More programs than ever are addressing the mental health needs of soldiers and their families, yet critics say the departments of defense and veterans affairs have failed to keep up with ballooning demand for behavioral health services brought about by repeated deployments in Iraq and Afghanistan.
Long waits for mental health appointments and shortages of trained personnel are among the issues listed in separate reports from special panels set up by the American Psychiatric Association and the American Psychological Association.
Allegations of poor coordination between agencies, wide variations in quality and availability of programs, and bureaucratic barriers that limit access to care also appear on the laundry lists of problems that need fixing.
"Strain on the system" was the most important finding of the psychological association's Presidential Task Force on Military Deployment Services for Youth, Families, and Service Members, according to director of communications Rhea Farberman. She said the task force members, virtually all of them members of the military or Veterans Affairs (VA) employees, could not answer questions because "their clearance was pulled" after the negative report became public.
The task force wrote that it "was not able to find any evidence of a well-coordinated or well-disseminated approach to providing behavioral health care to service members and their families. This appears to be the case both across and within each of the military branches.... It is the consensus of the Task Force that, overall, relatively few high-quality programs exist."
The report of the American Psychiatric Association's Board of Trustees Ad Hoc Work Group on Veterans Affairs and Military Initiatives recommended positions for the association to advocate in a platform subsequently adopted at the trustees' March meeting.
Key planks include improved access "to a continuum of mental health and substance abuse services" and funds "to support professional positions to staff the continuum."
The psychiatrists also want more funding for research on evidence-based treatment of posttraumatic stress disorder, traumatic brain injury, and other "war-related health consequences"; for the mental health needs of women in the military; and for programs aimed at reducing any stigma associated with seeking mental health and substance abuse services.
In the case of substance abuse, the work group charged that veterans with coexisting illicit substance abuse can face deductions of benefits and difficulty in accessing benefits and treatment. "Returning soldiers have always had an increased risk of developing alcohol and substance abuse problems in large part due to the stress and trauma encountered in their service," it wrote.
The work group characterized psychiatric services for children in military families as "very limited" and called for the military health system, called TRICARE, to provide timely access to psychiatric care "for family members with psychiatric disorders or combat-related stress responses." Dr. Mary Helen Davis, chair of the work group, said in a telephone interview that the association is working with the National Alliance on Mental Illness and Mental Health America to press for this agenda.
She credited the armed services with considerable expertise in the treatment of war-related mental health problems but said it must respond to new challenges such as how to provide care to veterans who live in rural areas far from veterans facilities and to women who served in high-stress deployments involving combat and/or sexual abuse.
"Part of the problem is that increased demand and need far exceed the capacity [for mental health services]," she said. …