The amount of resources devoted to mental health at the VA has increased substantially. For FY 2012, the president requested $7.2 billion to fund a variety of PTSD and related programs, including research, substance abuse, suicide prevention, and treatment of PTSD-TBI patients. This represents a 15% increase in funding over last year. The Defense Department plans on spending $1.2 billion itself on research and other programs related to PTSD.
The VA has hired more than 5,000 mental health professionals in the last two years, bringing the total in the agency to over 22,000. They have also added personnel to deal with the avalanche of disability claims, although the waiting period is still measured in years at some VA facilities. Nationwide, the average is about nine months.
VA officials say the money will also support:
collaborative programs with the Defense Department, including outreach to veterans, as well as new but unspecified types of treatment. It promises to lay the groundwork for psychological treatment “for many years to come.”
Outreach to veterans is key. Reducing the stigma of PTSD within the ranks is of paramount importance if those suffering from the condition are going to get well. Ron Capps retired in 2008 after a 25 year career in the Foreign Service and Army Reserve. His battle with PTSD was hampered considerably by his own martial code, and the code followed by his fellow soldiers:
In Army culture, especially in the elite unit filled with rangers and paratroopers in which I served, asking for help was showing weakness. My two Bronze Stars, my tours in Airborne and Special Operations units, none of these would matter. To ask for help would be seen as breaking.
But, finally, when in the middle of the day I was forced to hide, shaking and crying in a concrete bunker, railing against the noise and the images in my head, and when I understood that to continue was to endanger the soldiers I was sent to Afghanistan to lead, I asked for help.
Advocates say that Capps’ experience is not atypical. The Army has begun to train officers to recognize PTSD symptoms in their ranks, hoping early intervention can get help to the afflicted soldier quickly. Col Robert Saum, director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, explains:
This training is ongoing, and [the Army] has introduced a program called Comprehensive Soldier Fitness. It addresses not just physical fitness, but mental health fitness to the NCOs and the officer corps. The buddy-buddy system of taking care of each other is one of the primary things that the program addresses.
There is also a move to screen all returning war veterans for PTSD-TBI once a year. All soldiers returning from the front are currently tested for PTSD, but this isn’t good enough because a patient might not become symptomatic for months or even years after combat. Hence, the annual tests will help in identifying those who need treatment.
But the VA is having enormous difficulty in treating the cases they have already. A document recently released by the VA reveals some of the difficulties the agency will face in the near future:
The document, which veterans groups have unsuccessfully filed Freedom of Information Act (FOIA) requests to obtain, shows that there are now a total of 1,634,569 veterans from post-9/11 wars, and that 745,481 of these veterans have filed disability claims, which is an astonishing 46 percent.
The document also shows that while the number of veterans who have been diagnosed by V.A. doctors with PTSD is 247,243, the number of them who are actually getting disability benefits is 137,911. In other words, 44 percent of post-9/11 veterans diagnosed with PTSD are still not getting their benefits.
This, despite the president’s executive order streamlining the process to receive disability benefits and speed treatment of PTSD to those who need it. Clearly, there are improvements to be made by this president and future presidents because this is a problem that will haunt the VA for decades to come. Ten-thousand Iraq and Afghanistan veterans every month are currently pouring into VA facilities across the country. Already stretched to the limit, the VA is going to have to greatly increase its resources if it is to meet the demand for treatment from our returning veterans.
With combat operations over in Iraq and winding down in Afghanistan, the number of PTSD cases will probably tail off — even though being deployed to either of those countries is still no picnic. The government, while improving its response to this crisis, is still not doing enough. More money can be found, more doctors and clinicians hired, more staff brought on to deal with the crush of benefit applications — this is the easy part. All it takes is the will in the White House and the Congress to face the problem and meet the demand.
But changing the culture in the military that stigmatizes those who seek help for mental health problems is an entirely different matter. As with other institutional problems in the military, it will take time to alter fundamental perceptions about PTSD. It will also be difficult to instill confidence in the ranks that seeking help will not hinder a soldier’s career.
That is the greatest challenge facing the government and the military as our warriors return home with no visible scars of their combat experience, but needing help to battle their own personal demons that haunt their days and make their nights a living hell. And the tragedy is that PTSD is treatable — if only those who need help the most request it and the government charged with looking after them can respond humanely and in a timely manner.