RAND
Exposes Invisible Wounds of War |
By Jorge Casuso
June 13 -- After garnering national headlines, a report
on the mental impacts of war was the subject of a RAND forum Thursday
in Santa Monica, where the issue could have an impact on how the
homeless are treated in the think tank’s own back yard.
The report -- entitled “Invisible Wounds of War” -- found that
nearly 20 percent of the 300,000 military service members who have returned
from Iraq and Afghanistan reported symptoms of post traumatic stress disorder
(PTSD) or major depression.
In addition, RAND researchers found that some 19 percent of returning service
members reported that they experienced a possible traumatic brain injury while
deployed.
The report also found that only slightly more than half have sought treatment,
with many fearing the stigma of mental illness would harm their careers. Of
those treated, only about half receive "minimally adequate" treatment
for their illnesses, according to the report.
Many of the troops return with PTSD or stress disorders that are manifested
in “nightmares and flashbacks, recurrent thoughts, sleep disorder, sadness,
low mood and lack of energy,” said Lisa Jaycox, who co-led the 31 RAND
researchers who worked on the report.
The disproportionately high psychological toll -- compared to physical injuries
-- is likely due to the faster tempo of the war in the Middle East, the length
of deployment and the use of an all-volunteer force, researchers concluded.
“We don’t clearly understand all the issues, but it’s very
clear that we weren’t prepared,” said Fred Gusman, executive director
of the California Transition Center for Care of Combat Veterans-The Pathway
Home.
“I see this more as a public health problem,” said Gusman, one
of the panelists at the forum. “No one agency can solve this problem.”
Paul Rieckhoff, executive director and founder of Iraq and Afghanistan Veterans
of America, agreed. “The system is broken and it’s failing vets,”
he said.
Veterans returning from the current war often find themselves unemployed, engage
in domestic abuse and sometimes end up in jail, experts agree.
"If PTSD and depression go untreated or are under treated, there is a
cascading set of consequences," Jaycox said. "Drug use, suicide, marital
problems and unemployment are some of the consequences."
Rieckhoff said that a dozen members of his unit have divorced, one committed
suicide and another was charged with murder.
RAND researchers estimate that PTSD and depression among returning service
members will cost the nation as much as $6.2 billion in the two years following
deployment. This includes both direct medical care and costs for lost productivity
and suicide.
The 500-page study concludes that investing in more high-quality treatment
could save nearly $2 billion within two years by substantially reducing those
indirect costs.
"Unless they receive appropriate and effective care for these
mental health conditions, there will be long-term consequences for
them and for the nation,” said Terri Tanielian, a RAND researcher
who was the project's co-leader.
“Unfortunately, we found there are many barriers preventing them from
getting the high-quality treatment they need," Tanielian said.
Part of the problem stems from the Veteran Administration’s
reactive, rather than proactive, approach.
“The VA is a passive system,” Rieckhoff said. “They couldn’t
even advertise their services.”
In addition, the system lacks qualified staff to diagnose and prescribe
treatments based on a scientific approach with quantifiable results.
“They don’t have the tools,” Gusman said. “When a clinician
looks at them like a deer caught in the headlights, they know they should run.”
Gusman also suggested incorporating the technology commonly used by the new
generation of returning “warriors” -- iPods, cell phones and lap
tops.
The research should serve as a wakeup call for social service providers in
Los Angeles, where war veterans accounted for 12 percent of the area’s
estimated 68,000 homeless.
Santa Monica, which has a highly visible and concentrated homeless population,
will likely feel the impact of returning vets who need mental health care and
other services.
For the report, RAND researchers surveyed 1,965 service members from 24 communities
across the country to assess their exposure to traumatic events and possible
brain injury while deployed, evaluate current symptoms of psychological illness
and gauge whether they have received care for combat-related problems.
Service members said they were exposed to a wide range of traumatic events
while deployed. Half said they had a friend who was seriously wounded or killed,
45 percent reported they saw dead or seriously injured non-combatants and more
than 10 percent said they were injured themselves and required hospitalization.
Special training programs are needed to instruct mental health providers in
the military, veterans and civilian health systems about the type of “evidence-based
treatments” needed by service members, researchers concluded.
"It's going to take system-level changes, not a series of small band-aids,
to improve treatments for these illnesses," Tanielian said.
“I think if people heard what was really going on,”
Gusman said, “they’d say, ‘You’re totally
right. We really need to fix it.'”
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