Health email thisprint this Posted on Wed, Dec. 28, 2005 Post-trauma treatment costs turn politicalBy SHANKAR VEDANTAMThe Washington PostWASHINGTON - The spiraling cost of post-traumatic stress disorder among war veterans has triggered a politically charged debate and ignited fears that the government is trying to limit expensive benefits for emotionally scarred soldiers returning from Iraq and Afghanistan. In the last five years, the number of veterans receiving compensation for the disorder commonly called PTSD has grown nearly seven times faster than the number receiving benefits for disabilities in general, according to a 2005 report by the inspector general of the Department of Veterans Affairs. A total of 215,871 veterans received PTSD benefit payments last year at a cost of $4.3 billion, up from $1.7 billion in 1999, a jump of almost 150 percent. Experts say the sharp increase does not begin to factor in the potential impact of the wars in Iraq and Afghanistan because the increase is largely the result of Vietnam vets seeking treatment decades after their combat experiences. Facing a budget crunch, experts within and outside the VA are now raising concerns about fraudulent claims, wondering whether the structure of government benefits discourages healing, and even questioning the utility and objectivity of the diagnosis itself. ''On the one hand, it is good that people are reaching out for help,'' said Jeff Schrade, communications director for the Senate Veterans Affairs Committee. ''At the same time, as more people reach out for help, it squeezes the budget further.'' Among the issues being discussed, he said, was whether veterans who show signs of recovery should continue to receive disability compensation: ''Whether anyone has the political courage to cut them off -- I don't know that Congress has that will, but we'll see.'' Much of the debate is taking place out of public sight, including an internal VA meeting in Philadelphia this month. The Department of Veterans Affairs has also been in negotiations with the Institute of Medicine over a review of the ''utility and objectiveness'' of PTSD diagnostic criteria and the ''validity'' of screening techniques, a process that could have profound implications for returning American soldiers. The growing national debate over the Iraq war has added fuel to the fire, some participants said. ''It has become a pro-war war versus antiwar issue,'' said one VA official who spoke on condition of anonymity because politics is not supposed to enter the debate. ''If we show that PTSD is prevalent and severe, that becomes one more little reason we should stop waging war. If, on the other hand, PTSD rates are low... that is convenient for the Bush administration.'' As to whether budget issues and politics are playing a role in the agency's review of PTSD diagnoses and treatment, VA spokesman Scott Hogenson said: ''The debate is over how to provide the best medical services possible for veterans.'' People with PTSD have paralyzing memories of traumatic episodes they experienced or witnessed, a range of emotional problems and significant impairments in day-to-day functioning. Underlying the political and budget issues, many experts acknowledged, is a broader scientific debate over how best to diagnose trauma-related pathology, what the goal of treatment should be -- even what constitutes trauma. Harvard psychologist Richard McNally, for instance, argues that the diagnosis equates sexual abuse, car accidents and concentration camps, when they are entirely different experiences: A PTSD diagnosis has become ''a way of moral claims-making,'' he said. ''To underscore the reprehensibility of the perpetrator, we say someone has been through a traumatic event.'' The director of the VA clinic in Charleston, Chris Frueh, said the VA's disability system encourages some veterans to exaggerate their symptoms and prolong problems in order to maintain eligibility for benefits. ''We have young men and women coming back from Iraq who are having PTSD and getting the message that this is a disorder they can't be treated for and they will have to be on disability for the rest of their lives,'' said Frueh, a professor in public psychiatry at the Medical University of South Carolina. ''My concern about the policies is that they create perverse incentives to stay ill. It is very tough to get better when you are trying to demonstrate how ill you are.'' Most veterans Frueh treats for PTSD are seeking disability compensation, he said. The VA uses a sliding scale; veterans who are granted 100 percent disability status receive payments starting at around $2,300 a month. The VA inspector general's report found sharp differences in benefits payments in different states and ascribed it to the fact that VA centers in some states are more likely to grant veterans 100 percent disability. Psychiatrist Sally Satel, who is affiliated with the American Enterprise Institute, said an underground network advises veterans where to go for the best chance of being officially declared disabled. The institute organized a recent meeting to discuss PTSD among veterans. Once veterans are declared disabled, they retain that status indefinitely, Frueh and Satel said. The system creates an adversarial relationship between doctors and patients, where veterans sometimes take legal action if doctors decline to diagnose PTSD, Frueh said. The clinician added that some patients who really need help