggling to find their place in the world.
From my Lieutenant down to the gunners, no one has been spared.
Strained marriages, ruined engagements, methamphetamines, alcohol and
sleepless nights are just some of the stories I have heard.
Three out of the four gunners are suffering from severe PTSD and
substance abuse. The fourth went on active duty because he could not
think of being surrounded by civilians again. All of them are
desperately in need of help, but too proud to ask. One story in
particular breaks my heart. We call him Manimal (half man, half
animal). He had a smile like Clark Kent, a contagious hearty laugh, and
deadly right hook. He was a simple giant, whom the kids in Iraq loved
to play with.
On more than one occasion while serving in Iraq a car would come
too close, would ignore warning shots and Manimal would have to do his
job. I personally witnessed him light up three or four cars essentially
riddle them full of bullets because when the choice was between us and
them, Manimal was the most loyal friend one could ever have. I remember
one day finding Manimal alone in a corner and I asked him how he was.
He whispered but never made eye contact with me and stated, ``I saw my
bullet hit that driver in the chest. I saw his face as he lost control
of his car. I watched the car hit the wall as we drove by. I couldn't
say anything because . . . well because. We just kept driving.'' As a
medic I had to make life-and-death decisions when an emergency arose,
Manimal made them every time we crossed on to a highway.
When Manimal got home he never kept a job longer then 2 weeks. He
couldn't stand being told what to do by an 18-year high school graduate
who never saw what he saw. He often drank too much and one night he got
caught. He was charged with a DUI and lost his driver's license.
He would call me late in the night, just to talk . . . just to talk
with someone who understood. Finally Manimal decided he wanted to be a
medic. This profession would be his penance for the lives he took. He
finished Emergency Medical Technician (EMT) classes and passed the test
(a huge step because he never graduated high school) only to be told he
couldn't start till he got his driver's license back. As he waited to
start his job he spent all his money on a woman who said she loved him,
but when the money ran out so did she. Now a man who found his path
after coming home is still being held back by his past. Currently, he
is living on his mother's couch, still drinking too much, and is up to
his ears in debt. He only sees one solution out of this mess, to go
back to Iraq and be someone again.
Although we come from different backgrounds Manimal and I are very
similar. When we got home we both drank too much, made impulsive
decisions, shut the world out and tried to fill that gaping hole in our
souls with women. We are also too proud to ask for help and too scared
to admit when we have a problem. Two years later, the only difference
between Manimal and I is that I am blessed with friends who forced me
to get counseling. I was given an ultimatum, ``Go to counseling or lose
another friend.'' Sadly, Manimal's support network broke under the
weight of his problems.
The answer to the problems Manimal and I face requires face-to-face
counseling with a licensed mental health professional for every
servicemember returning home from a combat zone. Only then will we
remove the stigma and fear of asking for help. Don't misunderstand me,
because the soldiers will complain, but just like a kid complaining
about taking a bath after playing all day in the dirt . . . everyone
knows we just need to do it.
Once we get these servicemembers in the VA's door we need to make
sure they are in the counseling room and not waiting for hours in the
lobby. A recent USA Today article stated that although the number of
Iraq and Afghanistan veterans using the Vet Centers has nearly tripled
over the past 3 years, the number of staff has been increased by only
9.3 percent. We cannot wait for the storm to come to start preparing,
we must fully staff these facilities and look to expand them to new
communities.
Lastly, Manimal has only a few months left to enroll in the VA to
be treated for conditions ``potentially related to his combat service''
such as his readjustment issues. The 2-year eligibility window is
unrealistic and confusing for a National Guard soldier who thinks that
being in the Reserves means they are not yet a veteran, especially
those in a unit that will probably be redeployed in a matter of months.
A 5-year eligibility period would let our servicemen and women have the
opportunity to settle into their lives before they start to lose their
benefits.
Thank you for listening to my story. Thank you for listening to
Manimal's story. And thank you for listening to all of our stories.
This Congress has come a long way over the past 4 months, as evidenced
by the fact that Veterans and not administrators are the first to speak
at these hearings. Going forward, we have an obligation to create a
culture where veterans' needs also come first, and returning troops do
not have to beg for help because the help is already there.
Chairman Akaka. Thank you, Patrick Campbell.
Dr. Connie Best?
STATEMENT OF CONNIE L. BEST, PH.D., SENIOR FACULTY MEMBER,
NATIONAL CRIME VICTIMS RESEARCH AND TREATMENT CENTER, MEDICAL
UNIVERSITY OF SOUTH CAROLINA
Dr. Best. Good afternoon, Senators. It is indeed an honor
to address this Committee and to sit on this panel. I have been
asked to discuss the ability of the Department of Veterans
Affairs to meet the needs of veterans who have experienced
military sexual trauma with particular attention to the Guard
and Reserve.
I am a clinical psychologist and a professor in the
Department of Psychiatry and Behavioral Sciences at the Medical
University of South Carolina. Today, I am speaking to you from
several perspectives. First, I am a psychologist who has
treated victims of rape and sexual assault for more than 25
years. Second, I am someone who spent more than 20 years in the
Navy Reserve, retired in 2004 at the rank of captain, which is
an 06. Finally, I am a civilian psychologist who has served in
a variety of consulting and advisory capacities and positions
for the Department of Defense.
According to the VA term, military sexual trauma, or MST,
refers to both sexual harassment and sexual assault that occurs
in the military. It can be experienced by both men and women.
Numerous studies have documented in varying numbers the number
of rapes in the military in the veteran population. One study
of users of the VA health care system found that 23 percent of
them had reported experiencing at least one sexual trauma while
in the military.
There are aspects of sexual trauma that are unique to the
military. MST occurs on military installations where the victim
both lives and works, and so often the victims remain in close
proximity to their perpetrators. The perpetrators are
frequently their supervisors or a higher-ranking peer who would
be responsible for making decisions about their promotion and
their duty assignments, so the risk of re-victimization is
quite real. These factors combined with the value placed on
unit cohesion, particularly in combat theaters, add to the
reluctance of victims to come forward.
The devastating effects of military sexual trauma are
clear. As any veterans or their family members can tell you,
victims may suffer for years. They may develop post-traumatic
stress disorder, major depression, substance abuse problems,
and functional impairment in social, vocational, interpersonal
situations. The effects of military sexual trauma do not stop
once the servicemember leaves the military.
With approximately 76,000 Reservists currently deployed
worldwide in support of the War on Terrorism--and actually, in
2005, that number was 120,000 higher--members of the Guard and
Reserve face their own unique sets of challenges when they
experience MST. Once released from active duty recall, they do
not remain on military bases. They return to their hometowns.
This is an understandable urge to return as quickly as possible
to their spouses, children, jobs, and their normal lives. Once
returning home, they are away from their unit members and from
other military support systems.
During their post-deployment health assessment, which is
conducted immediately after returning from deployment, they are
given the opportunity to indicate if they have experienced MST
or that they might be experiencing other mental health issues
related to that trauma. Reservists are acutely aware that if
they do endorse a serious mental health concern such as post-
traumatic stress disorder, they will likely be retained on
active service and not allowed to return to their civilian
lives.
A 2006 study by mental health professionals at Walter Reed
Army Institute of Research found that the prevalence rates of
reporting a major mental health problem among servicemembers
returning from Iraq and Afghanistan are 19 and 11 percent,
respectively, with combat experience being the most frequently
cited reasons for their problems. If a servicemember was
unfortunate enough to have experienced both combat-related
trauma and military sexual trauma, the risk for developing
significant mental health problems would increase
exponentially.
One study found that members are also twice as likely to
report mental health problems at the three or four-month time
period after returning from deployment. That is a time that the
post-
deployment health assessment has been over with and that the
Guard members and Reserve members are typically at home.
I believe that the VA is staffed by some of the best mental
health care providers that there are and some have excellent
expertise in working with military sexual trauma. However, I
believe the problem facing the VA is one of sheer numbers. The
significant number of veterans who may be experiencing MST or a
combination of MST and combat-related trauma, compounded by the
fact of the long-lasting nature of PTSD, means that the VA must
be prepared to meet the needs of a growing number of victims
and of veterans over the years to come.
To quote a line from a well-known movie, ``Jaws,'' when one
of the characters saw the shark go under the boat for the very
first time, he uttered in understated and prophetic words,
``We're gonna need a bigger boat.'' That is what I would say to
the VA. We are going to need a bigger boat. That means more
qualified and appropriately trained providers must be
available. Those clinicians must be able to provide specialized
services, sexual assault services, and understand sexual trauma
in addition to combat-related trauma. They must be sensitive to
the issues of the Guard and Reserve communities. Perhaps now it
is time to consider some
of the following:
1. The addition of specialized training programs for
current providers in the treatment of MST;
2. Adding additional training program and internship sites
for psychologists and psychiatrists. Internship training sites
are very cost effective and it is a good way to ensure that you
will have mental health providers in the pipeline to address
the needs of our veterans in the years to come;
3. Collaborations with academic medical centers with
expertise in sexual trauma who can assist the VA in their
training of their own clinicians; and
4. The creation of specific outreach programs to address
the needs of returning Guard and Reservists who face
significant barriers to treatment.
Thank you for this opportunity to address you and for the
pleasure of sitting on this panel.
[The prepared statement of Dr. Best follows:]
Prepared Statement of Connie Lee Best, Ph.D., Senior Faculty Member,
National Crime Victims Research and Treatment Center, Medical
University of South Carolina
Good Afternoon Senators. It is indeed an honor to address this
Committee. I have been asked by this Committee's Chairman, the
Honorable Senator Akaka, to discuss with the Committee the ability of
the Department of Veterans Affairs to meet the needs of veterans who
have experienced military sexual trauma, with particular attention to
the National Guard and Reserve.
I am Dr. Connie Lee Best, a Clinical Psychologist and Professor in
the Department of Psychiatry and Behavioral Sciences at the Medical
University of South Carolina. Today I am speaking to you from several
perspectives. First, as a psychologist who has spent more than 25 years
treating victims of sexual assault. Second, as someone who spent twenty
years in the United States Navy Reserve, retiring in 2004 at the rank
of Captain (06). Third, as the Director of an office at the Medical
University responsible for responding to complaints of sexual
harassment within the University. Finally, as a civilian psychologist
who has served in a variety of consulting and advisory positions, both
paid and unpaid, for the Department of Defense.
According to the VA, military sexual trauma (MST) refers to both
sexual harassment and sexual assault that occurs in military settings.
It can be experienced by both men and women. Sexual harassment is
defined as repetitive, unwanted sexual attention or sexual coercion.
Sexual assault is sexual activity against one's will.
Numerous research studies have documented rates of rape ranging
from lows of 6 percent for active duty women and 1 percent for active
duty men to rates that are significantly higher. One study found that
23 percent of female users of VA healthcare reported experiencing at
least one sexual assault while in the military.
There are aspects of sexual trauma that are unique to the military.
MST most frequently occurs where the victims live and work so that
often the victims remain in close proximity to the perpetrators. The
perpetrators are just as frequently their supervisors or higher ranking
peers who will be responsible for making decisions concerning the
victim's promotion or duty assignments. The risk of re-victimization by
the same perpetrator is real. These factors, combined with the value
placed on unit cohesion, especially in the combat theaters, add to the
reluctance for victims to come forward. Even given the relatively new
system in the military that allows victims to seek medical and
psychological care without required reporting to law enforcement, the
unique aspects of MST have the effect of reducing the likelihood that
victims will seek psychological services.
The devastating affects of MST are clear. As any veteran or their
family members will tell you, victims may suffer the effects for years.
Those who have experienced MST often develop post traumatic stress
disorder (PTSD), major depression, substance abuse problems, and
functional impairment in social, interpersonal, and employment
settings. The effects of MST do not stop once the servicemember leaves
the military.
As of April, 2007, there are approximately 76,000 Reservists
deployed worldwide to support the War on Terrorism. In 2005, that
number was 120,000 higher. Members of the Guard and Reserve face their
own unique sets of challenges when they experience MST. Compared to
their regular active duty counterparts, many members of the Guard and
Reserve may not be as familiar with the resources available.
Once released from active duty recall, they do not remain on a
military base; they return to their hometowns. There is an
understandable urge to return as quickly as possible to their spouses,
children, jobs, and their ``normal'' lives. Once returning home, they
are often far away from needed resources, away from other unit members,
and away from their military social support systems. Although during
their Post-Deployment Health Assessment conducted immediately after
returning from deployment, they are given the opportunity to indicate
if they had experienced a MST or are experiencing mental health effects
associated with that trauma, Reservists are acutely aware that if they
do endorse serious mental health concerns such as PTSD, they will
likely be retained on active status and not be allowed to return to
their civilian lives. Furthermore, the victims of sexual trauma may
feel that if they could just return home to their families and jobs,
they will be able to overcome this experience on their own.
For Guard and Reserve members who have also experienced combat-
related trauma, the suffering can increase exponentially. A 2006 study
by mental health professionals at Walter Reed Army Institute of
Research, found that the prevalence rates of reporting a mental health
problem among servicemembers returning from Iraq and Afghanistan were
19 percent and 11 percent respectively, with combat experiences as the
most frequently cited reason for their problems. If a servicemember was
unfortunate enough to have experienced combat-related traumas and was
also a victim of sexual trauma, the risk would be expected to be great
for the development of significant mental health problems.
Another group of military researchers found that servicemembers are
twice as likely to report mental health concerns 3 or 4 months after
returning from deployment rather than immediately afterwards. This time
of greater reporting of PTSD and other mental health concerns is a time
well beyond when the Post Deployment Health Assessment screening
typically would occur. Members of the Guard and Reserve would already
likely be demobilized and at home.
I believe that the VA is staffed by some of the best mental health
providers and by some with exceptional expertise in MST. However, I
believe that one of the problems facing the VA in their responsibility
to meet the needs of today's veterans who have experienced MST is one
of sheer numbers. The significant number of veterans who may well be
experiencing MST, in addition to those who may also be experiencing
both sexual and combat-related trauma, combined with the long-lasting
nature of PTSD, means that the VA must be prepared to meet what is
expected to be a growing number of veterans in need of mental health
services in the years to come. To quote a line from a well known movie,
Jaws, when one of the characters saw the shark for the very first time
he uttered the understated and prophetic words---``we're gonna need a
bigger boat.'' That is what I would say to the VA--we are going to need
a bigger boat.
That means more qualified and appropriately trained providers must
be available. Those providers must be able to provide specialized
sexual assault services and understand the interaction of sexual trauma
with combat-related trauma. They must also be sensitive to the special
issues of the Guard and Reserve communities. Perhaps now is the time to
consider some of the following: adding specialized training programs
for providers in the treatment of MST; adding additional training
internship sites for psychologists and psychiatrists which are both
cost-effective and will ensure that there will be a sufficient number
of providers in the pipeline to meet the ever-increasing numbers and
needs of veterans; collaborations with academic medical centers with
expertise in sexual trauma; and the creation of specific outreach
programs to address the needs of returning Guard and Reservists who
face significant barriers to treatment.
Thank you.
Chairman Akaka. Thank you very much for your testimonies.
Let me tell you that according to our schedule, we are
expecting a vote to be called, or a series of votes, on the
floor. So as a result, I am going to ask each Member to ask one
question and then we will move it along quickly. If we have
time here for whatever reason, we will have a second round for
this panel. We have a second panel waiting here.
So let me ask my first question. Mr. Bailey and Mr. Omvig,
what would each of you tell families of those with
servicemembers in Iraq about what to watch for when the
servicemember comes home, and what to do if symptoms arise? Mr.
Bailey?
Mr. Bailey. The biggest thing I would tell anybody is to
not assume and to always ask questions. Do not assume the VA is
there to help without somebody who is going to be there to
guide them through every step because there are too many walls
at the VA. Just do not assume. Nothing will get done if you do.
Chairman Akaka. Thank you. Mr. Omvig?
Mr. Omvig. One of the points that we have brought up before
is peer counseling for families. As far as peer counseling, we
are talking about people that have been through situations like
ourselves being able to talk to families before the soldiers
come home, being able to give them a little bit of the insight
that took us too long to find out because it starts very slowly
and builds and builds up to the perfect storm, and then it is
almost too late.
