Healing Combat Trauma

"Give an Hour" Helps Fill Veterans Counseling Gap

Give an Hour -- the foundation that matches member psychogists and counselors with veterans and their families in need of counseling at no charge -- to fill the currently unmet gap in mental health services, has been in the news recently.  (You can learn more about Give an Hour's founder, Barbara V. Romberg, Ph.D., in her bio, linked here). It's truly fantastic to see this public-spirited act of service on the part of Give an Hour; at the same time, it's a shame that private industry, so to speak, has to jump in to fill the unmet gap of mental health care -- the need for which care is an entirely predictable "soft cost" of going to war.  Nevertheless, good stuff, and very altruistic and forward-thinking on the part of Dr. Romberg and her organization.

From a press release:

The American Psychiatric Foundation, Lilly Foundation And Give An Hour Join Forces To Provide Mental Health Care To Iraq And Afghanistan Veterans

Heeding the call of a growing public health crisis -- the unmet mental health needs of returning soldiers and their families -- Give an Hour (GAH) and the American Psychiatric Foundation (APF) announced a major expansion of a nationwide effort to help U.S. veterans returning from Iraq and Afghanistan.

GAH and APF, the philanthropic and educational arm of the American Psychiatric Association (APA), will be using a $1 million grant from the Lilly Foundation to recruit and educate volunteer mental health professionals, who will become part of a network aiming to bridge the gap in mental health services for soldiers returning from service, as well as their families. Among troops returning from Iraq and Afghanistan, approximately 40 percent of soldiers, a third of Marines, and half of the National Guard members report psychological problems, but mental health services are in short supply.

"This all-volunteer effort provides badly needed support to help our veterans, many of whom come home with mental health needs," said U.S. Representative Steve Buyer (R-Indiana), Ranking Member, House Committee on Veterans' Affairs. "I applaud the hard work of Give an Hour, the American Psychiatric Foundation, and the Lilly Foundation, which are stepping up to help those who have selflessly served."

Efforts will be made to create a large, national, volunteer network over the next three years to address postwar mental health issues such as post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), drug abuse, anxiety and depression.

"This grant will allow us to get out the message that help is available. We want to normalize what our military personnel and their families are experiencing and support the sacrifices that they are making by providing critical mental health support at no cost," said Barbara V. Romberg, Ph.D., founder and president of GAH. "We will be educating the military community and broader public about these mental health needs in hope of helping veterans keep their lives and families intact."

GAH is recruiting mental health professionals to volunteer one hour each week for a minimum of one year to provide direct services in person, by phone or in consultation with schools and community organizations that serve the military community. Services are wide-ranging and include marital and family therapy, substance abuse counseling and treatment for PTSD. APF brings strong ties to the psychiatric community and is actively encouraging psychiatrists to join the network.

"This grant will help us reach our goal of recruiting 10 percent of the 400,000 mental health professionals in the United States by 2015 to assist in this effort," said Dr. Richard K. Harding, M.D., president of the APF. "It is an ambitious goal, but we are confident it can be achieved."

The Department of Defense (DoD) is making an unprecedented attempt to encourage personnel to seek mental health treatment, but a significant increase in demand, in some areas, has forced the rationing of services, created long waiting lists and limited individual counseling sessions. In addition, some members of military families such as parents, siblings and unmarried partners do not qualify for care through the Veterans Administration or DoD but are affected nonetheless by the mental health of the veteran.

"We're privileged to be able to give something back to our troops, but we know there's still much more to be done," said Steven Paul, M.D., executive vice president for science and technology and president of Lilly Research Laboratories. "Lilly is fully committed to assuring that the best possible medicinal treatments are available, but unfortunately, we also know that having access to the best care -- in this case mental health services -- is essential."

