Tagged: veterans mental health

Mental Health Care for Veterans

Posted by Debi Teter
PTSD and veterans mental healthVeterans eligible for VA medical care may apply for general mental health treatment including specialty services such as Post Traumatic Stress Disorder and substance abuse treatment. Contact the nearest VA health care facility to apply. VA’s Comprehensive Assistance for Family Caregivers Program entitles the designated Family Caregiver access to mental health. These services may be offered at the VA and/or contracted agencies. General Caregivers (of all era Veterans) can receive counseling and other services when necessary if the treatment supports the Veteran’s treatment plan. For more information on VA Mental Health services visit the VA website.

Suicide Prevention Hotline

Veterans 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 Rehabilitation

Mental 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.

Mental Health and PTSD Among the Troops

Posted by Debi Teter
PTSD and mental health resource for soldiersTwo shootings at military installations in a week. More suicides by service members in a year than deaths in combat. These are the realities of today’s military. Theories are varied as to why suicides and murders by service members and veterans are on the rise. One point that everyone agrees on is that mental health issues have been stigmatized for so long that many people who need help are afraid to ask for it. The Defense Department and VA are concerned. When Leon Panetta was Secretary of Defense, he laid out a four-pillar strategic approach to prevent military suicides: leadership; improving health care quality and access; elevating the importance of mental fitness; and increasing research into suicide prevention. There is clearly still much work to be done, but there are resources available. The VA lists more than 20 organizations and services available to active duty personnel, veterans and families. The US Army offers a Psychological Health Care Fact Sheet. The American Psychiatric Nurses Association offers general mental health assistance in addition to services specific for PTSD and Traumatic Brain Injury. USAA provides a book on suicide prevention that is free to download. PTSD and other mental health issues also take a toll on military spouses and can cause serious health issues. Active duty troops and veterans alike may be able to benefit from the recent emphasis on suicide prevention. If you are currently feeling despair or hopeless, or if you are concerned about someone else’s health, please contact the National Suicide Prevention Hotline at 1-800·273-TALK (8255). #FtHood #PTSD #mentalhealth #veteransresources

Should We Use Marijuana to Treat PTSD?

Posted by Jason Van Steenwyk

militaryauthority.com medical marijuana for ptsdIn 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.

Report: VA Patients 33 Percent More Likely to Die of Overmedication

Posted by Jason Van Steenwyk

militaryauthority.com VA patients more like to overdosePatients at Veterans Affairs hospitals and clinics are 33 percent more likely to die from accidental overdoses of medications than the general population, CBS News has found.

The report focused on the case of a 35-year old Army veteran, Scott MacDonald, who was proscribed a cocktail of seven different medications for pain and psychiatric conditions, including narcotics like Percocet and Vicodin – both opiate derivatives.

According to CBS’s reporting, sources within the VA are saying that VA officials have been encouraging doctors to sign off on painkiller and other medications – including narcotics – on patients they don’t see. In the short run, the practice actually saves money, because patients with enough painkillers tend to make fewer appointments and consume fewer health care services.

In the long run, however, doctors signing off on these assembly line prescriptions are putting patients at risk of opiate or prescription medicine addiction and a host of negative side effects, including accidental fatal overdose. 

The CBS report builds on earlier reporting from a local NBC affiliate in Ohio, which found that the number of unintentional drug overdose deaths in Ohio tripled between 2001 and 2011. Furthermore, an earlier study published in the Journal of Psychiatry found that veterans had a significantly elevated risk of death due to accidental overdose compared to the general population nationwide.

In 2010, Dr. Pamela Gray, then a VA physician, became concerned because, as she states, VA officials were asking her and other doctors to sign off on continuing narcotics prescriptions on patients they had not even seen, much less evaluated. She took her concerns to Senator Jim Webb (D-VA), who in turn had the VA launch an investigation. Gray subsequently lost her job – she says because she blew the whistle, though the VA cites poor communications skills as the reason she no longer practices at the VA. However, according to reporting by the Virginian Pilot, the VA’s own internal investigation mostly cleared themselves of wrongdoing, though four of the fifteen physicians interviewed said they, too, had been asked to write prescriptions for patients they had not seen. The VA Inspector General’s office wrote that there was, indeed, a perception of pressure to write narcotics prescriptions and an expectation of retaliation against any doctor who failed to do so.

