PTSD/Substance Abuse Committee Update November/December 2020

Thomas C. Hall, Ph. D., PTSD/Substance Abuse Committee Chair

There is no known cure for post-traumatic stress disorder. But PTSD symptoms can be managed to a point at which they no longer interfere with a person’s ability to navigate work, social, and family life. These symptoms can be managed through the adoption of healthy behaviors and coping skills learned in evidence-based treatments.

Still, there is always the possibility that unanticipated triggers can cause an increase in PTSD symptoms. The VA’s National Center for PTSD has found that evidenced-based treatments, properly administered, can reduce symptoms in about half of veterans with symptoms of PTSD. We at VVA ask: What about the other half?

Many VA leaders insist that evidence-based treatments are the only treatments the VA will offer. PTSD clinics continue to ignore the chorus of veterans asking for continuing-care support rather than brief intervention practices.

To ignore the desires of veterans who want to get well and stay well is a major disservice. The voices of veterans who are in recovery and managing the day-to-day challenges of PTSD or substance use disorders should carry the greatest weight.

Many of us managing PTSD or substance use disorder know that, as Theodore Roosevelt once said, “It is not the critic who counts. The credit belongs to the man who is actually in the arena; whose face is marred by the dust and sweat and blood; who strives valiantly, who, at worst, if he fails, at least fails while daring greatly; so that his place shall never be with those cold and timid souls who know neither victory or defeat.“

Roosevelt knew whereof he wrote, having fought in the Spanish-American War. And yet the voices of those of us in the arena are largely ignored by the VA’s directors of behavioral health.

On this issue this committee is neither timid nor shy. The VA continues to ignore the need for clinicians to run continuing-care groups to help veterans manage their PTSD symptoms. Today, many of the groups at VA Medical Centers are not assigned a clinician. Without someone on staff assigned to monitor the ongoing struggles of these veterans, who will call attention to those who are in crisis?

Many of these groups are led by a peer, someone with the best of intentions but with no clinical training. Worse, some group members have been told to meet at a VFW post or a fast-food restaurant as they try to cope with feelings of betrayal, anger, family tension, suicidal ideation, depression, and other triggers that can cause PTSD symptoms to flare.

Understandably, the coronavirus pandemic has closed these continuing support groups. But we wonder what will happen after the pandemic finally passes. Will the VA support and help re-create the continuing-care outreach groups? Veterans who have taken part in these groups describe them as absolutely necessary for maintaining the resiliency necessary to manage the day-to-day triggers that cause a reoccurrence of their PTSD symptoms.

Capricious and arbitrary VA rules limit its ability to hire clinicians in a timely manner. As a result, VA psychiatrists must limit the time they spend with veterans seeking mental health services. Currently, most medical support assistants are instructed to schedule a veteran for only 30 minutes with a psychiatrist (new evaluations are given an hour).

During these evaluations, the psychiatrist is supposed to learn about the veterans’ symptoms, hear their stories, and build connections that will allow the veterans to share the impact that PTSD is having on their lives.

As you have probably already guessed, this scheduling policy dictates the length of time for the discussion but does not meet the real need of the veteran. Since they are only allotted a half-hour with each veteran, the psychiatrist’s time is often reduced to merely monitoring prescriptions. This can reduce a veteran’s experience to a hit-and-run brush with psychiatric medication managers. Is it any wonder that veterans report a disconnection from many VA psychiatrists?

In the military we were trained to improvise, adapt, and overcome problems we faced. Our training built a resilience that has proved crucial during the pandemic. For many of us, this resilience was nurtured, reinforced, and encouraged during continuing-care support groups. The committee asks all veterans to let their congressional representatives know in no uncertain terms how important continuing-care support is to veterans managing the ongoing effects of PTSD and recovery from substance use disorder.

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