About Give an Hour
Give an Hour is a nonprofit 501(c)(3), founded in September 2005 by Dr. Barbara V. Romberg, a psychologist in the Washington, D.C., area. The organization's mission is to develop national networks of volunteers capable of responding to both acute and chronic conditions that arise within our society. Currently, GAH is dedicated to meeting the mental health needs of the troops and families affected by the ongoing conflicts in Iraq and Afghanistan. Give an Hour now has approximately 1,200 providers across the nation and continues to recruit volunteer mental health professionals to its network. For more information or to volunteer to become part of the effort, please visit http://www.giveanhour.org.

About The American Psychiatric Foundation
The American Psychiatric Foundation is the charitable and educational subsidiary of the American Psychiatric Association. The mission of the foundation is to advance understanding that mental illnesses are real and can be effectively treated. For more information, please visit the foundation's web site at http://www.psychfoundation.org.

About Lilly
Lilly, a leading innovation-driven corporation, is developing a growing portfolio of first-in-class and best-in-class pharmaceutical products by applying the latest research from its own worldwide laboratories and from collaborations with eminent scientific organizations. Headquartered in Indianapolis, Ind., Lilly provides answers -- through medicines and information -- for some of the world's most urgent medical needs. Additional information about Lilly is available at http://www.lilly.com.

From Give an Hour's website:

Our Mission
Our mission is to develop national networks of volunteers capable of responding to both acute and chronic conditions that arise within our society. Our first target population is the U.S. troops and families who are being affected by the current military conflicts in Afghanistan and Iraq. Give an Hour is asking mental health professionals nationwide to literally give an hour of their time each week to provide free mental health services to military personnel and their families. Research will guide the development of additional services needed by the military community, and appropriate networks will be created to respond to those needs. Individuals who receive services will be given the opportunity to give an hour back in their own community.

Our Focus
Our organization is currently focusing on the psychological needs of military personnel and their families because of the significant human cost of the current conflicts. Over 1.6 million troops have been deployed in Afghanistan, Iraq, and the Persian Gulf since September 11, 2001. Nearly 550,000 of these troops have been deployed more than once. According to the U.S. Department of Defense, as of May 15, 2008, nearly 4,600 American troops have died in Iraq and Afghanistan. Roughly 32,875 U.S. troops have been injured during these conflicts.

In addition to the physical injuries sustained, countless servicemen and servicewomen have experienced psychological symptoms directly related to their deployment. According to a RAND report released in April 2008, over 18 percent of troops who have served in Iraq and Afghanistan--nearly 300,000 troops--have symptoms of post-traumatic stress or major depression. At the same time, about 19 percent of service members reported that they experienced a possible traumatic brain injury. And let us not forget: millions of Americans belong to the families of these servicemen and servicewomen. Spouses, children, parents, siblings, and unmarried partners of military personnel are all being adversely affected by the stress and strain of the current military campaign.

Our military leaders are well aware of the human cost of this campaign. Indeed, they are attempting to address the psychological needs of the troops through a variety of programs within the military culture. Unfortunately, the tremendous number of people affected makes it impossible for the military to respond adequately to the mental health needs in its greater community. For example, according to the RAND study, only 43 percent of troops reported ever being evaluated by a physician for their head injuries. Moreover, returning combat veterans suffering from depression, anxiety, and post-traumatic stress disorder (PTSD) are not routinely seeking the mental health treatment they need. RAND also reports that only 53 percent of service members with PTSD or depression sought help over the past year.

A major barrier preventing military personnel from seeking appropriate treatment is the perception of stigma associated with treatment. Many fear that seeking mental health services will jeopardize their career or standing. Others are reluctant to expose their vulnerabilities to providers who are often military personnel themselves, given the military culture’s emphasis on strength, confidence, and bravery. Servicemen and servicewomen might be more inclined to seek help if they know that the services provided are completely independent of the military. By providing services that are separate from the military establishment, we offer an essential option for men and women who might otherwise fail to seek or receive appropriate services.