never get it because they are unwilling to undergo the lengthy process of qualifying for disability benefits, which often requires them to repeatedly rehearse the painful episodes they experienced. The concern by Frueh and Satel about over-diagnosis and fraud -- what researchers call ''false positives'' -- has drawn the ire of veterans groups and many other mental health experts. A far bigger problem is the many veterans who seek help but fall through the cracks or who never seek help at all, a number of experts said. Studies have shown that large numbers of veterans with PTSD never seek treatment, possibly because of the continuing stigma surrounding mental illness. ''There are periodic false positives but there are also a lot of false negatives out there,'' said Terence Keane, one of the nation's best known PTSD researchers, who cited a 1988 study on the numbers of veterans who do not get treatment. ''Less than one-fourth of people with combat-related PTSD have used VA-related services.'' Larry Scott, who runs the clearinghouse www.vawatchdog.org , said conservative groups are trying to cut the VA's disability programs by unfairly comparing it to welfare. Compensating people for disabilities is a cost of war, he said: ''Veterans benefits are like workman's comp. You went to war. You were injured. Either your body or your mind was injured, and that prevents you from doing certain duties and you are compensated for that.'' (Optional Add End)| Scott said the VA's objectives were made clear in its request to the Institute of Medicine for a $1.3 million study to review how PTSD is diagnosed and treated. Among other things, the VA asked the institute, a branch of the National Academies chartered by Congress to advise the government on science policy, to review the American Psychiatric Association's criteria for diagnosing PTSD. Effectively, Scott said, the VA was trying to get one scientific organization to second-guess another. PTSD experts summoned to Philadelphia for the two-day internal ''expert panel'' meeting were asked to discuss ''evidence regarding validity, reliability, and feasibility'' of the VA's PTSD assessment and treatment practices, according to an e-mail invitation obtained by The Washington Post. The goal, the e-mail added, is ''to improve clinical exams used to help determine benefit payments for veterans with Post Traumatic Stress Disorder.'' ''What they are trying to do is figure out a way not to diagnose vets with PTSD,'' said Steve Robinson, executive director of the National Gulf War Resource Center, a veterans advocacy group. ''It's like telling a patient with cancer, 'if we tell you, you don't have cancer, then you won't suffer from cancer.''' Hogenson, the VA spokesman, said the department is not seeking to overturn the established psychiatric criteria for diagnosing PTSD. ''We are reviewing the utility and the objectivity of the criteria... and are commenting on the screening instruments used by VA,'' he said. ''We want to make sure what we do for screening comports with the latest information out there.'' Mental Health And Political Forums http://community.adlandpro.com/forumShow.aspx?ForumID=10129 http://community.adlandpro.com/forumShow.aspx?ForumID=9637 http://community.adlandpro.com/forumShow.aspx?ForumID=8212 http://community.adlandpro.com/forumShow.aspx?ForumID=7420 http://community.adlandpro.com/forumShow.aspx?ForumID=8259 Lifetime web building and hosting for under $40. One time payment http://www.superpayline.com/p002859 The most advanced VOIP system there is anywhere. https://wv0079721.betteruniverse.com/members/index.php?action=buy_miphone Better Universe. The People Helping People Company http://wv0079721.betteruniverse.com May a smile follow you to sleep each night, and be there waiting when you awaken. SIncerly, Bill Vanderbilt / Fanbelt

Greetings All The following article is going to upset you when you read it. It will make you angry, sad, confused and hopefully, it will inspire you to try to do something to change this situation for homeless veterans. Particularly those with a mental illness. This man shold never have died. He should have been given the care he needed and there are thousands more in the same situation. It breaks my heart to hear stories like this one but the stories keep comming in.Friends, you can help these poor veterans by writting to your state congressional leaders and ask them to take better care of our vets. They deserve it. Published January 19. 2006 3:06PM Homeless Vietnam vet receives a military funeral By CARLA CROWDER The Birmingham News Now that Joe Farmer is dead, people are rushing to honor him. He was a decorated Vietnam vet, a sergeant in the Army, people at his funeral noted. They carried his flag-draped casket to Fort Mitchell National Cemetery near Phenix City on Wednesday, where a cluster of strangers in uniform saluted. A chaplain prayed; a recording of taps was sounded. Funeral homes donated services to keep him out of the pauper's cemetery. When Farmer was in neurological intensive care barely breathing, medical specialists at UAB hovered over him for a week. No telling how many thousands of dollars it cost to keep him on life support. But what's tormenting Farmer's friends at the Church of the Reconciler is this: Why wasn't a fraction of this attention given when Farmer was huddled in the cold, homeless and psychotic and filthy, before he was beaten outside the downtown Birmingham church on the second