Peer Counseling, Family Education Could Ease Vets' Transition

The heavy reliance on National Guard and Reserve troops, with many units drawn from small towns, has increased the need for mental health services far from the usual sites of the Department of Veterans Affairs, Ralph Ibson of Mental Health America told senators in Washington, D.C., in April.

The stress of combat is only worsened by repeated tours of duty, he said at a hearing of the Senate Committee on Veterans Affairs.

“Half of all Army National Guard soldiers and 45 percent of Army and Marine reservists report mental health issues on their return from war,” he said. “The VA can do more and should do more for them.”

The VA health system has great strengths, he added. However, “it 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 health care facilities.”

Readjustment counseling could benefit most returning veterans, he said, but that help was usually limited to the 200 readjustment counseling centers (also called vet centers) and is not available at the VA's medical centers and clinics. There was no barrier preventing these larger sites from also providing such services, however, Ibson said.

Women make up 15 percent of the forces in Iraq and Afghanistan and even their “noncombat” roles—like driving trucks, flying helicopters, or serving as military police—frequently exposed them to traumatic episodes that would meet any definition of warfare.

“The jury is still out on care of women veterans and the perceptions of the VA as a welcoming, caring place for them,” said Ibson.

Ibson offered several suggestions for helping veterans and their families cope with the return of service members.

The VA should develop peer-based outreach programs by training veterans of Iraq and Afghanistan to work at the VA or in the community to provide support for vets and make VA facilities welcoming environments. Families should also be offered services, at least for a specified period after a service member's return home. Help for small-town or rural veterans might be offered at local community mental health centers, where they exist.

Finally, the window of eligibility during which veterans may sign up with the VA without proving a service connection for any complaints should be extended from two to five years.

Earlier in the hearing, the senators heard from families of a soldier and a Marine who had returned from Iraq and later died.

The parents of Spc. Joshua Omvig of Grundy Center, Iowa, an Army Reserve military policeman, told how their son was “unable to live with the physical, mental, and psychological effects” of his time in Iraq and committed suicide a year after he returned home from an 11-month tour in Iraq.

To avoid tragedies like their son's, other troops need peer counseling before they come home, family education and outreach, increased training on recognizing symptoms that could lead to suicide, and substance abuse treatment, said Randall Omvig. While troops are still in uniform, their transition back into civilian life might be eased by having them spend days doing service-connected work while spending evenings and nights with their families.

“It helps them process their experience,” said Omvig. “It would help them live the American dream that they fought for.”

Justin Bailey, a Marine veteran of the invasion of Iraq, died on January 27 in the West Los Angeles Veterans Affairs Hospital of an apparent overdose of prescription drugs, his father, Tony Bailey, told the senators. Despite a history of overusing drugs prescribed for pain from a war injury and for PTSD, Justin was given two-to four-week supplies of benzodiazepines, antidepressants, and methadone. Tony Bailey blamed “apathy and complacency” in the VA for his son's death.

“Nobody cared until I was on ABC News,” said Bailey, who served 20 years in the armed forces. Families of veterans needed to advocate for patients in the VA, he said. “Always ask questions. Don't assume the VA will help without someone to push.”

Speaking on behalf of the VA, Ira Katz, M.D., Ph.D., deputy chief patient care services officer for mental health, said the VA was already hiring more suicide prevention coordinators and was working to integrate its approach to substance abuse and mental health care.

“We want accountability,” said Katz. “But we must go beyond narrow silos.”

The effects of the “invisible wounds” suffered by veterans of the current conflicts will be felt for many years, said Sen. Daniel Akaka (D-Hawaii), the committee's chair, but he expected that the VA would adapt to meet the mental health needs of those and all veterans.

Written testimony from the Senate hearing is posted at<http://veterans.senate.gov/index.cfm?FuseAction=Hearings.CurrentHearings&rID=996>.▪