The $22 million Clay Hunt bill includes a new tool that the Veterans Affairs Department can use to recruit more mental health professionals — repayment of student loans for psychiatry students. VA officials say the pilot program will be a significant incentive for young psychiatrists to fill VA positions.
The law also mandates annual evaluations to determine the efficacy of VA suicide prevention programs, new veteran peer support programs and the creation of a new website to better explain what mental health resources are available to veterans.Veterans’ advocacy groups said the Senate’s passage of the bill will not end their push for improving mental health services for veterans. VFW National Commander John W. Stroud said the bill, “does strengthen and expand the mental health programs and services currently available to service members and veterans … [but what it] doesn’t do is go far enough.” The VFW and other groups had supported dropped provisions to improve access to mental health programs for reserve and National Guard members. Other dropped provisions include a mandated review of less-than-honorable military discharges to determine if the member’s behavior was linked to post-traumatic stress disorder, and to establish a single drug formulary for the VA and the Defense Department. Aleks Morosky, deputy director of legislative services for the VFW, said the VFW believes a single drug formulary for VA and DoD is critical for the care of troops transitioning from active-duty to veteran status. “Now, when you’re on active duty and get mental health care, you get a certain medication regimen” based on specific needs and met by the drugs available through the DoD’s inventory. Because getting the right medication is “trial and error,” it can be a difficult process finding the correct regimen, Morosky explained. “But since the VA does not have all the same drugs as the DoD, when you transition you have to start all over again. So we support them having a single formulary.” A provision calling for a single VA-DoD drug formulary may have been pulled because it directly affected the Defense Department, he said. That would have meant sending the bill to the armed services committees of the House and Senate for approval, thereby adding another legislative hurdle to passage.
People change, relationships change, and as a result…families change. Homes change, our daily routines change, and holidays change. When we hold too tight to the past and when we refuse to make new traditions, we miss out on the beauty of what is the present and the hope of what might be the future.
If you or someone you love is struggling a bit this year, here are a few tips that might help getting through the holidays easier, and even potentially lead to creating a good memory or two.
- Make a game plan. If you know that a family gathering is going to be in a crowded location, or there will be alcohol at a friend’s Ugly Sweater party, think through how you’ll handle it ahead of time. If you need to, write down a few of your best coping strategies and keep them in your pocket. If you start feeling anxious, excuse yourself to a private area and review your notes.
- Use the buddy system. Tell a trusted friend or family member that you may need their support when you’re going to be somewhere that could potentially be a stressful or sensitive situation. If you know a celebration will include children, but you’ve recently gone through a bitter custody dispute, for example, having a friend close by to talk to in you start to feel emotionally overwhelmed can help.
- Maximize the good. When you’re feeling good, take note of it. Practice deep breathing and relaxation during these times – they can turn into coping mechanisms during situations when you feel yourself getting anxious.
- If you have a spiritual side, nurture it. During the holidays, people tend to refocus on their beliefs and spirituality. Visiting your place of worship can be a profound way of connecting with others, celebrating the holiday in a personal manner, and can be a healthy way of managing emotions that can otherwise leave you feeling vulnerable.
- Be flexible. Most families have long-standing ways of celebrating the holidays – everything from the way they decorate the tree to what they eat and where they spend their time. When your own sadness or stress enters the picture, recognize it as a time to show some patience and understanding. Talk with each other and focus on creating a holiday that everyone can enjoy. For example, if large crowds and noise are a too much, maybe instead of blasting holiday music while you and your 26 cousins bake cookies and decorate the house, this year you donate some time at a homeless shelter.
- Have a safe word and an exit strategy. Come up with a ready-made reason for leaving a party/situation early, and have a safe word that indicates it’s time to leave.
- Give alcohol a time out. For many with PTSD, drinking alcohol can make symptoms worse. Turning to alcohol to get through 11 parties can quickly turn into a bad habit once the parties are over. If you’re hosting, limit the availability of alcohol. If you’re out somewhere, stick to the rum-free eggnog.
