Meeting the Mental Health Needs of Military and Veterans: Challenges & Solutions

     The Reserve Officers Association (ROA) sponsors a broad range of educational events through its educational branch, the Defense Education Forum (DEF). In its most recent symposium, Meeting the Mental Health Needs of Military and Veterans: Challenges & Solutions, ROA panelists addressed recent developments in behavioral health treatments, upcoming legislation, and current obstacles to ensuring veteran access to effective behavioral health professionals.

     Several lawmakers kicked off the symposium with presentations addressing legislative perspectives on veteran health care needs as well as proposed solutions. Senator Joseph Donnelly discussed his recently introduced Jacob Sexton Military Suicide Prevention Act of 2014, attached to this year’s National Defense Authorization Act. Most notably, the bill provides an annual mental health assessment for every member of the Armed Forces. The results, which remain confidential, are used to provide a platform for future diagnosis and treatment of behavioral health issues. The bill also attempts to address the disparity in mental healthcare resources between the active duty and the reserve components of the armed forces by increasing collaboration between the Defense Department and the Department of Health and Human Services. Major General Drew Davis, ROA Executive Director, emphasized the crucial nature of this particular provision. “What is lost on many Americans is the fact that out of the 2.3 million serving today, about 50% serve in the reserve components.” Donnelly noted the bill’s emphasis on a “best practices” approach. “We’re trying to review what practices are working in the various components and branches so we can implement them across the board.” Donnelly mentioned incorporating practices from the militaries of other nations as well, citing the Israeli Defense Force’s success in reducing suicides by 75%.

     Congressman Glenn Thompson of Pennsylvania’s 5th Congressional District described his in-progress Medical Evaluation Priority for Service Members (MEPS) Act of 2014 as “grounded in good statistical data and research.” Thompson noted that one in five military members entering service had a psychiatric history, and that half of all soldiers who attempted suicide had a previous attempt prior to enlisting. Congressman Thompson hopes to use the MEPS Act to bring mental health on par with physical health by mandating a mental health assessment before enlisting. The bill also ensures that the assessments remain private to prevent any detrimental career impacts. Senator Rob Portman, R-OH, who introduced the MEPS Bill in the Senate, emphasized that the bill is “not a complete solution, but it provides us with a baseline to take care of those who put their lives in harms way to protect us.”

     Each lawmaker took a moment to pay tribute to the late CAPT Marshall Hanson, USNR (Ret.), ROA’s Legislative Director, who passed away earlier this month. Congressman Glenn Thompson, R-PA, said, “We lost a great hero in Captain Hanson. He was a tireless advocate for veterans and service members. He is missed.” Senator Portman spoke warmly of Hanson. “He was a true professional and a pleasure to work with. Our thoughts are with everyone who knew him and who worked with him.”

     Sergeant First Class (SFC) Micah Welintukonis, led the Voice of the Veteran portion of the symposium. Welintukonis, a senior medic in the United States Army, gave attendees a firsthand account of the daily challenges brought on by Post-Traumatic Stress Syndrome (PTSS). SFC Welintukonis described the horrors of “losing my first guy” and “seeing children wounded by shrapnel.” He emphasized the long-term and often insidious nature of combat stress. During trauma- and stress-inducing events, “training just kicks in and you just react. There is no fear.” Resulting stress and mental complications emerge later; sometimes decades later. Welintukonis recounted his own emotional and mental responses after receiving serious wounds during a Taliban complex attack, describing feelings of guilt, stress, pressure, anguish, and not knowing where he fit in without a mission or soldiers to lead. He noted that his experiences with the Department of Veterans Affairs had been largely unsatisfactory, and emphasized that more work needs to be done to reach veterans suffering from the effects of combat stress. Based on his personal experience, he recommended implementing measures that would allow veterans suffering from combat stress and mental health issues to speak with persons of similar backgrounds.

      After the individual presentations, General Davis introduced two distinguished panels of experts. Terri Tanelian, Senior Social Research Analyst at RAND, Phil Carter, Director of the Military, Veterans, and Society Program at the Center for New American Security, Dr. Shelley MacDermid Wadsworth of the Purdue Military Family Research Institute, and Dr. Heather O’Beirn-Kelly of the American Psychological Association comprised the Clinical and Research Perspectives Panel. The panel focused on current mental health needs of Iraq and Afghanistan veterans and ways to ensure that clinical practitioners had access to the most effective treatments and screening procedures. Mr. Carter cited current research showing 60% of all Afghanistan and Iraq veterans were currently no longer affiliated with the active military, and about 20% of these had returned from combat with some form of TBI or PTSS. Ms. Tanelian estimated that only about half of the veterans currently suffering from PTSS had sought professional help for their conditions, highlighting the need to increase veteran access to care. Dr. O’Beirn-Kelly emphasized the need to balance clinical and research activities, warning against increasing treatment facilities and practitioners at the expense of research efforts. “Part of the reason we are aware of these problems in the first place is because of research efforts. We cannot short change research for clinicial work.”

     CAPT Richard Stolz, USN, Director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, and Dr. Wendy Tentula, National Director of the VA/DoD Integrated Mental Health program chaired the Policy Perspectives Panel. The panel discussed recent innovations in treatments and new programs designed to more effectively notify veterans of available treatment options. CAPT Stolz emphasized the need to minimize potential negative stigma attached to seeking help for behavioral issues, and highlighted some of the cutting-edge advances used by practitioners today, including smartphone applications that enable clinicians and patients to collaborate and tailor a specific treatment plan for each individual, sleep studies, and websites designed to maximize outreach to veterans and provide referrals and other resources. Perhaps most notably, the Defense Department has simultaneously increased and dispersed its behavioral health practitioners. Dr. Tentula emphasized the need for increased veteran outreach and outlined recent VA approaches, including one similar to the program suggested by SFC Welintukonis. In the last eighteen months, the VA has hired approximately 1000 “peer specialists”—individuals who have experienced the stresses of combat and received treatment—to interact with veterans currently experiencing similar issues and provide advice on how to overcome behavioral health challenges.

        Senator Donnelly captured the spirit of the symposium best in his closing remarks: “Every man and woman who has served our country has the right to come home in peace, to secure employment, and to know that we consider them extraordinary heroes.” The Reserve Officers Association will continue to maintain a strong commitment to these goals in the years to come.