A friend of my husband is back in the VA hospital again. His wife called last night to tell us where he was and what happened. While talking to her I was reminded of what I went through when my husband was needing help, seeing a psychologist and psychiatrist but not being totally honest when them. He tried to minimize what was going on inside his head and how drastically his life changed.
With all the research I had been doing, it was obvious that the spouse had to get actively involved in the treatment of the veteran. The family is expected to notice the signs and then be a support system for the veteran but what happens all too often is the VA shuts the family out of the treatment because of "privacy concerns" instead of the patients best interest. This is what our friend's wife is going through right now. She is trying to find out what is going on with her husband and trying to be able to let the doctors know what effects of PTSD are doing to him, their marriage and above all, jeopardizing his life.
Part of PTSD is the lack of being able to make rational decisions and the VA knows this. The thought process is altered with paranoia getting out of control. The spouse needs to be able to communicate what is real and what is simply being twisted in the veterans brain. Mood swings, often being misdiagnosed as just bipolar comes with extreme highs and deep depression while they make very irrational life choices. Some will end up undertaking legal choices that are risky. They enter into agreements that are unwise jeopardizing their finances but it is not just their finances, it is the families finances as a whole.
Some veterans will go on buying splurges with a huge windfall from a claim being approved and pro-rated back to the filing of the claim. This brings sudden wealth with thousands of dollars in many cases. Often they will go out and buy expensive "toys" like tougher trucks, motorcycles, speed boats or faster cars as rational choices go out the window.
Yet with what these veterans are being diagnosed with and treated for being ignored when it comes to their quality of life, the VA then turns on the spouse often hiding behind HIPAA and "privacy concerns" for the patient. How much time is wasted because the VA will not talk to the spouse?
I got lucky. I had been with my husband for most of his appointments. His doctors knew me. My husband had also given them permission to speak to me but this was before HIPAA. I often wonder if his doctors would have been as honest as they were with me had this rule been in place. I'm hearing from too many wives in the same position as our friend's wife. While I was lucky with the doctors, I was not so lucky when it came to the VA. I had to go through the DAV to find out what was going on. Simple questions were not being answered by the VA because I was not the veteran.
In our friend's case, his wife has power of attorney and medical power of attorney because her husband is not able to make rational decisions. They refuse to talk to her. He refuses to see her and the VA is ignoring the legal authority she holds.
This is what HIPAA says about privacy.
The following report should provide the sign of a clear need there is to have the spouse totally involved in the veteran's care. They are on the front line of getting the veteran as well as the GI to the help they need to heal as soon as possible. Unless the VA takes their involvement seriously, there is vital time wasted.
As more and more veterans will enter into the overloaded system, the need will grow to streamline the process. The testimony of the spouse to the psychologist and psychiatrist are key in providing the shortest distant from evaluation to healing.
This is why there are different figures presented as to the number of veterans being treated for PTSD. What experts predict is that we are looking at 800,000.
By 1978 there were 500,000 Vietnam veterans diagnosed with PTSD according to the DAV study done. By 1986 there were already 117,000 suicides connected to Vietnam. This came from the IFOC training. Also in the training came these percentages.
40% of people with physical trauma
60% of sexual assault victims will get PTSD
60% of incest victims will get PTSD and most will attempt suicide
90% of people who witness torture will get PTSD
100% of torture victims will get PTSD
While the veteran may be honest with the depth of the wound, all too often they want to minimize it. They hardly ever address the relationships changes between them and their spouse, avoiding topics they feel will make them less "normal" denying sexual problems, emotional problems and other character changes. The spouse can provide the truth they do not want to share with the doctor.
All too often families will say "they suddenly changed" not knowing fully what caused the change. Most of the time they will notice the change long after the service of the veteran has ended and will not make the connection between PTSD and the change. Some veteran will come back with mild PTSD, believing they can just "deal with it" and then recover from it.