We are also offering services to parents, siblings, and unmarried partners who are not entitled to receive mental health benefits through the military. Although these individuals may have access to mental health services through other means, they are less likely to seek the help they need and deserve if that help is difficult to find or costly. Our goal is to provide easy access to skilled professionals for all of the people affected by the current war. The participating mental health professionals offer a wide range of services including individual, marital, and family therapy; substance abuse counseling; treatment for post-traumatic stress disorder; and counseling for individuals with traumatic brain injuries. Whether it is a young military wife who is anxious because her four-year-old has had nightmares since her husband’s deployment or a father who is struggling to cope with his son's loss of a leg as a result of an explosion in Iraq, both will receive the assistance they need to move through their experience. The healthier the support system for the returning troops, the lower the risk of severe or prolonged dysfunction within these military families.

Our Plan
Give an Hour is reaching out to the military community in several ways. As a member of America Supports You, a Department of Defense program that provides opportunities for citizens to show their support for the U.S. Armed Forces, we are identifying individuals involved in post-deployment processing of returning troops. We are developing collaborative relationships with the commanding officers of returning troops so that these officers are aware of and comfortable with the services we provide. We are also working closely with a number of veterans service organizations to promote our services directly to the family members of troops. Furthermore, we are working with individuals affiliated with Walter Reed Army Medical Center in Bethesda, Md. We are also collaborating with the Veterans Administration to distribute information about our services through Vet Centers across the country.

Finally, we are promoting our services to the military community and the public through a media campaign that includes print, television, and radio coverage. In fact, our founder and president, Dr. Barbara Romberg, has been interviewed in national media outlets from the Washington Post to NPR's Diane Rehm Show, Ladies' Home Journal, and HD Net's World Report.

Give an Hour recruits mental health professionals in several ways. We have been endorsed by the American Psychiatric Association and the National Association of Social Workers and are seeking endorsements from other major mental health organizations. Only licensed mental health professionals are included in the network. Licenses are verified. Non-licensed pastoral providers may be included in the network as long as they meet other criteria, including membership in professional organizations. In addition to coordinating with national organizations, we also recruit mental health professionals through professional publications and Web sites.

As of May 2008 we have a redesigned Web site, expanded to include materials to guide visitors seeking services as well as reference materials to inform mental health professionals. Only mental health professionals trained and experienced to work with trauma victims will identify themselves as available to work with soldiers who have experienced combat. We are working with experts in the trauma field to prepare materials for our Web site and to find appropriate mental health professionals for recruitment.

The Eli Lilly and Company Foundation recently awarded Give an Hour, in partnership with the American Psychiatric Foundation, a major grant that will allow us to spread our message to the leaders of the mental health community in every state. 

We are recruiting volunteers from a number of organizations and institutions as well as through our Web site to assist us in the implementation of our program. Volunteers from retired military personnel to members of military families to concerned civilians throughout thte country are helping Give an Hour. Volunteers are checking licenses, distributing brochures, and coordinating community partnership opportunities for those troops and family members interested in giving back an hour to their own community.

Our Vision
Our primary focus will always be to attend to those in need by linking them to individuals in our society best equipped to respond effectively. In addition, we will develop research and educational programs to further promote the value and importance of a new kind of volunteerism. We hope to encourage an increase in shared responsibility for those citizens who are suffering. We need only look at the outpouring of aid and support following both the terrorist attacks of September 11, 2001, and Hurricane Katrina in August 2005 to see the potential we have to become a truly compassionate and united nation. And we need only look at the significant costs of the war in Iraq and the relief efforts for Katrina’s victims to see that federal and state governments are already strained beyond their means. We have not only the potential but the duty to help one another in times of need.

For more information, contact Barbara V. Romberg, Ph.D., Founder and President, Give an Hour.  Her email address is linked here.

John (Super) Powers, Friend of Vets

John Powers is the singular driving force behind something truly amazing, called "the Resource Guide for Veterans," now available for download in PDF form on his exceptionally thorough website, Operation Vets, linked here.  (Be sure you have a copy of the free Adobe PDF Reader before attempting to download.  You can get that here.) 

