Ms. Sue Bergeson
Chairman Michaud and members of the Committee:
On behalf of the Depression and Bipolar Support Alliance (or DBSA), thank you for the opportunity to testify today about mental health services offered to and needed by our veterans through the veterans centers of the Veterans Administration. DBSA further thanks you and the other members of the Committee for your efforts in focusing the attention of the nation on the plight of the men and women of our military forces who are returning from combat with their mental health devastated.
DBSA is the nation’s largest peer-run mental health organization, with more than 1,000 state and local affiliates in all 50 states. By peer-run, we mean that our organization is led by staff and volunteers living with mental illnesses – people like me – people who experience the debilitating effects of mental illnesses first-hand. Our organization focuses on the power of peer support as a key component in recovery from mental illnesses.
DBSA regularly partners with the VA on peer support training and technical assistance for veterans, both nationally and at local facilities. Additionally, DBSA has long been represented on the Consumer Liaisons Council to the VA Committee on Care of Veterans with Serious Mental Illness.
One of the most important services DBSA offers – indeed, our cornerstone – is helping people diagnosed with mental illnesses to help each other. We train individuals and establish support groups throughout the country, preparing them to assist their peers on the road to recovery.
Let me first briefly describe our perspective on the need faced by veterans today, a need of which I know this committee is all too aware, but which helps lay the groundwork for an effective and cost-effective solution.
Recent and continuing conflicts in Afghanistan and Iraq have placed a heavy burden on our country’s National Guard and Reserves, in addition to the standing armed forces. Not unexpectedly, these conflicts have taken a toll on the mental health of the men and women serving.
With more than a quarter million individuals returning from active military service in FY2006, many of them coming from postings of extreme danger and stress, there is an overwhelming need for mental health care for veterans. More than 35% of Afghanistan and Iraq veterans treated at the VA have been diagnosed with mental disorders.
The Defense Medical Surveillance System, in data reflecting the health self-assessments of service members who had returned from Iraq since June 2005, showed that 50% of Army National Guardsmen and approximately 45% of Army and Marine reservists reported mental health concerns. Much of the mental health treatment these service members receive is provided by the VA, which estimates that 35% of the care provided through its facilities from 2002 to 2006 was related to the diagnosis or treatment of a mental health disorder.
According to a recent article published in the Archives of Internal Medicine, veterans ages 18 to 24 returning from Afghanistan and Iraq are nearly three times more likely to be diagnosed with mental health or posttraumatic stress disorders, compared with veterans 40 years or older
Dr. Karen Seal, a physician at the San Francisco VA Medical Center and lead author of this new research, states, “You have a young population possibly not getting treatment for these conditions, and going on to have chronic mental illness … It’s potentially a big public health problem.”
In answer to calls by veterans and their families, screening of returning veterans for symptoms of mental illness is now more widespread. Yet this screening does not identify many affected individuals. Some veterans do not immediately experience symptoms, which arise much later after their return to civilian life. A high proportion of soldiers misinterprets or ignores symptoms in order to return home more quickly, or in response to the pervasive stigma of mental illness in the military.
At the very time the need for mental health services is the greatest, sadly, the Veterans Administration does not have the capacity to deliver these services to all veterans in need. Despite the valiant efforts of the many dedicated service providers working throughout the VA, current capacity cannot meet demand. News reports continue to document a staggering number of unfilled VA mental health positions. These shortages result in long waits for appointments and care, sometimes with tragic consequences for veterans in need.
Many veterans, distrustful of VA services and mental health professionals, or wanting to put all reminders of military service behind them, never seek available care or seek it only after reaching the crisis point.
In 2006, a committee of VA experts declared that the “VA cannot meet the ongoing needs of veterans of past deployments while also reaching out to new combat veterans … and their families by employing older models of care. We have a new job and we need to do it in a new way.”
Chairman Michaud, Today we have the greatest resource to help combat these grim statistics right at our fingertips – and that resource is our veterans themselves. The members of our armed forces pledge to leave no comrade behind on the battlefield. When the enemy becomes mental illness, our nation’s veterans stand willing to help each other in this new conflict. Such support comes naturally to veterans who have been trained to rely on each other in battle, and who now face the biggest battle of their lives – the struggle to overcome mental illness.
Veterans, who have successfully recovered from mental illnesses, reaching out to other veterans with mental illnesses, are an authentic source of hope for the future. Veteran peer supporters can connect with other veterans at a level no clinical provider, however dedicated, can match.