Mrs. Omvig. I might just like to say that it is really
important for, and it has been discussed before, other veterans
to be peer counselors, because they understand and so many of
the veterans or even active duty service people do not feel
safe or have various trust issues and only wish to speak or
wish to listen to somebody else that they know really does
understand what they have been going through or what they are
dealing with and they don't want to have to be educating
somebody about something they may not even be understanding
themselves. So they need another peer counselor.
Mr. Omvig. One thing that helped us tremendously early on,
and when we got into talking to other veterans, is that the
Vietnam veterans who have been struggling with PTSD so long,
dealing with their own problems, started helping us understand
what was going on with Josh. These guys who are fighting for
their lives right now are trying to help us understand what
happened to him, and they are some tremendous people.
Chairman Akaka. Thank you for your response, Mr. Omvig and
also Josh's mother, Ellen Omvig.
Senator Craig?
Senator Craig. Well, again, I thank all of you for your
testimony.
Possibly to you, Patrick, and to the Omvigs and to the
Baileys, do any of you know what stress management training or
preparations your sons may have received from the Marine Corps
or the Army, respectively, prior to the entry into combat that
might have helped them cope with what they experienced coming
out of it? That is also directed at you, Patrick.
Mr. Bailey. To my knowledge, the only thing my son talked
about was urban warfare training. No stress management
training. He was prepared to go fight in an urban combat
environment, but there were no personal well-being classes that
I am aware of.
Senator Craig. OK.
Mr. Campbell. Actually, I was very blessed. The thing that
saved me was right before we got into theater in Kuwait, we had
a police officer who does police officer training that talked
about what happens when you are in a stressful situation and
the physiological reactions. At the very end of that, they
talked about secrets and how the secrets that you keep are the
secrets that kill you. I remember thinking that was my mantra
when I got home, that was the only thing that saved me, because
the more I buried a story in my head, the more it just grew
like a cancer and made it harder for me to function.
That training is something that they give to police
officers all across the country as part of their academy
training, and I remember thinking, this needs to be told to
everyone, what you should expect when you fire your weapon, but
also what you should expect when you come home. And that is why
we believe that whenever--normally, a police officer, when they
fire their weapon and they see a weapon, they go through this
type of counseling. I was fired at, shot at, blown up 16 times
while I was there and I never once was required to get that
type of counseling. The police officer training that we have in
place already throughout this country would serve as an
excellent model for pre- and post-deployment.
Senator Craig. Thank you. Thank you, Mr. Chairman.
Chairman Akaka. Thank you very much, Senator Craig.
Let me do this by seniority. Senator Rockefeller, your
question, and we will follow with Senator Murray.
Senator Rockefeller. Mr. Chairman, I am going to depart
from the usual and suggest that--I looked at the votes that we
have coming up. I don't think they are going to change the
future of the world. As for myself, I have made the decision I
am just going to miss them because I think what we are doing
here is far more important than what they are going to be doing
on the floor of the Senate. So if you want to go on to somebody
else, I will be here until you all come back for the next
panel.
Chairman Akaka. Senator Murray?
Senator Murray. Let me just say that no apology or excuse
can ever make up for the loss that you have endured. We are
very grateful for you to have the courage to come here before
this Committee and share your story, especially because anybody
listening to this will hear something in it for them.
One of my deepest concerns is the men and women who have
separated from the service, gone home a year and a half ago,
and feel like nobody knows what is going on in their head and
don't get the help. So your words have made a difference for
us, for the policies that we need to put in place, but
hopefully for some soldiers out there that hear you, as well.
So I really appreciate it.
And Dr. Best, I wanted to thank you in particular for
talking about the really hidden, unspoken story of sexual
trauma from this war. It is a difficult issue because I have
heard personally from many women I know-- and men, as well--who
don't want to talk about it for obvious reasons, but also for
the unspoken reason that they don't want to put at risk women
in the military in general and we have got to figure out how to
walk through this. So I hope that at a future time, you and I
can sit down and talk about what we can do better to help
really bring that into the public and help those people who
have been traumatized, but do it in a way that provides them
the dignity that they really deserve for what they are doing.
So I only have time for one question and there are many I
think I would ask. Patrick Campbell, because you were in the
Guard and Reserve and came home, when the war started, and
talking to our own Guard and Reserve, they said the most
important thing was for the soldiers to get home and have that
90-day waiting period before they were called back to their
unit. I heard you say that is too long of a time, that getting
back and having the camaraderie of those that you served with
was absolutely critical for a number of reasons. Do we need to
relook at that for our Guard and Reserve and think about
bringing them back sooner, as hard as that is, when we want
them to get home to their families?
Mr. Campbell. No, I actually wasn't the one that said it.
It was Mr. Omvig.
Senator Murray. Oh.
Mr. Campbell. But I will say this, that there was nothing
more that I wanted to go than go and just disappear. I think
the idea is that the 90-day period is before you go and work
again. That makes complete sense. The idea that you don't come
back and just interact and have forced fun time or time where
you have to just decompress. That is completely different than
having to go clean your vehicles, start checking in the
weapons. Those are times that we can talk about.
I think that what Mr. Omvig said was exactly right on.
Let them go see their families. Let them have those
moments. Then have them there just during the day. Give them a
job for a couple weeks where they go in during the day, they
get to meet with their buddies, but at night, they get to go
see their families, and that makes all the difference.
Senator Murray. Mr. Omvig, I assume that meeting with their
buddies is an important way for them to be able to open up?
Mr. Omvig. It has to be, because they have to start talking
about the experiences that they shared together. You know,
going in and talking one-on-one with a counselor, they are not
going to share their deep thoughts of what went on. But as a
group, in group sessions, they are more likely to open up into
what actually went on there, and as it starts, it gets to be a
snowball and that snowball gets bigger.
Senator Murray. Yes.
Mr. Omvig. And the reason that it has to be during this 90-
day period is that the earlier we address the issues of mental
health, the faster we can start correcting the problems and
keeping them from growing chronic. Once to the chronic stage,
it is difficult to treat and deal with. And we need to give all
of our veterans the best opportunity to live the best life they
possibly can. They need to come back and be able to live the
American dream that they are over there fighting for----
Senator Murray. Yes.
Mr. Omvig [continuing].--not being affected and unable to
live the American dream because of what they did for our
service.
Senator Murray. Thank you, Mr. Chairman. I think there are
two issues. I think one is the stigma of this, and we have got
to all be talking about it more and working with our
communities and everybody involved to make sure that people
understand that we have to all understand this is part of the
cost of war.
And second, Mr. Chairman, I heard loud and clear what one
soldier said to me, and that is they trained me to go to war.
They never trained me to come home. And I think we seriously
have to look at how to train these men and women to come home.
Chairman Akaka. Thank you very much.
Senator Webb?
Senator Webb. Thank you, Mr. Chairman.
First of all, I would like to say just very quickly that a
number of you mentioned the difficulty with things such as
readjustment deadlines for people coming back and sort of the
delay fuse that often exists with PTSD. We did the pioneer
studies on this literally 29 years ago. I really want to make
sure that in terms of the way we look at PTSD that it is an
ongoing exercise by government.
I have seen in the people that I served with in Vietnam
cycles. It was like an 8-year cycle, and then there was like a
20-year cycle, and then there is a period when your regular
career starts to end when you start to reflect more. We can't
lose sight of that when we build these artificial deadlines
into when we administer benefits and this kind of thing.
But the question that I would have for all of you is given
what has happened and the different situations that you
described, how would you describe the reaction of the
Department of Veterans Affairs people that you have dealt with
after these incidents occurred? Do you feel they are being
responsive, or do you feel like we are not getting anywhere
here?
Mr. Bailey. Well, sir, when my wife and I were at the L.A.
VA Hospital, nobody would talk to us. Nobody cared. But they
sure cared when the ABC reporter got a hold of me and we were
on the news We were going to be on the news at 5:30 that night.
I got a call at 5:15 from the public affairs guy wanting to
know if he could be of any service. So without--I mean, the
media takes a big hit, but without the media, my son's story
would not have gotten out there.
Mr. Omvig. At the present time, there is nothing what they
call a CO officer assigned to military suicides that are not
active, and if this happens to a Guard or Reserve individual
that is not on active status, the parents basically take care
of everything that is going on. If they were a casualty, then
there would be a casualty officer with them for 10 days, taking
care of all the paperwork, all the things that may be presented
to them for help and everything else. We basically, and I know
it was a very difficult time for his unit, his company, but we
were given his Honorable Discharge and the papers at the public
viewing, the family viewing.
Mrs. Omvig. Which we lost.
Mr. Omvig. And I still don't know where they are.
I was not in the frame of mind. I don't know where they
were. So I think it is extremely important that we are looking
at this aspect, also, of helping families deal with a crisis,
the time where they are not thinking logically. They don't know
what is out there to assist them. We heard from the chaplain
once, but basically we have heard very little from his Reserve
unit since Josh was buried.
Mr. Bailey. I just want to say one more thing. I spent 20
years in the military, also, and the day we finally got to talk
to family services there, the one thing I really expected more
from my VA and my government was the man who came to give me my
son's flag, but it was in a box, just like they just had bought
it from Wal-Mart. It was in a box. It was just, like, oh, by
the way, here is your flag. Take care. Have a nice day. And
getting my son's flag in a box was the biggest insult to my
son.
Mr. Campbell. And just so we can tell a full picture, for
me, I am very blessed that I go to the D.C. Vet Center, which
of the Vet Centers is one under-utilized because people around
here are definitely the type of people who don't like to admit
that they have problems. At the Vet Center, I get great care.
You walk in and you say, welcome home. But I have a very--when
you go to a VA hospital, you might have a very different
experience.
Senator Webb. Thank you very much. Thank you, Mr. Chairman.
Chairman Akaka. Thank you.
Senator Tester?
Senator Tester. Thank you, Mr. Chairman.
Tony, you spoke of improvements in reducing dosages and
staffing increases and you made a statement at the end that we
are going to have to follow up on later, and that is evaluation
of the systematic problems and where to start there, because
that is no easy undertaking, but I appreciate that perspective.
I have a question that revolves around the bill that the
Omvigs have got the delegation from Iowa to put forth, and I
don't know if anybody else at the table has had a chance to
look at it, but there are 11 points on it.
Senator Murray talked about not only training to go to war,
but also training to come home. I am going to make two
assumptions and then I just need to get your opinion. The first
assumption is that it would pass. The second assumption is that
the things you talked about, the 11 points, would be
implemented fully. Is there anything else that we are missing
that we might want to take a look at that this bill doesn't
address that would solve or, at least, go a long ways in
solving the kinds of difficulties we are talking about with
mental trauma?
Mr. Omvig. Toward solving, no. As far as identifying, yes.
If you look at what has been going on with the bill, they
talked about 1,000 veterans being treated by the VA are dying
of suicide each year. Josh wouldn't have been one of those
numbers, and there are so many others that wouldn't have been
in those numbers. So we really don't know the magnitude of the
problem that is really out there. And until we know the
magnitude, it is going to be hard to address it one way or
another unless we address it right when it comes home.
Senator Tester. OK.
Mr. Campbell. I mean, just what I said in my testimony,
that every soldier who comes home gets a face-to-face--I mean,
this is beyond what is in this bill and that is that it is a
required face-to-face mental health screening with a licensed
professional. It is the only way to take away the stigma.
Chairman Akaka. At this time, I would like to call on the
second round of questions here.
Mr. Bailey, after Justin died, you and your wife visited
the domiciliary where he was staying following his 2-week
hospital stay. What can you tell the Committee about the level
of staffing there?
Mr. Bailey. Well, the day we got there, we were met by what
is called the dom assistant, who made a good effort. He was the
only one working and he made a good effort to get a hold of his
supervisors. One of his supervisors wouldn't talk to us on the
phone. The other one told him to stop talking to us.
Oh, and by the way, we were let in a side door, because we
didn't know where the front door was, by a resident, so we
could have been there to cause any sort of damage possible.
There was no staffing, except for the one dom assistant. This
was on a Sunday. Residents packed up my son's belongings and we
got them in garbage bags. You know, there was no respect given.
We got all of his stuff in a garbage bag.
Chairman Akaka. Thank you very much.
I should apologize to you in advance. There are a series of
votes that have been called and this is why the Members have
left, to go to the floor to vote. Senator Rockefeller feels so
strongly about this hearing, he will remain here and conduct
the hearing. Following this panel, we have a second panel that
will be testifying, and so I would like to pass the gavel to
Senator Rockefeller and add my thanks to you for your
testimony. Following the series of five votes, we hope to come
back again to this hearing.
Thank you very much, Senator Rockefeller.
Senator Rockefeller [presiding]. The question comes about
people not wanting to seek help, and I think that is true of
all people. Mr. Campbell, you spoke about a state of denial. I
am not a psychologist. I am not trained in anything in
particular. But I think that is the nature of the human being.
So let us say that you are over in Iraq or Afghanistan, or
let us say that you have just come back. Your every instinct is
not to go find somebody, and what you have all said in
different ways is somebody is going to find you.
But I have also heard you say that it isn't easy to talk
about PTSD or any other subject--mental health, trauma, sexual
trauma, anything--alone with a counselor, so that if a
counselor comes to you, if that was the situation, which gets
into the whole Vet Center thing, which I really do want to talk
about because I really do believe in that. I think that is the
closest thing to making it easier for you to get somewhere
where you feel comfortable, which isn't a huge building. But
you have also said that you really aren't comfortable with
other people, I mean, just doing it all by yourself.
So what is a possible way in your own thinking, if we could
get the right kind of money into the Veterans' Administration,
that people could reach out to you but still allow you to be
able to make that a valuable contact by telling them what you
could only tell them when you feel like telling them? It isn't
just that they find you and that you meet, it is that they find
you and that you begin to disgorge and begin to tell them what
they need to know. I am not sure of the conflict of that. Can
any of you speak to that?
Mr. Campbell. I have talked about this actually a lot
recently with some of the veterans we have in the D.C. area. I
remember a couple of weeks ago, I took a veteran who just got
off active duty into the D.C. Vet Center, and when he got out,
he said, ``I wish that he hadn't told me I had PTSD. I wish he
told me that I had a suit of armor that said I was impervious
to PTSD and I was just having some type of issues.'' About a
week later, he called me back and he said, ``I can't believe
you made me go. I don't have PTSD.'' Another week later, he
called me back and he said, ``Thank you.'' And a week later, he
called me back. I mean, all these calls when he tells me, ``I
don't have it, but thank you for sending me.''
The biggest obstacle for a veteran is going in that first
time and seeing that counselor, getting over the idea that you
are going to talk about it and just learning where it is. The
D.C. Vet Center is at 13th and Taylor. I don't know if you know
where that is, but that is nowhere near Metro. It shares a
place with a Montessori school. If you don't know what you are
looking for, you are not going to see it.
The fact that I went in there and I saw it, I was now able
to take people in there. Once people have gone once, it is so
much easier to go a second, a third, a fourth time. To be
honest with you, what I said in my first session did not help
me at all. It was the fact that I went is what caused me to
break down. And about 3 days later--I didn't say anything in
that first session that helped me, but 3 days later, I am in a
movie theater and I am crying my eyes out because I realized I
finally admitted that I have a problem to someone other than my
journal. I broke free and all of a sudden I felt like I was a
full human being again. Now, I had to face the fact that I was
in a lot of pain, but I was feeling for the first time in a
year since I got back.
So to answer your question specifically, it is getting
people to where they would be asking for help so they train--
just like we say in the military, muscle memory, so that you
keep doing it and you keep doing it so the next time when you
actually really need to do it, your muscles automatically do
it. When you know you have a problem, you automatically know
the phone number to call or the place to go, because otherwise,
I mean, if you have ever tried to navigate the VA, there is a
form you have got to fill out. You already know that. You go
in. I need to fill out this form. I need to talk to so-and-so.
It makes it so much easier.
Senator Rockefeller. Any other thoughts? Yes, sir?
Mr. Omvig. When he brought up the thoughts of forms, just 2
weeks ago, I was talking to a Guard member and he has a 40-
hour-a-week job. He was in an IED attack in Afghanistan and was
suffering from a TBI. He went to the Iowa City VA Hospital to
get some help. While there, they gave him nine forms to fill
out to get services. He said, if it wouldn't have been for a
VFW individual in the hallway to help him fill out that
paperwork, he would have gave the paperwork back and walked
away.