The focus of the Veterans' Guide is on Rhode Island, the smallest state in the country, although the structure of it could be expanded to cover every state in the entire country -- let's just say, we can imagine all of them need one!  John, a recent college graduate, worked on the Guide for over a year, and the work he did is both comprehensive and totally original --to the best of our knowledge, there is no other guide in the U.S. like this.  The quality of the work that John did -- before he even began the graduate degree program in social work that he's now enrolled in -- was a true "labor of love," inspired by a veteran friend of John's from high school days, who'd gone on deployment and come back troubled.  John Powers was recently profiled by Vietnam veteran and journalist Bob Kerr in the Providence Journal Bulletin.  Read the original article here.  Wherever John goes in life, from this point forward, he's already done some of what anyone else would consider their best work, in a lifetime of effort.  In honor of the upcoming Veteran's Day, be sure to check out both John's site, and his superlative guide.  John is a true, though young, hero and authentic "FOV" -- "Friend of Veterans."

(If by chance you happen to be on Facebook, check out the group called "From Combat to Campus: Vets in School," that we recently started together, to give veterans who are in school for the first time, or back in school after deployment, some resources and ability to connect with one another.  That's the non-profit commercial interruption.  Now back to the regularly-scheduled program.)

Here's what John has to say about his site:

Operation Vets was created in July 2007. The ideas and the resource guide I created began in October 2006. After graduating from high school in June 2002, one of my childhood friends went off to the Marines as I enrolled at the University of Rhode Island. When he came home for Operation Enduring Freedom in 2005, I saw how war can drastically affect a persons life. The transition from soldier to civilian was not easy for him, nor was it easy for all of our returning soldiers.

I wanted to learn more about combat, the effects of being in war, the effects it has on the families back home and more importantly I wanted to find out how I could help and truly “Support our troops”. I began reading, writing, and researching all the resources available to soldiers and families. I realized the Department of Veterans Affairs (VA) system was being overloaded with new veterans filing claims, for physical ailments, combat stress injuries, anxiety, depression, post traumatic stress disorder, the list goes on. The process of filing claims through the VA system can be stressful and time consuming.

As I found out through talking with soldiers coming back from War, they don’t need anymore stress than they already have to deal with. I fully understood that not only are the soldiers affected, but the families are directly affected as well. They need support and help just as much as the returning soldiers do. If soldiers and families don’t get the help they need it could have devastating affects on the soldier, the family, the children, and society in general. Our country is undoubtedly in a time of War and politics rule the news stations. I am trying to take the politics out of the equation and focus on our soldiers, our veterans, and their families.

Soldiers stories need to be heard, wounds need to be healed, regular civilians need to get involved and our country needs to unite just like it did after the attacks on 9/11. I refuse to allow our returning soldiers to “slip” through the cracks as many have, since returning from Iraq or Afghanistan and even Vietnam. These soldiers served our country and it’s time we serve our soldiers.

Read other blog entries we've done about John and his commitment to veterans here and here.

It Takes a Village -- But Should It Have To?

In Guerneville, California, a so-called "Veterans Village" -- a four story building on two acres of land, lovingly and recently donated by a World War II veteran who wishes to remain anonymous -- is slated to open in January and start housing soldiers back from Iraq and Afghanistan, who struggle with PTSD and/or combat trauma.  The project is the brainchild of a Gold Star mother, Nadia McCaffrey, who lost her son, Sgt. Patrick McCaffrey, in Iraq three years ago.  Her eventual goal is to build a national "Veterans Village" on land outside of Charlotte, North Carolina, in an ambitious project which will cost over $100 million.  ABC News, Channel 7, in the Bay Area, covered this story in print and with video.  Click here for the link.  The idea, with at least the California location, is that the building will serve returning soldiers with PTSD while they get a chance to acclimate back to being in the U.S. and receive therapy.

It's hard to tell whether this idea is really cool -- or just plain kooky.  It's obviously generous, sincere, and deeply heartfelt, on everybody's part who's involved.  That's all great.

