Testimonies

VA Mental Health Care

Mr. Chairman, Ranking Member, and members of the Subcommittee, thank you for inviting Iraq and Afghanistan Veterans of America (IAVA) to present our views on VA Mental Health care. Record budgets for VA over the past three years are testament to the hard work of each member of this committee. On behalf of our 180,000 members and supporters, we would like to thank this committee for your unwavering commitment to our nation’s veterans. My name is Todd Bowers. As a staff sergeant in the United States Marine Corps I have had countless conversations with my junior Marines on the stigma of mental health in our military. During my multiple deployments in support of operations Iraqi and Enduring Freedom, I have seen firsthand, the importance of the physical and mental health of my men. The members of IAVA know we must have this discussion.

“I believe the #1 issue facing veterans of Iraq and Afghanistan should be mental health. Being a veteran of Iraq, I have had some mental health issues and would like to see IAVA & Congress work harder to get the military to reduce the stigma of seeing mental help.” – IAVA Member

IAVA is pleased to see that the President’s VA budget submission has allocated $5.2 billion toward the treatment of hidden injuries such as PTSD and TBI, a sizeable 8.5% increase over last year’s budget.  This funding is critically needed  as the VA prepares for the “surge home” of veterans from Iraq and Afghanistan. While we are grateful for this dramatic bottom line, we believe that the VA must make a serious commitment to eliminate the stigma around seeking help for mental health injuries, prioritize VA outreach, ensure access to top quality mental health care and bring all veterans in from the cold.

I. The Most Dangerous Part Of Going To War These Days Is Coming Home.

When I was in Afghanistan, on my fourth tour, it was hard to imagine that there was anything scarier then road side bombs and snipers. I was wrong. Last year, more U.S. servicemembers died by their own hands than in combat in Afghanistan [1]. These numbers do not even include the veterans who commit suicide after their service is complete, whose deaths are insufficiently tracked. Recently released Department of Defense (DOD) numbers show that we are on track to break last year’s 30-year high suicide rate. Every Iraq or Afghanistan veteran  knows a fellow veteran who has  succumbed to suicide.

“Since my return, I have lost 2 close friends to suicide, 2... I said 2, from my platoon.  That is the sick reality.” – IAVA Member

Sadly, suicides are just the canaries in the mine when we try to understand the breadth of mental health care needs for our returning servicemembers. Untreated mental health problems can and do lead to substance abuse, homelessness and suicide. In 2008 a RAND study reported that almost 20 percent of Iraq and Afghanistan veterans screened positive for Post Traumatic Stress Disorder (PTSD) or major depression. A recent study by Stanford University found that this number may be closer to 35 percent. Not even half of those veterans suffering from mental health injuries are receiving sufficient treatment.

II. The World’s Best Mental Health Program Will Still Fail If No One Uses It.

Exacerbating the problem of inadequate treatment is the heavy stigma associated with receiving mental health care. More than half of the soldiers and Marines in Iraq, who test positive for a psychological injury, report concerns that they will be seen as weak by their fellow servicemembers. One in three of these troops worry about the effect of a mental health diagnosis on their career. As a result, those most in need of treatment may never seek it out.

“A paradigm shift must occur.... ‘you're a whimp if you see the wizard’ needs to go away and be replaced with ‘everyone needs someone’.” – IAVA Member

In order to end the suicide epidemic and forever eliminate combat stress stigma we believe that VA and DOD must declare war on this dangerous stigma by launching a nationwide campaign to combat stigma and to promote the use of DOD and VA services such as Vet Centers and the Suicide Prevention Hotline.

This campaign must be well-funded, research-tested and able to integrate key stake-holders like Veterans Service Organizations and community-based non-profits. Furthermore, the VA should develop and aggressively disseminate combat stress injury training programs for civilian behavioral health professionals that treat veterans outside of the VA (e.g., college counselors, rural providers, behavioral health grad students and professional associations).

We believe that VA must allocate specific resources toward battling this dangerous stigma or we will never see the critical mass of veterans coming into to seek help. Furthermore, in order for this campaign to have a lasting effect throughout the ranks of our forces, the DOD must include mental health in the training schools for junior officers and non-commissioned officers. 

III. IAVA’s Has The Department Of Veterans Affairs Back.

Based on our own historic Public Service Announcement (PSA) campaign with the Ad Council, we have learned a thing or two about stigma busting and veteran outreach campaigns. Hopefully by now you’ve seen our iconic PSAs such as the one featuring me and another young veteran shaking hands in an empty New York street.

“The Iraq and Afghanistan Veterans of America brilliantly portrayed this feeling of isolation in a 2008 ad where a soldier returning from the war walks through an empty airport. He continues through downtown Manhattan, which is also completely empty. No cars. No people. It isn't until a young veteran approaches the soldier with a handshake, a smile and pat on the back saying, "Welcome home, man," that the street becomes populated.

I was a bit shaken the first time I saw it, as it immediately resonated with me. It hit an exposed nerve, and I knew that those guys at the IAVA "got it." They knew exactly where we were coming from.

The problem, of course, is that we, as veterans, live the rest of our young lives in the "civilian" world and not on the battlefield. It took me several months to fully comprehend this. After realizing that my sense of isolation was alienating me from those I loved, I made the conscious decision to use my experiences in combat as a source of great strength, versus letting them become a weakness.”[2]

These TV ads are just one component of this groundbreaking campaign. They are complimented by billboards, radio commercials, and web ads that have blanketed the country and touched millions of Americans. In just the first year of the campaign, IAVA has secured $50 million dollars in donated media and reached millions of veterans.

This campaign directs veterans to an exclusive online community where their fellow veterans are there to support them. Or, to use the saying, which we at IAVA have embraced, “We’ve Got Your Back”. 