One of the big stumbling blocks we have--if a person has
got PTSD, if they have got TBI, if they have got any type of
disorder that they are having problems with, how are they going
to be able to fill out the paperwork themselves?
There is a big difference between advocacy and case
workers. We don't need more case workers. We need more
advocates for the veteran when they go in there to see that
they get all the benefits they absolutely deserve when they
finally break down and they finally go to the office to try to
get services, because if you don't fill out the paperwork
right, you don't cross all the ``T''s, you don't dot all the
``I''s, services are delayed and sometimes I have heard two, 3
months before they are even able to get in again.
So we need advocates, advocates that are going to be there
for the veteran, not case workers that are looking out to keep
the costs down for the company. There is a big difference there
and we have heard a lot in the news about having more case
workers and calling them advocates. Those are not advocates.
Advocates are people that are looking after veterans'
interests, not the company's interest in providing service.
Senator Rockefeller. And who might those advocates be? The
veterans service organizations? There are a lot of other
volunteer groups----
Mr. Omvig. Excuse me, I am sorry----
Senator Rockefeller. No, please go ahead.
Mr. Omvig. You have got great advocates right here. You
have got advocates in the DAV who absolutely know how to fill
out all the paperwork. You have the VFW that is in many of the
facilities that will help fill out the paperwork. But these
guys are doing it on a voluntary basis. They are all
volunteers, and they are doing a wonderful job for all of us.
It is that we need more of those advocates in every single
facility today. We don't have a veteran that is having problems
that can't hardly describe what is happening to himself try to
go in there and fill out nine to ten pages of paperwork before
he can even see somebody about his problem. We need to
streamline things and we need to get advocacy better.
Mrs. Omvig. I would like to also say, for outreach in that
not every place has a close veterans' clinic or VA hospital and
not all the veterans can either get transportation to get to a
place, or in the time frame, or to go and wait, have somebody
that will drive them somewhere, they wait for 4 or 5 hours to
get in, and then drive them the 3 hours back to their home. Not
everyone has people that can do these things. There are a lot
of places in this country that are not accessible, physically,
geographically accessible, and that is saying then if they do
have a place that it is a good place, because not all of them
are good places. So for both of those things, you need a lot of
help.
Mr. Bailey. You know, talking about the parts of the
country, we have recruiters that get our young men to sign up.
We could have an outfit or a unit designated for helping when
they get back. Put the unit in a truck, tell them Iowa or Idaho
is your district, and here is a list of your veterans. You are
on temporary duty. You drive around and you go to every one of
their houses and knock on their door and say, ``Hi, Bob. How
are you doing?''
And as far as the paperwork, there is no excuse for nine
different copies. When we went to the L.A. VA Hospital, the
first form we were given, the next day, we were told it was an
outdated form and was no good. And this is by employees of the
VA.
But I am saying, you know, we get a truck. You have an
active duty unit or a Guard unit, and that is their job, to
drive around to these veterans in the rural areas, and even in
the cities. You can get lost in the city probably almost easier
than you can in a small town. Touch them. Say hi. Ask what can
I do, or, how can I help you? Asking for help or having help
offered to you, maybe you might make that first visit.
Senator Rockefeller. A couple more questions. I come from
West Virginia, which is not exactly San Francisco, OK? It is
very rural. We have an enormous number of people who sign up to
serve. One of the biggest things that they tell me when they
come back, and this also--you could go all the way back to the
testing of the atomic bomb way out in the Pacific on instances
of this sort--they don't want to go somewhere, even if they
know it is for their own benefit.
For example, I will just use one that occurs to me now,
spinal cord injury, sort of a scary thing. It is not up here,
but it is up here as well as down there. If they have to go to
Salem, Virginia, which in West Virginia is where you have got
to go if you are going to get spinal cord injury service, many
veterans will make the decision not to go because people in
rural areas, in Appalachia, with all the mountains and the
winding roads and the psychology of Appalachia in general,
don't like to have to travel. They don't like to have to go
make that journey, even to a Vet Center.
I want to shift to that for a moment. I am a passionate
believer in Vet Centers for the sole reason that my very small
State of West Virginia has four huge veterans hospitals, and
they are, as you would expect, sort of distributed around the
State. Most of them have pretty good reputations, up until all
of this started. So what we have tried to work on is setting up
the system of Vet Venters, exactly what you are talking about,
which are user-
friendly. They absolutely--they may not be next to a Montessori
school, because I am not sure we have many of those in West
Virginia----
[Laughter.]
Senator Rockefeller [continuing].--but they are on the
street.
You walk from the street into the building and then there
is somebody, a Vietnam veteran or somebody who is sensitized
and they are in it because they believe in helping their fellow
veterans. And I don't know the state of their training, but I
do know that they are independent and I know they are not under
the control of the Veterans' Administration.
And what I want to ask you is if outreach is the deal when
you get back, forgetting the complexity of when does it come,
time with the family first then 3 weeks later or a month later
or whatever. Forget that for a moment. Are Vet Centers
something which, if proliferated, could, in fact, help when
people go there? Now, if they go there, they will find less
service professionally, but they will find more fellow veterans
to talk with because it becomes a gathering place, really the
only place that veterans can go and be together because they
are informal, comfortable buildings. But they are not under the
control of the Veterans' Administration. They run themselves.
Is that a formula for something that is useful, or is it a good
idea? But it is wholly inadequate to what we are going to be
facing.
Mr. Campbell. I think the Vet Centers are the model that we
need to go to, and the reason why is when I would go into the
Vet Center, the form that I need to fill out, it is a quarter-
sheet of paper. It asks my name and why I am there. There is a
little check box. So I have to write down two things and turn
it in and they call Mr. Phillip, who is my psychologist. It is
so personal.
I mean, you want that first experience with the VA to be a
positive one, because once you have that positive experience
and then you need help and they say, where do I go to get such-
and-such from the VA, they know the answer to that question.
They say, this is the VA hospital. This is the person you need
to talk to. This is a good person. Or if they are having
trouble with their case, they would be, like, this is the
number to the local VFW, DAV, American Legion. Those are the
types of things. If close to their house, they will go if it is
close, and if they have a good, positive first experience, they
will continue to go, and that will be their gateway into the
VA, not these monolithic hospitals where you get buried in
forms.
Dr. Best. Senator, I think that we can have a variety of
things that we should offer veterans. There is not one-size-
fits-all. I think Vet Centers can serve a purpose. They
certainly can be an entre where they can get some help, maybe
not at the level of care they could in a hospital, but they can
also interact with veterans. I think the hospitals that are
staffed by psychologists and psychiatrists can offer very
specific behavioral kinds of interventions that some people
with PTSD are certainly going to need that level
of care.
The one thing we have not mentioned today is the use of the
Internet. Our young folks are very savvy. They are very used to
doing that. Wonderful things could be done that could be
intervention-based, not just a reciting of what PTSD is, but
actually you can do assessments online, and then you can tailor
things to that and you can make that available to places that
are rural that they don't even want to drive--it is 20 miles or
30 miles down winding roads to the next city that might can
support a Vet Center.
So I think one of the things we can do is literally have an
array of options to offer veterans, because some might want to
go to Vet Centers. Some might be near hospitals. Some of the
flagship VAs have some great programs and that would be good.
But we also need Internet. We need lots of different things,
and to make it available so that veterans can pick and choose
what suits them, what helps them, and you can have things that
are specific for family members that are available online and
can address the family needs and answer questions for them.
So I just think that we need to sort of be creative in our
thinking. Now is the time to do it. The numbers are already
there and they are only going to get more with each passing day
and month. And so we owe it to our veterans to think out of the
box, to be creative, to have an array and offer it and let them
decide what might most work for them.
Senator Rockefeller. Let me come back to you with a
question that you brought up earlier, and that is psychiatrists
and psychologists. One of the magnificent things about VA
health care training is that 50 percent of all physicians in
this country intern or do residency at VA hospitals. So
automatically, 50 percent of all doctors everywhere in this
country, of all kinds, have trained at VA centers. Now, some of
them, yes, are doing research and that research is very, very
important.
My question for you is, I have never actually heard
somebody say that psychologists and psychiatrists are part of
that physician group. Do they also get residency training at VA
hospitals and thus have a chance to experience as they are
going into their professions what happens?
Dr. Best. We certainly have people here from the VA system,
but health care providers, psychologists and psychiatrists, do
not have to do an internship at a VA in order to become a VA
employee. Some of them that do participate in internships there
can remain on staff, but it is not a requirement. So you may
have a professional, a doctoral-level professional join the VA
system as a health care provider who has not done an internship
at the VA.
Senator Rockefeller. OK. Let me just understand that. I am
not saying that they have to--I am going back to my 50 percent
of all physicians. Do they fit into that category or do they
not, the psychologists and psychiatrists?
Dr. Best. I do not believe that 50 percent of the
psychiatrists and psychologists--are you talking about in this
country?
Senator Rockefeller. Yes.
Dr. Best.--have had internships at a VA.
Senator Rockefeller. That sounds like something to think
about. Please.
Mr. Omvig. Speaking for the Guard and the Reserve when we
bring them back and a possible changing of that defusing time,
a good idea would be to bring in a team from the VA during the
drill period when you are going to be able to get everybody
there as a group and start the initial process of dealing with
what they have all been through. And if you bring the team in
and give them a good first appearance and that you are really
going to try to handle what has gone on with them and create a
process here, not just a one-time deal and we are gone, here
deal with it, but that we are going to continually work with
you to try to help you deal with it, it is easier if you are
with the group that you were actually with. You can talk about
like experiences. I understand what happened to you. I saw it,
too. I am also having problems with it.
Mrs. Omvig. I would like to also explain that even--I think
a lot of people are under the false assumption that all the
Guard goes as a group or all the Reserve go as a group. They
cherry-pick out to fill in their ranks. One thing we got asked,
well, why didn't your son drop by after work and tell them that
he needed to talk to someone? Well, when my son decided the way
to cope was to be a workaholic. So he worked all the double
shifts because it kept him very busy and thought that was going
to serve his purpose.
Another thing is his base was over 3 hours away from his
home and thus he couldn't drop by after work on their hours at
the base to say something to someone. And he wouldn't have done
it anyway because it would have, not just the stigma, but the
way the laws are written up now, it would have affected his
military and his personal career choice of being a police
officer. I mean, he wasn't just dreaming that one up. It was
real.
So I wanted to discuss that kind of thing. There were
people that were brought in also that were from other States
into his company to fulfill how many people they needed to have
in their company. So his Reserve company, they spread out all
over Iowa, they spread out all over Illinois because it is
right there on the river, Davenport. They brought in people
from other States besides those two main States to fill them
in, so they were gone. Everybody was gone. There was nobody
close, a few that did live in the area, but other than that,
they were just far-flung. Guard also do that type of thing,
too. So contrary to what you think, they don't all go over as a
unit and all come back as a unit. It is all different.
Mr. Campbell. I just want to add one real quick thing if
you don't mind me, Senator. The VA has a great program that
they are implementing as a pilot where they go into a Guard
unit, they show a couple of videos and use that as an
opportunity to have discussions. Sadly, the day that they did
that with my unit back in Louisiana, they did it for 40
soldiers, which happened to be my platoon. But the guy who I
lived next door to was in another platoon and he decided that
day he was going to take his life because he didn't get to go
to the training.
For me, I mean, these tools exist. We have created them and
we are really good at this. It is just about implementation. We
can go--we know what we need to do when we go into these units.
I remember when I called my lieutenant about this, when he told
me that this soldier had committed suicide, that everyone was
laughing about--this is before we knew--they were laughing, oh,
you are going to cry, or you are going to tell some story. As
soon as the video came on, it wasn't some cheesy DOD movie
where everyone is happy, it was a serious look at post-
traumatic stress disorder and kinds of the experiences people
have, everyone got quiet and then people started telling their
story.
I remember my lieutenant saying, this is the most amazing
thing ever, and then he called me an hour later and said, I
can't believe what I have to tell you. I just think if it just
had been First Platoon as opposed to Second Platoon, that guy
would still be here today. That was a pilot program. We know it
works well. Why aren't we doing it?
The only last thing is that you have three different types
of Reservists. You have the Reservists who stay in their unit.
You have the Reservists like myself who volunteer as a filler.
I have never been back to Louisiana since then. And then you
have the people who get out. We have a whole different
population of people we have got to worry about, the people who
separate the day they get home.
They say, ``I am done with the military.'' We have still
got to go after those people because they are almost in more
danger.
Senator Rockefeller. Sure. Let me ask a final question of
this panel and then we have to move on. I don't want to, but we
have to.
I am going to start this off with my very first experience
on this Committee 24 years ago, when I was very junior and I
remember right back there were the television cameras. They had
a guy who I think had come back from Bimini and it was the time
before the Second World War when the United States was testing
different things in places where possibly nobody would know
about or whatever. His testimony, he said, ``I want you to
understand what it is to have been given cancer by your
government and to be dying from that cancer,'' which he was
fairly close to doing, ``because I want you to understand how I
feel.''
OK, now we skip forward. It is very hard to skip by World
War II, North Korea. What people went through in North Korea is
unbelievable, but you get to the Vietnam War and there was this
thing called Agent Orange. We used that to defoliate so we
could find the enemy and in the process thousands of our people
were getting cancer and dying. But the government and the
military would never admit that. And the only thing that made
it possible for people who were dying from cancer or who had
been exposed to Agent Orange and therefore might be but might
not know it yet was when an admiral's son--remember Admiral
Zumwalt? His son died of cancer of Agent Orange. He came and
testified before some Committee, and all of a sudden, Agent
Orange compensation was made available. It is a pretty horrible
way of conducting government policy.
Skip one war forward, Gulf War and something called the
Gulf War Syndrome. I was Chairman of this Committee at that
time and I absolutely knew the DOD said that this problem did
not exist and I was just making up stuff. But every soldier was
required to take a pill in Kuwait called pyridostigmine
bromide, and that pill--I talked to some people back home in
West Virginia and they said they took one and they knew it was
just going to tear them apart. They just stopped. But that is
what you had to do every morning.
So you wander around West Virginia, and obviously around
the rest of the country, and the country is full of tens and
tens and tens of thousands of people who cannot read, who
cannot sleep, who cannot keep a marriage, who break out in
rashes. I remember one woman who was absolutely normal, except
if you touched her on her right arm, she would start screaming
in just unbelievable ways, and everything else about her was
perfect.
The military to this day denies any such thing ever
happened. And now we have this. The story really of all of you
is, whether it was the garbage bag, which is horrible beyond
description to hear you even say it, the flag in a box, the
papers which became outdated the next day, it is almost like
you went over there to fight for the country and you ended up
fighting the people that you were fighting for, which is why it
always troubles me when people talk about not standing up for
the troops. Everybody salutes the troops. It is the
policymakers, the civilian policymakers who make the policy
that get the troops in trouble or the VA, whatever it is. They
are the ones.
My question to you is philosophical. We are a generous and
a great country. We are not particularly generous to the rest
of the world. We don't do foreign aid. We don't worry about
Africa. We don't worry about all kinds of places where the War
on Terror is building. What, in your view, is it that makes it
like this? Is it something as simple as a lack of money? Why
does this happen in America?
Mr. Bailey. Well, sir, my answer is pretty simple. Apathy
and complacency, which is what I ran across at the VA. They
could have a wonderful program. Apathy, complacency, and just
not caring. That is what I ran across, and I am sure there are
people who do care, but I didn't run across them.
Senator Rockefeller. I am sort of talking about people at
the top level, to be honest with you, the people that run the
VA hospitals locally, the people that run the VA in Washington,
the people who make military policy wherever it is made, DOD,
the White House, all the rest of it. They don't get it. We have
this hearing. Will they get it after this hearing? Will they
take up the budget?
I think we will, and I think we will for one reason,
because of a building which I have now come to cherish called
Building 18 at Walter Reed Hospital, which has caused an
explosion of anger here in Washington and across the country,
which has suddenly delineated the difference between the
warfighter and the warfighter who comes back, maybe shot
through with some of those Iranian shards of metal so that they
can't remove them surgically without cutting an organ or
cutting an artery, so the person is in a wheelchair, probably
wondering whether it would have been better for him to have
been shot and killed rather than sit in a wheelchair in agony
for the rest of his life. Why?
