Mr. Chairman, and members of the Subcommittee, the Paralyzed Veterans of America (PVA) appreciates this opportunity to present its views and recommendations concerning how the U.S. Department of Veterans Affairs (VA) can best assist veterans with mental illness by providing counseling and education services to their families.

Mr. Chairman, evidence is growing that the prevalence of mental illness is high in veterans who served in Iraq and Afghanistan.  Combat exposure coupled with long and frequent deployments are associated with an increased risk for Post Traumatic Stress Disorder (PTSD) and other forms of mental illness.  VA reports that Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF) veterans have sought care for a wide array of possible co-morbid medical and psychological conditions, including adjustment disorder, anxiety, depression, PTSD, and the effects of substance abuse.  VA reported that of the 299,585 separated OIF/OEF veterans who have sought VA health care since fiscal year 2002, a total of 120,049 unique patients had received a diagnosis of a possible mental health disorder.  Almost 60,000 enrolled OIF/OEF veterans had a probable diagnosis of PTSD, almost 40,000 OIF/OEF veterans have been diagnosed with depression, and more that 48,000 reported nondependent abuse of drugs[1].

The impact of a veteran’s mental illness is far reaching and obviously has serious consequences for the individual veteran being affected.  However, less obvious are the serious consequences, stemming from a veteran’s mental illness, that confront his/her spouse, their children and other family members.  Families of veterans provide the most basic support network for returning veterans.  Spouses of veterans are usually the first to identify readjustment issues, and they are usually the best advocates for guiding the veteran into professional care.  However, to provide correct guidance on treatment these family members must have a basic understanding of VA mental health resources and how to access them.  This understanding can only come from comprehensive VA family counseling and education services. 

Additionally, spouses and other family caregivers who provide love, support and assistance to the veteran must also cope with tremendous personal stress as well.  Unfortunately, VA’s Mental Illness family support services are limited or restricted.   PVA believes that Congress should formally authorize, and VA should provide, a full range of psychological and social support services as an earned benefit to family caregivers of severely injured and ill veterans. 

Family counseling support services that are needed by recently returning OIF/OEF veterans are only available, on a limited basis in VA, despite the increasing need for such services.  For example, in the most recent survey of soldiers and marines in Iraq, which included a large number of reservists, 20 percent of soldiers and 13 percent of marines indicated that they were planning a divorce, double the rate found just two years ago[2].  Additionally, in a recent anonymous survey of Maine National Guard members, after repatriation from deployments, 36 percent acknowledged relationship problems with a spouse and/or children[3].  Despite this information few VA medical centers or VA community-based outpatient clinics provide any marital and/or family counseling. 

Mr. Chairman, VA’s Vet Center program has a long history of treating the mental health needs of America’s veterans.  Family counseling is provided when possible and as needed for the adjustment of the veteran. However, veteran’s families represent the “front line” of the support network for returning veterans.  PVA believes, a veteran’s successful mental health treatment often depends on the stability and understanding of his/her family unit.  Therefore, PVA believes that VA should expand its support services for veteran’s families.  We support expansion of mental health services for veterans and counseling/education services for families in all VA major care facilities.  However, in the near term, Vet Centers should increase coordination with VA medical centers to accept referrals for family counseling; increase distribution of outreach materials to family members with tips on how to better manage the dislocation; improve reintegration of combat veterans who are returning from deployment; and provide information on identifying warning signs of suicidal ideation so veterans and their families can seek help with readjustment issues. 

PVA believes that an effective VA mental illness family counseling/education program can improve treatment outcomes for veterans, facilitate family communication, increase understanding of mental illness, increase the use of effective problem solving and reduce family tension[4].  PVA agrees with VA’s Family Mental-Health Learning Program (FaMHeLP) when it says, “Working with family members helps both veterans and their families.  Research has shown that family members of veterans with mental illness are happier when they fully understand the nature of the illness.  Family members also want to learn the best ways to help their loved ones.  Family members are often in a good position to help because they know the veteran better than anyone else.  Veterans do better in their daily lives at home and work when they live with family members who understand their illness.  These veterans are also less likely to have a mental health crisis.”

