Stripes: With the budget increase … are you simply throwing money at the problem? How are you going to approach the next wave of psychological disorders that are coming in?
President Barack Obama: Throwing money at the problem by itself is not enough, but money helps.
First of all, I do think there’s been a sea change in attitudes around stress disorders since the Vietnam era. I think both DoD and the VA take the issue of PTSD very seriously.
One of the best things we can do to reduce incidents of PTSD is to reduce the amount of time in theater without a break. So the steps that we’ve taken to increase our forces, particularly in the Army and Marines, the authorization I provided to Secretary Gates to advance the increase in forces for our Army so we can end stop loss policy sooner than we otherwise would have been able to do: All of those things will make a difference at reducing stress.
Because what you’ve seen are the incidents of post-traumatic stress disorder increase with each deployment.
So that’s step number one. Step number two is making sure that we’re doing the screenings that are necessary so that problems don’t fester, and eliminating the stigma that may have historically existed when someone is showing symptoms of PTSD, particularly when they’re still in theater, still on active duty.
I think you’ve seen steps within all the armed forces to talk about these issues, encourage people to avail themselves of services while they’re in theater but also when they get home. That’s been combined with the much-more aggressive systematic screening now being done by the VA, for those who are discharged.
Then the third part of it is to actually provide the mental health services, once people have been identified as needing help. Money will pay for more counselors, more mental health specialists, more facilities.
It’ll allow us to target specific aspects of PTSD; For example, women veterans. We are trying to make sure there are services available for women veterans in every VA facility, or as many as we can. The issues of potential sexual abuse, for women’s veterans is being addressed directly, in a way it hasn’t in the past.
So I think this kind of comprehensive approach will help, but it’s something that will still require a lot of work.
That’s what Ric referred to when he was talking about working with the homeless population. By the time somebody is homeless, it’s safe to assume we’ve missed a lot of warning signs and opportunities of intervention. That’s what we’re trying to close the gap on.
VA Secretary Eric Shinseki: I think “throwing money at this” is just a bit off point. We’re hiring mental health care providers: we’re up to 18,000 today.
And part of that, we also have a national suicide hotline, where you call in and it’s not a 911 operator, it’s a mental health professional. These folks have taken something like 150,000 phone calls, and addressed needs, focused people into getting help. 3,200 interventions online, where suicides were in the process. But because you have a mental health professional recognizing some cues -- they have a name, you know a location – you can begin to vector, whether it’s police or local authorities, to help.
3,200 interventions to date, one of them in Baghdad. A mother calls in, she’s online with her son, we get through to DoD, they notify the youngster’s unit and intervened.
We know a lot about PTSD, but we don’t know enough. We know that PTSD is in there for a long time. The 131,000 homeless veterans, many of them are Vietnam veterans, many of them started out with PTSD and went down that long road.
What we don’t know about PTSD, and this is why we have to put a lot of effort into research, why do Shinseki and Smith go through the same incident, Smith comes through it essentially unharmed and unaffected, and Shinseki has a heavy impact. There’s something here that we don’t understand.
Is it personal make-up, resilience, how kids were raised, whatever? Unlocking that door for both DoD and VA will be important, because it will help us understand how we can teach resilience. And to some degree, resilience does count here.
So, a lot of research work. We’re putting mental health into the primary areas of each of our hospitals, and as the president indicated 153 hospitals, all of them have been directed to have a women’s program coordinator. I think we’re at 144 out of the 153 hospitals.
By putting mental health into the primary care areas of the hospital, as opposed to a separate entity, we’re trying to attack that stigma of “I’m going to mental health” as opposed to “I’m going to the hospital” which isn’t as visible.
I think we have to remind ourselves we’re dealing with 20-year-olds. Some of this is just the invincibility of youth, having been that age at one time. I don’t have a problem, I can deal with this, I don’t need help. We have got to work through that. That’s part of the reason, at that age, that their insurance is a heck of a lot more expensive, because of that youthful aspect.
So some of that is just having to break through the invincibility of youth. We can help.
We know if we get them into treatment, they get better. We also know if we don’t get them into treatment, it doesn’t get better, and more often it becomes debilitating.
Stripes: When we sat down this time last year you said you wanted to see a change in attitude at the VA. Has that happened?
Obama: I think there’s no doubt we’ve had a change in attitude. Now translating a change in attitude at the top with transforming a massive agency, with 288,000 employees … this is a big operation.
As much progress as we’ve made, I think it’s fair to say this is a multi-year project. We are going to be working vigilantly, we’re going to keep on pushing, we’re going to keep on prodding. Both the VA and DoD understand these very human issues are dealt with in the most thoughtful and effective way possible. I’m confident that we’re moving in the right direction.
We’re putting resources behind it. We’re putting time and energy behind it. I’m focused on it personally. But it’s going to take some time.
But I think we also have to acknowledge that, as I said before, there is a direct connection between the problems of PTSD and the pace of military operations. As we are phasing down our operations in Iraq, we’re going to see fewer PTSD cases coming out of Iraq. As we’re seeing increased velocity of operations in Afghanistan, that’s going to put more strain on the military personnel who are located there.
This is why I take so seriously my role as commadner in chief in deploying these men and women. No matter how good a job the DoD or VA is doing, war is a difficult, painful process. We have to be mindful of that.