Mr. Omvig. At one point, you talked about money, and I want
to ask you, who in our society in the United States deserves
more the appropriations and the funds to take care of them than
our
veterans. Who?
Senator Rockefeller. Nobody.
Mr. Omvig. Then we should take care of them.
Senator Rockefeller. But you see, the problem is----
Mrs. Omvig. You all have to decide that you are going to do
it, and if you don't think that your constituency is going to
vote for you, then you have a job of helping to sell this, and
there are a lot of people that would be glad to help you to
help sell this idea, that the veterans earned their right,
implied or contractually, and that they deserve this.
Senator Rockefeller. Doesn't it strike you as odd that we
are fighting in Afghanistan and we are fighting in Iraq, and
forget what one thinks about Iraq, and we are doing it all on
borrowed money, so there is no budget. We have borrowed off of
the Chinese, the South Koreans, and the Japanese, and a few
others. So there is no end to what you can spend.
But then you come home injured or you come home uninjured
or you come home thinking you are uninjured--I don't know how
people come home who aren't injured after an experience like
that--and then all of a sudden you fall under a national budget
which has a limit. It is a national health care system, the
only one in the country. No borrowing of money, but a budget.
To me, that is obscene, where you can endlessly spend and
borrow to fight, but you are under a tight budget when it comes
to the pain at the end.
Mr. Omvig. My question is, what does this tell the rest of
the world about the United States of America and our policies--
--
Senator Rockefeller. Well----
Mr. Omvig [continuing].--how we are dealing with the people
that are serving for us when we--these are our people. These
are our people, and how we are dealing with them. How does the
rest of the world look at that?
Senator Rockefeller. I suspect that the rest of the world
looks at that as pretty unimpressed. On the other hand, what I
am trying to find out is what we can do about it right here,
right now. I mean, if anybody has anything else they want to
say on this----
Mr. Campbell. You know----
Senator Rockefeller. We are a good people. Americans are a
good people. And yet how many people know that we are borrowing
all that money to fight, that there is no end to the amount
that we can do? And how many know that you are under a budget?
And people can use that as an excuse, can't they? Well, we
don't have the money. We don't have the personnel.
Mr. Bailey. The only thing--I only have one question,
really, and I guess you could call it the intersection
question. Building 18--how long was Building 18 there before
the Washington Post brought it to light?
Senator Rockefeller. You have got it. You said the same
thing about your son.
Mr. Bailey. How long was it there? And now it is on TV. Now
people care. It is like the intersection. How many car wrecks
does it take to get a stoplight?
Mr. Campbell. For me----
Senator Rockefeller. From my point of view, to end on a
hopeful note, I think the climate, and I think the Chairman
would agree with me, has been profoundly changed in these
square acres and across this country about veterans because of
something called Building 18, which people will never
understand and its mold, but it had nothing to do with it. It
was the fact that veterans were not being respected. I think, I
pray, and I hope that we will--not everything can be solved by
money, but you know what? It is not a bad place to start.
I mean--Mr. Chairman, I apologize, I have talked too much--
the average nurse in the VA system has served for 27 years.
Now, you can say, oh, that is because the benefits are great. I
don't think so. I think it is because the average nurse in the
VA system believes in trying to help people, and that is a life
cause for them. So they do it for their life. I think that is
the way we are as people. It is just that we don't seem to be
able to function
that way.
I think that we are 6 years into this now and I think
America has been changed in many ways, many, many ways, some
for the better, some for the worse. I am deciding this is a way
that we are going to change for the better.
Thank you, Mr. Chairman.
Chairman Akaka [presiding]. Thank you, Senator Rockefeller.
I want to thank you for continuing with the panel here.
I want to thank this panel for your testimony. It will help
us make decisions as to what can be done to improve the
services that we can provide for returning patriots and
soldiers to this country. Thank you for journeying this far to
testify here today. So on behalf of the Committee, let me say
thank you very, very much. Thank you.
I would like to welcome our second panel of witnesses. We
have asked VA to provide three of these witnesses to discuss
some of the VA's very best mental health programs in suicide
prevention, PTSD, substance abuse, and sexual trauma.
Let me call a brief recess at this time for just a couple
of minutes.
[Recess.]
Chairman Akaka. This hearing will come to order.
We welcome our second panel of witnesses. Dr. David Oslin
is the Director of the Network 4 Mental Illness Research,
Education and Clinical Center. Dr. Jan Kemp is Associate
Director for Education of the Network 19 Mental Illness
Research, Education and Clinical Center. Dr. Patricia Resick is
the Director of the Women's Division of the National Center for
Post-Traumatic Stress Disorder.
They are accompanied by Dr. Ira Katz, VA's Deputy Chief
Patient Care Services Officer for Mental Health.
I also welcome Mr. Ralph Ibson, Vice President for
Government Relations of Mental Health America. Mr. Ibson
testified before this Committee in 2002. We have asked him to
pull it all together again for us so that we can focus on
bridging the gap between the very best programs and the utter
lack of services.
I thank all of you for being here today and want you to
know that your full statements will appear in the record of the
Committee.
Now, I ask Dr. Oslin to begin with your statement.
STATEMENT OF DAVID OSLIN, M.D., DIRECTOR, VISN 4
MENTAL ILLNESS RESEARCH, EDUCATION AND CLINICAL CENTER,
DEPARTMENT OF VETERANS AFFAIRS
Dr. Oslin. Thank you, Mr. Chairman, and thank you, Mr.
Rockefeller, for being here today and doing this important
work. We want to express our condolences to the families that
were here earlier. This is a very important issue, indeed, and
we really want to work with the families and you in moving this
issue forward.
I am a physician at the Philadelphia VA. I am the Director
of the Mental Illness Research, Education and Clinical Center,
MIRECC. I am very proud to be a physician in the VA. I was one
of those 50 percent that trained during my residency in a VA
and stayed in the VA since that time.
I am here today to talk to you about our substance abuse
program in Philadelphia and how we are reaching out to
veterans. Our MIRECC supports research on the treatment of
addiction. It also runs the integrated care service for our
facility.
As a start, I would like to remind the Committee Members of
the devastation that addiction brings to patients and families
in our veterans. Simply put, addiction is a very deadly
illness. As an example, alcohol misuse in this country creates
more financial burden to our society than any other health
behavior, including smoking and obesity, and it is often
neglected. The toll on families, friends, and coworkers is
incalculable, as we have heard today.
Despite that devastating nature of the illness, research
such as that conducted in our center has clearly demonstrated
that addiction is an illness not unlike hypertension or
diabetes and that through good care, it is treatable. Our
program, we have intentionally built a program that encompasses
a broad spectrum of care and incorporates treatments that have
an evidence base
behind them.
We particularly start in the primary care setting,
realizing that a lot of the veterans won't come to us in the
specialty care setting. The VA currently and, has for the past
several years, annually required screening of all veterans for
alcohol misuse. Our integrated care program, called the
Behavioral Health Laboratory, provides systematic follow-up for
those veterans that screen positive for alcohol misuse as well
as PTSD or depression.
That follow-up actually starts with a structured telephone
call. We call the veterans in their homes and don't require
them to necessarily show up to a clinic visit or the burden of
having to deal with the transportation hassles. After that
telephone assessment, we determine the level of need of
services and reach out to the veteran, including those that are
OEF and OIF veterans, who will have particular concerns, as we
have heard here today, about the stigma associated with coming
to a mental health clinic.
Based on the assessment, we can begin to provide treatment
in that primary care setting outside of the stigmatizing
setting of mental health, and the variety of services will
include things like brief alcohol interventions, psycho-
education or education, as well as referral into our specialty
care programs. There is pretty clear evidence that these
proactive public health initiatives can be very effective in
reducing the addiction process and reducing the burden
downstream. The effective use of brief interventions also keeps
our veterans from the specialty care services that they so
often
fear to use.
This part of the program has also brought education and
training to our internists, family therapists, family
practitioners, and other primary care staff to approach mental
health just like another health disorder, just like the
diabetes or hypertension.
Moving up the ladder of our program, the next component
would be our Addiction Recovery Unit. Here, veterans are
assessed using a multidisciplinary team to assist in treatment
planning. We offer a wide variety of outpatient treatments,
including 12-step programs, pharmacotherapy, opiate
substitution therapy, individual psychotherapy, and group
therapy. We also have access to inpatient rehabilitation
services in our Coatesville and Lebanon facilities and acute
inpatient psychiatric care in Philadelphia.
Additionally, another critical element to our program is
the integration of physical, emotional, social, as well as
addictive components that are afflicting the veterans' lives,
the assessment of those issues. Many of our veterans have a
multitude of problems, including PTSD or post-traumatic stress,
depression, psychosis, and bipolar illness. We have to assess
each veteran for their needs in order to provide an appropriate
therapeutic environment.
We are particularly proud that our program has integrated
primary care within our addiction program so veterans don't
have to go to a multitude of different places to get support.
We also integrate homeless programs, peer support, family
therapy, and the recovery model into the services.
It is clear that the treatment of addiction has changed
substantially in the last decade and now includes a wide
variety of effective treatments. We are striving in our program
to provide the best available treatments to our veterans. In
order to accomplish this, we stress the importance of
effectively engaging patients in treatment, which entails
listening to and honoring their preferences in their treatment,
as well. This emphasis is coupled with continually evaluating
the program and adapting to a growing evidence base for
treatment.
We are also keenly aware, though, that our treatments are
not universally effective and we emphasize ongoing research in
our facility to develop new treatment options and new
opportunities for interventions.
In closing, I would welcome the Committee Members to visit
our facility at any time, meet with our staff and the veterans
we so proudly serve. Thank you.
[The prepared statement of Dr. Oslin follows:]
Prepared Statement of David Oslin, M.D., Director, VISN 4 Mental
Illness Research, Education and Clinical Center, Department of Veterans
Affairs
I would like to thank you for this opportunity to describe our
substance abuse treatment program at the Philadelphia VA Medical
Center. I am a physician at the Philadelphia VA Medical Center and the
Director of the Mental Illness Research Education and Clinical Center
or MIRECC. Our MIRECC not only supports research on the treatment of
addiction but also runs our integrated care program for the treatment
of addiction.
I would first like to remind Committee Members of the devastation
caused when the disease of addiction goes untreated. Alcohol misuse
creates more financial burden to our society than any other health
behavior, including smoking and obesity. Addiction is also a deadly
disease. The toll on families, friends, and coworkers is incalculable.
Despite the devastating nature of the illness, research such as that
conducted in our center has clearly demonstrated that addiction is an
illness not unlike hypertension or diabetes. The critical implication
of such research is that addiction is a treatable condition, with a
growing evidence base for an array of effective treatments.
In our program, we have intentionally decided to build a program
that encompasses the broad spectrum of severity and incorporates
treatments that have an evidence base supporting their effectiveness.
We start in the primary care settings. Throughout the VA system all
veterans are screened annually for alcohol misuse. Our integrated care
program, the Behavioral Health Laboratory, provides systematic follow-
up for veterans who screen positive for alcohol misuse. The follow-up
begins with a structured telephone assessment that includes questions
about a range of mental health symptoms, including illicit drug use and
suicidality. It is important to note here that this program has been
very effective in reaching OEF/OIF veterans who may be particularly
worried about the implications or stigma of going directly to a mental
health clinic. Based on both the assessment results and the veterans'
preferences, patients are triaged to the most appropriate level of
care. We offer a broad array of services including brief interventions,
education, and referral to our specialty care clinics. There is a clear
evidence base that this type of broad-based public health initiative
can identify veterans earlier in the addiction process and prevent
substantial burden in the future. The effective use of brief
interventions also keeps many veterans from needing specialty care
services. This part of the program also provides education and training
to internists, family practitioners and the other staff in primary care
and approaches addiction just like any other health problem.
The next component of our program is our addiction recovery unit.
Here veterans are assessed by a multidisciplinary team to assist in
treatment planning. We offer a wide array of outpatient treatments
including traditional 12-step programs, pharmacotherapy, opioid
substitution therapy, individual psychotherapy, and group therapy. We
also have access to inpatient rehabilitation services at the
Coatesville and Lebanon facilities and an acute inpatient program in
Philadelphia.
Additionally, another critical element of our program is the
integration of assessments of the physical, emotional, social, and
addictive components of veterans' lives. Many of our veterans not only
have addictive disorders but also suffer from post-traumatic stress,
depression, psychosis, and bipolar illness. Assessing each veteran for
all their health needs is crucial to providing a therapeutic
environment. We are particularly proud that our addiction program
integrates primary care, homeless programs, peer support, family
therapy, and the recovery model for those veterans in need of these
services.
The treatment of addiction has changed substantially in the last
decade and now includes a variety of effective treatments. We are
striving in our program to provide the best available treatments to our
veterans. In order to accomplish this goal, we stress the importance of
effectively engaging patients in treatment, which entails listening to
and honoring their preferences for treatment. This emphasis is coupled
with continually evaluating the program and adapting the growing
evidence base for treatment. We are also keenly aware that our
treatments are not universally effective and we emphasize ongoing
research as a mechanism for developing new treatment options.
In closing, I would welcome any of the Committee Members to visit
our facility and meet our staff and the veterans we so proudly serve.
Chairman Akaka. Thank you very much, Dr. Oslin.
Dr. Kemp?
STATEMENT OF JAN KEMP, R.N., PH.D., ASSOCIATE DIRECTOR
FOR EDUCATION, VISN 19 MENTAL ILLNESS RESEARCH, EDUCATION AND
CLINICAL CENTER, DEPARTMENT OF
VETERANS AFFAIRS
Dr. Kemp. Mr. Chairman and Senator Rockefeller, thank you
for the opportunity to be here. I am one of those 20-year-plus
nurses who is not with the VA because of the benefits and I am
very glad to have this opportunity.
The VA recognizes that suicide prevention requires a
comprehensive plan that involves integrated strategies,
coordinated efforts, and a steadfast commitment to
implementation and evaluation. Based on CDC data and not
controlling for VHA population-specific factors, it is
estimated that there are up to 1,000 suicides per year among
veterans receiving care within the VHA and as many as 5,000 per
year among all living veterans.
Various strategies have been put into place in order for
the VA to understand the problems associated veteran suicide,
assess veterans under their care for suicide risk, and provide
treatment strategies aimed toward suicide prevention. In
addition, the Mental Illness Education Research and Clinical
Centers are involved in several clinical research endeavors in
the areas of various treatment strategies and
neurophysiological approaches to the management of suicide and
are working closely with the NIH-funded Suicide Prevention
Centers to understand and disseminate current information.
The VISN 19 MIRECC in Denver has implemented a template
tracking system which allows identification of suicide attempts
within our network in order to provide follow-up care for these
veterans as well as to identify system issues that could be
resolved in order to improve the care that veterans receive.
To date, we know that over 250 veterans in the Rocky
Mountain Network have attempted suicide since October 1, 2005.
We have learned a great deal about this particular group of
veterans. Thirty-two of them have died as a result of their
attempt. A vast majority have been diagnosed with various
mental illnesses, including PTSD and major depression disorder.
Many have substance abuse problems and many have chronic pain
issues.
While knowing the numbers and tracking the statistics is
critically important to our work, we are also very cognizant of
the fact that we are dealing with individual lives and that
each life is invaluable. Implementing treatments that we know
are useful with suicidal patients has become our mission across
the country. We have begun an extension education and awareness
campaign aimed first at mental health and primary care
providers. We know that increased awareness of the possibility
of suicide will lead to better identification of those who are
at risk and improve our ability to implement appropriate
suicide prevention treatments.
In March of this year, I was giving a program in Battle
Creek, Michigan. A psychologist who was taking urgent care
calls that day was pulled from the program because a veteran
was on the phone asking for an appointment. She came back to
the program and stated since suicide was forefront in her mind,
she had asked the right questions and was able to determine
that this patient was at extreme risk and had gotten him
immediate help. We need to keep suicide in the forefront of all
of our providers' minds.
We are currently in the process of implementing
demonstration projects that will allow us to gather
effectiveness data while providing veterans with the most
current treatments in suicide. These include training
therapists in cognitive behavioral therapy techniques and the
collaborative assessment and management of suicidality problem
developed by Dr. David Jobes.