Suicide Prevention HotlineVeterans experiencing an emotional distress/crisis or who need to talk to a trained mental health professional may call the Veterans Crisis Line lifeline 1-800-273-TALK (8255). The hotline is available 24 hours a day, seven days a week. When callers press “1”, they are immediately connected with a qualified and caring provider who can help. Chat feature: Veterans Chat is located at the Veterans Crisis Line and enables Veterans, their families and friends to go online where they can anonymously chat with a trained VA counselor. Veterans Chat can be accessed through the suicide prevention Website www.Veterancrisisline.net by clicking on the Veterans Chat tab on the right side of the Webpage. Text feature: Those in crisis may text 83-8255 free of charge to receive confidential, personal and immediate support. European access: Veterans and members of the military community in Europe may now receive free, confidential support from the European Military Crisis Line, a new initiative recently launched by VA. Callers in Europe may dial 0800-1273-8255 or DSN 118 to receive confidential support from responders at the Veterans Crisis Line in the U.S. For more information about VA’s suicide prevention program visit: www.mentalhealth.va.gov/VAMentalHealthGroup.asp Make the Connection Resources: help Veterans and their family members connect with information and services to improve their lives. Visitors to MakeTheConnection.net will find a one-stop resource where Veterans and their family and friends can privately explore information, watch stories similar to their own, research content on mental health issues and treatment, and easily access support and information that will help them live more fulfilling lives. At the heart of Make the Connection are powerful personal testimonials, which illustrate true stories of Veterans who faced life events, experiences, physical injuries or psychological symptoms; reached out for support; and found ways to overcome their challenges. Veterans and their families are encouraged to “make the connection” – with strength and resilience of Veterans like themselves, with other people who care, and with information and available resources for getting their lives on a better track. For more information, go to: www.MakeTheConnection.net Coaching Into Care: works with family members or friends who become aware of the Veteran’s post-deployment difficulties, and supports their efforts to find help for the Veteran. This national clinical service provides information and help to Veterans and the loved ones who are concerned about them. More information about the service can be found at www.mirecc.va.gov/coaching/contact.asp. VA’s National Center for PTSD serves as a resource for healthcare professionals, Veterans and families. Information, self-help resources, and other helpful information can be found at www.ptsd.va.gov. The PTSD Coach is a mobile application that provides information about PTSD, self assessment and symptom management tools and provides information about to connect with resources that are available for those who might be dealing with post trauma effects. The PTSD Coach is available as a free download for iPhone or Android devices.
Mental Health Residential RehabilitationMental Health Residential Rehabilitation Treatment Programs (MH RRTP) (including domiciliaries) provide residential rehabilitative and clinical care to Veterans who have a wide range of problems, illnesses, or rehabilitative care needs which can be medical, psychiatric, substance use, homelessness, vocational, educational, or social. The MH RRTP provides a 24-hour therapeutic setting utilizing a peer and professional support environment. The programs provide a strong emphasis on psychosocial rehabilitation and recovery services that instill personal responsibility to achieve optimal levels of independence upon discharge to independent or supportive community living. MH RRTP also provides rehabilitative care for homeless Veterans. Eligibility: VA may provide domiciliary care to Veterans whose annual gross household income does not exceed the maximum annual rate of VA pension or to Veterans the Secretary of Veterans Affairs determines have no adequate means of support. The co-pays for extended care services apply to domiciliary care. Call the nearest benefits or health care facility to obtain the latest information.
In a move that could cause a massive eastward migration of veterans from Hawaii and California and boost New England Cheetos sales numbers by double digits, the State of Maine has authorized the use of medical marijuana to treat post-traumatic stress disorder, or PTSD.
A competing therapy – thus far legal, though not yet proven – involves injecting an anesthetic directly into the spine with a horse needle.
We’ll take option A, thanks, and throw in a bag of Doritos.
Don’t look for the Bangor, Maine VA clinic to start handing out dime-bags like it’s going out of style, though. While a number of states have actually legalized marijuana under their own state laws, and a half-dozen states have specifically authorized medical marijuana as an approved treatment for PTSD, old Mary Jane is still illegal under federal law. Federal policy prohibits VA doctors from prescribing it or even assisting with documentation required to get other doctors to prescribe it.
