Returning military personnel and their families will need better access to
mental health services, combined with more vigorous efforts to reduce stigma
within the armed forces and in the Department of Veterans Affairs (VA), APA
president-elect Carolyn Robinowitz, M.D., told the House Appropriations
Subcommittee on Military Quality of Life and Veterans Affairs last month.
"We recommend improved and long-term access to the continuum of
mental health and substance-use disorder services.... along with funding for
sufficient professional positions to staff this continuum," she
The VA should invest resources to develop a nationwide system of care that
includes intensive case management, psychosocial rehabilitation, peer support,
housing, integrated substance use and mental illness treatment, and other
services for veterans with serious mental illnesses, she emphasized.
Younger veterans of the wars in Iraq and Afghanistan appear to be
especially vulnerable to the psychological effects of their experiences,
Robinowitz said. "In Iraq or Afghanistan, everywhere is the front line
today," she said. "So there's no place to step back and recover
In addition, traumatic brain injuries are leading to an increase in
casualties with complex neurological, physical, and psychiatric consequences
that require equally complex, well-coordinated care.
"It is critical that psychiatrists lead the treatment teams
responding to these patients' psychiatric needs," Robinowitz stated at
"You really do need an M.D., someone who understands and can put the
physical and mental together," she added later in an interview with
The VA also needs resources to add staff to cope with not only the influx
of newer, younger veterans but also the danger of staff members feeling
overwhelmed in the face of the increased demand for services.
Women veterans will also present a new challenge to the VA, which is
accustomed to an older, male population, she said. Women veterans in their
reproductive years may be commonplace patients soon.
Robinowitz commended VA and military health officials for placing mental
health services in primary care settings to lessen the stigma that often
deters service members from using such services in free-standing sites.
Administrators at the VA, she said, often display the general public's view of
mental illness as something alien or frightening, but also reflect the
attitudes of some in the armed forces that it is a sign of weakness or
Special attention should be paid to National Guard and Reserve members,
because they often return quickly to civilian life, isolated from the support
of buddies in their units or geographically distant from rehabilitation
services, she said.
Continued research, supported by increased funding, is also needed to
improve evidence-based treatment for the long-term health effects of
posttraumatic stress disorder, traumatic brain injury, and other war-related
mental health outcomes, she added. ▪