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
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
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
"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.