Furthermore, marijuana is still listed as a Schedule I drug – a drug for which there are “no currently accepted medical uses,” according to the Controlled Substances Act. However, in 2010 and 2011, the Department of Veterans Affairs relaxed its existing policies against medical marijuana by affirming that veterans who were using marijuana under a legal state program could still participate in VA-sponsored therapeutic activities without fear of punishment.
“VHA policy does not administratively prohibit Veterans who participate in State marijuana programs from also participating in VHA substance abuse programs, pain control programs, or other clinical programs where the use of marijuana may be considered inconsistent with treatment goals,” stated the VA in a fit of clarity. “While patients participating in State marijuana programs must not be denied VHA services, the decisions to modify treatment plans in those situations need to be made by individual providers in partnership with their patients.”
Leadership from the Top
If there’s ever been a president who should be open to legalizing marijuana for this purpose, you’d think it would be Barack Obama, the notorious former head of the pot-smoking “Choom Gang,” while a high school student at the elite Punahou prep school in Honolulu, Hawaii. But this President has been widely seen to have led a crackdown on marijuana users now that he is president. Further confusing the matter, though, the DoJ announced it won’t challenge State marijuana laws and will focus only on serious trafficking cases.
Is marijuana effective? It seems to be – though conducting a full-scale clinical trial is very difficult due to federal restrictions. But a study done on rats from the University of Haifa indicates that a quick hit of marijuana just after a traumatic incident may even help prevent the development of PTSD symptoms…if you believe that people behave like rats.
Meanwhile, the folks down the road in Tel Aviv have discovered that sleep deprivation may also help mitigate the effects of PTSD.
How do you feel about medical marijuana and its potential usefulness in treating PTSD? Should research be allowed despite it being an illegal drug? Tell us in the comments.
Should the DoD recognize servicemembers with post-traumatic stress syndrome with a Purple Heart? Most combat veterans would say ‘no.’ One says yes – and recently published an essay on the political news and commentary website, The Daily Beast.
The author, Benjamin Tupper, isn’t some silver-ponytailed hippie on the faculty at Columbia University or Olympia College. He’s actually a Guardsman, an infantry officer, an Afghanistan War veteran and the author of two books about his experiences in Afghanistan, Greetings From Afghanistan: Send More Ammo and Dudes of War.
Tupper doesn’t attempt to make an affirmative argument for the inclusion of PTSD as a qualifying criteria for the Purple Heart. He cites the anecdotal case of a soldier in his platoon having received a Purple Heart for a minor wound, but not receiving one for injuries incurred when he spent months in a hospital after getting drunk and speeding – his preferred method of self-medication for dealing with PTSD after returning home from Afghanistan – and driving his car off the road.
Ultimately, Tupper advocates that so long as the DoD is trying to remove the stigma of seeking help for PTSD, then not awarding the Purple Heart for PTSD sends a mixed and inconsistent message. Tupper is looking to use the Purple Heart as a means to help legitimize PTSD, and remove any stigma from the diagnosis for those who struggle with it.
From his column:
Granting the Purple Heart is just the first step in fully legitimizing and addressing PTSD. We also need systemic reform of the VA and a better system for providing the long-term clinical treatment that its casualties deserve. But awarding the medal in cases of PTSD will accomplish one essential goal: giving the respect and acknowledgement to those who are suffering from invisible wounds that we already bestow on those with scars we can see. By doing this, we would acknowledge that the anxiety, rage, depression and disrupted emotional and social lives that veterans with PTSD experience are a result of war, and not some personal defect. By honoring them like we honor those scarred by bullets and IEDs we may be able to alleviate some of the shame and fear that have led so many to suicide.
But if the irresponsible and reckless actions of Tupper’s friend represent the positive case for awarding one of our most prestigious decorations, Tupper’s argument doesn’t get off the ground.
