1
The Honorable Senator Leticia Van de Putte 201 East 14th St., Sam Houston Building, Suite 345 Austin, TX 78701 July 16, 2012 Re: Status of mental health services for Veterans and Texas Military Forces Madam Chairwoman: Thank you for this opportunity to testify about the status of mental health services for Veterans and Texas Military Forces. I am a Veteran of Operation Iraqi Freedom and a board member of the Iraq and Afghanistan Veterans of America. I am proud to be the manager of TexVet.org, an initiative of the Texas A&M Health Science Center, indexing resources and events for Texas military, Veterans, and families to the local level across the state. This has offered me the opportunity to gain what I think most of our new Veterans need a job and a cause larger than themselves. There is a growing awareness of the need for mental health services for Texas military, active duty troops in Texas, Veterans, and family members. There are some solutions for addressing this need but challenges remain. All of the needs are not covered yet. Our Veterans and families deserve better. Depending on how you ask the question: are you a Veteran? there are about 1.7 million Veterans in Texas. This includes about 109,000 active duty troops over nine percent of the total force. When you count the Reserve and Texas National Guard, commonly referred to as the Texas Military Forces, there are over 190,000 personnel on duty in Texas. This would equate to a city the size of Amarillo. Some 107,000 Army soldiers have been deployed to war three or more times since 2001, or some 20 percent of the active-duty force. More than 50,000 of those currently in uniform have completed four or more combat tours. It is safe to assume that tens of thousands of both active duty and former military with deployment experiences are living and working among us. The Army, the largest provider of both active duty troops and Veterans in Texas, must shrink over the next ten years. This will require the release of about 80,000 Soldiers. More germane the Army will shrink from its current 45 combat brigades to 32. There are nine brigades in Texas now losses will hit the state at a higher rate than others. Texas suffered over 400 casualties in Iraq, with more than 2,800 troops wounded. There have been nearly 1,000 casualties, including 150 deaths, in Afghanistan of Texas troops. Although 2
suicide is certainly not the totality of the problems facing our troops and Veterans, as the most demonstrative of the ills that can befall them, it is instructive to examine. Between 10 and 20% of troops deployed to Iraq or Afghanistan screen positive for some degree of brain injury, approximately one-third report some sort of mental health issue, and as many as ten percent may be diagnosed with Post Traumatic Stress Disorder. An incident that occurred at Fort Hood last year is illustrative in the challenges in providing for and tracking mental health issues in the state. After at least one deployment, former Soldier Justin R. Languis medically separated from the Army in May 2010. On January 10, 2011, he shot himself in front of his old unit as they gathered for physical training. Arguably, his suicide was related to his service, yet he will not appear in the Army s listing of suicides. He will not be counted in Fort Hood s totals, which are based only on Soldiers assigned to Fort Hood at the time of their death. The Army itself does not keep track of attempts at all. In the weeks leading up to this hearing, I have filed several Freedom of Information Act requests with various offices of the Army and the Defense Department attempting to discern the amount of military suicides in Texas and have, so far, been rebuffed. The first step in solving a problem is to identify it, but we have a difficult time defining the scope of this problem, denying the application of other resources beyond the Army s good effort. Veterans deserve better. The Department of Defense, state, and hundreds of other institutions offer services to troops and Veterans. For the person in need, the various systems can offer a challenge to navigate. It is often difficult to discern a person s eligibility for a service. The eligibility of any particular person is closely tied to his or her status and of these, there are many: Active duty troops or family member, Reserve or National Guardsman on active duty, the same when not on active duty, the same when recovering from wounds or injuries, Veterans with various types of discharges, and the family members and caregivers that are often the frontline of support but the last to receive support. By denying treatment to troops with symptoms of Post Traumatic Stress, the military pushes its responsibilities to the state and local level, and precipitates a crisis later. Active duty troops at large military installations like Fort Hood or Fort Bliss have a variety of health and behavioral health options open to them. The Joint Mental Health Team 7 report, produced by the Department of Defense in 2011, says that the reporting curve for stigma is basically flat but this remains a bar against seeking treatment. Involved and present chains of command and non-commissioned officer channels of support are able to observe and interact with their troops daily and counter that to some degree. It should be noted that with the large amount of active duty troops in Texas, and by conservative estimate more than half a million family members sponsored by them - some will fall through the cracks. Even at Fort Bliss this January, the commanding general wrote that he was personally fed up with soldiers who are 3