Often they are able to hide what is going on, acting as if nothing is wrong, until they experience the secondary stressor. This could come from a number of events. The loss of a family member, health problems with someone they are close to, the death of a friend, accidents, loss of employment, natural disasters, as well as other stressful situations most of us also experience from divorce, financial problems, drastic changes like buying a house or loosing a house, a sudden empty nest or any extreme changes including their own health.
Many veterans reach out for help following these secondary stressors and it is even more urgent they get help because PTSD surfacing after a secondary stressor is like PTSD ravages on steroids.
Again, the VA has to pay attention to the law and what is right for the sake of the veteran at the same time. In the case of the spouse having the power of attorney, especially the medical power of attorney, the law is on the side of the spouse. They are given this power for a reason. The VA must honor it. They also need to take the role of the spouse as seriously as they truly are connected to the veteran and the recovery of the veteran.
When it comes to mental health care the patient needs someone watching over them and making sure the veteran is being served as well as providing support. If they continue to shut the family out of the treatment, they will continue to see more and more veteran falling through the cracks, families falling apart and veterans with risky behaviors as well as thinking more and more about suicide.
One of the hardest things to do is to decide to stand by the side of the veteran with PTSD trying to take control over their lives. It is a lot easier to end the marriage than it is to stay. When the decision is made to stay with the veteran, the spouse needs all the support and involvement they can get. They are part of the treatment the veteran receives in order to heal. It is about time they were included as vital to this goal as the talk therapy provided by the psychologist and the medications provided by the psychiatrist. When PTSD strikes, the spouse switches from bystander to advocate. This needs to be honored because of the sacrifices they are willing to make for the sake of someone they love.
Chaplain Kathie Costos
Namguardianangel@aol.com
http://www.namguardianangel.org/
http://www.namguardianangel.blogspot.com/
http://www.woundedtimes.blogspot.com/
"The willingness with which our young people are likely to serve in any war, no matter how justified, shall be directly proportional to how they perceive veterans of early wars were treated and appreciated by our nation." - George Washington
With all the research I had been doing, it was obvious that the spouse had to get actively involved in the treatment of the veteran. The family is expected to notice the signs and then be a support system for the veteran but what happens all too often is the VA shuts the family out of the treatment because of "privacy concerns" instead of the patients best interest. This is what our friend's wife is going through right now. She is trying to find out what is going on with her husband and trying to be able to let the doctors know what effects of PTSD are doing to him, their marriage and above all, jeopardizing his life.
Part of PTSD is the lack of being able to make rational decisions and the VA knows this. The thought process is altered with paranoia getting out of control. The spouse needs to be able to communicate what is real and what is simply being twisted in the veterans brain. Mood swings, often being misdiagnosed as just bipolar comes with extreme highs and deep depression while they make very irrational life choices. Some will end up undertaking legal choices that are risky. They enter into agreements that are unwise jeopardizing their finances but it is not just their finances, it is the families finances as a whole.
Some veterans will go on buying splurges with a huge windfall from a claim being approved and pro-rated back to the filing of the claim. This brings sudden wealth with thousands of dollars in many cases. Often they will go out and buy expensive "toys" like tougher trucks, motorcycles, speed boats or faster cars as rational choices go out the window.
Yet with what these veterans are being diagnosed with and treated for being ignored when it comes to their quality of life, the VA then turns on the spouse often hiding behind HIPAA and "privacy concerns" for the patient. How much time is wasted because the VA will not talk to the spouse?
I got lucky. I had been with my husband for most of his appointments. His doctors knew me. My husband had also given them permission to speak to me but this was before HIPAA. I often wonder if his doctors would have been as honest as they were with me had this rule been in place. I'm hearing from too many wives in the same position as our friend's wife. While I was lucky with the doctors, I was not so lucky when it came to the VA. I had to go through the DAV to find out what was going on. Simple questions were not being answered by the VA because I was not the veteran.
In our friend's case, his wife has power of attorney and medical power of attorney because her husband is not able to make rational decisions. They refuse to talk to her. He refuses to see her and the VA is ignoring the legal authority she holds.
This is what HIPAA says about privacy.