He does somewhat better countering some of the obvious arguments against awarding the Purple Heart for PTSD:
Argument 1: It’s not a real wound. Tupper argues that “more combat veterans from Iraq and Afghanistan die from suicide related to wartime service and mental health issues, than from enemy bullets and bombs. That should offer grave and definitive proof that PTSD is very real and that its consequences can be as deadly as an IED.” However, recent research into veteran’s suicides indicates that there’s not much of a link between direct combat experience and suicides.
Argument 2: The mental disorder does not cause physical damage. Tupper responds that there is nothing in the regulations that limits the Purple Heart to physical wounds. He then argues that traumatic brain injury, or TBI, also causes no physical disfigurement but qualifies for the Purple Heart. However, the TBI is a brain injury that frequently causes identifiable physical symptoms and has effects that show up in MRIs and other tests that are certainly physical, as opposed to psychological.
Argument 3: There’s no clear chain of causation from a specific event to a PTSD diagnosis. Tupper’s argument is that this is also true of TBI, where there may have been a pre-existing injury from playing high school sports that got aggravated by an IED, for example. However, Tupper fails to address that you still have the TBI, and you still have an IED or other explosion caused by enemy action. Awarding the Purple Heart for PTSD will require much less of a chain of causation than that.
Argument 4: People will fake symptoms to earn the award. Tupper argues that this can be the case with any award, which is why we have sworn statements documenting combat experience. However, there are many more ways to get PTSD in the military than combat. Military sexual trauma is an obvious example. If we’re going to award the Purple Heart to people who suffer from combat-related PTSD – or claim to – what is the message we are sending to those who contract PTSD through rape or sexual assault or some other act of violence? Yes, the regulations state that the Purple Heart must be awarded for causes attributable to enemy action. But if the goal here is to destigmatize PTSD and encourage those who suffer from it to get help, then awarding it to combat-related PTSD cases and withholding it from MST-related PTSD sufferers will create two classes of PTSD patients – the combat ones with Purple Hearts and the others.
Tupper also fails to consider the effect on the award itself. The minute we take this award long established for recognition of actual combat wounds received in the service of this country and award it for a nebulous complex of psychological ailments, we will essentially put an asterisk on all subsequent Purple Hearts. It will also cause a flood of claims, as all of a sudden every single fobbit who never left the wire now has a basis for a claim from a single mortar shell – and can push to receive the award.
Let’s not turn the Purple Heart into the CAB. The value and prestige of the award will be cheapened, not enhanced, by Tupper’s proposed measures. Expanding the award criteria to include a PTSD diagnosis is an insult to generations of warriors who earned it the old-fashioned way: shedding blood on the battlefield.
What are your thoughts on this? Hacce you experienced PTSD and do you think it merits an award such as the Purple Heart? Tell us in the comments.
A recent doctoral thesis by University of Utah graduate student Catherine Caska suggests that the negative health effects of post-traumatic stress disorder, or PTSD, spill over into spouses, too.
The study compared emotional and physiological responses of two groups of military veterans and their partners during and after engaging in a “disagreement task” set in a clinically-monitored environment. The veterans in one group had been diagnosed with PTSD, and those in the control group had not.
According to the researchers, the most remarkable finding was that the partners of veterans with PTSD showed even greater increases in blood pressure during conflict than the veterans with PTSD themselves, suggesting that these partners may be at similar, if not greater, risk for health consequences from relationship conflict and PTSD as the veterans.
The study found that female spouses and other partners of veterans who have PTSD had even bigger blood pressure spikes than the vets. While the fact that those diagnosed with PTSD are liable to have significant blood pressure increases during periods of stress has been long established, Caska’s study was the first to look specifically at the experiences of spouses.
“Overall, we found that couples where the veteran has PTSD showed greater emotional and relationship distress than military couples without PTSD,” said Caska. “The couples affected by PTSD also showed greater increases in blood pressure, heart rate, and other indicators of cardiovascular health risk in response to the relationship conflict. Veterans with PTSD showed larger increases in blood pressure in response to the relationship conflict discussion than did veterans without PTSD. These responses and the greater emotional reactions and overall relationship distress reported by veterans with PTSD could contribute to the increased risk of cardiovascular disease previously found to be associated with PTSD.”