choosing to take their own lives so that others can clean up their mess." Army leadership intervened and he quickly retracted the statement but it is clear that there is still more to be done in encouraging our troops to seek help. Mixed messages spread confusion and delay. Our troops deserve better. For instance, Fort Hood advocates the services of a hotline 1-855-VET-TALK provided by the University of Medicine and Dentistry in New Jersey. This is interesting since the Army also embraces the Military Crisis Line of the National Suicide Hotline- 1-800-273-TALK (8255) - Press 1 for military that is endorsed by the VA and virtually every other organization providing mental or behavioral health services. At the end of this testimony, I list eight different websites, in various states of upkeep, which the Department of Defense uses for suicide prevention. Once discharged, if your final military discharge paperwork is stamped honorable, you may apply for medical care with the Veterans Health Administration. The VA has worked hard to increase access to health care including mental health care for Veterans in Texas. Many organizations, such as the South Texas Iraq and Afghanistan Veterans Association, work to increase enrollment at the VA and give it a better picture of its customer s needs. There are seven large hospitals, four VA Medical Centers, 18 Outpatient Centers, 21 VetCenters, and 38 Community Based Outpatient Clinics in Texas. The goal of the VA is to have care within 30 miles or 30 minutes of a Veteran s home and to provide care to all groups of Veterans. But, the VA s own inspector general recently found that Veterans, on average, have to wait nearly two months far longer than the VA has claims to be seen. It also confirmed observations by members of Congress that Veterans access to mental health services has been much more problematic than department officials have acknowledged. We all deserve better accounting from the nation s largest bureaucracy. Veterans Health Administration (VHA) policy requires that all first-time patients requesting mental health services receive an initial evaluation within 24 hours, and a longer, more comprehensive follow-up appointment within two weeks. VHA officials had said that 95 percent of its new patients were seen in that time frame. The April 2012 inspector general report called those calculations confused and inaccurate. By their researchers count, fewer than half of those patients were seen within the 14-day requirement. The average wait for a full evaluation among the rest was 50 days. Partly in response to this report, the VA plans to add health care workers, in particular behavioral health care workers, to their system. But, depending on distribution, 1900 new clinical staff throughout the country only adds approximately one person per discipline per VA facility. Veterans waiting for treatment deserve better. Texas has an additional challenge it is the only state served by three separate Veterans Integrated Service Networks, the administrative division that the VA uses to deliver health care. 4
This can lead to geographic disparities and confusing differences in services for Veterans and families. In the words of a Veteran from Tomball: I can tell you the Vet Center and the Houston VA suck when it comes to dealing with mental health. I was told by one Vet Center that since I wasn t a Vietnam Vet they wouldn t help me; the other gave me a packet on post-menopausal treatment. I am a 40 year old male - not a candidate for menopause at all. The Houston VA said that I just have a "readjustment disorder" and that they could only medicate me - but the meds were highly addictive and made me sleep a lot. With a full time job and 2 young kids that wasn t an option. So in short, the mental health care in Houston is horrible. Texas Military Forces, many of who do not have access to the health care on large military bases and whose families live at remote locations; have less recourse to these services. There is a single, heroic, Resilience Team at the Texas Military Forces headquarters at Camp Mabry and one suicide prevention officer. The state has worked hard to train troops in peer facilitation and suicide prevention but this vulnerable population often has the least use of services of any of the populations we are discussing today. There are military family life consultants, and the State Family Program office does an amazing job with volunteers, but the fact remains that Texas has the largest state forces in the nation, spread across the largest occupied state and the systems to support mental health and families are very thinly stretched. Since 2005, Texas has seriously addressed many of these issues, with multi-million dollar grants from both the federal and state government, providing for a statewide network of both professional, evidence-based treatments such as cognitive processing therapy and a statewide network of volunteer peer facilitators. This network is currently oriented on Local Mental Health Authorities which may raise stigma as a bar to use although it does surface many of the most vulnerable to the most effective treatments. It also conceals gaps in federally funded