On April 25, the Senate Veterans’ Affairs Committee held a hearing on veteran’s mental health issues, including the needs of women veterans.
Sen. Sherrod Brown (D-OH) stated, “Today, we are going to focus on suicide attempts, PTSD [post-traumatic stress disorder], military sexual trauma [MST], and substance abuse. We are going to look at the incidence of these physical and mental health threats among our Veterans, what the VA [Department of Veterans Affairs] is doing, and what Congress can do to help.” Noting that more than “one third of soldiers returning from the Wars in Iraq and Afghanistan will seek mental health services” and that, during “the last 5 years, nearly 20 percent of women seeking VA care reported experiencing MST,” Sen. Brown said, “The VA must do a better job of predicting and preparing for those coming home from war.”
Addressing the issue of MST, Connie Lee Best of the Medical University of South Carolina stated, “According to the VA, military sexual trauma (MST) refers to both sexual harassment and sexual assault that occurs in military settings. It can be experienced by both men and women. Sexual harassment is defined as repetitive, unwanted sexual attention or sexual coercion. Sexual assault is sexual activity against one’s will. Numerous research studies have documented rates of rape ranging from lows of 6 percent for active duty women and 1 percent for active duty men to rates that are significantly higher. One study found that 23 percent of female users of VA healthcare reported experiencing at least one sexual assault while in the military.” Dr. Best explained that in the military, “MST most frequently occurs where the victims live and work so that often the victims remain in close proximity to the perpetrators. The perpetrators are just as frequently their supervisors or higher ranking peers who will be responsible for making decisions concerning the victim’s promotion or duty assignments. The risk of re-victimization by the same perpetrator is real. These factors, combined with the value placed on unit cohesion, especially in the combat theaters, add to the reluctance for victims to come forward. Even given the relatively new system in the military that allows victims to seek medical and psychological care without required reporting to law enforcement, the unique aspects of MST have the effect of reducing the likelihood that victims will seek psychological services.”
Describing the “devastating effects of MST,” Dr. Best said, “Those who have experienced MST often develop post traumatic stress disorder (PTSD), major depression, substance abuse problems, and functional impairment in social, interpersonal, and employment settings. The effects of MST do not stop once the service member leaves the military.” She pointed out that National Guard and Reserve members face particular challenges regarding MST: “Although during their Post-Deployment Health Assessment conducted immediately after returning from deployment, they are given the opportunity to indicate if they had experienced a MST or are experiencing mental health effects associated with that trauma, Reservists are acutely aware that if they do endorse serious mental health concerns such as PTSD, they will likely be retained on active status and not be allowed to return to their civilian lives. Furthermore, the victims of sexual trauma may feel that if they could just return home to their families and jobs, they will be able to overcome this experience on their own.” Dr. Best made several recommendations to the committee, including “more qualified and appropriately trained providers,” outreach programs “specifically to address the needs of returning Guard and Reservists who face significant barriers to treatment,” and “collaborations with academic medical centers with expertise in sexual trauma.”
Patricia Resick, director of the Women’s Division of the Department of Veterans Affairs National Center for Post Traumatic Stress Disorder detailed the women’s programs at VA Boston Healthcare System: “Like all VA hospitals we have a Women Veterans Program Manager and a Military Sexual Trauma (MST) coordinator who serve as advocates for information and referrals to appropriate programs. We have a separate Women’s Health Center that provides primary care, gynecological care, osteoporosis assessment and treatment, urgent care and social services. The Women’s Stress Disorder Treatment team, located in its own wing of the hospital, offers outpatient mental health treatment for post traumatic stress disorder and other trauma-related mental health problems. A full line of services including psychiatry, individual and group therapy, psychological assessment and consultation are available. There is a separate wing of the acute inpatient psychiatric program designated for women to provide them security and privacy. We will soon open a residential program for women with co-occurring PTSD and substance abuse disorders. The goal is to help women develop skills to maintain abstinence, manage PTSD symptoms, and address their traumas. The program offers assessment; group, individual and psycho-pharmacological treatment and psycho-educational programs while supporting participants in the development of their own long-term recovery plan.”
She continued, “The Women’s Homelessness Program provides an array of services to homeless women and women at high risk for homelessness. Our transitional residence, TRUST House, specializes in the treatment of women with post traumatic stress, mood and substance use disorders. Up to seven women live in the residence. The treatment program involves individual therapy, case management, group therapy, house meetings, and paid work experience through the Veteran Industries Vocational Program. Women are assisted in making the transition from VA supported employment to employment in the community.”
Mental Health America Vice President for Government Affairs Ralph Ibsen highlighted women servicemembers and trauma in his testimony: “Women represent some 15 percent of those in the OIF/OEF [Operation Iraqi Freedom/Operation Enduring Freedom] theaters. And while not serving in infantry units, they are more exposed to trauma driving in convoys, serving in security assignments, and even flying aircraft than in any other military engagement in our history. It should also be acknowledged that the range of trauma to which women in service are being exposed ranges from the threat of IED’s [Improvised Explosive Device] to marital and family stresses.” He stressed the importance of examining the gap between the “mental health needs of women veterans and VA’s capacity to meet those needs, consistent both with expectations of privacy and of a welcoming climate,” stating, “It would be most helpful in this connection to survey women OIF/OEF veterans, in order to understand their experiences and perceptions regarding care in a system long seen as an enclave for treating an almost exclusively male population.”
Concerning the effect of PTSD on families, Mr. Ibsen said, “Research on PTSD, for example, has shown that it has had severe, pervasive negative effects on marital adjustment, general family functioning, and the mental health of partners, with high rates of separation and divorce and interpersonal violence. PTSD can also have a substantial impact on veterans’ children. Not surprisingly, in a military engagement that has required multiple tours of duty of many service-members and in which the burden has fallen heavily on citizen-soldiers of the National Guard and military reserves, the impact on families has been particularly hard, and may be implicated directly in mental health problems in family members of the veteran.” Asserting that current law limits VA’s assistance to family members, he recommended “that VA be authorized to provide immediate family members with both support services AND (when needed) mental health services to help foster the veteran’s readjustment or recovery.”
Also testifying were Tony Bailey, father of an Iraq war veteran who died of a drug overdose; Randall Omvig, father of an Iraq veteran who committed suicide; Patrick Campbell, legislative director, Iraq and Afghanistan Veterans of America; David Oslin, director, Mental Illness Research Education and Clinical Center, Department of Veterans Affairs; and Jan Kemp, associate director for Education, Mental Illness Research Education and Clinical Center, Department of Veterans Affairs