Caska is no newcomer to the study of the unique mental health problems and needs of military families. In 2009, she authored a thesis paper called Caregiver Burden in Spouses of National Guard/Reserve Service Members Deployed During Operations Enduring and Iraqi Freedom.
Caska also co-wrote a chapter in the book Risk and Resilience in U.S. Military Families entitled “Distress in in Spouses of Combat Veterans with PTSD: The Importance of Interpersonally-Based Cognitions and Behaviors.”
“The results of our study emphasize the potential role of relationship difficulties in the increased risk for cardiovascular disease among Iraq and Afghanistan War veterans with PTSD,” concludes Caska. “These data also suggest the possibility of similar heath risks for their partners. These findings could have important implications for the focus of treatments and services for this population, and further drives home the need to continue to focus research and resources on understanding and better serving military families.”
WarriorSongs, a non-profit organization to help veterans recover from combat experiences, military sexual trauma or other military-related mental health challenges, will be holding a workshop from June 19th to the 23rd at Wallingford, Pennsylvania. Structured as a poetry and songwriting retreat, director and songwriter Jason Moon, himself an Iraq war veteran, will guide participants through a weekend of creativity, music, poetry, reflection, healing and bonding.
The event will take place at Pendle Hill, a Quaker study center founded in 1930. Lodging is available on site. Full scholarships are available from Warriorsongs.
Jason Moon, the founder and director of Warriorsongs, returned from a deployment to Iraq with a combat engineer company in 2004. Struggling with PTSD, Moon abandoned his pre-war passion for songwriting and instead turned increasingly to alcohol and risky behavior, in an attempt to recreate the kind of adrenaline rush he experienced in Iraq.
“Before the war, songwriting was my greatest joy, and suddenly, I couldn’t write about anything,” he says. “Even writing about something happy just reminded me of how sad I was.” Moon took a five year hiatus from songwriting – ending shortly after he was hospitalized for depression and suicidal ideation culminating in an attempt to take his own life by overdosing on prescription drugs and alcohol.
While recuperating, he participated in the filming of On the Bridge, a film by Oliver Morel on the struggle to overcome PTSD. Morel asked Moon to contribute some original songs – and the floodgates opened.
Since beginning his workshops, Jason and Warriorsongs have been featured prominently by the Associated Press and the Huffington Post, and have had favorable mentions in many local papers where Warriorsongs has held workshops and events across the country.
The Wallingford retreat is limited to 17-18 participants. Scholarships are available. Contact Warriorsongs for more information at firstname.lastname@example.org.
Last Friday, America was forced to confront the problem of evil. And we may yet again fail to recognize it where it exists.
I do not use the word ‘tragic’ or tragedy when referring to the outrage that took the lives of 20 schoolchildren and seven adults. The word applies where those who fell died because of some fault of their own – the tragic flaw of Greek and Shakespearian drama. Tragedies are, by definition, self-inflicted at some level.
This was not the case in Newtown, nor Clackamas, nor at Columbine, the Aurora Theater or Tuscon.
Tragedy has logic. This was simply murder.
The shooting has naturally resulted in calls for increased restrictions on legal gun ownership – and gun rights advocates have also resorted to the usual arguments in favor of 2nd Amendment rights.
The Newtown incident has also resulted in more calls for reforms in mental health care – a welcome development, and certainly one of interest to veterans in the VA system as well as to the general population.
But large swathes of the mental health care advocates likewise miss the target – the problem of evil.
The mental health industry – including families struggling with mental illness or personality disorders within their own homes – would argue that we need better access to mental health treatment, early intervention, up to and including involuntary commitment for individuals who have not yet committed a crime.
The mental health industry is part of the health care complex in the United States, and has adapted itself to define mental health issues in such a way as to maximize reimbursement from health insurance plans, including Medicare and Medicaid. In order to do this, it has adopted a medical treatment, documentation and financing model for mental illnesses of all stripes.