What isn't great, in my mind, are two things:

One, it's never a good precedent to start doing things privately in lieu of getting the government to step up and provide the care they're contracted to give returning veterans.  It's a troubling precedent, and it's becoming too frequent a pattern, to see private citizens step up where the government should be, but isn't, or isn't working fast enough, to take care of problems.  That's a giant problem, in my opinion.  Selfless, altruistic concern and doing good are fantastic, and they're a core attribute of wonderful people in our society.  But the government can do more, more effectively, and needs to be held accountable for the care it's already supposed to be providing.  Doesn't the government have a duty to care for its veterans?  If not, shouldn't it have one?  I can easily see where people get distressed because, in essence, good help for veterans is not coming fast enough, by a long shot.  That's very true.  But it's the government, not private citizens, who needs to to be ministering to the very real needs of returning soldiers.  What private citizens do should be icing on the cake.  Disturbingly, they're trying to provide the cake.  That's not a good situation, or a good precedent.

Secondly, it's hard to tell what the plan here is, and how well thought-through it is, or isn't.  Returning servicemembers, aka veterans, who are affected by PTSD and combat trauma, according to what we know, may not even start showing signs of distress for months afterwards -- so the timing is difficult.  Do veterans themselves decide when it's time to pay a visit to this village?  That could possibly work.  But how would the capacity of the place be balanced to accommodate potentially wide fluctuations in who needed help when?  And what sort(s) of help would be offered?  It's potentially quite chaotic to have a group of any people residing in one place who are at risk for experiencing disturbing episodes, such as PTSD can trigger.  At minimum, trained professionals (psychologists and the like) who are able to manage such an environment would need to be on staff, because that's a job not just anyone is going to be able to do.  It's definitely clear that veterans heal better or best in community with other veterans -- that's a huge check on the "plus" side.  On the minus side, though, is the potential chaos that could ensue with people in close proximity going through flashbacks in a group residential setting.

I don't suppose these are really reason not to do this venture; but just to approach it with caution.  My main concern is that combat veterans suffering from PTSD or combat trauma are, tough as they might be as people, a vulnerable population because of their injuries. It really wouldn't be good at all to offer people at a vulnerable low point in their lives a lifeline that turns out to be too flimsy to support them.  Ultimately, that would add hardship, not create good.  And let's not do things like this in lieu of requiring our own government to care for its veterans.  If the government isn't doing its job to provide the quality of care we should expect for our veterans -- let's lean on the government to do so, not just pitch in and try to do it ourselves.  That would be like having insurance, and when your car gets totalled in an accident, replacing it out of pocket.  Ummmm, no.  Even if it takes a while and is a pain, that's WHY you have insurance.  And the car accident wasn't your fault. 

The Dole-Shalala's Commission's findings showed what the VA needed to do.  Lawmakers and others have let those resolutions linger in some form of limbo.  As they used to say with the justice system, justice delayed is justice denied.  In this case, care delayed is care denied.  If the government isn't doing enough for returning veterans, especially those who suffer from PTSD, let's lean on the government to do more -- to do what it ought to do.  And then we can supplement that care with our own civic goodheartedness, but never in place of what our government ought to be doing.  As taxpayers and voters, we should be very clear about the power we wield to hold our own government accountable for doing what's right by all its citizens, including and especially, for the sake of this conversation, our veterans.

In the sixties, there was a bumper sticker that said something like, "Wouldn't it be nice if schools had all the supplies they needed, and the AIr Force was forced to hold a bake sale to buy its bombers?"  I'm loosely paraphrasing here, but the concept was clear: schools nationally suffered cutbacks and often did hold bake sales so that students received the supplies they needed; whereas the military budget was rarely cut.  Without detouring into any pro-war or anti-war ideology here, which would be seriously missing the point, there's an analogy here with veterans care.  Why are private citizens trying to offset what the government should be doing?  When the government estimates the cost for going to war, what portion do they estimate for taking good care of the veterans who fight?  Or is the focus on weapons and warfare and infrastructure, and very little on caring for those who fight?  If that's the case, that's the first place the wrong should be redressed.  Then private citizens can jump in and add their care to their mix, but as a supplement, not as the essential care veterans should be receiving.