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Vets' MH Care Must Be on Front Line, APA Says

Troops returning home from Iraq and Afghanistan will need greater access and higher quality mental health services from the Department of Veterans Affairs, APA's president-elect tells Congress.

Returning military personnel and their families will need better access to mental health services, combined with more vigorous efforts to reduce stigma within the armed forces and in the Department of Veterans Affairs (VA), APA president-elect Carolyn Robinowitz, M.D., told the House Appropriations Subcommittee on Military Quality of Life and Veterans Affairs last month.

"We recommend improved and long-term access to the continuum of mental health and substance-use disorder services.... along with funding for sufficient professional positions to staff this continuum," she said.

The VA should invest resources to develop a nationwide system of care that includes intensive case management, psychosocial rehabilitation, peer support, housing, integrated substance use and mental illness treatment, and other services for veterans with serious mental illnesses, she emphasized.

Younger veterans of the wars in Iraq and Afghanistan appear to be especially vulnerable to the psychological effects of their experiences, Robinowitz said. "In Iraq or Afghanistan, everywhere is the front line today," she said. "So there's no place to step back and recover from stress."

In addition, traumatic brain injuries are leading to an increase in casualties with complex neurological, physical, and psychiatric consequences that require equally complex, well-coordinated care.

"It is critical that psychiatrists lead the treatment teams responding to these patients' psychiatric needs," Robinowitz stated at the hearing.

"You really do need an M.D., someone who understands and can put the physical and mental together," she added later in an interview with Psychiatric News.

The VA also needs resources to add staff to cope with not only the influx of newer, younger veterans but also the danger of staff members feeling overwhelmed in the face of the increased demand for services.

Women veterans will also present a new challenge to the VA, which is accustomed to an older, male population, she said. Women veterans in their reproductive years may be commonplace patients soon.

Robinowitz commended VA and military health officials for placing mental health services in primary care settings to lessen the stigma that often deters service members from using such services in free-standing sites. Administrators at the VA, she said, often display the general public's view of mental illness as something alien or frightening, but also reflect the attitudes of some in the armed forces that it is a sign of weakness or malingering.

Special attention should be paid to National Guard and Reserve members, because they often return quickly to civilian life, isolated from the support of buddies in their units or geographically distant from rehabilitation services, she said.

Continued research, supported by increased funding, is also needed to improve evidence-based treatment for the long-term health effects of posttraumatic stress disorder, traumatic brain injury, and other war-related mental health outcomes, she added.

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