day of the New Year? The former soldier died Jan. 10. Police say he was killed for a few dollars. "We are deeply spiritually ill if resources for death are so freely available, why aren't resources for life available?" the church pastor, the Rev. Lawton Higgs, recently asked, his voice hoarse with grief. Farmer, 56, turned up at the church, as so many homeless do, months ago. When his mental illness made company and conversation impossible, Higgs let him camp outside the building. The people who brought him food, who urged warm coffee into his shaky hands knew he was growing sicker. Farmer needed medication he refused to take. He needed shelter but refused to move. Other homeless people tried to tidy his pallet of soiled blankets and help him stay warm. With a motto promising "radical hospitality," the Church of the Reconciler's leaders are loathe to force their wishes on their homeless friends. On any given morning, it's a place where Birmingham's otherwise castoff eat a hot meal, borrow the phone, pray. A place where they can let their guard down. So when Higgs decided to call authorities for help, it was hardly a decision made in haste or an urge to run off the troubled soul outside. Farmer's illness was obvious, and his inability to protect himself made him easy prey. Yet there he remained, despite repeated efforts by Higgs and others to alert the agencies designed to protect people like Farmer. "I had been working two months to get him off the street and at every turn I was stonewalled," Higgs said. "We failed him. This community failed him," said Michelle Farley, executive director of Metropolitan Birmingham Services for the Homeless. The breakdown in the systems designed to prevent this sort of lapse has caused soul-searching among advocates for the poor and homeless. They say they can't blame any single agency; this isn't the time for finger-pointing. Still, something needs to be done. "The caregivers are overwhelmed. We don't want to be critical of them," Higgs said. The futility of his efforts to save a sick veteran is testing the pastor's spirit of forgiveness. Failing to persuade Farmer to voluntarily get treatment, the pastor sought a pickup order from the Mental Health Division of the Jefferson County Probate Court. But there's a long wait for psychiatric beds. Four times in four days Higgs left messages with the staff at the Jefferson-Blount-Shelby Mental Health Authority, hoping they'd declare the situation an emergency. As a last resort, Higgs called police. He said he was prepared to press trespassing charges and put Farmer in jail, where Higgs believed the staff would put him back on medication. But the officers refused to arrest him. He was on a public sidewalk. Even the VA hospital, when Farmer finally agreed to let Higgs drive him, put a cast on Farmer's broken leg and gave him fresh clothes, but declined to admit him for mental health treatment. A cab returned him to the church the next day, Dec. 21. "We've got a very good program here, and our friend Mr. Farmer was very well taken care of here," VA spokesman Jeff Hester said last week. If a patient appears to be a threat to himself or others, the hospital can keep them, Hester said. But from what he could tell from Farmer's records, he wasn't, Hester said. "For the life of me, I cannot understand how the VA could put him in a taxi and send him back to the street. Lord have mercy," said John Key, a Salvation Army worker who arranged for his military funeral after learning that burial had been planned for the county paupers' cemetery. Then Higgs arrived one morning in late December to find Farmer had been assaulted by thugs with a paintball gun. It was growing more dangerous to leave him on the street. Higgs returned to Probate Court Dec. 27 to add an emergency addendum to the pickup order. It had been pending since Dec. 14. As is often the case, Probate Judge Alan King couldn't locate a bed. "At any given time we have in excess of 40 petitions on file with the court and we just don't have enough psychiatric beds," King said in an interview this week. "I wish we had about triple the psychiatric hospital beds that we have in Jefferson County." In looking through Farmer's file, he found that a VA social worker requested a psychological evaluation when Farmer was there for his broken leg. It was not done. Normally, the Birmingham VA is known for its excellent mental health care. "We have lower numbers of veterans on the streets than other communities. We do an exceedingly good job. But we didn't do the job for this man," Farley said. "I am just heartbroken by what happened to Mr. Farmer... To be attacked by paintball idiots, and then to be beaten to death all alone in the cold," she said, choking back tears. When Higgs arrived at his church Jan. 4, where Farmer once sat were two bloodstains matted with feathers from the dying man's coat. Seven phone calls later, Higgs located Farmer at UAB. For their part, Birmingham police acted quickly. Three days after the beating, while Farmer was still alive, they arrested Danny Wayne Turner, also a homeless man. Detective Mike Allison said a witness pointed them to Turner, that robbery appeared to be the motive. Turner was charged with capital murder and is being held without bond at the Jefferson County jail. "It's a shame to see somebody that's pretty much harmless from what I can tell be taken advantage of," the detective said. A shame, but not a surprise. "There's probably