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PTSD, GETTING BIGGER ALL THE TIME 06/23/2012

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Our independent feature, “Purple Mind,” deals with one Iraq combat veterans struggles with PTSD.  Our aim is to bring PTSD and its various element to the attention of a larger number of people.  Thus, part of our blogging is aggregating some of the week’s most significant coverage of PTSD in the press.

This week, David Zucchino reported in the Los Angeles Times the story of Tech. Sgt.. Stanley Friedman, who recently was diagnosed with post traumatic stress disorder, having suffered flashbacks and nightmares, flailing about in bed as memories of being rocketed and bombed had played intensely in his head for years.  An Iraq or Afghanistan war vet?  No, this has been going on since 1944!  Sgt. Friedman is 92 years old and received his first disability check for PTSD only a few weeks ago.

Friedman has been fighting the VA since 1946, but it wasn’t until he got the help of lawyers from the law firm DLA Piper who spent hundreds of hours of pro bono work for veterans digging up evidence of the Sergeants WW II service and his debilitating PTSD, that the VA finally accepted Friedman’s claim.

Unlike the 19,000 WW II vets who kept their service and medical records and currently receive benefits for “shell shock,” the equivalent of PTSD, Friedman did not, and his resulting battle to receive compensation took over fifty years.

During the past few months, more than 3,000 soldiers in the Oklahoma National Guard’s 45th Infantry Brigade returned from Afghanistan and Kuwait. VA program manager Edwina Luker is part of a task force looking at how to deal with the influx.
“My bigger concern is not how we’re going to handle them, but getting them here at all,” Luker said. “Typically, this age group (early 20’s) does not want to have anything wrong with them. And they certainly don’t want to have mental health things wrong with them or traumatic brain injuries.”

Far too many Vets aren’t living long enough to receive treatment, much less benefits.  The Associated Press reported the death of a soldier who was killed after an altercation with police who said the Vet, Scott Chappell, had served in Afghanistan and “might have” been suffering PTSD.
Scott Chappell’s mother said, “He would sometimes leave during a violent movie because he couldn’t handle it,” Cindy Chappell, his sister, told the Mail Tribune, “He didn’t like to talk about it, but he did tell us that he saw people blown up over there.”

Family members and police tell two conflicting versions of the circumstances of Chappell’s death.  Carol Kidder, Chappell’s mother, says police need to be better trained in dealing with those suffering from PTSD.
“He made it through the war zone and ends up getting killed here,” she said.

Chappell returned from duty in Afghanistan and became active in local veterans’ activities.  His family said Chappell was attending community college to attain a nursing degree.

Graham Brewer wrote in the Oklahoman  about former Army Reservist and Iraq veteran Joe Collins and his daily struggle to forget the horrors of war.  Collins is staying with his mother while recovering from drug addiction and seeking treatment for post-traumatic stress disorder.   In the eight years since his return from combat, Collins has lost his teeth and gall bladder to drug addiction.  He also lost his job, his home and his self-sufficiency, all to post-traumatic stress disorder.

Cody Green, served in Afghanistan with the Oklahoma National Guard in 2004. After his return to Norman, it was evident to those close to him that his drug use was becoming a serious problem.

Green struggled with PTSD for years. Last summer, after a series of suicide attempts, his mother sought help from the VA. She was told her son was on a waiting list to receive treatment, but would not be admitted for a couple of months.
“I just said he needs it, and he needs it now; he’s in trouble,” she recalled.

After pressing her case, she was able to arrange an initial treatment session a couple of weeks away. But the appointment didn’t arrive soon enough.  “A week before that, he committed suicide,” she said.

