Mr. Chairman, ranking member and distinguished members of the committee, on behalf of Iraq and Afghanistan Veterans of America, and our tens of thousands of members nationwide, I thank you for the opportunity to testify today regarding this important subject. I would also like to point out that my testimony today is as the Director of Government Affairs for the Iraq and Afghanistan Veterans of America and does not reflect the views and opinions of the United States Marine Corps.
During the Iraq and Afghanistan Wars, American troops’ mental health injuries have been documented and analyzed as they occur, and rates are already comparable to Vietnam. But thanks to today’s understanding of mental health screening and treatment, the battle for mental health care fought by the Vietnam veterans need not be repeated. We have an unprecedented opportunity to respond immediately and effectively to the veterans’ mental health crisis.
Mental health problems among Iraq and Afghanistan veterans are already widespread. The VA has given preliminary mental health diagnoses to over 100,000 Iraq and Afghanistan veterans. But this is just the tip of the iceberg. The VA’s Special Committee on PTSD concluded that:
“15 to 20 percent of OIF/OEF veterans will suffer from a diagnosable mental health disorder... Another 15 to 20 percent may be at risk for significant symptoms short of full diagnosis but severe enough to cause significant functional impairment.”
These veterans are seeking mental health treatment in historic numbers. According to the VA, “OEF/OIF enrollees have significantly different VA healthcare utilization patterns than non-OEF/OIF enrollees. For example OEF/OIF enrollees are expected to need more than eight times the number of PTSD Residential Rehab services than non-OEF/OIF enrollees.” With this massive influx of veterans seeking mental health treatment, it is paramount that we ensure the treatment they are receiving is the most effective and will pave a path to recovery.
But before I speak about the specifics of PTSD treatment and research, I’d like to talk about two of the barriers that keep veterans from getting the proper treatment in the first place.
The first step to treating PTSD is combating the stigma that keeps troops from admitting they are facing a mental health problem. Approximately 50 percent of soldiers and Marines in Iraq who test positive for a psychological problem are concerned that they will be seen as weak by their fellow service members, and almost one in three of these troops worry about the effect of a mental health diagnosis on their career. Because of these fears, those most in need of counseling will rarely seek it out. Recently, my reserve unit took part in completing our Post-Deployment Health Reassessment, which includes a series of mental health questions. While we underwent the training, one of my Marines asked me about Post Traumatic Stress Disorder. He said: “If there is nothing wrong with it, then why is it called a Disorder?” I could not have agreed with him more. To de-stigmatize the psychological injuries of war, IAVA has recently partnered with the Ad Council to conduct a three-year Public Service Announcement campaign to try and combat this stigma, and ensure that troops who need mental health care get it. Our goal is to inform service members and veterans that there is treatment available and it does work.
Once a service member is willing to seek treatment, the next step is assuring that they have convenient access to care. On this front, there is much more that must be done, particularly for rural veterans. More than one-quarter of veterans live at least an hour from a VA hospital. IAVA is a big supporter of the Vet Center system, and we believe it should be expanded to give more veterans local access to the Vet Centers’ walk-in counseling services.
The problems related to getting troops adequate mental health treatment cannot be resolved unless these two issues – stigma and access -- are addressed. However, once a service member suffering from PTSD has access to care, we also need to ensure they receive the best possible treatment.
Currently, a variety of treatments are available. Psychotherapy, in which a therapist helps the patient learn to think about the trauma without experiencing stress, is an effective form of treatment. This version of therapy sometimes includes “exposure” to the trauma in a safe way – either by speaking or writing about the trauma, or in some new studies, through virtual reality. Some mental health care providers have reported positive results from a similar kind of therapy called Eye Movement Desensitization and Reprocessing (EMDR).
In addition, there are medications commonly used to treat depression or anxiety that may limit the symptoms of PTSD. But these drugs do not address the root cause, the trauma itself. IAVA is very concerned that, in some instances, prescription medications are being seen as a “cure-all” that can somehow “fix” PTSD or replace the face-to-face counseling from a mental health professional that will actually help service members cope effectively with their memories of war.
Everyone knows that counseling and medication can be effective in helping psychologically wounded veterans get back on their feet, and IAVA encourages any veteran who thinks they may be facing a mental health problem to seek treatment immediately. But we are also aware of the limitations of current research into the treatments of PTSD.
A recent Institute of Medicine study, entitled “Treatment of Posttraumatic Stress Disorder: An Assessment of the Evidence,” outlined the many gaps in current research. Among the problems they identified:
“Many studies lack basic characteristics of internal validity.” That means too many people were dropping out of these studies, the samples were too small, or follow-up was too short.
The IOM committee also identified serious issues with the independence of the researchers. “The majority of drug studies were funded by pharmaceutical manufacturers,” and “many of the psychotherapy studies were conducted by individuals who developed the techniques.”
Finally, the committee concluded that there were serious gaps in the subpopulations assessed in these studies. Veterans may react differently to treatment than civilians, but few of the studies were conducted in veteran populations. There’s also not enough research into care for people suffering from co-morbid disorders, such as TBI or depression.
The solution is more and better research. To respond to the IOM findings, IAVA wholeheartedly supports more funding for VA research into PTSD and other medical conditions affecting Iraq and Afghanistan veterans.
Thank you for your attention and your work on behalf of Iraq and Afghanistan veterans. If the Committee has any questions for me, I’ll gladly answer them at this time.
Director of Governmental Affairs
Iraq and Afghanistan Veterans of America