dozens and dozens of folks out there on the street in his same shape," Allison said. There's a misconception that people such as Farmer prefer to be on the streets. But for the untreated mentally ill, shelter life can be excruciating, said Dr. Jim Parker, a Birmingham psychiatrist who's been working with the homeless for 13 years. "If they're off their medication, they may simply be too paranoid to stay in a facility with lots of other people. Shelters are loud, chaotic. It's difficult for some non-psychotic people to tolerate, much less someone who has a mental illness," Parker said. He suggested the city add some sort of safe haven for homeless who can't live in typical shelters, possibly a single-room occupancy facility where the mentally ill would feel safe. "A lot of times that's the only way to get someone into the system," Parker said. How Farmer came to have even a few dollars is a mystery to the people at the church. But then so much about Farmer is. Last week, they gathered around tables in the church's dining room and discussed a memorial service planned for Friday, searching their memories for clues to the person he was before psychosis took over. Higgs learned from Farmer's family in Arkansas that he married after the war. But his wife died young and her loss sent his war-tattered psyche on a deeper spiral. He'd also been a journalist. Maybe they could locate a piece of his work to read at the service? Did he fancy a certain hymn? A poem? The phrase "that'll work" keeps coming back to volunteer Judson Armstrong. Tossed into Farmer's unintelligible word salads, it was his stock answer when someone offered coffee or a sandwich. One man suggests that maybe they can take up a collection for a plaque, inscribed in Farmer's memory, to hang on the wall where they gather for breakfast every morning. "Let's not set our goals so low," Higgs said. He wants Farmer to be remembered long after taps stops sounding at the Fort Mitchell cemetery. "Let's name this specialty shelter we're going to get built after Joe." Maybe that'll work. The Church of the Reconciler, at 112 14th St. North, will hold a memorial service for Joe Farmer at 10:30 a.m. Friday. The public is invited. --- Information from: The Birmingham News Mental Health And Political Forums http://community.adlandpro.com/forumShow.aspx?ForumID=10129 http://community.adlandpro.com/forumShow.aspx?ForumID=9637 http://community.adlandpro.com/forumShow.aspx?ForumID=8212 http://community.adlandpro.com/forumShow.aspx?ForumID=7420 http://community.adlandpro.com/forumShow.aspx?ForumID=8259 Lifetime web building and hosting for under $40. One time payment http://www.superpayline.com/p002859 The most advanced VOIP system there is anywhere. https://wv0079721.betteruniverse.com/members/index.php?action=buy_miphone Better Universe. The People Helping People Company http://wv0079721.betteruniverse.com May a smile follow you to sleep each night, and be there waiting when you awaken. SIncerly, Bill Vanderbilt / Fanbelt

Hello Friends I have copied this post from one of my other forums because there is actually some good news in this post and I wanted to share it with as many of you as I could. I also have to say something here that shames me a bit. I think that I should have dedicated one of my forums to our soldiers and veterans rather than just a thread or two. So, this will be my last post on this thread. Keep an eye out for my next new forum where I will be paying much more attention to our military people than I have been. Thank you all for your support here and I hope that you will join me in honoring our soldiers on the new forum. To any of you who are soldiers, present or past, I apologize for this oversight and I thank you all for the sacrafices you have all made for our country. Sincerly, Bill Vanderbilt It is with great pleasure that i bring you this message of hope for our returning war veterans. Due to the fact that newer types of medical treatments are available now that weren't in past wars, more of our soldiers are living through traumatic injuries. The downside of course is that these soldiers have suffered unbelievable injuries that have left them in physical states of being that sometimes make them wish that they had not survived their injuries. On the bright side, the VA is finally recognizing the fact that for these soldiers, mental health treatment is every bit as important and the physical. The following article is about new programs being developed to better treat our soldiers. Mental disorders affect third of Iraq vets UPI - Friday, January 27, 2006 Date: Friday, January 27, 2006 9:26:15 PM EST By OLGA PIERCE, UPI Health Business Correspondent WASHINGTON, Jan. 27 (UPI) -- About 40,000 soldiers returning from Iraq and Afghanistan have been found to show symptoms of mental health disorders, a Department of Veterans Affairs (VA) representative said Friday. In fact, a mental condition known as Post Traumatic Stress Disorder (PTSD) --first recognized during the Vietnam era -- is being diagnosed frequently among troops returning from the Middle East, and the VA has had to adjust its treatments and infrastructure to accommodate this, as well as the changing face of the American soldier. Although the fraction of soldiers diagnosed, about one-third, is higher than in the past, the VA has "no real way to know - in a true epidemiological sense - whether the rate is higher than past conflicts," Antoinette Zeiss of the VA office