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Leila Levinson Headshot

Time to Pay the Price of War

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The Lives of Others is a 2006 German movie about a secret policeman who spies on civilians suspected of criticizing the East German government. As well as revealing the consequences for the policeman of eavesdropping on individuals, the movie argues that a society's suicide rate (which the East German government went to great lengths to keep secret) indicates the moral health and legitimacy of the society.

This past July, 38 American soldiers committed suicide, the highest rate since the Army began keeping count. A veteran commits suicide every 80 minutes. If you have ever known someone who lost a family member to suicide, you've had a glimpse of the devastation suicide leaves in its wake.

Help has been slow to come for members of our military and our veterans in crisis. Nearly 1 million veterans from various wars await a ruling from the Veterans Administration on their claims for disability. The VA estimates that in the next several months, another 1.2 million claims will come in as more troops return and more veterans recognize that they suffer from PTSD.

On Aug. 31, President Obama signaled that the government is making the mental health of our service members and veterans a top priority. Obama issued an executive order called "Improving Access to Mental Health Services for Veterans, Service Members, and Military Families" that mandates several essential concrete measures. And while each and every one of these measures is laudable and critical, one component is missing from the order: funding.

Let's look at the mandates:

1. Expanding the capacity of the Veteran Crisis Line by 50 percent so veterans have timely access to responders. As Paul Sullivan of Veterans Outreach at Bergmann and Moore reported, the Veterans Crisis Line has made a profound difference in the rate of veterans' suicide. As of this past July, it had received 723,115 contacts via phone, chat, and text. Its dedicated staff assisted with 23,483 rescues, where the veteran was brought in by first responders for medical care. (The number of the Veterans Crisis Line is 1-800-273-8255, and press 1.)

2. That the VA ensure that any veteran who identifies him or her self as being in crisis connects with a mental health professional or trained mental health worker in 24 hours.

3. That the VA expand the number of mental health professionals available to see veterans beyond traditional hours.

4. That the VA and the Department of Defense jointly develop and implement a 12-month suicide prevention campaign that will seek to persuade service members and veterans to reach out proactively to support services.

5. That they identify key program areas within the DoD that have had the greatest impact and shift more resources to those programs.

6. That where the VA has "faced challenges in hiring and placing mental health service providers and continues to have unfilled vacancies or long wait times" the VA and the DoD will establish pilot programs of partnering with community health clinics and health centers to see if such partnerships can help meet the veteran's mental health needs.

Of the above, all except perhaps number five require additional funding. It isn't as though the VA has been choosing not to hire more mental health professionals.

I live in Austin, Texas and serve on the Austin VA's advisory council, a group of veterans, family members of veterans, and VA employees who work to improve services of the Austin VA. We repeatedly have called for what above items 1-4 articulate. Even as simple a step as making providers available after 5 p.m., when most working veterans would be able to show up, has not been feasible due to the expense of having guards on duty and keeping the building open. The result of our advocacy has been extending hours to 6 p.m. one evening a week.

Texas is home to the second-largest veteran population in the country behind California; but, as reported by the Austin American Statesman, veterans in central Texas, have the nation's longest average wait time for disability claims processing: roughly 393 days, according to the VA's most recent numbers. (Before a veteran can access services at the VA, they need a finding of disability.)

"Over the past 12 months, nearly 1 of every 5 claims processed in Waco [the regional office for Central Texas] has been plagued by errors, which can range from incorrect paperwork to failure to locate records or order medical tests, according to agency numbers. Inaccurate claims often lead veterans into appeals that can last for years."

And Waco's 17.5 percent error rate is the eighth worst in the country -- so there are seven regional offices that do even worse.

At our last meeting of the advisory council, someone referred to Governor Perry's decision to spend $1.5 million to create special teams of claims counselors to reduce the backlog of claims. A veteran of Vietnam responded, "And what happens when those veterans get their claims processed? Where do we find the providers for them?"

Simply put, the VA does not have the resources necessary to meet veterans' mental health needs. Every single VA facility in the country is overstretched, even before another million service members become veterans. The Congressional Budget Office testified this past spring that the annual cost of caring for veterans from the Iraq and Afghanistan wars would nearly triple in the next decade, rising from $1.9 billion in 2010 to somewhere between $5.5 billion to $8.4 billion in 2020. As economists Joseph Stiglitz and Linda Blimes have written in The Three Trillion Dollar War, the total cost of health care and disability compensation to veterans of the current wars will be nearly $1 trillion over the next 40 years.

As the daughter of a WWII veteran who never received a diagnosis of and help for the trauma he suffered, I applaud the president's executive order that includes families of veterans and service members among those deserving mental health care. But think about how many people we are talking about. As it is, very few veterans receive one-on-one mental health care within the VA. The most common form of therapy occurs within a group. The few spouses and children who currently receive services at the VA do so as part of the services their veteran spouse or parent receives. For spouses and children to receive meaningful individual care, the VA would need to expand beyond my ability to imagine, yet alone quantify.

Obama's executive order doesn't say a word about money. Amazingly enough, a key item of the order -- the last -- seems to punt the ball to "community heath clinics and centers."

Austin, Texas, is midpoint between Fort Hood and San Antonio, Texas, and home to the University of Texas at Austin and an excellent community college system: Austin Community College. As a result, Travis County (which includes Austin) is home to approximately 53,000 veterans. Statewide, the number of veterans waiting to hear about their disability claims is more than 100,000 (an increase of 60,000 since 2009). Let's say one-fourth of those 100,000 are in central Texas, a low estimation. What difference can the community health centers of Travis County make in assuring these veterans have access to mental health?

Community health clinics generally serve people without health insurance or who are eligible for government-sponsored care such as Medicare, Medicaid or the Children's Health Insurance Plan (CHIP). One of Travis County's clinics -- People's Community Clinic -- is Austin's only independent clinic offering comprehensive health and wellness care to the uninsured. According to the clinic's website:

"The need in Central Texas for uninsured medical services is enormous: the Travis County Healthcare District estimated in December 2008 that 20.7 percent of the county's population is without health insurance. That means more than 200,000 people must turn to alternative sources for medical care. 10,000 patients call People's Community Clinic their medical home."

It does not have a behavioral health care component.

A community health clinic in Austin that does have one offers it in collaboration with the county's mental health and mental retardation center. There is one M.D. on that staff; five others are licensed professional counselors and one is a licensed social worker. None list adult PTSD as a speciality. The website says:

"The behavioral health care providers use a variety of brief therapy approaches to assist patients challenged by mild to moderate behavioral disorders. This includes substance abuse disorders. Our approach to behavioral health services helps us meet the demands of the fast paced primary care clinic setting, allowing us to serve more patients on a daily basis."

Out of necessity, the emphasis is on serving the maximum number of patients possible, a goal at odds with providing quality mental health care. Is this clinic equipped to respond to the needs of Travis County's veterans suffering from PTSD and TBI? What criteria will the VA and the DoD use to assess the qualifications of a clinic to provide for veterans' mental health needs? And most important, will the clinics receive compensation?

Community health clinics and centers are already stretched to the breaking point due to cuts in funding and skyrocketing demand. It does not seem realistic to turn to them to help meet the mushrooming demand for services from veterans.

While the executive order says all the right things, on closer inspection these statements are meaningless without providing for funding. For the order to be more than rhetoric, uttered during a campaign, the administration must forcefully present the case to Congress: You voted for these wars, wars for which you allocated no money.

The time has come to pay the price.

Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.

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