At the same time media reports are highlighting the possible overreliance on psychoactive medications such as anti-psychotics in more general settings. 

DoD Introduces New Online Tool to Help Troops and Veterans Combat Stress

Posted by Jason Van Steenwyk

militaryauthority.com DoD tool for veterans stressIf you are a servicemember or veteran and you are undergoing one or more stressors in life, well, you can join the club. But you can also go online to www.startmovingforward.org and get some coaching to help you navigate some of life’s challenges. 

The website walks you through common stressors that most of us go through at one time or another, from financial difficulties to relationship problems, and helps you identify different things you can do to cope with the problem. Some of these coping behaviors are positive and effective, of course, while others, like avoidance and procrastination, are negative coping mechanisms. The website is designed to help veterans and servicemembers develop successful strategies, and avoid falling prey to the unsuccessful ones.

The site is the brainchild of Art and Christine Nezu, two Philadelphia-area psychologists who emphasize cognitive-behavioral therapy in their own practices.

We’ll let them describe the cognitive-behavioral therapy (CBT) approach in their own words:

CBT places a strong emphasis on the principles of learning and how faulty learning may cause problems in a person’s life. This approach also involves evaluating how effective a therapy is by monitoring a patient’s progress. A “behavioral” approach to treatment focuses on a patient’s current circumstances as one important factor that affects a person’s behavior. Behavioral procedures generally are geared to improve upon a person’s self-control by expanding their skills and abilities. Often this is accomplished with the help of homework assignments and practice of new behaviors in a patient’s environment as part of treatment. A “cognitive” approach to treatment views problems as stemming from maladaptive and dysfunctional thoughts, ideas, and beliefs that have been learned earlier in life. Consequently, such ways of viewing the world can affect a person’s behavior and emotions in negative ways. The goal of cognitive therapy is to modify a person’s way of thinking so that a change in behavior and emotions can occur. This is achieved by monitoring tasks, such as tracking thought patterns and performing experiments in everyday life, in order to determine if the ideas or beliefs are actually valid.

CBT combines behavioral and cognitive approaches to treatment and focuses on helping people become more aware of their emotions and how such feelings influence their thoughts and behavior. CBT includes many different techniques and interventions that have been found to be scientifically sound. It helps people achieve specific goals and changes. 

Goals might include:

  • New ways of acting or behaving, such that the likelihood of future behavior problems is significantly reduced and new skills are developed (such as assertiveness, communication, self-management, or parenting skills).
  • New ways of managing feelings, such as helping a person to understand and better manage feelings of fear, depression, anxiety, shame, or hostility. A focus on feelings may also help people experience more positive emotions, such as joy, gratitude, or peace.
  • New ways of thinking, such as learning to solve relationship problems or change negative thinking. 
  • New ways of coping, such as being able to more accurately identify problems, change cognitive distortions, tolerate and use negative emotions more effectively, and change destructive relationship patterns.

CBT usually focuses on the current situation, rather than the past. However, consistent with our integrative psychotherapy approach, it is important to note that early emotional learning experiences can significantly contribute to current thoughts, feelings, and actions. Some CBT strategies work on changing views that were learned early in one’s life experience and replacing ways of living that do not work well with behaviors that are more effective in order to provide individuals with more control over their lives.

The website, an initiative of the Department of Defense’s National Center for Telehealth and Technology and the Department of Veterans Affairs, is intended to give servicemembers and veterans who may not have ready access to mental health professionals, who cannot afford counseling or who may be averse to counselors for whatever reason a way to get some help and perspective without having to go to a clinic, or speak to strangers on the phone.