DAILY RX says, “Approximately 11 million people in the United States suffer from post-traumatic stress disorder. PTSD occurs when an individual experiences an extremely stressful event such as a war, natural disaster, an automobile accident or other trauma…

Wray Herbert reported in the Huffington Post about a regiment of Danish soldiers who were the subject of a documentary, “Armadillo,” and also an independent psychological study conducted over the years between basic training and their return from Afghanistan’s Helmand Provicce.   The study found that the Danish soldiers who developed PTSD were much more likely (compared to resilient soldiers) to have suffered emotional problems and traumatic events prior to deployment. In fact, it wasn’t traumatic war experiences that predicted the onset of PTSD, but childhood experiences of violence, especially punishment severe enough to cause bruises, cuts, burns, and broken bones. PTSD sufferers were also more likely to have witnessed family violence, and to have experienced physical attacks, stalking, or death threats by a spouse. They were also more likely to have past experiences that they could not, or would not, talk about.

These previously overlooked PTSD sufferers were also much less educated than the resilient soldiers. This disadvantage, combined with their pronounced mental-health problems before going to war, suggests that they may in reality have been escaping a different war zone: the family. In other words they only showed improvement as soldiers because they were in such poor psychological condition in civilian life. Army life, even combat, offered more in the way of social support and life satisfaction than they had experienced at home. These soldiers were probably benefiting emotionally from being valued as individuals for the first time ever, and from their first authentic camaraderie — mental-health benefits that diminished when they once again returned to civilian life.  Could this suggest a bias against those prone to suffering the effects of PTSD?

The News Tribune said it is welcome news that the Department of Defense is expanding its review of post-traumatic stress syndrome diagnoses. That review will now date back to the 2002 start of the war in Afghanistan and include all branches of the military, not just the Army.

If recent reversals of many diagnoses made at Madigan Army Medical Center are any indications, too many veterans of the wars in Iraq and Afghanistan have been wrongly told that they do not suffer from the disorder, affecting their ability to get treatment and receive disability benefits.

According to U.S. Sen. Patty Murray – who has been a pit bull on the subject of veterans’ mental health care – many soldiers whose diagnoses have been reversed said they were told “they were exaggerating their symptoms, lying and accused of shirking their duties.”

In any large group of people, there will always be some bad eggs trying to game the system. Those who don’t deserve disability benefits shouldn’t get them. But the high suicide rate among those serving in the military shows that mental health issues are a big problem for the military.

Suicide is now killing more active-duty service members than combat. And about 14 percent of Iraq and Afghanistan veterans have sought mental health treatment from the Department of Veterans Affairs.

With tightening military budgets, it’s unclear how the Pentagon plans to solve the problems of the past while keeping up with current and future PTSD cases. The Department of Defense needs to be more forthcoming with its plans for cutting through the bureaucracy and funding treatment for mental health problems that will continue much longer than the wars that led to them.

But how is this supposed to happen when the US Senate this week overwhelmingly rejected a bid to preserve some $4.5 billion in food stamps funding, as part of the massive farm bill.  If budgets are so tight in the U.S. that we can’t afford to grant food stamps to half-a -million US households in the Supplemental Nutrition Assistance Program (SNAP), how are we to expect that treatment and benefits due military veterans will be delivered?

Over the same ten years that suicide and mental health problems have been on the rise in the military, food stamp rolls have also doubled to 46 million people, driven by the recession.  The Congressional Budget Office estimated recently that the demand for food stamps will continue to grow through 2014 in the wake of the US economic downturn.

But according to Fox News via Stars and Stripes, officials of the Department of Veterans Affairs say that since the Department has increased its focus on mental health over the last few years,  they have seen improvement in the treatment of veterans at risk for suicide.

However, officials also estimated that of the veterans who do commit suicide, only one-third had turned to the VA for help.  What would explain those discouraging numbers?

Mental health treatment needs for returning soldiers has become so great that officials are looking in unlikely places for solutions.  According to CORRECTIONS.COM, officials of Caro, Michigan toured a closed prison facility looking to establish a treatment center for veterans.

Those who did the tour were: 84th District State Rep. Kurt Damrow (R – Elkton) Tuscola County Economic Development Director Steve Erickson county commission Chair Jerry Peterson, county Controller Mike Hoagland, MDOC’s Administrator Denise Allsberry, Director Daniel Heyns, and Legislative Liaison Jessica Peterson.