In many cases, this is absolutely appropriate. Some mental illnesses, including bipolar disorder, schizophrenia and some forms of depression respond very well to medication. The mental health industry has also adopted a medical model to treat drug and alcohol addiction – though with less success.
And then there are the so-called personality disorders: Borderline personality disorder, narcissism and sadism – a cluster of sociopathologies that the medical model continues to have trouble addressing. This is because the medical model has trouble identifying the difference between genuine mental illness and evil. If the system cannot identify evil, it cannot address it.
Public discourse on the shooting centers on keeping guns out of the hands of the “deranged,” but we fail to define our terms beyond that.
Meanwhile, we run the risk of eroding valuable constitutional freedoms.
We are already seeing that within our own community of veterans – a recent bill before Congress sought to strip veterans under VA care of their 2nd amendment rights simply on the say-so of a mental health professional, without any kind of a priori judicial review.
A VA bureaucrat social worker, under the proposed law, could refer a veteran to the FBI simply because he was bad with money.
And history is replete with state abuse of the mental health system to warehouse those who were perfectly sane, but whose ideas were considered a threat to the power structure. Imperial Japan had the Tokk? – quite literally referred to as the “thought police” between 1925 and 1945. Its function was to stamp out and suppress “dangerous thought.” Among the dangerous thoughts it suppressed: Opposition to the simultaneous war with China, the United States and Great Britain which ultimately resulted in the country’s utter devastation.
If mental health workers have a reputation for referring struggling patients to law enforcement – or committing them involuntarily to mental institutions, the potential for perverse effects is obvious: Those with enough cognizance to be extremely deadly criminals will avoid seeking care, or will say what they think the shrink wants them to say, and therefore fall outside the system’s grasp, even as the constitutional rights of less maladjusted people are eroded.
Meanwhile, the mental health field will continue to struggle with the problem of evil that cannot be medically addressed. There was nothing insane nor irrational about men like Timothy McVeigh, or MAJ Nidal Hassan. They knew exactly what they were doing. They had a goal and set about to kill to achieve it. They knew full well the devastating impact their actions would have on their victims and their victims’ families. They just did not care.
No amount of medication, nor cognitive ‘talk therapy,’ nor any number of billable hours, will correct that, no matter how skilled the practitioner.
Hassan’s case is particularly revealing: As an Army psychologist himself, Hassan was routinely in contact with many other military health care professionals – yet despite tipping his hand several times in formal presentations as an adherent of radical and violent Islam, the Army mental health care system could not identify an evil right under their noses.
In the case of the Tuscon, Arizona shootings and the Aurora. Colorado Theater shooting, we have a more ambiguous case. Clearly, neither shooter was playing with a full deck of cards. In these cases, perhaps some early intervention could have prevented the problem. The warning signs were there – and recognized by people around them at the time. James Holmes, the shooter in Aurora, was actually regularly seeing a mental health professional at the time. So access to mental health care was not the problem.
Holmes himself had actually received a degree in neuroscience, with highest honors, and had been described as a “very effective group leader” as an undergraduate. He would have had access to counseling and health care as an undergraduate student, and as a graduate student at the University of Colorado, where he was still technically enrolled at the time of the shooting. His psychological decompensation seems to have been rapid, though.
Jared Lee Loughner, the Tuscon murderer, had a long history of borderline psychosis, perhaps as a result of the chronic use of hallucinogenic drugs. Loughner had already been identified as a criminal risk, and was barred from reenrolling at Pima Community College until he received a clearance from a mental health professional stating he was not a risk for violent behavior.
Seung Hui-Cho, the murderer in the Virginia Tech Shootings who took the lives of 32 people and wounded 17 in 2007, was identified as a danger as young as 15, when he was transfixed by the Columbine murders and wrote that he wanted to repeat them. In this case, mental health care officials intervened early, and he was placed in special education with an emotional disorder and excused from a number of routine events in high school, such as group presentations. He eventually began to refuse treatment.
Privacy laws, such as HIPAA, prohibited his mental health care professionals from notifying Virginia Tech officials of his violent tendencies.