Through the newly established Center of Excellence in
Canandaigua, we will initiate intensive suicide prevention
programs in VISN 2 and in VISN 7, with national implementation
soon after.
We have also begun to use alternative treatment options
with those veterans who require enhanced monitoring and
management of their cyclic and persistent suicide ideation.
This includes the use of our Health Buddy, a tele-health unit
that we give to veterans that they use to track their health
care concerns and get immediate education and advice.
In Denver, we have seven chronically suicidal patients
currently using the depression module on the Health Buddy. Each
of these chronically suicidal patients has had several serious
suicide attempts. Since they have been working with the Health
Buddy, none of them have attempted. One patient told us that he
followed the Health Buddy protocols late one night with a gun
in his lap. By the time he got to the directions to call for
help, he had realized that help was really only a phone call
away and that the urge to kill himself had passed. He came into
the facility the next day, was admitted, and is currently
receiving ongoing treatment and has been doing well with no
attempts for over a year.
Another patient said that he feels the Health Buddy is the
missing piece of the puzzle he needed to know that his
depression and PTSD are manageable.
Each veteran's story is compelling and each treatment
success a valuable lesson. It is by working with individuals,
assessing their risk, and providing them with appropriate
treatment that we will reduce the number of suicides among our
Nation's veterans.
New concerns are constantly emerging. Our newer veterans
are coming to us with risk factors such as PTSD and traumatic
brain injury that both carry with them a high suicide risk
rate. We have developed a manual to help the providers who care
for patients with traumatic brain injuries understand their
patients' risk for suicide.
We are in the process of placing suicide prevention
coordinators at each facility that will carry on these
approaches in their own local communities. We are developing
awareness programs to reach all of our staff and community
partners who work with veterans. Mechanisms to share best
practices and ideas will be put into place through the Center
of Excellence.
We have a large task in front of us. Awareness, training,
and access to appropriate mental health care continue to be the
major components of our multi-faceted approach to reaching and
helping these individuals while we continue our research
programs to determine and refine our treatment strategies.
Thank you again, Mr. Chairman, for inviting me today.
[The prepared statement of Dr. Kemp follows:]
Prepared Statement of Jan Kemp, R.N., Ph.D., Associate Director for
Education, VISN 19 Mental Illness Research, Education and Clinical
Center, Department of Veterans Affairs
Mr. Chairman and Members of the Committee, good afternoon.
VA recognizes that suicide prevention requires a comprehensive plan
that involves integrated strategies, coordinated efforts, and a
steadfast commitment to implementation and evaluation. Based on CDC
data and not controlling for VHA population specific epidemiologic
factors, it is estimated that there are up to 1,000 suicides per year
among veterans receiving care within VHA and as many as 5,000 per year
among all living veterans. Various strategies have been put into place
in order for the VA to understand the problems associated with veteran
suicide, assess veterans under their care for suicide risk and provide
treatment strategies aimed toward suicide prevention. In addition, the
Mental Illness, Education, Research and Clinical Centers (MIRECC) are
involved in several clinical research endeavors in the areas of various
treatment strategies and neurophysiological approaches to the
management of suicide and are working closely with the NIH-funded
suicide prevention centers to understand and disseminate current
research information.
The VISN 19 MIRECC in Denver has implemented a template tracking
system which allows identification of suicide attempts within the
network in order to provide follow-up care for these veterans as well
as to identify system issues that could be resolved in order to improve
the care that these veterans receive. To date we know that over 250
veterans in the Rocky Mountain Network have attempted suicide since
October 1st of 2005. We have learned a great deal about this particular
group of veterans. Thirty two of them died as a result of their
attempt. A vast majority have been diagnosed with various mental
illnesses (including PTSD and major depression disorder). Many have
substance abuse problems and many have chronic pain issues. The VISN 3
MIRECC is installing and implementing an evidence-based risk assessment
tool which is linked to the alerts and clinical reminders sections of
our electronic medical record.
While knowing the numbers and tracking statistics is critically
important to our work we are also cognizant of the fact that we are
dealing with individual lives and each life is invaluable. Implementing
treatments that we know are useful with suicidal patients has become
our mission across the country.
We have begun an education campaign aimed first at mental health
and primary care providers. To date, over 750 VA clinicians have been
provided with up-to-date information on suicide. This includes two
regional evidence-based intervention conferences co-sponsored by VISNs
3, 4 and 19. One was held in Atlantic City in June 2006 and one in
Denver this past February. At both of these conferences experts from
across the country were brought in to share the latest developments in
assessing suicide risk and providing care for those at risk for suicide
in our population. National satellite programs have been offered and a
Web-based program is in development. VISN 19 has held individual face-
to-face programs at over 30 medical centers at this point and several
others are planned. VISNs 3 and 4 have also extensively trained their
providers at regular conferences and programs.
We know that increased awareness of the possibility of suicide will
lead to better identification of those who are at risk and improve our
ability to implement appropriate suicide prevention treatments. We will
continue our awareness campaign. In March of this year I was giving an
education program in Battle Creek, Michigan. A psychologist who was
``taking urgent care calls'' that day was pulled from the program
because a veteran was on the phone asking for an appointment. She came
back to the program and stated that since suicide was forefront in her
mind, she had asked the right questions and was able to determine that
this patient was at extreme risk and had gotten him immediate help and
he was being admitted. We need to keep suicide in the ``forefront'' of
all of our provider's minds.
We are currently in the process of implementing demonstration
projects that will allow us to gather effectiveness data while
providing veterans with the most current treatments in suicide. These
include training therapists in Cognitive Behavioral Therapy techniques
and the Collaborative Assessment and Management of Suicidality (CAMS)
program developed by Dr. David Jobes. Through the newly established
Center of Excellence in Canandaigua we will be initiating intensive
Suicide Prevention Programs in VISNs 2 and 7 with national
implementation soon after.
We have also begun to use alternative treatment options with those
veterans who require enhanced monitoring and management of their cyclic
and persistent suicide ideation. This includes the use of our Health
Buddy, a tele-health unit that we give to veterans that they use to
track their health care concerns and get immediate education and
advice. In Denver, we have 7 chronically suicidal patients currently
using the depression module on the Health Buddy. Each of these
chronically suicidal patients has had several serious suicide attempts.
Since they have been working with the Health Buddy none of them have
attempted. One patient told us that he followed the Health Buddy
protocols late one night with a gun in his lap. By the time he got to
the directions to call for help he had realized that help was really
only a phone call away and the urge to kill himself had passed. He came
into the facility the next day, was admitted, and is currently
receiving on-going treatment and has been doing well with no attempts
for over a year. Another patient said that he feels the Health Buddy is
the missing piece of the puzzle; he needed to know that his depression
and PTSD are manageable.
Each veteran's story is compelling and each treatment success a
valuable lesson. It is by working with individuals, assessing their
risk, and providing them with appropriate treatment that we will reduce
the number of suicides among our Nation's veterans. New concerns are
constantly emerging. Our newer veterans are coming to us with risk
factors such as PTSD and traumatic brain injuries that both carry with
them a high suicide risk rate. We have developed a manual to help the
providers who care for patients with traumatic brain injuries
understand their patients risk for suicide.
We are in the process of placing Suicide Prevention Coordinators at
each facility that will carry on these approaches in their own local
communities. We are developing awareness programs to reach all of our
staff and community partners who work with veterans. Mechanisms to
share best practices and ideas will be put into place through the
Center of Excellence. We have a large task in front us. Awareness,
training, and access to appropriate mental health care continue to be
the major components of our multi-faceted approach to reaching and
helping these individuals while we continue our research programs to
determine and refine our treatment strategies.
Thank you again, Mr. Chairman for inviting me today. At this time,
I will answer any questions you or other Members may have.
Chairman Akaka. Thank you very much, Dr. Kemp.
Dr. Resick?
STATEMENT OF PATRICIA RESICK, PH.D., DIRECTOR,
WOMEN'S DIVISION, NATIONAL CENTER FOR POST
TRAUMATIC STRESS DISORDER, DEPARTMENT OF
VETERANS AFFAIRS; ACCOMPANIED BY IRA KATZ, M.D., PH.D., DEPUTY
CHIEF, PATIENT CARE SERVICES OFFICER FOR MENTAL HEALTH,
DEPARTMENT OF VETERANS
AFFAIRS
Dr. Resick. I would like to thank the Committee for the
opportunity to discuss best practices today. I was asked to
speak on two separate topics. The first is the National
Training Initiative I am currently conducting to train
therapists, along with my colleagues, in an effective therapy
for PTSD. The other topic I was asked to speak about is the
women's programs at the VA Boston Health Care System as an
example of best practices for women veterans.
We have effective therapies, particularly cognitive
behavioral therapies, such as cognitive processing therapy,
that can significantly reduce symptoms of PTSD and can cure it
in many cases. Cognitive processing therapy, which I developed
almost 20 years ago, is a 12-session treatment for PTSD which
can be implemented in groups or individually. It has been shown
to be effective for combat, sexual assault, and other traumas.
Once cured, we have not found relapse in PTSD over long periods
of time that have been assessed in research, and that is 5 to
10 years we have
tracked people.
Therapies such as cognitive processing therapy for PTSD
require 1-hour weekly therapy for 13 to 14 sessions, including
intake appointments. In order to conduct this therapy,
therapists have to be trained and provided support, such as
case consultation with experts in the therapy. In order to
implement cognitive processing therapy effectively, therapists
should have no more than 25 cases in their caseload at any
given time.
VA's central office has funded an initiative that I am
conducting to train and support 600 VA therapists nationally in
cognitive processing therapy. To this end, my colleagues and I
have written a treatment manual with everything needed to
conduct the therapy, have trained qualified trainers for 2-day
workshops and case consultation, which will be available 50
hours a week across time zones. Over the next 2 years, we will
be providing 22 workshops throughout the country followed by
these support efforts, and that will also include online
supports, as well.
On the second topic, VA Boston is a good example of best
practices for services for women, because in addition to being
able to receive services from any clinical program, women can
receive services from specialized women's programs that
represent a continuity of care. Like all VA hospitals, we had a
Women Veterans Program Manager and a Military Sexual Trauma
Coordinator who serve as advocates for information and
referrals to appropriate programs. We have a separate Women's
Health Center that provides primary care, gynecological care,
osteoporosis assessment and treatment, urgent care, and social
services.
The Women's Stress Disorder Treatment Team, located in its
own wing of the hospital, offers outpatient mental health
treatment for post-traumatic stress disorder and other trauma-
related mental health problems. A full line of services,
including psychiatry, individual and group therapy,
psychological assessment, and consultation are available.
There is a separate wing of the Acute Inpatient Psychiatric
Program designated for women to provide them security and
privacy. We will soon open a residential program for women with
co-
occurring PTSD and substance abuse disorders. It will be the
first of its kind in the country.
The goal is to help women develop skills to maintain
abstinence, manage PTSD symptoms, and address their traumas.
The program offers assessment, group, individual, and psycho-
pharmacological treatment and psycho-educational programs while
supporting participants in the development of their own long-
term recovery plan.
The Women's Homelessness Program provides an array of
services to homeless women and women who are at high risk for
becoming homeless. Our transitional residence, called the TRUST
House, specializes in the treatment of women with post-
traumatic stress, mood and substance use disorders. Up to seven
women can live at this residence at a time. The treatment
program involves individual therapy, case management, group
therapy, house meetings, and paid work experience through the
Veterans Industries Vocational Program. Women are assisted in
making the transition from VA-supported employment to
employment in the community.
Thank you again, Mr. Chairman, for inviting me today, and
at this time, I can answer any questions that you or any other
Members may have.
[The prepared statement of Ms. Resick follows:]
Prepared Statement of Patricia Resick, Ph.D., Director, Women's
Division, National Center for Post Traumatic Stress Disorder,
Department of
Veterans Affairs
I would like to thank the Committee for the opportunity to discuss
our program. I was asked to speak today on two topics. First, the
national training initiative I am currently conducting to train
therapists in an effective therapy for PTSD and the women's programs at
VA Boston Healthcare System as an example of best practices for women
veterans.
We have effective therapies, particularly cognitive behavioral
therapies, such as cognitive processing therapy (CPT), that can
significantly reduce symptoms of PTSD and can cure it in many cases.
Cognitive processing therapy, which I developed almost 20 years ago, is
a 12-session treatment for PTSD which can be implemented in groups or
individually. It has been shown to be effective for combat, sexual
assault, and other traumas. Once cured, we have not found relapse in
PTSD, over long periods of time that have been assessed in research (5-
10 years). Therapies such as CPT for PTSD require 1-hour weekly therapy
for 13-14 sessions (including the intake appointments). In order to
conduct this therapy, therapists have to be trained and provided
support such as case consultation with experts in the therapy. In order
to implement CPT effectively, therapists should have no more than 25
cases in their case loads at any given time. VA Central Office has
funded an initiative that I am conducting to train and support 600 VA
therapists nationally in cognitive processing therapy. To this end, my
colleagues and I have written a treatment manual with everything needed
to conduct the therapy, and have trained qualified CPT trainers for 2-
day workshops and case consultation available 50 hours a week across
the time zones. Over the next 2 years, we will be providing 22
workshops throughout the country followed by these support efforts.
VA Boston is a good example of best practices for services for
women because, in addition to being able to receive services from any
clinical program, women can receive services from specialized women's
programs that represent a continuity of care. Like all VA hospitals, we
have a Women Veterans Program Manager and a Military Sexual Trauma
(MST) coordinator who serve as advocates for information and referrals
to appropriate programs. We have a separate Women's Health Center that
provides primary care, gynecological care, osteoporosis assessment and
treatment, urgent care and social services. The Women's Stress Disorder
Treatment team, located in its own wing of the hospital, offers
outpatient mental health treatment for post traumatic stress disorder
and other trauma-related mental health problems. A full line of
services including psychiatry, individual and group therapy,
psychological assessment and consultation are available. There is a
separate wing of the acute inpatient psychiatric program designated for
women to provide them security and privacy. We will soon open a
residential program for women with co-occurring PTSD and substance
abuse disorders. The goal is to help women develop skills to maintain
abstinence, manage PTSD symptoms, and address their traumas. The
program offers assessment; group, individual and psycho-pharmacological
treatment and psycho-educational programs while supporting participants
in the development of their own long-term recovery plan. The Women's
Homelessness Program provides an array of services to homeless women
and women at high risk for homelessness. Our transitional residence,
TRUST House, specializes in the treatment of women with post traumatic
stress, mood and substance use disorders. Up to seven women live in the
residence. The treatment program involves individual therapy, case
management, group therapy, house meetings, and paid work experience
through the Veteran Industries Vocational Program. Women are assisted
in making the transition from VA supported employment to employment in
the community.
Thank you again, Mr. Chairman, for inviting me today. At this time,
I will answer any questions you or other Members may have.
Chairman Akaka. Thank you very much for your testimony.
Now we will hear from Ralph Ibson.
STATEMENT OF RALPH IBSON, VICE PRESIDENT FOR
GOVERNMENT RELATIONS, MENTAL HEALTH AMERICA
Mr. Ibson. Thank you, Mr. Chairman. I am pleased to be here
testifying today on behalf of Mental Health America, which is
the country's oldest and largest nonprofit organization
addressing all aspects of mental health. I appear before you
today as a veteran, a veteran of the United States Army, of the
staff of the House Veterans' Affairs Committee, and of the VA.
I want to commend you and the staff for putting together an
extraordinary panel of witnesses who I think have framed the
central issues that confront both the VA and the Congress, and
let me try and highlight what I think has emerged from the
testimony today. I think it has been exceptional.
First of all, it strikes me that our military operations in
Iraq and Afghanistan differ markedly from prior combat
engagements in at least two important respects.
First is the extensive reliance on the National Guard and
the Reserves, and second, the reliance on multiple tours of
duty, repetitive tours of duty. I think both are critically
important in terms of their implications for the mental health
of our veterans and the way we approach these issues.
To clarify the point, deploying to a combat zone can be
enormously stressful for a soldier and for that soldier's
family members, and that stress increases markedly with each
subsequent deployment.
Secondly, as I think many of the witnesses emphasized
today, members of the Guard and Reserve who make up such a
large percentage of our fighting forces overseas are largely
returning to rural America and to small towns and communities
often very distant from the network of VA facilities and DOD
facilities that might otherwise be there to serve them.