The Privacy Rule permits a covered entity to use and disclose PHI, with certain limits and protections, for TPO activities [45 CFR § 164.506]. Certain other permitted uses and disclosures for which authorization is not required follow. Additional requirements and conditions apply to these disclosures. The Privacy Rule text and OCR guidance should be consulted for a full understanding of the following:
Required by law. Disclosures of PHI are permitted when required by other laws, whether federal, tribal, state, or local.
Public health. PHI can be disclosed to public health authorities and their authorized agents for public health purposes including but not limited to public health surveillance, investigations, and interventions.
Health research. A covered entity can use or disclose PHI for research without authorization under certain conditions, including
1) if it obtains documentation of a waiver from an institutional review board (IRB) or a privacy board, according to a series of considerations;
2) for activities preparatory to research; and
3) for research on a decedent's information.
Abuse, neglect, or domestic violence. PHI may be disclosed to report abuse, neglect, or domestic violence under specified circumstances.
Law enforcement. Covered entities may, under specified conditions, disclose PHI to law enforcement officials pursuant to a court order, subpoena, or other legal order, to help identify and locate a suspect, fugitive, or missing person; to provide information related to a victim of a crime or a death that may have resulted from a crime, or to report a crime.
Judicial and administrative proceedings. A covered entity may disclose PHI in the course of a judicial or administrative proceeding under specified circumstances.
Cadaveric organ, eye, or tissue donation purposes. Organ-procurement agencies may use PHI for the purposes of facilitating transplant.
Oversight. Covered entities may usually disclose PHI to a health oversight agency for oversight activities authorized by law.
Worker's compensation. The Privacy Rule permits disclosure of work-related health information as authorized by, and to the extent necessary to comply with, workers' compensation programs.
Other Authorized Disclosures
A valid authorization is required for any use or disclosure of PHI that is not required or otherwise permitted without authorization by the Privacy Rule. In general, these authorizations must specifically identify the PHI to be used or disclosed; provide the names of persons or organizations, or classes of persons or organizations, who will receive, use, or disclose the PHI;
state the purpose for each request;
notify individuals of their right to refuse to sign the authorization without negative consequences to treatment, payment, or health plan enrollment or benefit eligibility, except under specific circumstances;be signed and dated by the individual or the individual's personal representative;
be written in plain language;
include an expiration date or event;
notify the individual of the right to revoke authorization at any time in writing, and how to exercise that right, and any applicable exceptions to that right under the Privacy Rule;
and explain the potential for the information to be subject to redisclosure by recipient and no longer protected by the Privacy Rule.
The Privacy Rule and Public Health
The Privacy Rule recognizes 1) the legitimate need for public health authorities and others responsible for ensuring the public's health and safety to have access to PHI to conduct their missions; and 2) the importance of public health reporting by covered entities to identify threats to the public and individuals. Accordingly, the rule
1) permits PHI disclosures without a written patient authorization for specified public health purposes to public health authorities legally authorized to collect and receive the information for such purposes, and
2) permits disclosures that are required by state and local public health or other laws. However, because the Privacy Rule affects the traditional ways PHI is used and exchanged among covered entities (e.g., doctors, hospitals, and health insurers), it can affect public health practice and research in multiple ways. To prevent misconceptions, understanding the Privacy Rule is important for public health practice. Some illustrative examples are presented in this report (Box 4).
Also provided are sample letters that might prove useful in clarifying relationships involving public health and the Privacy Rule (Appendix B).
http://www.cdc.gov/mmwr/preview/mmwrhtml/m2e411a1.htm
The following report should provide the sign of a clear need there is to have the spouse totally involved in the veteran's care. They are on the front line of getting the veteran as well as the GI to the help they need to heal as soon as possible. Unless the VA takes their involvement seriously, there is vital time wasted.
MENTAL HEALTH CARE
Va. Braces for Veterans' Needs
Some Returning Troops Rely on Local Services, Not Military
By Chris L. Jenkins
Washington Post Staff Writer
Saturday, March 1, 2008; Page B10
Virginia officials are preparing for a sharp increase in requests for community mental health services from troops returning from Iraq and Afghanistan, and they are concerned that the system will be overwhelmed.
