March 1, 2008 – Virginia officials are preparing for a sharp increase in requests for community mental health services from troops returning from Iraq and Afghanistan, and they are concerned that the system will be overwhelmed.
Mental health experts and officials said they are seeing a growing number of recently returned military personnel with post-traumatic stress disorder, depression and other ailments seeking services from behavioral health clinics.
But with a waiting list of about 5,700 for community mental health services, many officials are concerned that the state will not be able to adequately serve the veterans and family members going to these clinics, operated by what are known as community services boards.
State officials said they are preparing for a 15 percent increase over the next decade in people seeking services from the state’s mental health network, especially in emergency situations. That does not include family members who might need counseling. The issue is of particular concern in Virginia because the state has the third highest number of military service members in the country, behind California and Texas.
“This is a population that we’re going to have to think about for some time,” said James Reinhard, commissioner of the state Department of Mental Health, Mental Retardation and Substance Abuse Services. “We’re concerned and believe that [the population] is going to clearly have an impact on our services.”
Paul, a reservist with the 890th Transportation Company, said the flashbacks and nightmares started a month after he returned from Iraq’s Sunni Triangle. Violent images woke him at night and sometimes jolted him during the day. He knew he needed help.
There was a veterans hospital outside of Roanoke, 100 miles from his Shenandoah Valley home, but he had heard stories of long waits and lots of paperwork. He was given the number of a mental health clinic a short drive from his home, so he showed up one afternoon.
“The only thing I could think about was getting to someone close and fast because I was in such pain,” said the 39-year old reservist, who asked that his last name not be used to spare his family media attention. He receives weekly treatment at a Charlottesville clinic that serves veterans. He said he has continued to go to the clinic because, during a long stretch last year, he had difficulty accessing his military insurance coverage.
“I didn’t think about anything else” but getting help, he said.
Veterans who serve less than 20 years, including those who served in the reserves and National Guard, are eligible for mental health care after discharge through the Veterans Affairs Department’s system of hospitals, clinics and drop-in centers. Because of recent changes by Congress, combat veterans are guaranteed mental health evaluations within 30 days of a request, and the period during which they may seek care from the VA has been increased from two to five years.
But Virginia officials said there are signs that many returning soldiers and their families are not accessing services immediately after discharge, and the delay can worsen their conditions. A national study released in November found that mental health problems showed up in higher levels in military screenings three to six months after returning from Iraq than in screenings done immediately upon returning home.
“We’re already seeing people come in, but I think, over time, this is just the beginning,” said Charles A. Hall, director of the Hampton-Newport News Community Services Board, which is near several military bases from which troops have been deployed to Iraq and Afghanistan. “We’ve had a few veterans who have come in two years after being home and say they’ve been struggling all that time and never went anywhere for help.”
In addition, mental health officials in Hampton Roads said they are treating dozens of active duty soldiers and family members who have quietly sought services away from the military’s programs.
The reasons veterans choose community services over military services vary. Some don’t want to be seen in VA facilities out of concern of being perceived as weak by their comrades. They see the community centers as more private. Others say it’s a matter of familiarity and convenience.
“The issue for me is that I wanted someone nearby . . . and I wasn’t trying to see the inside of a vet hospital, ” said Wesley Hull, 25, a Marine who served two tours in Iraq before returning home to Nelson County, just north of Charlottesville.
To address the issue, the state Senate and House of Delegates have passed legislation that could allocate up to $2 million a year for tracking the mental health needs of combat veterans who do not engage with the VA system or private health care. The bills are subject to revision and must be signed by Gov. Timothy M. Kaine (D). The state also is seeking grants from the federal government to help coordinate services between veteran’s hospitals and state mental health agencies.
The issue is not confined to Virginia. Several states, including Kentucky and Missouri, also have established programs to help returning veterans. “The VA isn’t the bad guy here, but they can’t be responsible for the mental health needs of all 1.7 million soldiers deployed,” said Pat Kerr, director of Operation Outreach for the Missouri Veterans Commission.
VA officials said they think they have the structure in place — 152 VA hospitals across the country and 740 mental health agencies they contract with — to meet the needs of returning veterans. Virginia has three VA hospitals and four counseling centers and contracts with 29 outpatient facilities across the state. But the officials acknowledge that there is more work to do.
“We know we have to make access easier in some areas,” said Ira Katz, head of the VA’s mental health services. “We’re not sure we know what the best mechanism is to do that yet. But the important thing is for the VA and mental health providers to work together in the community.”