Let me illustrate the value of veteran peer support services through the example of a resident of the Chairman’s home state of Maine. Jack Berman is a resident of South Portland, Maine. He is a disabled veteran who has served as vice president of the Maine Military Coalition, and as president of the Military Officers’ Association of America (MOAA).
Seventy-nine year old Jack Berman is a man of many talents – in spite of the adversity he has faced in his life. An entrepreneur, a rehabilitation counselor, a highway-planning engineer for the New York Port Authority – these are just a few of his accomplishments.
Mr. Berman was appointed first lieutenant during the Korean War and fought on the front lines. In 1953, he finished his tour of duty and was awarded five medals, including three bronze stars for Korean service, the United Nations medal and the American National Defense medal.
Yet while in training to go overseas, he was hospitalized and diagnosed with bipolar disorder with episodes of severe depression. As an individual living with a mental illness, how did Mr. Berman survive and excel in so many areas? The answer was connecting with individuals just like him.
As Mr. Berman tells us, veterans are not often inclined to share their stories about the terrible experiences of war with those who may not be able to understand or identify with them. As he told DBSA, “These guys are willing to get their medications from a psychiatrist, but they don’t want to talk to them. They want to talk to others like them.”
That is why Mr. Berman believes that peer-to-peer support is the ideal solution for our country’s many veterans who are now experiencing the impact of returning from active duty. “When a soldier is able to openly share his feelings with another soldier like himself, someone else with a mental illness, something magical happens,” Mr. Berman says. “Talking to my peers was the healing factor in my recovery.”
Our country’s third President, Thomas Jefferson, said, "Who then can so softly bind up the wound of another as he who has felt the same wound himself?”
Peer support in the mental health arena represents a bond between two individuals who share the common experience of a mental illness, and who commit themselves to helping each other achieve lasting recovery. Peer support services have been demonstrated to be an effective supplement to clinical care for mental illnesses.
Solid research shows that peer support is an effective tool in improving mental health, leading to improvement in psychiatric symptoms, decreased hospitalization and decreased lengths of hospital stays, enhanced self-esteem and social functioning of those served, and lower services costs overall.
A proven method to harness the power of peer support and overcome the significant barriers to successful treatment is the Certified Peer Specialist. These individuals are trained and certified to help their peers – other people with mental illnesses – deal successfully with their challenges and move forward with their lives. Peer Specialists help those they assist to make informed, independent choices, and to gain information and support to achieve those goals. They demonstrate recovery from mental illness and how to maintain ongoing wellness.
Peer Specialists offer more regular interaction with others than overworked clinical staff can provide. The outreach they provide in the community and through veterans centers makes support accessible to larger numbers of veterans than can be reached through traditional means alone. And this new role provides opportunities for meaningful work and financial independence for veterans with mental illnesses, who otherwise may have difficulty finding employment.
Peer Specialist services are also significantly cost-effective and have been shown to cost up to 5 times less than older models of care, with improved clinical outcomes. The VA has already identified paid Peer Specialist services as a priority in its Mental Health Strategic Plan and has provided very limited funding for implementation at local VA facilities. DBSA is proud to have assisted in many of these efforts.
However, barriers to full VA implementation of Peer Specialists remain. Some voluntary veteran peer support initiatives exist but are not always integrated into care and/or seen as effective by providers. Veterans need quality training to help them work effectively as peers, and VA providers need preparation to help them fully understand and accept this new approach. Many VA facilities are moving to hire veterans as Peer Support Technicians (the VA’s terminology for Peer Specialist), but no consistent guidelines and standards exist for training and integrating these positions as a key element of mental health services.
There is a critical need for implementation of a national-level pilot project that sets the gold standard for VA Peer Specialist training and delivery of services. Current and future needs require a large-scale and coordinated national effort to make quality peer support services a reality nationwide through the VA.
Therefore, we urge the committee to encourage the VA Office of Mental Health Services to take these three steps:
- Identify and allocate a significant increase in funding for a national veterans mental health peer training and employment initiative.
- Establish and fund a VA Technical Assistance Center for Peer Support Services, partnering with an established national organization with demonstrated experience in peer support training.
- Create and pilot national veteran Peer Support Technician training and certification projects in multiple locations throughout the country.
These actions are just a small part of what we can do to provide our veterans with the necessary tools to fight this new battle on their return home.
DBSA stands ready to assist the committee in its efforts. I thank you for this opportunity to offer our input and would be happy to answer any questions.