Health Subcommittee Hearing on PTSD & TBI

Washington, Sep 28 -  At a Subcommittee on Health oversight hearing today on research, treatments and effects of post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI), Chairman Henry Brown (R-S.C) and subcommittee members expressed concern that the Department of Veterans Affairs (VA) had not spent all of the mental health care dollars appropriated for it in Fiscal Year 2005.

“Veterans expect that wounds suffered in service, be they to mind or body, will be cared for by the nation they served,” Brown said. “I thank those who testified today for their service to our wounded veterans. While the quality of veterans’ health care has come far, I find disappointing today’s GAO statement that VA last year used less than the full $100 million Congress allocated for mental health,” he said of a September 28 Government Accountability Office statement for the record provided for today’s hearing.

Brown has expressed his intent to conduct greater oversight on the issue “to determine what VA is spending and how it is being spent, to ensure that funds allocated by the American people are used as intended.”

Acknowledging that in the past five years mental health care has significantly progressed, VA’s acting principal deputy under secretary for health, Dr. Gerald Cross, spoke of the extended time servicemembers and veterans need for rehabilitation from PTSD and TBI, due to the “complexity of the wounds.” He told the subcommittee of the need for continued research and the value of multi-disciplinary treatments.

Col. Elspeth Ritchie, M.D, a psychiatry consultant to the U.S. Army Surgeon General, said stigma associated with asking for help with mental health problems keeps many servicemembers from seeking assistance. Ritchie said the Army is integrating behavioral healthcare into primary care to assure those suffering from mental health problems the same immediate attention those who are experiencing physical problems. Richie also emphasized the role of chaplains throughout the military in providing therapy and counseling.

“Tools work for those who have access,” responded Representative Michael Michaud (D-Maine). Michaud expressed concern that a lot of veterans, “have difficulty getting to the VA or are not enrolled,” and that the lack of access is an even greater problem for rural veterans. “This is a family values issue. It affects not only veterans, but families of veterans.”

Col. Dr. Charles Hoge, chief of psychiatry and behavior sciences of the Division of Neurosciences at Walter Reed Army Institute of Research, cited the Army’s Post-Deployment Health Reassessment (PDHRA), a self-administered assessments from soldiers who had returned from Iraq between 3 and 6 months previously. Thirty-five percent of those responding reported any mental health concern; 19 percent endorsed 2 or more of the 4 PTSD-related questions and 11 percent endorsed 3 or more of the 4 PTSD questions. Percentages were lower for soldiers returning from service in Afghanistan and other assignments.

Hoge cited studies showing symptoms of mental health problems of Reservists and Guardsmen emerge often after they have been home for some time, and that members of the reserve components experience higher rates of PTSD than their active-duty counterparts. This has in part been attributed to the peer companionship and support experienced by active duty troops, who on redeployment often remain surrounded by wartime comrades.

Hoge, pressed by skeptical subcommittee members, explained the comprehensive resources available to these servicemembers, even after they separate from the military, which include follow-up contacts to identify latent symptoms.

Ira Katz, M.D., VA’s deputy chief patient care services officer for mental health, with Michaud’s concerns in mind, explained that the “purpose of outreach is to overcome the barriers of getting into the medical centers and clinics.”