“The property would make an excellent veterans home for southeast Michigan. The building and grounds are in great shape, much of it looks new,” said Damrow noting that fact could be a leverage to convince the federal government to back a veteran program there.

Imagine all the happy veterans who would jump at the chance to share an 8 by 10 prison cell in order to receive mental health treatment in Caro.

The Ninth Circuit Court of Appeals recently upheld a lower court’s position that it was not a matter for the courts to rule on whether the VA has knowingly underreported veteran suicides — it now estimates 18 per day.   But the court did criticize the VA for “unchecked incompetence,” and the case may head to the Supreme Court.

Thankfully, the VA knows that what is really needed are sparkling new and attractive mental health centers.  The Mercury News reported that Chris Hurt walked the wide-open halls of the new Mental Health Center at the VA Palo Alto campus, admiring the airy feel of an 80-bed unit that features enclosed courtyards and even an area to play basketball.

The acute inpatient psychiatric facility, he said, is like “night and day” from the old, claustrophobic building next door where he recently spent two weeks.

“Every single person here goes through moments where they’re so miserable that they just want to get out,” said Hurt, 25, who served two tours in Iraq as an Army specialist. “I don’t think anybody wants to be here. But this is better because it’s more like a hospital and less like a psych ward.”

The 76,000-square-foot center, which will be unveiled in a ribbon-cutting ceremony today, is a tangible example of the U.S. Department of Veterans Affairs’ national expansion of mental health services to meet the record number of Iraq and Afghanistan veterans seeking help for emotional problems like post-traumatic stress disorder — the signature, invisible wound of these conflicts.

But while the VA is in the process of hiring 1,900 mental-health workers, the government agency has endured withering criticism from many veterans and advocacy groups for being behind the curve in helping America’s newest warriors — especially when it comes to resolving a crushing backlog of disability claims.

“I’m sorry, but this is all smoke and mirrors,” said Shad Meshad, co-founder and president of the National Veterans Foundation. “There are 2.4 million people who have served in these wars. There’s a tsunami of mental health issues coming which will be with us for decades. It’s great that the people who use these 80 beds have a shot. But as a country we have yet to put our arms around this problem.”

Dr. Jerome Yesavage, the Palo Alto VA’s associate chief of staff for mental health and a Stanford University professor of psychiatry, said the system now is better equipped to deal with the growing need.

“There’s been a huge effort made to de-stigmatize mental-health problems by the VA and military,” Yesavage said. “The VA is much more organized to be a welcoming place for veterans with these problems.”

While VA staffing jobs are short term and not necessarily attractive to medical professionals, the hope is new state-of-the-art facilities will be a recruiting tool.  The $60 million Mental Health Center is part of a $1 billion construction boom at the Palo Alto facility over the next eight years. Another centerpiece will be a 174,000-square-foot rehabilitation center — scheduled to open in August 2014 — that will house the hospital’s polytrauma center, which has been treating some of the most grievously wounded troops since the wars began.

Yesavage said the newest building should largely be populated by younger veterans and will treat patients with severe emotional problems who might pose a threat to themselves or others. Because many of these patients are hospitalized involuntarily, three of the four wards are locked units and the entire building is designed with safety features to prevent suicides.

Paul Rieckhoff, founder and executive director of Iraq and Afghanistan Veterans of America, believes that the new Mental Health Center and other coming facilities in Palo Alto are important if the VA, nationally, hopes to catch up to the growing demand for services.

“I’m hopeful that this is something good because I think the rest of the VA looks to Palo Alto for leadership,” Rieckhoff said. “If Palo Alto can make this work, it can be a powerful model for the rest of the country.”

Hurt said the hospital has made a difference in his life. A native of the Central Valley town of Ripon, Hurt voluntarily admitted himself after family members convinced him that he needed to seek help after he spoke of hearing voices.

“We come back from war and everything just seems so normal,” said Hurt, who served 27 months in Iraq. “That just throws us off. We try to act like nothing’s wrong when something is wrong.”

Released from the VA on Monday, Hurt said he hopes to come back in August when the new building is opened to patients.

“But just as a visitor,” he said.

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