A big focus for the website is stress management. The site helps viewers develop positive stress management behaviors, while avoiding negative ones. The site fits in a broader spectrum of mental health resources available for veterans and service members, along with www.militaryonesource.com, military and VA counselors and clinics, private clinics, suicide hotlines, and medical professionals.

The Moving Forward website is not designed to replace an in-person professional therapist, psychologist or other medical professional. It is also not designed to replace anti-anxiety, anti-depression or other beneficial medications, if appropriate. If your issues are severe, the Nezus and the DoD urge you to additionally see a mental health professional in person. 

For a referral qualifying individuals can contact www.militaryonesource.com, www.veteranscrisisline.net, the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) (Spanish/Español 1-888-628-9454). Veterans press “1” after you call.

An additional listing of available support agencies and services in place to help service members, veterans and their families can be found here.

Civil Liberties Organization Sues on Behalf of Marine Jailed, Committed to VA Psychiatric Ward for Facebook Post

Posted by Jason Van Steenwyk

Marine jailed for Facebook postsThe Rutherford Institute, a non-profit organization dedicated to preserving civil liberties, has filed suit against the Government on behalf of a Marine veteran who was jailed and then involuntarily committed to a VA psychiatric hospital for posts he wrote on his Facebook page.

According to the Rutherford Institute, a team of police, FBI agents and Secret Service personnel came to the home of Brandon Raub, then 26, near Richmond, Virginia, and asked to speak with him about the content he was posting on his Facebook account. He had been posting a lot of song lyrics, politics content, and items that suggested that the U.S. Government itself had masterminded the attacks on 9/11. For example, he posted a photograph of the damage to the Pentagon in the aftermath of the attack, with the caption, “where’s the plane?,” suggesting that the Pentagon was struck by a missile, not by a passenger jet.

Again, according to the Rutherford Institute and contemporary news accounts, the agents asked him to step outside, and without explanation nor charges, nor did they read him his rights at the time of the arrest, part of which was captured on cell phone video.

Raub was taken to the police station, and from there transported to the psychiatric ward of a local VA Medical Center, where he was held against his will until he received a hearing. Virginia law allows physicians to hold individuals in psychiatric institutions involuntarily for a period of time if they believe they may be a danger to themselves or other people. A magistrate reviews the involuntary hold in a few days to ensure that there is a rational legal basis for the hold.

Meanwhile, his mother, Cathleen Thomas, was able to get on Facebook herself to generate publicity and get attorneys to work on Raub’s behalf.

Raub received a hearing before the magistrate four days after his arrest, on August 20th. At that hearing, law enforcement officers told the magistrate that his controversial Facebook posts were the sole reason for the hold. Among the posts that law enforcement found troubling were the lines, “sharpen up my axe and I’m back/ it’s time to sever heads.” This post and others in that vein had caused others who saw the Facebook posts to report him to authorities. Raub countered that his posts were actually song lyrics, or dialogue from an online card game, and law enforcement officials were reading them out of context. The axe quote above is indeed from the lyrics to a song called “Bring Me Down” from a band called Swollen Member. However, the judge ruled against Raub, and ordered him to be held involuntarily for another 30 days. Officials also ordered him transferred to a facility some three hours away from his legal team and his family.

At that point, Raub’s attorneys, provided to him by the Rutherford Institute, appealed to the court system for his release. On August 23rd, a judge threw the case out, ruling that there was no factual basis to detain Raub, and ordered him released immediately.

The judge found that the paperwork used to send police to Raub’s door contained “no facts,” that Raub was not informed of the reason for his detention as required by law, and that the charging sheet contained a signature but not even an allegation of a crime. The affidavit detaining Raub, the judge ruled, was “so devoid of any factual allegations that it could not be reasonably expected to give rise to a case or controversy.”

Raub, with the support of the Rutherford Institute is now suing the government for false imprisonment, denial of due process and unlawful search and seizure. He filed the suit last week, personally suing Daniel Bowen and Russell Granderson, both Chesterfield County law enforcement officers, as well as Michael Campbell, a licensed psychotherapist, and social worker Lloyd Chaser and LaTarsha Mason, according to the Chesterfield Observer.

