PTSD/Substance Abuse Committee Update September/October 2020

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


As the chair of VVA’s National PTSD and Substance Abuse Committee, I, and other mental health experts, have relied on guidance from the Department of Defense’s Center for the Study of Traumatic Stress (CSTS) and Center for Deployment Psychology (CDP). The very existence of these programs is threatened, and I need your help.

These two centers are responsible for major advances in understanding the physical and mental toll of deployment, including early detection and treatment of PTSD, TBI, suicide prevention, and other visible and invisible wounds of war, as well as advancing evidence-based responses to natural disasters and pandemics. Both centers are a part of the Uniformed Services University of the Health Sciences, and are essential to the nation’s effective response to deployment-related behavioral health problems among service members, veterans, and their families. But now these two facilities are at imminent risk of closure. The direct and long-term negative impact of their loss will be immeasurable.

Due to the increased cost of purchasing private-sector care, the Military Healthcare System (MHS) has imposed cuts on in-house military providers, facilities, and programs. These cost increases are a direct result of DOD’s Cost Assessment and Program Evaluation’s (CAPE) decision to shift a growing share of military health care rendered to retirees, military families, and even service members to private health care providers who are likely to have less experience in military medicine or culture. CAPE has sought and secured far larger reductions in the MHS budget, directly in opposition to congressional intent.

Funding directives set forth in the National Defense Authorization Acts (NDAA) of recent years, including the House and Senate versions of the FY2021 NDAA, alter the basic structure of the MHS. Congress’ objective is to achieve efficiencies and heighten readiness by merging many elements of the Army, Navy, and Air Force health systems—including management and administration of Military Treatment Facilities—under the Defense Health Agency. But CAPE’s implementation has resulted in the MHS sustaining more than $70 billion in cuts since 2012, even as overall federal and private health spending continued to rise steadily. These cuts have gone far beyond desired efficiencies to degrade readiness, beneficiary care, and capability to support U.S. military operations with high-quality medical and trauma care.

Despite recent statements to the effect that proposed changes to the Military Healthcare System will be “postponed,” the downstream effects of eliminating the Center for the Study of Traumatic Stress and Center for Deployment Psychology—and the cumulative impact of resource realignments across MHS embedded in these plans—will further degrade MHS capability, access to care, medical education programs, and health research activities system-wide. Postponement is not a decision to forego planned new cuts, nor will it mitigate their negative impact.

Now, CAPE is seeking to slash funding for military health research programs that seek effective treatments for current health challenges to U.S. forces and that anticipate and work to counter future threats. These activities are mainly supported through the Defense Health Program’s Research, Development, Test, and Evaluation (RDT&E) program, which funds research to reduce medical capability gaps and supports medical laboratories. RDT&E has already experienced crippling funding decreases.

In addition to pursuing additional cuts to military health RDT&E atop the billions already imposed, CAPE is targeting the DOD’s leadership academy for military health—the Uniformed Services University of the Health Sciences (USU)—for “right sizing or elimination.” This despite the fact that in 2019 the Secretary of Defense rejected the option to close USU.

The cuts proposed by CAPE would strip away 90 percent of USU’s remaining RDT&E funding and eventually eliminate all basic research dollars for combat casualty care, infectious disease research, and military medicine research. And it would close many highly effective and beneficial research programs that support warrior behavioral health and military readiness.

Although the decision to eliminate CSTS and CDP are not specifically noted in the draft FY2021 NDAA, the cuts that CAPE seeks would force USU to shutter both programs, along with several others. These closures will have a profound negative impact on the nation’s ability to respond to the invisible wounds of wars. The continued push to privatize the Military Healthcare System, combined with other resource realignments promoted by CAPE, will continue to drive up the cost of providing health care for active-duty forces and other eligible beneficiaries while fragmenting that care across multiple health providers and medical record systems.

The result will be a marked loss of health care providers who understand the background and health risks of service members, veterans, and their families, as well as the crippling of our ability to anticipate and counter future threats. These decisions on the Military Healthcare System will progressively degrade the readiness, health, and well-being of the military community.

While your members of Congress are home this month, many campaigning for re-election, we urge you to reach out to them and demand they protect and preserve funding for the CSTS and CDP, maintain the USU, and protect the Military Healthcare System from further degradation. Send an email, make a call, or attend their virtual or in-person town halls.

VVA has software to help you quickly find the contact information and send correspondence to your members of Congress. Click here to help ensure we don’t leave these brave men and women behind by allowing further degradation of the Military Healthcare System.

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