PVA strongly believes that VA must embrace new models of support for the families of this generation of combat veterans.  Family counseling support services that are needed by recently returning OIF/OEF veterans must be expanded.  The spouse of a veteran with combat related mental illness is likely to be young, have dependent children, and reside in a rural area where access to support services of any kind can be limited.  It is additionally possible that other individuals who play significant roles in the veteran’s life such as, mom and dad, the significant other, the best friend, a brother or sister or a paid personal care attendant will also require access to these services.  Whether the caregiver resides in an urban or rural setting, VA mental health services for veterans and services for veteran’s family or caregivers members must be readily available. 

PVA also believes Congress should formally authorize, and VA should provide, a full range of psychological and social support services as an earned benefit to family members of severely injured and ill veterans.  At a minimum this benefit should include education on mental illness, relationship and marriage counseling, family VA benefit counseling, and related assistance for the family coping with the stress and continuous psychological burden of caring for a severely injured or mentally ill veteran. 

As this Subcommittee moves forward with deliberations on how best to provide services to the families of veterans with mental illness it may be worth reviewing VA progress regarding Section 214 of Public Law 109-461.  Section 214 required VA to implement a pilot program to assess and improve caregiver assistance services.  Public Law 109-461 required the VA Secretary to carry out the pilot over a two-year period within 120 days following enactment of Public Law 109-461.  Caregiver assistance referred to VA services that would assist caregivers such as:

• adult-day care.
• coordination of services needed by veterans, including services for  readjustment and rehabilitation.
• transportation services.
• caregiver support services, including education, training, and certification of family members in caregiver activities .
• home care services.
• respite care.
• hospice services and other modalities of non-institutional VA long-term care.

This list of services is part of VA’s basic benefit package and is available to all enrolled veterans.  PVA believes that the availability of these long-term care benefits should be a part of any family counseling/education program under consideration.  Public Law 109-461 authorized $5,000,000 for each of fiscal years 2007 and 2008 to carry out the pilot project.  PVA has made inquiries to VA regarding the status of the pilot project but has yet to receive a detailed briefing of the projects progress.

Finally, Mr. Chairman, PVA has over 60 years of experience understanding the complex needs of spouses, family members, friends and personal care attendants that love and care for veterans with life long medical conditions.  Additionally, because some PVA members with spinal cord injury also have a range of co-morbid mental illnesses, we know that family counseling and condition specific education is fundamental to the successful reintegration of the veteran into society.  Our experience has shown that when the veteran’s family unit is left out of the mental illness treatment plan veterans with spinal cord injury who also have mental health conditions experience life long reoccurring medical and social problems.  However, when family counseling/education services are provided by VA, veterans are more apt to become independent and productive members of American society.

Mr. Chairman, I would like to thank you again for the opportunity to address this important subject.  This concludes my statement.  I will be happy to answer any questions that you may have.

[1]  Department of Veterans Affairs, VHA Office of Public Health and Environmental Hazards.  “Analysis of VA Health Care Utilization Among US Global War on Terriorism (GWOT) Veterans: Operation Enduring Freedom, Operation Iraqi Freedom,” January 2008.

[2]  Office of the Surgeon Multinational Force – Iraq (OMNF-I) and Office of the Surgeon General United States (OTSG), U.S. Army Medical Command, Mental Health Advisory Team (MHAT-IV), Operations Iraqi Freedom 05-05 Final Report, 17 November 2006.

[3] Wheeler, E. Self-Reported Mental Health Status and Needs of Iraq Veterans in the Maine Army National Guard.  Community Counseling Center, 2007 (unpublished).

[4]  FaMHeLP, North Florida/South Georgia Veterans Health System (NF/SGVHS) Psychology Service.  For more information contact: Jennifer W. Adkins, Ph.D., Psychology Service (352) 246-1420 or Sheryl A. Conner, Ph.D. LCSW, Social Work Service (352) 246-1282.