Among the complaints: The therapist who advocated detaining Raub had not even met him.

The complaint also alleges that a special Department of Homeland Security program, called Operation Vigilant Eagle, contributed to Raub’s unlawful incarceration. Vigilant Eagle is ostensibly intended to help law enforcement prevent ‘lone wolf’ terrorist attacks. However, the DHS put special emphasis on returning Afghanistan and Iran veterans as potential risks for terrorist attacks.

Warrior Songs to Hold Veteran Songwriters Retreat at Wallingford, PA, June 19-23rd

Posted by Jason Van Steenwyk

warrior songs logoWarriorSongs, 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.

You can purchase a copy of Jason Moon’s CD, Trying to Find My Way Home, here. His ReverbNation page allows you to listen some of his material as well.

The Wallingford retreat is limited to 17-18 participants. Scholarships are available. Contact Warriorsongs for more information at info@warriorsongs.org

Vets Gun Rights Bill Stalls in Senate: VA Bureaucrats Can Still Take Your Guns Away

Posted by Jason Van Steenwyk

Vets Gun Rights BillA word from a VA case manager can still cause you to lose your 2nd Amendment rights. While a variety of gun control amendments failed to pass cloture in the Senate on Wednesday, the Senate also failed to pass legislation that would have prohibited Veterans Administration bureaucrats from stripping certain veterans of the right to own firearms without a court order from a judge or magistrate declaring the veteran to be a danger to himself or others.

The legislation in question was a proposed amendment to Senate Bill 649, the so-called “Safe Communities, Safe Schools Act, which was introduced by Senator Richard Burr (R-NC). According to Senator Burr, at least 149,000 veterans have had their 2nd amendment rights stripped from them, simply because they had a fiduciary appointed for them to manage their financial affairs. 

“Depriving someone of a Constitutional right is a serious action, and veterans should be afforded the same treatment under the law as all other American citizens,” Burr said in a press release. “This legislation would protect the rights of veterans and their families by ensuring that only a proper judicial authority is able to determine who is referred to NICS. Our veterans took an oath to uphold the Constitution and they deserve to enjoy the rights they fought so hard to protect.” 

The VA had recently testified that they wanted to retain the ability to strip veterans of their right to own firearms unilaterally, without a court order or review. The VA defended the practice to the House Veterans Affairs Committee, arguing that there is a process in place for veterans challenging the decision to appeal to get their rights restored. “VA has relief procedures in place, and we are fully committed to continuing to conduct these procedures in a timely and effective manger to fully protect the rights of our beneficiaries,” VA says. “Any person determined by a lawful authority to lack the mental capacity to manage his or her own affairs is subject to the same prohibition.”

However, according to Senator Burr, only 200 veterans have challenged the revocation of their rights, and only six have done so successfully.

The VA’s position doesn’t hold water. First of all, they are begging the question. There is no reason to accept the VA’s assumption that a cub-scout caseworker in the VA bureaucracy, acting without any kind of review from either a magistrate, judge or even a medical professional, is in any sense a “lawful authority.”

Second, constitutional rights are God-given. They are not there for the executive branch to unilaterally revoke without any burden of proof that the veteran is a danger. The VA is trying to put the onus of proof on the veteran, rather than on the government to show why society at large has a compelling interest in revoking the citizen’s constitutional rights. The VA’s attitude flips the centuries old tradition of civil liberties and due process of law on its head.

Eleven Senators co-sponsored the Burr legislation: Senators Boozman (R-AR), Wicker (R-MS), Risch (R-ID), Moran (R-KS), Chambliss (R-GA), Roberts (R-KS), Thune (R-SD), Enzi (R-WY), Vitter (R-LA), Crapo (R-ID), and Inhofe (R-OK) are cosponsors of the legislation. The measure got a majority of Senators to vote in favor – the final vote was 56-44 – Senate rules require 60 votes to break cloture and receive a final up-or-down vote.