Our Community of Veterans, also directs veterans to a wide range of mental health, employment and educational resources—operated by both private non-profits and the VA.  This campaign is just an example of the type of innovation coming out of the VSO community that can help guide the VA. Innovative, aggressive outreach programs like this must become part of the new VA culture and programs like this can fuel-inject outreach efforts. We are learning what works, and we are eager to share our experience and best practices.

IV. Outreach, Outreach, Outreach.

The Department of Veterans Affairs must shed its passive persona, by adopting a customer-centered approach, and by recruiting veterans and their families more aggressively into VA programs. This means developing a relationship with the servicemember while they are still in the service, much like many successful college alumni associations do, by greeting students at orientation and putting on student programs throughout a student’s time in college. And once a veteran leaves the military, the VA should create a regular means of communicating with veterans about events, new programs and opportunities. If I got half as many letters and emails from the VA as I do from my College Alumni Association, we would be in great shape. The VA must also reach out to those veterans who have yet access their VA benefits and aggressively promote VA programs.

“The VA could be more aggressive in contacting OIF/OEF veterans and at least talking to them before the veteran has a mental health crisis. They need to be proactive instead of reactive.” –IAVA Member

In order to accomplish this phase of transformation, IAVA believes that the VA must prioritize outreach efforts and include a distinct line item for outreach within each VA appropriation account. This line item should help fund successful outreach programs such as the OEF/OIF Outreach Coordinators, Mobile Vet Centers and the VA’s new social media presence on Facebook and Twitter. Right now, these outreach programs are still too small and under-sourced to make a transformative difference. IAVA was disappointed that there were only a few brief mentions of outreach activities throughout the President’s VA budget submission and none of which was a dedicated outreach campaign.

V. “Eight Weeks To See A Counselor?”

Convincing a veteran to overcome their fears and choose to seek help is hard enough, we should ensure that once the veteran makes the choice to seek care they have ready access to the care they need. Too many of our veterans have complained about long wait times and inconvenient hours for seeking help.

“It took me over 6 months for a mental health appt through VA and this was after I told them I was having suicidal and homicidal ideations. I’m still waiting now for some appointments.” – IAVA Member

“The VA needs to expand its staff and its hours of operation so that Veterans aren't forced to get help only between the hours of 8am and 4pm.  As it currently stands, Veterans are forced to choose to put off treatment in order to stay at work while our economy is at its worst in decades.” – IAVA Member

We believe that the VA should be focusing on dramatically increasing the number of mental health providers within the VA. This will reduce wait times and improve overall quality of care.

“The VA clinic in Salt Lake City is understaffed and underfunded.  While the people are great, their giant case loads distract from treating patients.” – IAVA Member

“We need a ‘surge’ of mental health professionals!  It is time the rest of the country steps up and begins to sacrifice as well.” – IAVA Member

IAVA also supports creative solutions for rural veterans who are just too far from a local VA facility for treatment to make sense. We continue to support contracting with local community mental health clinics  as well as the VA providing grants for groups providing peer to peer counseling.

“I went 80 miles to the local VA outpatient treatment facility, they did not have anyone on staff to talk to. They have group meetings, but again, its 80 miles roundtrip and I would have to be there by 4. I work till 5. That means that I would have to leave almost 2 hours early to drive 80 miles roundtrip just to talk to someone who had a similar experience. I can't do that.” – IAVA member

VI. Coming In From The Cold.

Depression, post-traumatic stress, substance abuse and divorce are believed to be potential root causes that can lead a veteran down the path to homelessness. The VA and DoD must confront the stigma of seeking treatment for mental health issues throughout our military and veteran community.

The VA estimates there are 107,000 veterans homeless on any given night and nearly twice as many veterans experience homelessness at some point during the year. New veterans are especially at risk. At the height of the housing crisis, foreclosure rates in military towns were increasing at four times the national average, and already shockingly, more than 3,700 Iraq and Afghanistan veterans have been seen in the Department of Veterans Affairs’ homeless outreach programs. Unlike previous generations of veterans, Iraq and Afghanistan veterans are often appearing in the nation’s homeless shelters within two years of separation from the military, and a significant amount of the homeless are female veterans and their children.

“We still have a lot of veterans here in Long Island NY, who are homeless. They need to know there is help at the VA hospitals for us, and they will help us find homes.  A lot of the veterans think they are alone with their mental issues, and are ASHAMED to face it.  We need to get the word out there more.  I found out all this in Groups at the VA hospital I attend from other veterans.” – IAVA member

In 2009, the VA laid out a bold vision to fully eradicate homelessness among veterans within the next 5 years. This ambitious plan will require a new model for serving veterans and extensive collaboration between government agencies, traditional Veterans Service Organizations (VSOs), and the new breed of grassroots and nontraditional nonprofit organizations, such as the Coalition of Iraq and Afghanistan Veterans (CIAV). This partnership between the public and private sector must also be utilized to smooth the transition home for all veterans. IAVA believes that granting VA discretion to match the Grant and Per Diem (GPD) program payment rates to the actual cost to help a homeless veteran and expanding the HUD-VA Supportive Housing (HUD-VASH) voucher program, to include the funding of 30,000 additional housing vouchers, will transform the lives of tens of thousands of homeless veterans.

IAVA applauds the VA’s goal to cut in half the number of veterans sleeping on our streets by the end of this year and we believe that the additional $294 million for joint VA-HUD programs in the President’s budget request will go along toward accomplishing that goal.

[1] In 2009 a record 334 servicemembers committed suicide.

[2] “Back from Iraq war, and alone.” Mike Scotti, March 10, 2010.