A professor of his at Virginia Tech had already removed him from her class because of menacing behavior. He was also involved in at least three incidents of stalking while enrolled at Virginia Tech, but was allowed to remain a student. Professors had already alerted the dean and campus police that Cho was a problem, but were informed that there was nothing they could do until Cho committed a crime.
In 2005, Cho was actually found by a magistrate to be a danger to himself and others around him. But the magistrate in question, Special Justice Paul Barnett, sentenced him to outpatient treatment, rather than committing him full time to an institution.
In each of these cases, mental health professionals were already involved, and clearly there was plenty of early warning in most of them. In each case, the mental health professionals and court apparatuses could not or would not take decisive action to remove these individuals from society. Access to mental health care was not an issue. The issue was the recognition of evil.
The medical model has no structural incentive to attribute to evil what it can attribute to something billable.
But that brings us back to veterans: If we adopt a system in which we are quicker to involuntarily commit those we suspect of being psychotic, or with severe personality disorders, to mental institutions, bias and prejudice against combat veterans and ignorance about PTSD will ensure that we are first in line for detention.
There are certainly reforms that can be made, both to the system that regulates firearm distribution and ownership, as well as mental health reforms. But is the 2nd amendment that guarantees the government can never have the power to create a Tokk? of its own, and allows the weak and good to defend themselves against criminals who are strong, armed, evil and/or crazy.
There are constitutional concerns in strengthening the mental health industry’s pull – and they have powerful financial incentives to commit more and more patients to their care. Meanwhile, for every Cho, there are thousands of people who enter the system who would be harmless, yet have their freedoms abridged all the same.
We should be very cautious of broad, ham-handed measures in either field to prevent future shootings. Evil has always been among us, and while you can regulate away the ability of law abiding citizens to defend themselves against people like Cho – and more run-of-the-mill criminals – you cannot treat away nor regulate away the presence of evil.
The battle’s been brewing for years. Veterans coming back from wars with symptoms of post-traumatic stress disorder, as well as other psychological ailments such as depression and anxiety disorders that may or may not be directly related to trauma, are fighting to claim a benefit: A trained service dog – at government expense.
The problem: The expense is significant. It can cost anywhere from $10,000 to $30,000 to breed and fully train a service dog. And the Veterans Administration says it has more productive uses for the money.
Veterans groups and a loose association of dog breeders and trainers that have formed a small cottage industry providing service dogs to veterans, of course. And the veterans who have them love their service dogs and are grateful for the benefit. But after reviewing the issue, and after a period of public comment, the Veterans Administration has elected not to cover service dogs for PTSD and other psychiatric conditions.
Service dogs have long been used to help vision-impaired and hearing-impaired people and people with mobility issues. And the benefits and cost-effectiveness of seeing-eye dogs for the blind has been accepted for years.
Originally, the VA could only provide seeing-eye dogs to blind veterans. However, President George W. Bush expanded that authorization when he signed the Department of Veterans Affairs Health Care Programs Enhancement Act, which authorized the Veterans Administration to provide service dogs as a benefit for other conditions as well. However, in a 2007 memorandum, the VA concluded that there was not sufficient evidence that service dogs were a cost-effective remedy for vision and mobility-impaired veterans. However, the VA left the door open to providing a service dog on a case-by-case basis to individuals who could show that the therapeutic value of a dog and the potential cost savings over other forms of therapy justified the use.
In 2009, Congress voted to expand authorization of a service dog benefit to veterans with mental illnesses. And in 2010, Congress passed the Franken Amendment, which directed the executive branch to launch a three-year pilot program to study the therapeutic effects of service dogs for PTSD.
So What Can a Dog Do?