In addition to broad Republican support, the amendment also received support from these Democrats and Independents: Joe Donnelley (Indiana), Kay Hagan (North Carolina), Heidi Heitkamp (North Dakota), Angus King (I-Maine), Mark Begich (Alaska), Mary Landrieu (Louisiana), Mark Pryor (Arkansas), Bernie Sanders (I-Vermont), Claire McCaskill (Missouri), Jon Tester (Montana) and Max Baucus (Montana).

According to reporting from The Hill, Senator Chuck Schumer (D-New York) expressed strong opposition to the amendment, calling it “ridiculous” because there were some veterans who had had their 2nd amendment rights revoked for a good reason.

A similar bill, sponsored by Representative Jeff Miller, the current Republican chairman of the House Veterans Affairs Committee, is alive in the House of Representatives. 

22 Veterans per Day Commit Suicide as VA Struggles to Trim Wait Lists

Posted by Jason Van Steenwyk

describe the imageYou know it’s bad news if it gets released on a Friday right before Superbowl Weekend.

On Friday, February 1, the Department of Veterans Affairs released a new report, detailing the suicide problem among veterans and highlighting the demographics most affected. The report found that about 22 veterans per day, on average, committed suicide in 2012. Similar numbers of veterans committed suicide each day in 2010 and 2011. The long-term average is about 20, according to the VA. The data showed that veterans identified as having committed suicide were more likely to have higher levels of academic achievement, were more likely to have been married, widowed or divorced and more likely to be non-Hispanic whites.

The report also says that women who commit suicide may be underreported as veterans, because their veteran status is less likely to be identified on their death certificates. This means that the actual rate of suicide among veterans is likely to be somewhat higher.

Meanwhile, the Veterans Administration is having trouble ensuring that veterans reporting a need for mental health care are receiving treatment in a timely manner: The Veterans Affairs Office of the Inspector General found that a number of VA clinics in the Atlanta area had unacceptably high numbers of patients seeking mental health or substance abuse treatment on the wait list in 2010.

They also found that the VA had not established a metric or standard to ensure that once a veteran had been seen in an initial appointment, that the veteran could receive follow-up or continuing treatment in a timely manner.

Because of this glitch, VA staff could see a new patient quickly, and then put him back on the wait list. In this manner, clinical directors could look good in their reports and evaluations, while still having large numbers of patients on long waiting lists for appointments and follow-up care.

Another report by the VA Office of the Inspector General issued in 2012 excoriated the Veterans Health Administration for the same reason – indicating not much had changed in the two years between the IG inspection of the Georgia clinics in 2010 and this report:

In VA’s FY 2011 Performance and Accountability Report (PAR), VHA reported 95 percent of first-time patients received a full mental health evaluation within 14 days. However, this measure had no real value as VHA measured how long it took VHA to conduct the evaluation, not how long the patient waited to receive an evaluation.

For example, if a patient’s primary care provider referred the patient to mental health service on September 15 and the medical facility scheduled and completed the evaluation on October 1, VHA’s data showed the veteran waited 0-days for their evaluation. In reality, the veteran waited 15 days for their evaluation.

The report went on to note that a wait list of 50 days was regular and routine among those not seen in the first 14 days – which was 52 percent of them. Since the number was an average, a significant number of these veterans seeking mental health care waited longer than that.

The Inspector General also found that the VHA’s own numbers were neither accurate nor reliable, and they routinely and significantly overstated their success in meeting the 14 day requirement established by the Secretary of Veterans Affairs.

Further, according to the office of Representative Jeff Miller (R-FL), the chairman of the House Veterans Affairs Committee, VA clinics were operating with mental health care staff vacancies as high as 23 percent, and 70 percent of VA mental health staff believed they did not have enough staff to cover the workload.

The Department of Veterans Affairs did announce it was increasing mental health staff by 9 percent last April, and in August of 2012, the President signed an executive order directing the significant expansion of mental health care staff throughout the VA. 

Newtown School Massacre Raises Issues for Veterans, Mental Health and Law Enforcement

Posted by Jason Van Steenwyk

veterans mental healthLast 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.