I think experts agree, and you heard the same from many of
the panelists today, that virtually all returning veterans face
readjustment problems and that it is advisable to provide
counseling and support to veterans and their families to ease
in that transition. I think this Committee historically has
laid an extraordinary foundation with the Vet Center program
and there are powerful lessons to be learned and opportunities
to build on that success. The preventive approach of the Vet
Centers, I think, has helped avert the development of serious
mental disorders, like depression and substance use disorder,
and we should employ such a preventive approach today.
I think a third point is that the prevalence of mental
health problems among these OIF/OEF veterans appears to be
significantly higher than was anticipated. One statistic that
was not aired today that I find compelling is relatively recent
DOD data on those who have served in Iraq which show that some
50 percent of Army National Guard members and some 45 percent
of Army and Marine Reservists have reported mental health
concerns--half of all Army National Guard members report mental
health concerns!
A fourth point, certainly heavily emphasized by many of the
witnesses, is the profound stigma associated with mental health
care and the deterrent effect that has, particularly among the
Guard and Reserves, on help-seeking.
Further, family members of OIF/OEF veterans are
experiencing mental health problems related to the veterans'
service. Research has shown that PTSD, for example, can have a
profound impact on members of the veteran's family. We
certainly have particular concern for the family members of
Guard and Reservists who have faced repeated deployments and,
again, who tend to be isolated from the community support
systems that may be available to family members of active duty
members who live on or close to military bases.
And sadly, despite many outstanding programs and best
practices at individual VA facilities, and we certainly have
heard about them just now, I think VA as a system can still do
more and ought to be doing more. I think the earlier testimony
reinforces that point, but let me offer a few examples or recap
points made by earlier witnesses.
I think it is true of VA as it is true of most health
systems that they are largely passive, and we heard today of
the importance of outreach, the importance of the use of peers,
the importance of drawing veterans into readjustment, into care
systems, into screening, into help. While VA's 207 Vet Centers
play an important role in providing much-needed readjustment
counseling assistance to veterans, it strikes me that the
Department's more far-reaching network of medical centers,
clinics, and other facilities really don't have the opportunity
or take the opportunity to provide the kinds of preventive
services that experts say all returning veterans need as we
heard from several previous witnesses.
Helping these veterans readjust or overcome PTSD often
requires working with that individual's family, but there are
both fiscal disincentives to that in VA medical centers and
what I believe are outright statutory barriers to that kind of
engagement. There, too, I think changes are in order.
VA's resource allocation methodology and its decentralized
decision-making, it strikes me, give no assurance that the kind
of targeted mental health funding that Congress has so
carefully dedicated itself to will not be offset by cuts to
other VA mental health programs and similarly give no assurance
at the facility level where there are such extraordinary
pressures competing for scarce dollars that mental health will
get the priority it needs as against high-tech medicine or the
many other services that lay claim on those dollars.
And although efforts have been made to improve services, it
is not clear, at least from my vantage point, that VA's
substance use services have been fully restored from the cuts
that have been sustained over the years and that this Committee
has so carefully sought to reinstate.
And finally, notwithstanding excellent programs and
outstanding practices that we see at Boston and other VA
facilities, I think the jury is out in terms of women veterans
and their perceptions, regardless of the reality, but their
perceptions of VA as a welcoming, caring set of institutions,
given the breadth of issues we have heard today ranging from
the extraordinary combat trauma to which women are exposed in
Iraq to the tragic sexual assaults that we learned about
earlier.
What does all this tell us? I think I would go a step
further than Dr. Best, who called for a ``larger boat.'' I
think we need to think about some redesign or reconfiguration
of that boat to address some of these issues.
Again, several witnesses stressed outreach, and I believe
there would be great value and we heard discussion of the role
of peers. I see an opportunity for a robust national VA program
of training a cadre of OIF/OEF veterans, veterans who have come
back with these kinds of problems--with PTSD, anxiety, other
readjustment problems--training those veterans in perhaps week-
long sessions. Such programs do exist. After undergoing such
training, such individual could be employed in VA and by
community providers to do the kind of outreach and to provide
the kind of support that Patrick Campbell and others spoke
about as so necessary to make VA a help-without-hassles,
welcoming place in which the stigma they anticipate is
diminished and in which care can be furnished and successfully
so. As Sergeant Campbell testified, some veterans just need to
talk to someone who will understand, and certainly Josh Omvig
and Justin Bailey needed a person like that.
Secondly, I believe there is also a need for time-limited--
I would stress time-limited--service-delivery mechanism that
would enable OIF/OEF veterans who are returning to those small
towns and rural areas that are remote from VA facilities, and
remote from DOD facilities, to get the kind of care that they
need. I see an opportunity for that in the network of Community
Mental Health Centers. Under a carefully designed program, VA
can contract for those services and set requirements. It can
require, for example, that those centers hire trained peers,
and that they meet criteria that VA set. A time-limited program
like that can be a very important stop-gap measure to reach
veterans who are now not only underserved, but not served at
all.
I would concur certainly with Sergeant Campbell in
recommending that the 2-year eligibility window for combat
veterans is far too short and should be extended to 5 years.
And lastly, I would urge the Committee to consider
legislation, again, on a time-limited basis, to authorize VA to
provide immediate family members with both support services
and, when needed, mental health services to help foster the
veterans' readjustment or recovery.
We would certainly be happy to work with the Committee and
its outstanding staff to develop those recommendations further,
and I would be pleased to join others in answering any
questions you might have, Mr. Chairman.
Thank you.
[The prepared statement of Mr. Ibson follows:]
Prepared Statement of Ralph Ibson, Vice President
for Government Affairs, Mental Health America
Mr. Chairman and Members of the Committee:
Mental Health America (MHA) is the country's oldest and largest
nonprofit organization addressing all aspects of mental health and
mental illness. In partnership with our network of 320 state and local
Mental Health Association affiliates nationwide, we work to improve
policies, understanding, and services for individuals with or at risk
of mental illness and substance-use disorders. Established in 1909, the
organization changed its name last November from the National Mental
Health Association to Mental Health America in order to communicate how
fundamental mental health is to overall health and well-being. MHA is a
founding member of the Campaign for Mental Health Reform, a partnership
of 17 organizations which seek to improve mental health care in
America, for veterans and non-veterans alike.
Mr. Chairman, we commend you for scheduling this important, timely
hearing, and in doing so, providing visibility and focus for critical
questions that must be answered if we are to avoid mistakes of the
past. While we know that servicemembers have experienced mental health
problems in every war, our operations in Iraq and Afghanistan differ
markedly from prior combat engagements, with critically important
implications for veterans' readjustment and recovery.
unique aspects of operations iraqi freedom
and enduring freedom (oif/oef)
Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF)
are unique in their heavy reliance on the National Guard and Reserves
who make up a large percentage of our fighting forces. Reserve forces
alone have made up as much as 40 percent of U.S. forces in Iraq and
Afghanistan, and at one point, more than half of all U.S. casualties in
Iraq were sustained by members of the Guard or Reserves. These
operations are also unique in their reliance on repetitive deployments.
Deploying to a combat zone is necessarily enormously stressful to a
soldier AND his or her family; that stress increases markedly with each
subsequent deployment.
The impact of those deployments on servicemembers has already been
profound. The prevalence of mental health problems among OIF/OEF
veterans appears significantly higher than had earlier been
anticipated. To illustrate, recent data from the Defense Medical
Surveillance System (reflecting post-deployment health self-assessments
since June 2005 of servicemembers who had served in Iraq) show that 50
percent of Army National Guardsmen and some 45 percent of Army and
Marine reservists have reported mental health concerns. Unexpectedly
high percentages of OIF/OEF veterans are receiving VA mental health
services, many with very serious problems like PTSD and depression.
According to VA data, more than 35 percent of OIF/OEF veterans who
accessed VA care from 2002 through November 2006 were diagnosed or
being evaluated for a mental health disorder.
The high percentages of Guard and Reservists among the OIF/OEF
cohort creates unique challenges that VA has not previously faced.
First, these ``citizen-soldiers'' often live in communities remote from
VA medical centers. Yet they are as likely to have readjustment issues
or to experience anxiety, depression or PTSD as veterans who have good
access to VA health care. Long-distance travel is a very formidable
barrier to a veteran's seeking (and continuing) needed treatment. That
barrier is likely to be even higher for veterans with mental health
needs, given the lingering stigma surrounding mental health treatment.
Second, with activation to and from active duty associated with
multiple deployments, health care responsibility for these
servicemembers shifts from DOD to VA to DOD, with each shift in
responsibility inviting confusion.
veterans' mental health needs
OIF/OEF veterans are experiencing a broad range of post-deployment
mental health issues--some of which require treatment, while others
call for some combination of education, support and counseling. VA data
identify PTSD (seen in 15 percent of those evaluated at VA facilities),
drug abuse (13 percent) and depression (10 percent) as the most
prevalent disorders being treated in its facilities. Importantly,
another 5 percent were diagnosed with a psychosis, reflecting severe
mental illness. A recent study on the mental health status of Iraq
veterans in the Maine National Guard provides another illuminating
snapshot. That survey found that 25 percent of these veterans reported
significant problems with PTSD, alcohol or depression. But the study
data also indicate the extent to which these veterans are experiencing
readjustment problems. For example, more than 43 percent had problems
with anger (compared with 16 percent in Guard members who had not been
deployed), more than 35 percent had relationship problems (vs. 15
percent among the nondeployed), and 22 percent reported sexual problems
(vs. 10 percent among the nondeployed). Significantly, only 15 percent
of those Maine veterans had sought help from a mental health
professional.
VA's Special Committee on Post-Traumatic Stress Disorder (a
statutorily created panel of clinicians which reports annually to VA
and to Congress) has provided a helpful assessment of the wide range of
post-deployment mental health issues confronting veterans and their
families. Its February 2006 report advised that ``VA needs to proceed
with a broad understanding of post deployment mental health issues.
These include Major Depression, Alcohol Abuse (often beginning as an
effort to sleep), Narcotic Addiction (often beginning with pain
medication for combat injuries), Generalized Anxiety Disorder, job
loss, family dissolution, homelessness, violence toward self and
others, and incarceration.'' The Committee advised that ``rather than
set up an endless maze of specialty programs, each geared to a separate
diagnosis and facility, VA needs to create a progressive system of
engagement and care that meets veterans and their families where they
live . . . The emphasis should be on wellness rather than pathology; on
training rather than treatment. The bottom line is prevention and, when
necessary, recovery.'' Importantly, the Special Committee also advised
that ``Because virtually all returning veterans and their families face
readjustment problems, it makes sense to provide universal
interventions that include education and support for veterans and their
families coupled with screening and triage for the minority of veterans
and families who will need further intervention.'' [Emphasis added.]
Certainly our perspective is too general when we speak globally and
without distinctions of ``veterans' needs.'' Of particular significance
surely are the contributions that women are making in these ongoing
operations. Women represent some 15 percent of those in the OIF/OEF
theaters. And while not serving in infantry units, they are more
exposed to trauma--driving in convoys, serving in security assignments,
and even flying aircraft--than in any other military engagement in our
history. It should also be acknowledged that the range of trauma to
which women in service are being exposed ranges from the threat of
IED's to marital and family stresses.
family issues
While there is widespread recognition of the prevalence of post-
traumatic stress disorder (PTSD) and other war-related mental health
problems among veterans of service in Iraq and Afghanistan, less
attention has been given to the toll these military operations have had
on the mental health of our veterans' families, and the implications of
those problems on the veteran's readjustment and health. Research on
PTSD, for example, has shown that it has had severe, pervasive negative
effects on marital adjustment, general family functioning, and the
mental health of partners, with high rates of separation and divorce
and interpersonal violence. PTSD can also have a substantial impact on
veterans' children. Not surprisingly, in a military engagement that has
required multiple tours of duty of many servicemembers and in which the
burden has fallen heavily on citizen-soldiers of the National Guard and
military Reserves, the impact on families has been particularly hard,
and may be implicated directly in mental health problems in family
members of the veteran.
Despite recognition in the VA regarding the mental health needs of
returning veterans' families and the importance of engaging family
members in the veteran's readjustment, current law and practice limit
VA's assistance to, and work with, family members. The Special
Committee on PTSD reports that ``the strength of a war fighter's
perceived social support system is one of the strongest predictors of
whether he/she will or will not develop PTSD.'' VA is an integrated
health care system which offers a relatively full continuum of care and
services for eligible veterans. Family therapy is often a component of
the readjustment counseling provided at VA ``Vet Centers'' that are
usually located in population centers and operated independently of VA
medical centers and clinics. But veterans and family members who live
far from a Vet Center and who rely instead on a VA medical center or
clinic routinely encounter a system that discourages family therapy.
Most VA health facilities focus exclusively on the veteran-patient
(rather than on the veteran as part of a family unit) and provide
incentives through measures of ``workload'' that fail to provide any
workload credit for helping the veteran's family. This patient-centered
workload system effectively discourages medical-center clinicians from
providing family therapy and support services that are routine in a
parallel system of VA facilities. There is no sound programmatic
rationale for encouraging family support at one set of VA facilities
(the Vet Centers) and discouraging it at others. VA health care, and
particularly mental health care, would often be more effective if
barriers to family involvement were eliminated.
Current law compounds the difficulty. While the law (38 U.S.C.
1710(e)(3)(C)) authorizes VA to provide medical care and services
(subject to a 2-year time limit) to a veteran who served in a combat
theater, section 1782(b) of title 38 of the U.S. Code would limit
counseling for a family member of a combat veteran receiving treatment
to circumstances where the counseling had been initiated during a
period of hospitalization and continuation is essential to hospital
discharge (while family members of veterans receiving treatment for a
service-connected condition can receive counseling as needed in
connection with the veteran's treatment). Insofar as the law
effectively treats the veteran who served in a combat theater on a
presumptive service-connected basis for a time-limited period, we
recommend that VA be authorized to provide immediate family members
with both support services AND (when needed) mental health services to
help foster the veteran's readjustment or recovery. And, to ensure that
the benefits of such family support and mental health services are
realized, we recommend that legislation require the Department to
revise its workload measurement system to eliminate the disincentive
to, and provide credit for, working with family members of veterans
where such education, counseling, or therapy would help foster the
veteran's readjustment or recovery. Yet additional consideration should
be given to the mental health needs of survivors of those who have lost
their life in Iraq and Afghanistan, including parents who generally are
not even eligible for VA grief-counseling.
stigma surrounding mental health treatment
There is wide recognition of the importance both of preventing
readjustment problems from worsening and of treating behavioral
disorders as early as possible. Left untreated, mental disorders like
PTSD and depression are likely to become chronic and severely
disabling.
The stigma surrounding mental health disorders--and the degree to
which that stigma deters help-seeking--has profound implications for
the long-term health and recovery of OIF/OEF veterans. Data do show
some decline in the stigma associated with seeking behavioral health
care (as reported in DOD's May 2006 report of its Mental Health
Advisory Team on Operation Iraqi Freedom (MHAT III)), but the level of
stigma among these servicemembers remains troublingly high. The MHAT
III report indicates, for example, that among those who met criteria
for mental health problems and were asked to identify factors that
might affect their decision to receive mental health counseling or
services, 53 percent thought they would be seen as weak. High
percentages of OIF/OEF veterans responded affirmatively to concerns
that seeking mental health assistance might (a) lead unit leadership
``to treat me differently'' (29 percent); (b) result in ``members of my
unit [having] less confidence in me'' (26 percent); and (c) ``would
harm my career'' (17 percent).
While substantial numbers of OIF/OEF veterans are being seen at VA
facilities with behavioral health problems, there are compelling
reasons to question how many are not seeking needed treatment. Congress
and VA could learn much from an independent study on the numbers of
OIF/OEF veterans who have mental health needs but elect not to seek
treatment because of stigma.
va's capacity to provide for veterans' needs
This hearing provides an important opportunity to question whether
the VA health care system--with all its strengths--is adequately
staffed, adequately configured, and operating with appropriate
incentives--to meet the mental health needs of returning
servicemembers. VA's health system has great strengths, and many
centers of excellence within it. But we should be mindful of the gaps
in that system, especially with respect to mental health needs, and
find ways to fill those gaps.