Mental health experts and officials said they are seeing a growing number of recently returned military personnel with post-traumatic stress disorder, depression and other ailments seeking services from behavioral health clinics.
But with a waiting list of about 5,700 for community mental health services, many officials are concerned that the state will not be able to adequately serve the veterans and family members going to these clinics, operated by what are known as community services boards.
State officials said they are preparing for a 15 percent increase over the next decade in people seeking services from the state's mental health network, especially in emergency situations. That does not include family members who might need counseling. The issue is of particular concern in Virginia because the state has the third highest number of military service members in the country, behind California and Texas.
"This is a population that we're going to have to think about for some time," said James Reinhard, commissioner of the state Department of Mental Health, Mental Retardation and Substance Abuse Services. "We're concerned and believe that [the population] is going to clearly have an impact on our services."
Paul, a reservist with the 890th Transportation Company, said the flashbacks and nightmares started a month after he returned from Iraq's Sunni Triangle. Violent images woke him at night and sometimes jolted him during the day. He knew he needed help.
There was a veterans hospital outside of Roanoke, 100 miles from his Shenandoah Valley home, but he had heard stories of long waits and lots of paperwork. He was given the number of a mental health clinic a short drive from his home, so he showed up one afternoon.
"The only thing I could think about was getting to someone close and fast because I was in such pain," said the 39-year old reservist, who asked that his last name not be used to spare his family media attention. He receives weekly treatment at a Charlottesville clinic that serves veterans. He said he has continued to go to the clinic because, during a long stretch last year, he had difficulty accessing his military insurance coverage.
"I didn't think about anything else" but getting help, he said.
http://www.washingtonpost.com/wp-dyn/content/
article/2008/02/29/AR2008022904190.html
As more and more veterans will enter into the overloaded system, the need will grow to streamline the process. The testimony of the spouse to the psychologist and psychiatrist are key in providing the shortest distant from evaluation to healing.
Testimony
Before the Committee on Veterans’
Affairs, U.S. Senate
VA DISABILITY BENEFITS
AND HEALTH CARE
Providing Certain Services
to the Seriously Injured
Poses Challenges
Statement of Cynthia A. Bascetta
Director, Health Care—Veterans’
Health and Benefits Issues
For Release on Delivery
Expected at 10:00 a.m. EST
Thursday, March 17, 2005
VHA manages one of the largest health care systems in the United States
and provides PTSD services in its medical facilities, community settings,
and Vet Centers.4 VA is a world leader in PTSD treatment and offers PTSD
services to veterans. PTSD can result from having experienced an
extremely stressful event such as the threat of death or serious injury, as
happens in military combat, and is the most prevalent mental disorder
resulting from combat.
In regard to psychological injuries, our September 2004 report noted that
mental health experts have recognized the importance of early
identification and treatment of PTSD. VA and DOD jointly developed a
clinical practice guideline for identifying and treating individuals with
PTSD. The guideline includes a four-question screening tool to identify
servicemembers and veterans who may be at risk for PTSD. VA uses these
questions to screen all veterans who visit VA for health care, including
those previously deployed to Afghanistan and Iraq. The screening
questions are:
Have you ever had any experience that was so frightening, horrible, or
upsetting that, in the past month, you
• have had any nightmares about it or thought about it when you did not
want to?
• tried hard not to think about it or went out of your way to avoid situations
that remind you of it?
• were constantly on guard, watchful, or easily startled?
• felt numb or detached from others, activities, or your surroundings?
In dealing with psychological injuries such as PTSD, VA also faces
challenges in providing services. Specifically, the inherent uncertainty of
the onset of PTSD symptoms poses a challenge because symptoms may be
delayed for years after the stressful event. Symptoms include insomnia,
intense anxiety, nightmares about the event, and difficulties coping with
work, family, and social relationships. Although there is no cure for PTSD,
experts believe that early identification and treatment of PTSD symptoms
may lessen the severity of the condition and improve the overall quality of
life for servicemembers and veterans. If left untreated it can lead to
substance abuse, severe depression, and suicide.