VA care our Veterans deserve better. Peer Support Providing peer support training to service members and Veterans, many of whom are already providing informal social support, can increase the effectiveness of the individual providing support as well as increase his or her ability to identify a potential high-risk situation before a crisis event occurs. As a group, Veterans tend to self-organize, and, after accessing services successfully, tend to move out of the indigent health care system or stay to assist others. Dollars invested in Veteran health care tend to be returned as an investment. There have been over 12,000 documented interactions with Veterans by this peer network since 2009. TexVet.org currently lists over 340 active peer volunteers operating in the state of Texas, conducting over 200 meetings around the state through November of this year. They also do a lot of what we call behavioral health triage or navigation of systems. This is a good way to stretch our health care dollars and ensuring access to services by those less able to use contemporary systems. 5
Caregivers Caregivers are defined as the spouse or other family member of seriously, long-term, wounded Veterans who cannot care for themselves without assistance. For VA eligibility, including a monthly stipend, the injury must have occurred after September 11, 2001. The services do not cover every need of a typical family. Many of the programs for these families are targeted at a much older demographic than the typical injured service member. This has led one caregiver to express frustration at the circle of nothing. There are gaps in the coverage of medical supply refills, support groups for younger spouses, and the simple fact that ambitious, vital spouses must put aside career and often personal life to care for a person in very different circumstances than when they married. These families deserve a fair chance to live and grow. Families Families who live far from military installations are at risk. Secondary PTSD related to the conditions at home or after a parent is deployed has been reported. We do not have a good handle on the numbers involved but, given the youth of the military population, it may be substantial. Communities I would like to address two recent paradigms that of community collaborations and Veterans Courts. I think that both are great ideas and, by working at the community level, are an organic and more sustainable solution to a multiplicity of issues. There are at least 11 Veteran Courts in Texas right now and legislation you passed in the 81 st Legislature may help in growing more. Your continued encouragement is imperative and I am sure that commissioner courts across the state would appreciate any funding assistance you can offer. Our Veterans deserve a fair shake in the courts. Regarding community collaborations, although beneficial and sincere in their approach, there are a number of guides and blueprints available to encourage communities to come together in support of troops and Veterans. These various models introduce confusion to the good work they advocate. There are at least four of these plans in some sort of implementation stage around the state. The US Army alone has two the Community Covenant and the Alliance Development Model. Collaborations abound the Lone Star Military Resource Group in Jacksonville, the Lone Star Veterans Association in Houston, Allies in Service in Dallas. But there are little formalized or documented organizations beyond local champions and ad hoc groups in most of these instances. Data One real need in Texas, as everywhere, is quantifiable data and accurate reports. Much of the data that both official institutions and non-governmental organizations use is based on predictions, actuarial tables, and anecdote. The Texas Veterans Commission has worked hard to collect statistics about their activities and the Texas A&M Health Science Center is working hard to document the Military Veteran Peer Network and its activities. Still the numbers of 6
actual family members, trends in suicide, numbers and locations of school systems impacted by Guard and Reserve deployments, and many other important data points are basically a mystery. More study and the continued recording of information gathered are necessary to determine baselines of both status and success. Limited access or poor data conceal problems. Summary In summary, there are about 1.7 million Veterans in Texas and nearly 200,000 troops serving in uniform. Many of our brave troops have served one or more deployments; they, along with their families, have mental health needs. The many different institutions involved with military and Veterans in Texas offer a variety of programs with varying qualification criteria and access points. This can lead to confusion, denial, refusal of care, and ultimately wasted time for the Veteran. Military peers can help the most vulnerable access services. Caregivers and family members are the next wave of customers for these systems. Holistic means of addressing these issues like Veteran Courts and community collaborations can help with access but problems must be identified and baselines determined. We are facing a crisis and our Veterans deserve better. Thank you very much for your service and your attention. Very Respectfully; Perry Jefferies First Sergeant, United States Army (Ret.) Manager, TexVet Initiative 7