VA is a facility-based system that does not necessarily provide
good access to care for veterans in rural America or in other areas
remote from its healthcare facilities. As noted above, these gaps are
particularly pronounced in light of the pressing mental health needs of
OIF/OEF veterans, many of whom are citizen soldiers of the National
Guard and Reserves who have returned from overseas deployments to
communities far from VA facilities. Those distances are all the more
formidable in the face of the stigma still surrounding mental health
care.
VA facilities themselves do not necessarily provide a full range of
needed mental health services. To illustrate, experts believe that most
servicemembers returning from a combat deployment face readjustment
issues during what is essentially a transition from the trauma and
horrors of war to reintegration to their communities and families. That
need for readjustment should not be seen as a pathology that requires
treatment; rather, readjustment counseling, education and support are a
preventive, health-promoting measure. Most returning veterans could
benefit from readjustment counseling, and the failure to make that
these services available can lead to behavioral health problems. But
VA's current capacity to provide this important service is generally
limited to its array of approximately 200 readjustment counseling
centers (Vet Centers). The department's extensive network of medical
centers and clinics, which provides a range of intensive treatment
services, generally do not provide the largely preventive services
furnished by the Vet Centers. While the unique circumstances of the
Vietnam era help explain the development of these parallel systems
(with their own separate administrative structures), there is no
statutory barrier to VA medical centers providing readjustment
counseling services, and--given the need--no obvious reasons not to
make such services more widely available through other health-care
facilities. We urge the Committee to explore having VA medical centers
provide readjustment counseling services to OIF/OEF veterans and
immediate family members. In that regard, it is important to remember
that the Vet Center program was established with a ``help without
hassles'' philosophy. For veterans struggling to readjust, and needing
help with anger, feelings of grief, or problems with relationships, for
example, there is great value in a ``help without hassles'' approach.
And we find no requirement in law that OIF/OEF veterans must enroll for
VA care in order to be eligible to receive readjustment counseling in a
VA medical center, and urge that such a precondition not
be instituted.
Another gap in the VA health care system is the still uneven
distribution of treatment resources for veterans who have substance-use
problems. VA's arsenal of resources for treating substance-use
disorders was profoundly diminished a decade ago with the closure of
inpatient programs. It is our understanding that the department's
substance-use treatment capacity has grown in subsequent years, but
does not appear to have been fully rebuilt. There is also need to
question the breadth of the gap between women veterans' mental health
needs of women veterans and VA's capacity to meet those needs,
consistent both with expectations of privacy and of a welcoming
climate. It would be most helpful in this connection to survey women
OIF/OEF veterans, in order to understand their experiences and
perceptions regarding care in a system long seen as an enclave for
treating an almost exclusively male population.
To its credit, Congress has appropriated additional funds in recent
years to upgrade VA mental health and substance-use services. It is
difficult, however, to gauge the adequacy of mental health staffing and
capacity in this large health system. VA is unquestionably seeing more
patients with PTSD, for example. But is that due to increased staffing
or some contraction in the intensity of service-delivery? The
complexities associated with distributing and allocating funding in the
VA health care system invites question as to whether new funding finds
its way, dollar for dollar, into increases in mental health staffing.
Are there medical centers that receive new money for a specific mental
health initiative, but offset such increases in part by cutting
staffing of other mental health programs? It should be possible to
monitor and measure the net gain in staff associated with efforts to
expand mental health funding, and we urge the Committee to direct such
action. But unless such monitoring is done with rigor and with
consequences, one cannot be certain that the system's capacity will
reflect congressional expectations.
In that connection, we also recommend that the Committee examine
the incentives and disincentives in VA's resource allocation
methodology (VERA) as it relates to mental health service-delivery. To
its credit, VA leadership embraced the recommendations of the
President's New Freedom Commission on Mental Health with its emphasis
on the importance of fostering recovery from mental illness rather than
simply managing symptoms. Many fine VA mental health programs are
essential to fostering veterans' recovery from mental illness, and
should be encouraged. But among those programs, valuable initiatives,
like supported employment and peer supports, do not add to ``workload''
and therefore are not rewarded by VA's resource allocation methodology.
We urge the Committee to explore avenues to ensure that VA fiscal
incentives reward efforts to foster recovery from mental illness, not
simply efforts to increase numbers of patients served.
Finally, anecdotal data suggest that some veterans are encountering
barriers in getting needed VA mental health services. How many more
veterans would get VA services if travel distances were not so great,
or if stigma were not so pervasive, or if VA staff were perceived as
more welcoming, or if VA conducted active outreach efforts using peer
outreach workers? It would not be difficult to conduct an independent
survey of OIF/OEF veterans to gauge the relative ease of access to VA
mental health care, to determine the percentages who are not able to
get services, and to identify the factors, if any, that discouraged
veterans from getting needed help. We urge the Committee to consider
directing the conduct of such a survey.
closing gaps in va service-delivery
The principle that a veteran with a service-incurred health problem
should have equitable access to treatment (that is, that a veteran
should not be barred from getting needed care) regardless of where he
or she lives is well-established. In our view, there is a growing need
to establish a time-limited mechanism that could be implemented
relatively quickly to provide high quality mental health and
readjustment services to OIF/OEF veterans who do not have reasonable
access to VA care. Specifically, we see great benefit for veterans in
the development of a targeted mechanism (in areas distant from VA
medical centers) that would combine (a) outreach and ongoing support
from trained OIF/OEF peers with (b) provision of mental health services
by clinicians knowledgeable about PTSD, the combat experience and the
unique circumstances of military service and veteran status. Such a
mechanism could be established through VA contracts with community
mental health centers for provision of needed services for OIF/OEF
veterans who live far from VA mental health centers under which such
centers would be required to (1) participate in a VA-conducted national
training program; (2) employ an OIF or OEF veteran who has completed a
peer outreach/support training and certification program; (3) secure
prior approval from VA (in accordance with a VA-provided protocol)
before the Department would incur any liability for provision of
services for an OIF/OEF veteran; and (4) provide VA with annual summary
data on numbers of veterans served, diagnosis, course of treatment, and
demographics. We recommend further that VA contract with a not-for-
profit national mental health organization to train OIF/OEF veterans
for employment as ``stigma-busting'' peer outreach workers and peer
counselors. (The use of peer-counselors and support specialists is a
well-established, cost-effective modality in mental health care that
has been employed with success at a number of VA centers.) Instituting
such a training/employment program is a step that would not only help
participating OIF/OEF veterans further their own recovery, but pave the
way to overcoming the stigma that remains a formidable barrier to
needed counseling and treatment.
next steps
VA and DOD have unquestionably taken important steps to understand
and address the mental health needs of OIF/OEF veterans, and Congress
has played a vital role in mounting much-needed oversight and providing
needed funding. Yet there remains much to be done, and, in our view,
compelling reason to pursue new directions: (a) to work to fill the
wide mental health service-delivery gaps in the VA health care system,
(b) to address (in at least a time-limited way) the war-related mental
health needs of veterans' family members, (c) to make peer-outreach and
support in VA service-delivery the norm rather than the exception, (d)
to develop better data to support Committee oversight and VA mental
health management, and (e) to align fiscal incentives with clinical
imperatives.
Such steps, in our view, will go a long way toward fostering the
readjustment and reintegration of returning veterans, and the recovery
of those who have experienced mental health problems as a result of
their service to their country.
We look forward to working with the Committee to help achieve those
goals.
Chairman Akaka. Thank you very much for your testimony, Mr.
Ibson.
I want to welcome Dr. Katz here on the panel. Dr. Katz, Mr.
Ibson's testimony points to, among other things, shortages of
informal counseling services in VA clinics and a substance
abuse program which has not been fully rebuilt since the
reductions were made several years ago. My question to you is,
how do you respond to the previous panel and Mr. Ibson's
testimony?
Dr. Katz. Well, let me focus. I was, as everyone else in
the room, profoundly affected by what we heard. I want to say
with respect to the issues that the Bailey family raised that
my colleague from the Office of Mental Health Services is in
Los Angeles now looking very carefully at that program and
looking for lessons to be learned to improve residential and
other forms of care in the VA.
I have been struck by the Omvig family's work and I admire
and applaud their willingness to talk about it. VA is grateful
for the House, Mr. Boswell, and for Mr. Grassley and Mr. Harkin
for raising that bill, the Omvig's veteran suicide prevention
bill. We are implementing it already. The suicide prevention
coordinators called for in the bill are being hired as we speak
throughout our system. There will be one in each medical
center. We are working hard to take the lessons that we have
learned from hearing about Joshua Omvig to make sure it doesn't
happen, or to decrease the rates of suicide among veterans.
We are expanding and enhancing mental health services
throughout VA, not only in the specialty care setting, but by
making mental health an important part of primary care.
It is a way of easing the stigma, making it easier for
veterans to receive care. We call this an in-reach approach. At
the same time, Dr. Butteriss, my colleague, is working very
hard to expand the veterans center program through outreach and
now at most post-deployment health reassessment, there is a
veterans center outreach person there to meet veterans and to
talk about the VA.
There is no wrong door. The Vet Centers are often the only
mental health care that is needed. When it is not, it is an
important point of entry to mental health services. It is what
we often call stepped care. If the Vet Centers work, wonderful.
If not, a referral to mental health services in medical centers
and clinics is helpful. In the same way, the integration of
mental health and primary care is another important way to
facilitate access. We are making care available.
About substance abuse, the number of beds in inpatient
substance abuse care settings has decreased, but the overall
number of beds, including other forms of residential care and
homeless programs focusing on substance abuse, have actually
increased. What we have done in large part is to work to
overcome the siloing of care that is often a problem. Let me
give you an example of that.
If I, as a middle-aged man, were to have a heart attack
tomorrow, I would get depressed over it and I would probably
drink to treat my depression. With three related problems like
that, I would have to get care in three different settings and
I probably couldn't manage it. We need to fix that and we are
working for it.
So 40 percent of substance abuse care in VA is in specialty
substance abuse care. About 30 percent is in other mental
health services, and about 30 percent is in primary care. We
want accountability. We should be held accountable for serving
these veterans with substance use problems. But the way we look
at this has to go beyond the narrow silos that characterize
care in the past.
I see time is up. So much has been said. These have been
some first thoughts in response.
Chairman Akaka. Thank you, Dr. Katz.
Dr. Katz, the National Center continues to give VA the best
tools to deal with PTSD. Has funding and has staff for the
center increased in recent years?
Dr. Katz. Our look at the budget for the National Center
for PTSD includes a number of components. There is the core
funding for the National Center and a number of additional
mechanisms for funding other components of their activities.
So, for example, Dr. Resick receives funding for the
Women's Division of the National Center that she directs.
She also receives funding for the implementation and
dissemination of the cognitive processing therapy she talked
about. Dr. Friedman receives funding for his division and for
the overall direction of the National Center. He also receives
funding for studies, for example, of the primary care treatment
of PTSD.
So if one looks at the entire VA support of the National
Center, including both its core funding and its project-
specific funding, it is increasing over time.
Chairman Akaka. We have been trying to increase the budget
of the Department of Veterans Affairs and have been able to do
that, as you know. Of course, the hope is that it will give you
license to, if needed, increase personnel wherever it is
necessary and deal with some of these complaints, let me say,
and shortfalls that have occurred. So we look forward to
working this with you, as well, to try to bring this about and
give the best kind of service we can to all veterans. This is
what it is all about.
Dr. Katz. Yes.
Chairman Akaka. I want to thank all of you for being here,
for your testimony. We truly appreciate your taking the time to
give us all a better understanding of the challenges facing VA
mental health care and of efforts to meet those challenges. I
look forward to continuing to work with you on that.
My expectation is that VA will adapt to meet the mental
health needs of the newest generation of veterans and to
prevent the tragic stories we have heard today from happening
again.
So again, thank you so much for all of this. This hearing
is now adjourned.
[Whereupon, at 4:53 p.m., the Committee was adjourned.]
A P P E N D I X
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Female Soldiers and Sexual Trauma: Operation Iraqi Freedom (OIF) \1\
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\1\ Submitted by SGT Carolyn Schapper of Virginia National Guard.
She served as an Interrogator/HUMint Collector in Iraq from October
2005 to September 2006 with the 221 st MI BN.]
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Define ``sexual trauma.'' When one hears the phrase sexual trauma
it is natural to quickly assume we are talking about rape and physical
confrontation. Rape is universally understood as wrong, so with its
easy definition it is what one focuses on. Although it is a problematic
crime in the Army, I do not know if statistics would tell you that it
is more of a crime in the Army and/or the military in Iraq, than in
society in general. What I do know is that when I asked my fellow
female soldiers about it and thought of my experiences and, the
experiences of those I served with, I realized sexual trauma has a much
broader and murky definition, and everyone had a story. Rape is not the
crux of this issue, nor the prevalent issue in my opinion. True sexual
trauma in Iraq involves ambiguous Equal Opportunity (EO)/gender issue
situations that always exist within Army culture. However, EO
violations are exacerbated in the Iraqi environment where males, are
supposed bastions of sexual frustration and are in constant and close
proximity to limited female soldiers. This close proximity disallows
female soldiers the ability to ``walk-away'' when they find themselves
in a situation they would rather not be in.
Furthermore, upon discussing this topic with fellow female soldiers
I realize women serving in Iraq get put into categories, as defined by
their male counterparts, based on the females' reactions to daily
exposure to questionable situations. Army women in a war situation must
overlook, on a daily basis, statements against their gender as well as
a plethora of images that objectify women, all that would be legally
unacceptable in the civilian world. More than once have I heard, ``all
Rules go out the window in War,'' and many people believe that
justifies violations of the standards. Thus the true sexual trauma in
wartime Iraq is when the character of the female soldiers is determined
by their male soldiers. I have tried to work out how to paraphrase some
of the definitions so I do not offend anyone, but the reality is I
cannot, nor should I, because these are the labels female soldiers are
given everyday in Iraq and they are not easy to live with and they
cannot be sugar-coated. The following are the loose categories for
female soldiers that I have come up with: the weak and emotional female
who cannot hack it, or the poor sport; the bitch; the good sport or the
``pal''; the flirt which will ultimately evolve into ``slut''; and/or
certain combinations of the above.
Following are five brief stories of five different women who have
served in Iraq between September 2005 and present-day:
story one
My story. I was assigned to a small Infantry base where very few
female soldiers lived, or had ever been. Aside from lack of female only
facilities (i.e., showers and latrines) I lived in a house with 20
males. Nearly every living space in the house was covered with photos
of scantily clad women from FHM and Maxim magazines. More than one
conversation was an inappropriate conversation of a sexual nature. But
these are the things I overlooked in order to be a ``soldier'' and not
a ``female soldier.'' However, mainly due to my mature age (usually at
least 10 years older than those I was serving with) I found it easy to
steer clear of immature conversations and chose not to participate. Nor
did I flirt with them as other females did, in order to boost their
egos. I quickly became the ``poor sport'' and/or ``bitch.'' When they
mocked me about my age and my appearance, I was deemed a weak female
that could not hack it when I took offense at being called unattractive
and old.
As the deployment progressed my Team Leader took liberties with my
personal space. We were only separated by a thin wooden wall and a
curtain for a door. He would routinely bust into my living space
without knocking, under the premise that I was a ``soldier'' and not a
``female.'' I began to weigh my curtain down with heavy items to
discourage him, it did not work, he only pulled harder. More than once
I was lying on my bed with headphones on only to look up and see he had
already made it into my room and was staring at me. I began to dress in
the shower room for fear he would walk in at any moment.
In addition, my objection to my Team Leaders included his
aggressive actions on missions. My objections got me deemed a weak and
emotional female. My Team Leader would act aggressively on the roads
and run Iraqi drivers off the road, more for sport, than for safety.
One day, it became an almost deadly situation. A male team member who
outranked me, said he would speak to our Team Leader about it. Nothing
changed. I once found an article about how poor soldier road behavior
creates enemies among the civilian populations of Iraq/Afghanistan. I
showed my Team Leader. Afterwards, I found out he went to a training
weekend that had representatives from several teams with varying ranks
in our Area of Operations and was mocking me openly because I was upset
when he ran non-threatening Iraq civilians off the road. He made no
mention of the male team members who objected, but blamed my emotional
predisposition as a female for my protests.
