IAVA Todd Bowers Testifies On PTSD

April 4, 2008
IAVA Testifies Before HVAC
Filed under: PTSD, Testimony, VA, Washington — Todd Bowers @ 5:18 pm
On April 1st, I testified before the House Veterans Affairs Subcommittee on Health. The hearing focused on Post-Traumatic Stress Disorder treatment and research. In case you missed the hearing, you can now watch the webcast here.

Below is my testimony:

Mr. Chairman, ranking member and distinguished members of the committee, on behalf of Iraq and Afghanistan Veterans of America, and our tens of thousands of members nationwide, I thank you for the opportunity to testify today regarding this important subject. I would also like to point out that my testimony today is as the Director of Government Affairs for the Iraq and Afghanistan Veterans of America and does not reflect the views and opinions of the United States Marine Corps.

During the Iraq and Afghanistan Wars, American troops’ mental health injuries have been documented and analyzed as they occur, and rates are already comparable to Vietnam. But thanks to today’s understanding of mental health screening and treatment, the battle for mental health care fought by the Vietnam veterans need not be repeated. We have an unprecedented opportunity to respond immediately and effectively to the veterans’ mental health crisis.

Mental health problems among Iraq and Afghanistan veterans are already widespread. The VA has given preliminary mental health diagnoses to over 100,000 Iraq and Afghanistan veterans. But this is just the tip of the iceberg. The VA’s Special Committee on PTSD concluded that:

“15 to 20 percent of OIF/OEF veterans will suffer from a diagnosable mental health disorder… Another 15 to 20 percent may be at risk for significant symptoms short of full diagnosis but severe enough to cause significant functional impairment.”

These veterans are seeking mental health treatment in historic numbers. According to the VA, “OEF/OIF enrollees have significantly different VA healthcare utilization patterns than non-OEF/OIF enrollees. For example OEF/OIF enrollees are expected to need more than eight times the number of PTSD Residential Rehab services than non-OEF/OIF enrollees.” With this massive influx of veterans seeking mental health treatment, it is paramount that we ensure the treatment they are receiving is the most effective and will pave a path to recovery.

But before I speak about the specifics of PTSD treatment and research, I’d like to talk about two of the barriers that keep veterans from getting the proper treatment in the first place.

The first step to treating PTSD is combating the stigma that keeps troops from admitting they are facing a mental health problem. Approximately 50 percent of soldiers and Marines in Iraq who test positive for a psychological problem are concerned that they will be seen as weak by their fellow service members, and almost one in three of these troops worry about the effect of a mental health diagnosis on their career. Because of these fears, those most in need of counseling will rarely seek it out. Recently, my reserve unit took part in completing our Post-Deployment Health Reassessment, which includes a series of mental health questions. While we underwent the training, one of my Marines asked me about Post Traumatic Stress Disorder. He said: “If there is nothing wrong with it, then why is it called a Disorder?” I could not have agreed with him more. To de-stigmatize the psychological injuries of war, IAVA has recently partnered with the Ad Council to conduct a three-year Public Service Announcement campaign to try and combat this stigma, and ensure that troops who need mental health care get it. Our goal is to inform service members and veterans that there is treatment available and it does work.

Once a service member is willing to seek treatment, the next step is assuring that they have convenient access to care. On this front, there is much more that must be done, particularly for rural veterans. More than one-quarter of veterans live at least an hour from a VA hospital. IAVA is a big supporter of the Vet Center system, and we believe it should be expanded to give more veterans local access to the Vet Centers’ walk-in counseling services.

The problems related to getting troops adequate mental health treatment cannot be resolved unless these two issues – stigma and access — are addressed. However, once a service member suffering from PTSD has access to care, we also need to ensure they receive the best possible treatment.

Currently, a variety of treatments are available. Psychotherapy, in which a therapist helps the patient learn to think about the trauma without experiencing stress, is an effective form of treatment. This version of therapy sometimes includes “exposure” to the trauma in a safe way – either by speaking or writing about the trauma, or in some new studies, through virtual reality. Some mental health care providers have reported positive results from a similar kind of therapy called Eye Movement Desensitization and Reprocessing (EMDR).

In addition, there are medications commonly used to treat depression or anxiety that may limit the symptoms of PTSD. But these drugs do not address the root cause, the trauma itself. IAVA is very concerned that, in some instances, prescription medications are being seen as a “cure-all” that can somehow “fix” PTSD or replace the face-to-face counseling from a mental health professional that will actually help service members cope effectively with their memories of war.

Everyone knows that counseling and medication can be effective in helping psychologically wounded veterans get back on their feet, and IAVA encourages any veteran who thinks they may be facing a mental health problem to seek treatment immediately. But we are also aware of the limitations of current research into the treatments of PTSD.

A recent Institute of Medicine study, entitled “Treatment of Posttraumatic Stress Disorder: An Assessment of the Evidence,” outlined the many gaps in current research. Among the problems they identified:

• “Many studies lack basic characteristics of internal validity.” That means too many people were dropping out of these studies, the samples were too small, or follow-up was too short.

• The IOM committee also identified serious issues with the independence of the researchers. “The majority of drug studies were funded by pharmaceutical manufacturers,” and “many of the psychotherapy studies were conducted by individuals who developed the techniques.”

• Finally, the committee concluded that there were serious gaps in the subpopulations assessed in these studies. Veterans may react differently to treatment than civilians, but few of the studies were conducted in veteran populations. There’s also not enough research into care for people suffering from co-morbid disorders, such as TBI or depression.