According to the Psychiatric Service Dog Society, a trained service dog can help an individual with PTSD or other depressive or anxiety disorders in the following ways:
- Help overcome reclusiveness by accompanying the individual on trips outside the home
- Awaken an individual suffering from night terrors
- Turn on a light to alleviate night terrors
- Help with hypervigilance by searching a room for intruders
- Interruption of dissociative spell
- Alert and intervene or distract in moments of emotional escalation
Benefits of Pet Ownership
There is little doubt that pet ownership correlates strongly with improved mental and physical health outcomes. Studies indicate that pet owners are less likely to commit suicide, get more exercise, are less likely to have heart attacks, and less likely to suffer from severe depression than those with no pets. It is not clear to what extent that relationship between pet ownership and improved health outcomes is causative versus correlative. For example, people who are more active may be more likely to go out and adopt a pet in the first place.
In any event, though, it is not necessary to have a highly-trained service animal with a five-figure price tag to realize these benefits. Most of the beneficial effects can be had with any reasonably well-behaved and affectionate dog, without any specialized training whatsoever.
So the argument for highly trained service animals for PTSD patients at government expense must go beyond the basic therapeutic effects that you can get with any good pet, and address the possible law of diminishing returns. It is possible that the government could spend larger and larger sums for trained service animals for smaller and smaller benefits.
Testing the Theory
It occurred to us that if there is any validity to the use of service dogs to treat PTSD, they would already be in common use among psychiatric patients in other contexts – possibly for rape survivors. Are dogs effective in helping rape survivors recover and function? Do they help with agoraphobia symptoms, and hypervigilance? And if they do, are they typically professionally trained and certified service dogs? What do women do who are survivors themselves but who don’t qualify for VA services? Do they seek out trained dogs? Is the benefit powerful enough that those who can afford it choose to pay for the costs associated with a trained dog with their own money?
It turns out that there is, indeed, a precedent for the use of dogs to help survivors of rape and other violent crimes overcome anxiety and other PTSD symptoms. Service Dogs for Victims of Assault, which is now defunct, was formed in 1999 to help provide dogs to survivors and raise awareness of their value in helping survivors. We spoke to their chief clinical practitioner, Carmen Davis, Ph.D., via telephone.
Dr. Davis’s Portland, Oregon practice centers largely on patients who are struggling with PTSD, often through severe child abuse. Symptoms include dissociative disorders – a psychological phenomenon in which the patient re-experiences the trauma. Other therapists sometimes refer patients to him if there is a potential need or desire for a service dog.
Davis was not familiar with any clinical studies demonstrating the effectiveness of service dogs for the PTSD population, though he did report positive results on an anecdotal basis. However, none of his patients required dogs that needed extremely high-end, specialized training that would result in a five-figure price tag. None of Davis’s clients could afford that, anyway.
“You really just need a dog with good basic obedience training, and public access training.”
However, Davis did point out there were instances where a dog could sense when an owner was going through a dissociative episode and could bring them out of it. In Carmen’s experience, though, the owners would obtain dogs with good temperaments and obedience training, and continue training the dogs themselves. Expense to the government was generally nil in these cases, but these patients did, by and large, believe that the dogs were helpful enough to justify spending their own money.
From the VA’s point of view, absent a solid clinical study demonstrating effectiveness, it would be extremely difficult to justify awarding service dogs as a benefit to treat PTSD – especially when the assumption is that a fully-trained service dog would cost tens of thousands of dollars.
However, there is a whole continuum of needs within the PTSD community. Only a very few veterans will require a high-end service dog for PTSD symptoms. It may make sense to recalibrate our thinking, and scale down the cost assumptions to reflect it.
For example, of the population of veterans collecting 50 percent or greater disability compensation because of PTSD, how many of them would trade 20 percentage points of disability for a service dog? After all, if the dog doesn’t make them less disabled, then you cannot justify the expenditure. But if the dog does result in a significant reduction of disability, then the cost of the dog could be offset by a reduction in VA benefits – perhaps on a sliding scale, reflecting the training cost of the dog. The veteran could select the desired training level himself, though it would affect VA disability compensation benefits.
If enough veterans jump at the chance, even where it costs them money, then we probably have a worthwhile benefit. If nobody takes the dog over the cash, then the whole push to cover service dogs for PTSD appears to be an attempt to latch on to the VA benefit gravy train.
Photo credit: Ed Andrieski/AP