In particular, the attorneys working on this issue claim that the VA is "structurally unsuitable" for dealing with post-traumatic stress disorder (PTSD) which is "a signature problem" veterans of the Iraq and Afghanistan wars are suffering from (Weinstein). Symptoms of PTSD include: "…intense anxiety, persistent nightmares, depression, uncontrollable anger, and difficulties coping with work, family, and social relationships" (Weinstein).
There an estimated 1.6 million men and women who have served the U.S. In those two conflicts, and according to a Pentagon Task Force report an estimated "38% of soldiers and 50% of National Guard members" that returned home from Iraq or Afghanistan "have mental health issues, ranging from post-traumatic stress disorder to brain injuries" (Weinstein). Those numbers, along with the assertion that only 27 of the VA's 1,400 medical facilities have inpatient post-traumatic stress disorder programs, create an enormous gap in needs vs. services, the lawyers for the plaintiffs point out (Weinstein).
The lawsuit does not ask for a monetary reward; it is designed to prevent the VA from "systematically denying what it asserts are valid claims by injured veterans" (Weinstein). Moreover, the lawsuit asserts that the VA has "consistently presented misleading statistics" that have to do with the number of veterans who need mental health services, the length of time it takes to process a claim, and the amount of money the VA needs to meet it's full obligations to veterans.
Meanwhile a report by the Institute of Medicine (IOM) (a branch of the National Research Council, an independent organization that provides advice and research data to the U.S. Government) indicates that soldiers returning from Iraq and Afghanistan "aren't getting enough attention" when it comes to mental health. The IOM urged the Veterans Affairs Department (VAD) to research the problem of "traumatic brain injuries" that are caused when roadside bombs go off near troops (www.CBC.ca.news). The long-term effects of traumatic brain injuries can include seizures, reduced mental capabilities and dementia, according to the IOM report. The report resulted from research conducted by a 16-member IOM panel; on that panel was Dr. George Rutherford, professor of epidemiology and biostatistics at UC San Francisco, who said:
"Job training and job loss due to multiple deployments are other serious issues facing these individuals, as is doctors' ability to diagnose and treat traumatic brain injuries" (CBC).
Also today there is a serious problem with veterans' healthcare in that an estimated 107,000 veterans are homeless -- and many of those are living on the street. The Secretary of Veterans Affairs, Eric K. Shinseki, has restructured the VA's budget for homeless veterans so that 85% of the VA's budget request for next fiscal year (July 1, 2010 -- June 30, 2011) will be spent on medical services (Miles, 2010). This means that health issues like substance abuse, depression, PTSD, traumatic brain injury and other injury-related issues will be addressed more fully.
One fact that is troubling is presented in a research report (Himmelstein, et al., 2007) in the American Journal of Public Health; "…Only a minority of veterans -- those disabled by military service -- are automatically eligible for VA care" (Himmelstein, p. 1). Also, as of 1996, veterans who are "non-poor" (earning more than $30,000 a year) were required to make co-payments at the VA up to $50 a day (Himmelstein, p. 1). Using surveys conducted by the federal government, the authors determined that 1.8 million veterans were not insured and not receiving Veterans Administration care in 2004 (Himmelstein, p. 1).
Another troubling statistic that results from a Harvard Medical School study and is presented by the Physicians for a National Health Program shows that 2,266 American veterans under the age of 65 "died last year  because they lacked health insurance and thus had reduced access to care" (www.pnhp.org).
Specific solutions to remedy VA healthcare shortcomings are urgently needed. Moving the federal government -- the executive branch and Congress -- to action is a painstakingly sluggish process. These solutions require lobbying by nationally known advocacy groups which will require millions of donated dollars to purchase high-visibility media messages.
ONE: The VA must: a) fund research on the healthcare needs of veterans, their families based on multiple deployments in Iraq / Afghanistan; b) begin hiring and training thousands of mental health doctors and nurses to deal with the long-term needs of veterans with multiple traumas, PTSD, and brain injuries; assignments will be based on need and proximity to VA facilities; c) reduce the stigma of mental health problems within the military; many soldiers do not wish to admit they have combat-related mental problems.
TWO: With regards to PTSD, the VA must move towards a "Knowledge Management System" (Ruzek, et al., 2005): a) training doctors, nurses and staff to implement cognitive-behavior therapy (CBT) interventions ("cognitive-processing therapy" and "prolonged exposure therapy"); b) in addition to the therapies the VA must hire and train staff to carefully, accurately monitor the ongoing CBT interventions; Is there a better design for treatment? How can the clinician and the patient work more closely together to add to the accountability of the treatment? c) the prescribing of psychotropic medications must be in line with clinical practice guidelines -- guidelines to be updated as the program to treat PTSD and other mental issues is launched.
THREE: How will these solutions be implemented? Veterans groups and other legitimate advocacy organizations in all 50 states must embrace proven, high-visibility methods (media, direct action demonstrations, use of celebrity spokespersons and more) to apply pressure to U.S. senators, Congressional representatives, mayors, governors and other leaders. There are risks involved in this strategy, and this will take time, but the Obama Administration (including First Lady Michelle Obama, who has advocated for military families) has reached out to veterans and their families and therefore the President of the United States can be the most effective ally in the effort to provide mental and physical health upgrades to the existing VA services.
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