Another challenge VA faces in dealing with veterans with PTSD is the lack
of accurate data on its workload for PTSD. Inaccurate data limit VA’s
ability to estimate its capacity for treating additional veterans and to plan
for an increased demand for these services. For example, we noted in our
September 2004 report that VA publishes two reports that include
information on veterans receiving PTSD services at its medical facilities.
However, neither report includes all the veterans receiving PTSD services.
We found that veterans may be double counted in these two reports,
counted in only one report, or omitted from both reports. Moreover, the
VA Office of Inspector General found that the data in VA’s annual capacity
report, which includes information on veterans receiving PTSD services,
are not accurate. Thus, VA does not have an accurate count of the number
of veterans being treated for PTSD.
http://www.gao.gov/new.items/d05444t.pdf
This is why there are different figures presented as to the number of veterans being treated for PTSD. What experts predict is that we are looking at 800,000.
By 1978 there were 500,000 Vietnam veterans diagnosed with PTSD according to the DAV study done. By 1986 there were already 117,000 suicides connected to Vietnam. This came from the IFOC training. Also in the training came these percentages.
40% of people with physical trauma
60% of sexual assault victims will get PTSD
60% of incest victims will get PTSD and most will attempt suicide
90% of people who witness torture will get PTSD
100% of torture victims will get PTSD
While the veteran may be honest with the depth of the wound, all too often they want to minimize it. They hardly ever address the relationships changes between them and their spouse, avoiding topics they feel will make them less "normal" denying sexual problems, emotional problems and other character changes. The spouse can provide the truth they do not want to share with the doctor.
All too often families will say "they suddenly changed" not knowing fully what caused the change. Most of the time they will notice the change long after the service of the veteran has ended and will not make the connection between PTSD and the change. Some veteran will come back with mild PTSD, believing they can just "deal with it" and then recover from it.
Often they are able to hide what is going on, acting as if nothing is wrong, until they experience the secondary stressor. This could come from a number of events. The loss of a family member, health problems with someone they are close to, the death of a friend, accidents, loss of employment, natural disasters, as well as other stressful situations most of us also experience from divorce, financial problems, drastic changes like buying a house or loosing a house, a sudden empty nest or any extreme changes including their own health.
Many veterans reach out for help following these secondary stressors and it is even more urgent they get help because PTSD surfacing after a secondary stressor is like PTSD ravages on steroids.
Again, the VA has to pay attention to the law and what is right for the sake of the veteran at the same time. In the case of the spouse having the power of attorney, especially the medical power of attorney, the law is on the side of the spouse. They are given this power for a reason. The VA must honor it. They also need to take the role of the spouse as seriously as they truly are connected to the veteran and the recovery of the veteran.
When it comes to mental health care the patient needs someone watching over them and making sure the veteran is being served as well as providing support. If they continue to shut the family out of the treatment, they will continue to see more and more veteran falling through the cracks, families falling apart and veterans with risky behaviors as well as thinking more and more about suicide.
One of the hardest things to do is to decide to stand by the side of the veteran with PTSD trying to take control over their lives. It is a lot easier to end the marriage than it is to stay. When the decision is made to stay with the veteran, the spouse needs all the support and involvement they can get. They are part of the treatment the veteran receives in order to heal. It is about time they were included as vital to this goal as the talk therapy provided by the psychologist and the medications provided by the psychiatrist. When PTSD strikes, the spouse switches from bystander to advocate. This needs to be honored because of the sacrifices they are willing to make for the sake of someone they love.
Chaplain Kathie Costos
Namguardianangel@aol.com
http://www.namguardianangel.org/
http://www.namguardianangel.blogspot.com/
http://www.woundedtimes.blogspot.com/
"The willingness with which our young people are likely to serve in any war, no matter how justified, shall be directly proportional to how they perceive veterans of early wars were treated and appreciated by our nation." - George Washington
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