Aside from my Team Leader, I felt safe with those I served with
when we went out on missions into the villages. It was only when I
returned back to base did I feel ostracized and thus did I isolate
myself more and more in the ``safety'' of my room as the mission
progressed. According to the males I served with I was, at the same
time, overly emotional and a bitch, two ideas that would seem naturally
contradictory.
story two
Another female that was on my base did play at the game of
flirtation to get what she wanted from her male counterparts. She told
me once she enjoyed her celebrity-like status on the small base and
used it to her advantage. Many guys liked her because she was a ``good
sport'' and would joke around with them. Eventually they turned against
her. By the end of our deployment her picture had been posted on a wall
in an open office environment with the phrase ``Slut of Bayji (our base
location),'' underneath it. With only two weeks left in Iraq, her work
environment had become so hostile that she asked me if I could convince
my team leaders to let her work from our office instead, even though it
was further away from her living quarters and her chain of command. We
allowed her to work with us. Her demeanor had changed completely, she
barely talked to anyone in the carefree manner she had before and could
rarely be found. She has since left the Army.
story three
Female Three was to be transferred to our team because her Team
Leader had exposed himself to her. When word got out that another
female was coming to our house many of the guys I was living with kept
saying they hoped she would be put into their room because she was
``hot.'' Similar comments even came from those who knew why she was
being transferred. They did not see her as another soldier that would
assist our mission capabilities, but as an opportunity for flirting,
and perhaps, sex. Fortunately, mission focus changed and she was never
transferred to us.
story four
The next case I hesitate to bring up because I know the female will
be judged before most people get passed the immediate description of
her case and will pass judgment on her and may not look beyond it to
determine whether she was treated fairly or not, and/or subjected to
gender specific punishment. I will set up the situation and then let
her own words make her case, she is still currently serving in Iraq
under this command.
Female Four is a friend of mine and I have not worked with her in
Iraq, but know her personally and feel I can describe her and her
likely conduct in Iraq with some authority. Female Four is an
attractive, petite and friendly female. Because of her self-confidence
she can hold her own in many a ``questionable'' conversation and would
likely overlook these conversations and other aforementioned scenarios
as most female soldiers would in order to focus on the mission. She is
fully capable of her position as an Arabic-trained interrogator.
Unfortunately, Female Four unknowingly became pregnant during the
mobilization process in the States, but it was such an early pregnancy
it was missed at the mandatory pregnancy test administered before
deploying to Kuwait/Iraq. While conducting missions in Iraq she became
very ill. It took several weeks to determine that the cause was morning
sickness. It turned out she was pregnant. From here I will let her tell
her story in her own words:
``I deployed August 11, 2006 to Kuwait, and found out
September 26, 2006 that I was pregnant, 10 weeks pregnant. I
informed my First Sergeant [1SG] the same day and told him that
it was my intent to have an abortion and return to Iraq as soon
as possible.
My immediate chain of command was supportive. Within a few
days I had my stuff packed and was in Baghdad, I thought,
waiting for a flight. Turns out I was wrong. They did a 15-6
investigation into the incident, which makes sense. During the
investigation the officer in charge told me, ``you can write
whatever you want in your statement but there is nothing in
general order number one that says you can not have sex.'' No
matter how many times I said it happened before I got here, I
am pretty sure no one outside of the people who know me,
believed me. (Note: some females get pregnant on purpose to get
out of deployment, in which case an investigation would be
warranted, however, a soldier who did it on purpose would not
likely get an abortion and request to return to duty.)
I was stuck in Baghdad for over a week and worried because I
thought I had only until my 12th week to have an abortion
legally. Anyway, I finally got notified that I had a flight and
was called into the Battalion Commander's (BN CDR) office the
afternoon prior. I assumed it was for encouraging words.
Instead I was read the most horrifically offensive,
insensitive, immature letter of reprimand I could imagine. The
letter promised that the Brigade (BDE) would personally make
sure I was barred from reenlistment, among other downright
nasty insults, insults of a personal, not a professional
letter.
I was furious. I went to JAG immediately but was pretty much
told--see JAG when you get back to the States. All I was able
to do was apply for an extension so that I could write my
rebuttal (the timing was such that I would most likely get back
to the States the day my rebuttal was due, without having had
time to go to JAG). My request for a ten-day extension was
denied--I was granted five.
Two days after I got back to the States I had my abortion.
I went the next day to JAG, wrote a letter of rebuttal,
outlining all of the facts, that clearly showed I became
pregnant through normal sexual behavior, clearly had no
intention of becoming pregnant, and clearly had no knowledge
that I was pregnant. Moreover, I had chosen the mission first
and would be returning.
A day later my rebuttal was rejected. My rejection letter
reiterated that the Brigade Commander, COL XXXXX had already
initiated my bar to reenlistment.
I had to wait in the U.S. five weeks until I finally passed a
pregnancy test. I came back to my unit and was welcomed back by
everyone. I was told that I was to return to my team in a few
days.
A few days later I was told that my team was changing
locations and would be moving all of their things to Baghdad,
so I would just wait in Baghdad, get my interrogation
certification training done, then move out with them to Tikrit.
I was in Baghdad for two more weeks when I was told that COL
XXX XX had picked me to move to the HARC [a military
intelligence office position]. I would be transferring
battalions the next day, but they were barely expecting me,
they had not been looking for someone to fill the slot and they
were shocked to find out that I was a 97E Arabic linguist, an
interrogator not an intelligence analyst. They were even more
shocked to find out that I did not have a Top Secret clearance
and so could not take the job ``hand-picked'' for me.
When they took this up the chain of command, they were told
that they had to keep me and to put me to work in the orderly
room. The 1SG, a friend of my original 1SG, said he had no work
for me. This saved me.
I got transferred a few days later back to the 502d MI BN. I
was put into HHS and told that I would be working in the S3, a
logistics position and I had no choice. I met my new NCOIC (Non
Commissioned Officer In Charge) and was told that I would be
the Air Movement Request person. I would work at the TOC 12
hours a day, and put in flight requests for any of the S02d
line companies.
I was freaking out. I went to EO, IG (Inspector General) and
JAG. Everyone told me the same thing--it sounds like this is
personal, but a commander had leeway to move his assets however
he wants. I even asked--so if I do not get an EOT (Equal
Opportunity Treatment Complaint), I do not get promoted and I
am shuffled around to worse and worse jobs by him personally
for the rest of the tour--I have no recourse? The answer was
``yes.'' I asked, ``who has oversight?'' ``No one'' was the
answer, unless I wanted an open door with a one-star General
who would probably not get a chance to see me until the end of
my tour, if ever.
So I went to the logistics position. The CSM (Command
Sergeant Major) actually told me to come to his office. He
said, I bet you are wondering why you are here. I asked. I
asked a lot. And he told me, ``the BOE commander had issued a
direct order that you will not be on any [Tactical HUMint
Team], nor will you have any soldiers under you. Period. We had
to fight hard to even get you in the S3--this was the best we
could get for you. It is personal from him to you.''
Yes, the CSM actually told me this.
So that is my story. Is it sexual trauma--no. But is it
harassment of the worst form? Yes. Is it applying a ludicrous
series of emotionally fueled assumptions about ``female
behavior'' in general onto one person, with no eye to the
circumstances and no attempt to behave professionally? Yes.
This man has power, but he uses it when he does not need to.
The only way that I am not barred from reenlistment is that
he tried to order my company commander to initiate it and my
commander, after going to JAG, refused.
My old team leader even went to the BOE COR and asked for me
back. When he said my name the COL got all red in the face and
yelled NO WAY!
story five
Female Five is the most extreme of cases. She is young, petite,
pretty and friendly, all things that would prove to work to her
disadvantage. I have worked with her in the past and know her to be of
a strong character that does not use her appearance to take advantage
of her situation. When she got to Baghdad-area she was separated from
the Military Intelligence (MI) command she came with and placed with a
group of Military Police (MP) who had specifically requested a female
interrogator. She was the lowest ranking of those she served with and
the only female. Highly inappropriate conversations of the sexual
nature followed her wherever she went. Unlike myself, who felt safe and
insulated from derogatory commentary while on missions, for her, her
harassment continued. For example, a Senior NCO that outranked her by
three ranks would call out over the radio, while on mission, and ask
her about her preferred sexual positions. Everyone would hear this and
laugh. She was decidedly embarrassed. Other MPs that she worked with
would routinely graze her breasts or touch her thigh in fictional
scenarios that involved them reaching across her. The following is her
story in her words:
As a female in the military, you are considered either a
``bitch'' or a ``slut''. A female that keeps to herself, who
works hard at her job, and who demands that people take her
seriously as a soldier is considered a bitch. Whereas a female
that is friendly, outgoing, and that enjoys having fun is
thought of as a slut. In a military environment, there is no
in-between; both carry stigmas and neither title is avoidable
or reversible. I have been both a ``bitch'' and a ``slut'' at
different times throughout my military career.
I quickly learned that by being the social butterfly that I
am gave me ``slut'' status. I felt like flypaper for freaks.
Although having ``slut'' status meant I could be myself, I was
insulted that my guy friends never really viewed me as just a
friend. I was not taken seriously and was constantly being
disrespected. The general opinion that I was ``easy'' followed
me from my second training station to my third, and when I was
finally handed my 00214 release from active duty I vowed to not
be quite as personable the next time. So when I was mobilized a
year later, I built a wall around myself and reentered active
duty with my guard fully up, allowing myself to quickly obtain
``bitch'' status.
At first I was relieved; no more unwanted attention, no more
random guys trying to get my number, nobody knocking on my door
at night trying to get me to go out so they could attempt to
get me drunk. I was a bitch, and I intended to keep it that
way.
Upon arrival in Iraq, I was assigned to a military police
(MP) brigade, and my team of two other guys were given a squad
of nine MPs to escort us on our missions throughout Baghdad.
Each of the men on our squad detested three things in
particular: Military Intelligence, ``bitches,'' and above all,
taking instructions from ``bitches''. They had wanted a
``slut'' as the only female on their squad, and they were
beyond disappointed when they got me. I had no intention of
taking my guard down; I was there to do a job, and that's all I
was going to do.
As the assistant team leader of my tactical human
intelligence team, I often planned my team's missions for our
squad to escort us out on. My job was to then inform our squad
leader of our plans and it was his job to prepare a convoy
plan. But my squad hated taking instructions from me, not only
because I was a female but because I was about 10 years younger
than each of them. Often times they disregarded my plans and
caused our team to lose access to valuable intelligence. I
ended up having to have one of my male teammates present my
mission plans to our squad just to avoid their disrespect. But
that plan backfired on me when they started rumors that I was
no longer doing my job planning missions. However, that was the
least of my problems. They slowly began breaking me down with
their words, each day bringing me closer and closer to giving
up completely.
In the Army, they brief you every six months on sexual
harassment. They tell you that you should first confront the
person bothering you, and if that does not work, utilize your
chain of command. So I confronted the two guys that harassed me
the most. I told them the things they were saying made me
uncomfortable and that they were egging the other guys on. They
were surprisingly cool about it; they said they would cut it
out. The next day I arrived at our headquarters only to have
every guy on my squad making fun of me; cracking jokes and then
sneering at me saying, ``I'm sorry, did I offend you, Smith?
Are you uncomfortable?''
The harassment worsened; I endured countless rude comments,
filthy jokes, and inappropriate questions from the MPs. I was
disgusted with myself for even coming forward and telling them
to quit it in the first place. So disgusted, in fact, that when
my First Sergeant got wind of what was going on, I denied
everything, saying they were just being playful and they did
not bother me in the least. I feared that if my chain of
command investigated the situation, the MPs would deny
everything and the harassment would only get worse.
My fears came true when my First Sergeant finally went to
speak to the MPs. I told him later what had gone on because of
his interference in the situation, and asked if I could be
removed from the team. I was told there was no other place for
me; that a female was necessary on that specific team, and I
was the only one available for the job. I was devastated; not
only had my situation worsened, but the person who had
seemingly been on my side a day earlier was now leaving me to
be preyed upon by my harassers.
As a soldier, you are trained to ``drive on'', no matter the
circumstances. ``Adapt and overcome!'' they say. For 6 months I
``drove on''. I thought, ``Maybe they are right, maybe I am
just being sensitive.''
But in reality, the harassment was killing me; I lost my
appetite, stopped exercising, did not socialize, rarely called
home, and was crying on a regular basis.
I began to wonder what it would have been like had I obtained
``slut'' status instead. Would my deployment have been easier?
Would my squad respect me? Could any female soldier, bitch or
slut, ever have her male counterparts actually respect her? If
respect was impossible to attain, should I have strived for
their admiration instead? Upon realization that I was beginning
to justify the harassment, I decided that I desperately needed
help; I needed a way out of this situation.
So I reluctantly went to my unit's Chaplain, who listened to
each of my woes without a word. ``Should I beg for them to let
me off the squad? Go to my chain of command about the
harassment? Or see a psychiatrist because maybe I am just crazy
and none of this is really happening? '' My mind was full of
questions, and what I wanted was an answer to my problems.
I finished speaking and was staring at the Chaplain with a
look of desperation on my face. He nodded his head slowly like
he understood completely, as if he knew exactly what I should
do. I was practically on the edge of my seat when he finally
answered. ``Smith'', the chaplain said, ``I've known some great
guys that were MPs. Great guys. . . My best friend was an MP.
But those guys were exceptions, because MPs are scumbags.''
This was hands-down the best piece of information I had ever
received. This was better than any therapy session or anti-
depressant. It was so simple, yet it made so much sense. These
guys were not even worth worrying about. They were scum.
The Chaplain continued to explain that I would meet many more
scumbags in both my military and civilian life, and these guys
were like practice for the future. If I let these scumbags get
the best of me that was like letting them win on behalf of
scumbags everywhere.
With that, I left his office feeling not so lucky to be
tested by a bunch of scumbags under such stressful conditions,
but still feeling a whole lot better.
The next day I woke up half an hour earlier than usual. I was
the first one at headquarters, and had my vehicle cleaned and
fully maintained before the rest of my squad even showed up.
Every day, I arrived a little earlier and worked a little
harder than my male colleagues. If they made a filthy comment
or cracked a rude joke, I would roll my eyes and shrug it off.
I did not try to crack one back; I did not want to lower myself
to their scumbag level. I went out and collected more Intel
than ever, and produced 75 percent more reports than my male
teammates. This was not a competition; I was not trying to
prove myself to them or anyone else. I was showing them that
they could not break me. That I was not backing down. I made it
nearly impossible for them to give me any grief. By not
appearing uncomfortable by their crude talk, their harassment
even began to subside. They had nothing on me.
Before I knew it, my deployment was ending. I had had 17
Intel reports published nationally since my talk with the
chaplain, several more than the 6 months prior. I had
accomplished more than some people accomplish in their
lifetime. I had not been able to be myself for a whole year,
but I had not gone to Iraq to be myself. I had gone there to
accomplish a mission, and that is exactly what I did. I cannot
say my squad respected me much more than before, but I can say
that I was no longer disrespected like the ``sluts'' were.
Being considered a ``bitch'' really sucks, but it has more
pay-offs than being considered a ``slut''. I left Iraq with
something way more precious than a long list of admirers. I
left Iraq with more courage, greater confidence in myself as a
soldier, and most importantly, self-respect.
Female Five now holds the strongest opinion against females serving
in a war-zone. She does not think any female should be sent to a war-
zone unless she specifically volunteers because the hostile work
environment is so severe that it is debilitating. What I found most
troubling about her story was that the Chaplain told her scumbags were
everywhere. When I told her that in my 13 years of civilian employment
I had never been treated poorly due to my gender and that the civilian
world is 180 degrees different than the military she was relieved that
the severity of issues she experienced would not likely be repeated on
the civilian side. She has since gone through therapy to work through
these issues.
To conclude, we do our female military personnel serving in Iraq
and Afghanistan a great disservice by focusing on rape as the
definition of sexual trauma. Respective chains-of-command can often be
the problem or fail to offer a solution to harassment at its most basic
levels, so why would female soldiers trust them when the stakes
increase? As these stories have shown a woman enters war often at a
disadvantage that she will never overcome no matter what her behavior.
This is sexual politics and trauma of the most extreme kind. Every
soldier, female and male, needs their head in the game when at war and
female soldiers should not be suffering from physical or emotional
trauma from their fellow soldiers simply because they were born female
while they deal with the stress of war.