The solution is more and better research. To respond to the IOM findings, IAVA wholeheartedly supports more funding for VA research into PTSD and other medical conditions affecting Iraq and Afghanistan veterans.
http://www.iava.org/blog/?p=12420

April 1, 2008 at 10 a.m.Subcommittee on Health Hearing“PTSD Treatment and Research: Moving Ahead Toward Recovery”
http://veterans.house.gov/hearings/hearing.aspx?NewsID=188

I just watched the hearing. The only thing I learned that I did not already know is that it will get worse than I thought it would. Over the years I've posted about the need to provide education on what PTSD and what the cause is. I've posted on the need to remove the stigma and have tried a thousand different ways to do this. The most successful attempt has been the videos I’ve done. There have been a great number of emails coming in telling me how much they helped get the stigma out of the way. I plan on doing many more of them. I am saddened that there is not more watching these videos. They are easy to understand and as I became more proficient in how to create them, they also became easier to view.

This is the rest of the hearing with the most important remarks I think need to be paid attention to.

Col. Hoge testimony
Sent back with PTSD
They are given prescription medicine like Prozac, may be put on suicide watch and then when they are taken off suicide watch, they end up killing themselves.
Higher access to firearms.
Gunshot wounds are treated without their permission but PTSD is not.
Desire has to be there to recover from PTSD. You cannot force them to get help.
Therapy works when there is an alliance between provider and soldier.

Mandatory counseling? Will not work and will be a drain on resources without providing enough benefit.
May force them to rebel against it.
Most do not recognize they have a problem.
Options, Military One Source
Chaplains
Veteran Centers

Outside doctors are not being paid in a timely manner by the VA to provide outsourced services when the VA cannot. They are more reluctant to treat veterans.
Within DOD mental health task force looked at resources in remote operational areas and found very troubling challenges with trained professionals able to treat soldiers.

Employers reluctant to hire veterans because of PTSD. Great need to educate the general public on what PTSD is.

National Guard-Reservists vs Military
Military One Source is available to them. Yet there is not enough to support these families.

Multiple deployments
12% on 1st deployment
20% on 2nd deployment
30% on 3rd deployment
These are those who have been diagnosed.

TBI and PTSD have shown half cases of TBI are connected to PTSD and are misdiagnosed.

12 month dwell time not enough to reset.

Mental Health Assessment
6 month assessment shows 2-3 fold increase of diagnosed cases.

Individual therapy seems to work best than group therapy.

Research is that BattleMind does not work as well as they hoped it would. They are developing a more advanced version of it.








Problems to getting treatment
Limited ability to get them to want help.
Stigma still remains on getting mental health treatment.
Accessibility to find help.
Change in psychologist when they begin to get treatment and then the psychologist is deployed or moved, replace by another and the process of learning to trust begins again.
Stigma prevents over half not seeking help.
Perceptions of how they will be regarded by fellow service people and commanders.
The greatest need is to de-stigmatize the wound.

Chemical changes in the brain.
PTSD comes with changes in the body from stress and leads to physical problems. More pain, more headaches, heart problems and immune problems. Normal biological processes that are needed in combat. Hyper-alert, sleep depravation, and other changes that are necessary to survive the combat environment. Much of which are retained while back home. The body is conditioned to react in times of stress and much of this is retained when it is not needed.



Dr. Baum
VA staffing problems.
It is necessary to reach out to the communities and professionals to fill in the gaps.

Occupational therapists
Expand the student loan to those working for the VA.
Salaries in VA are lower than outside. Average salary in California $20,000 lower than outside professionals.
Need to treat everyday issues the veterans and the families face.
Volume problem and vacancy problems in the VA increase the need for Occupational Therapists





Dr. Matchbar
Institute of Medicine
Committee assessment
Inconsistent results on drug studies
Exposure therapy seemed to have better results.
All PTSD is not the same depending on the cause and the sub groups need to be studied.
Sub population needs to be studied differently.
Substance abuse, physical disabilities and other sub groups, like ethnic and social classes.


Dr. Wiederhold
Virtual Reality Medical Center
12 years with 92% success rate
Exposure therapy
Regulate system to reduce flight or fight reaction
Used on different causes of PTSD
Brain imaging shows changes
Nero inhibitors, biochemical changes occur in PTSD and may be able to be blocked.
Blind study and Marines with PTSD and mild TBI, treated group did better in 12 weeks.


Dr. Thomas Berger
Vietnam Veterans of America
No one really knows how many will be affected by PTSD.
23% to 40% seek treatment. The rest do not even after being found positive because of the stigma.
Female veterans find it harder to get treatment.
Access to and availability of is still problematic.
Western and rural states are particularly troublesome.
Most treatment means have not proven effective accept exposure therapy.
Reduce the stigma
Increase social roles
Provide treatment
Help them get their lives back together with helping them live with the symptoms that do remain.
Intervention


There is the first key to healing and that is to get the stigma out of the way! Every expert I have read or listened to over 25 years has said this over and over again. So when are we going to do this?

Combat cuts deeper because they are part of the trauma and the events happen over and over again. So when will we address the need to debrief them in field? We do this with police officers and fire fighters. Why don't we do this with the warriors?

Again, I think that awarding a medal for these kind of wounds is a huge step in the removal of the stigma of having a combat wound. Please support the Wound Chevron and provide these wounded veterans with one more hand up out of the pit of the stigma that should have been done away with a long time ago. It's a wound! It's a normal reaction to an abnormal event. Can you think of anything more abnormal than combat? How many of us go into the military and how many of us are exposed to the things they are? Combat is not normal! They are!