of mental health services, said at the National Press Club. The higher fraction could, in part, be due to increased screening, she said. As troops return home, they face the challenge of restarting their lives. Though most of the approximately 400,000 servicemen and women never seek help from the VA, those who do often must cope with the lingering effects of debilitating mental and physical injuries that differ from those in previous wars. Fortunately, new approaches to treatment are available as well. PTSD is the most common mental health problem among the troops returning home. The ailment, which results from exposure involving direct or indirect threat of serious injury or death, results in recurrent thoughts of trauma, reduced involvement in work or outside interests, hyper alertness, anxiety and irritability. Nearly 19,000 veterans of the conflicts in Afghanistan and Iraq were treated for post-traumatic stress between 2002 and 2005 in the administration's network of 160 specialized programs. The VA says it plans for 2006 a $29 million expansion of its post-traumatic stress services for veterans returning from Iraq and Afghanistan. In addition, 14,000 of the veterans diagnosed with PTSD were also treated for drug dependencies -- although the mix of drugs differs somewhat from the Vietnam era -- and 11,000 were treated for depression. Although all three of these most common problems were present in past wars, the administration has had to adapt its treatments to changing circumstances, Zeiss said. The veterans of these most recent wars are older, because the military has relied more heavily of National Guard and National Reserve units. About half of the troops are between 20 and 29, and another half are older than 30. Thirteen percent of the veterans receiving treatment are women, higher than in any past conflict. The role of women in the military has also changed. "We need to think not only about women veterans, which have always been a part of the VA," Zeiss said, "but also women warriors." The VA now operates seven outpatient women's stress disorder treatment teams to meet the special needs of female veterans. Treating veterans is also more complicated because of the more varied cultural and religious traditions of troops, Zeiss, who has spent many years treating veterans for mental problems, said. "It's important to remember how multi-cultural the United States - and its troops - are," Zeiss said. "The VA is trying to think in a cross-cultural way." Another more-frequent phenomenon is known as poly-trauma, when returning soldiers have both severe physical and mental wounds. Many soldiers with severe injuries, who would have died in past conflicts, are now surviving and require specialized care, Zeiss said. The VA has plans to expand the number of poly-trauma centers it operates from four to 21 to accommodate this increased need. For all veterans who suffer from mental disorders, methods of treatment are changing. The past practice of isolating them in hospitals has been replaced by an approach that stresses integrating patients into the community, and the support it can provide, as soon as possible. And recent studies have confirmed that new medications, such as SSRI drugs developed to treat depression, can be effective in treating Post-Traumatic Stress Disorder, an option not available in the past. A 2004 study, published in the New England Journal of Medicine, of nearly 6,000 Marines returning from Iraq and Afghanistan found that between 15 and 17 percent of Iraq conflict veterans and about 11 percent of veterans who served in Afghanistan suffered symptoms of mental disorders when they returned home. However, less than half of those affected sought care, in part because they feared they would be looked down on by their fellow soldiers and superior officers. The VA is reaching out to veterans to overcome attitudes and get them the help they need, Zeiss said. -- Copyright 2006 by United Press International. All rights reserved. Mental Health And Political Forums http://community.adlandpro.com/forumShow.aspx?ForumID=10129 http://community.adlandpro.com/forumShow.aspx?ForumID=9637 http://community.adlandpro.com/forumShow.aspx?ForumID=8212 http://community.adlandpro.com/forumShow.aspx?ForumID=7420 http://community.adlandpro.com/forumShow.aspx?ForumID=8259 Lifetime web building and hosting for under $40. One time payment http://www.superpayline.com/p002859 The most advanced VOIP system there is anywhere. https://wv0079721.betteruniverse.com/members/index.php?action=buy_miphone Better Universe. The People Helping People Company http://wv0079721.betteruniverse.com May a smile follow you to sleep each night, and be there waiting when you awaken. SIncerly, Bill Vanderbilt / Fanbelt

Hello Everybody

   While there really isn't any bright side to a war, there are some parts that are more tragic than others. For me, one of the most tragic elements of war is suicide. U.S. combat troops are killing themselves at an alarming rate. A rate that is higher than for any previous war. What does this say about the way things are going in this war. Has the mentality of our troops changed over the years causing this rise in suicides. Could it be the way this war is being fought. What ever the reason, it is a very serious problem and needs to be looked much closer by those in charge. The following is an article that may shed a little light on this most painful of topics.

Tuesday, November 14, 2006