Pete Abel lands the exclusive and discusses the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act Of 2008.

The following passage highlights one of the most important parts of the legislation because it shows how genuine policy compromise got this passed…

TMV: As I understand it, the current bill is not a mandate to offer mental health benefits. Instead, it’s a mandate that, if an insurance company already offers mental health benefits, it must then offer them at parity with physical health benefits. Are you at all concerned that this requirement might discourage insurance companies from offering any mental health benefits?

RPK: No. If we had mandated coverage of (the entire diagnostic manual), this bill would not have become law. Part of our compromise was to let employers and insurance companies determine what they would cover, with medical necessity as the determinant of the day, not arbitrary selectivity.

Our fall back position is that we want the GAO to study the patterns of mental health coverage going forward … to see how widely mental health diseases are being covered. If the GAO determines those diseases are insufficiently covered, we’ll have to come back and shore up the law.

Also, we have very strong language in the law defining “medical necessity” and how to determine a patient’s eligibility for mental health coverage, so that when people sign up for coverage, they know what the grounds are for denying coverage, strengthening their ability to appeal arbitrary decisions.

Check out the whole thing here.

That’s what the Pentagon is pondering, and although it’s nothing more than a gesture, making PTSD and other invisible battlefield scars worthy of this historic recognition would be something I’d welcome wholeheartedly.

From Wash Post:

WASHINGTON — Centuries before Iraq and Afghanistan, George Washington created the Purple Heart to honor troops wounded in combat.

But with an increasing number of troops being diagnosed with post-traumatic stress disorder, the modern military is debating an idea Gen. Washington never considered — awarding one of the nation’s top military citations to veterans with psychological wounds, not just physical ones.

Defense Secretary Robert Gates offered cautious support for such a change on a trip to a military base in Texas this month.

“It’s an interesting idea,” Mr. Gates said in response to a question. “I think it is clearly something that needs to be looked at.”

Others are opposed…

Opponents argue that the Purple Heart should be reserved for physical injuries, as has been the case since the medal was reinstituted by Congress in 1932. Military regulations say the award should go to troops with injuries “received in action with an enemy.” Some opponents also note that PTSD can be faked, which can’t easily be done with a physical wound.

And here’s how many may be suffering under this sometimes debilitating condition…

A recent California-based research institution Rand Corp. study concluded that 300,000 of the military personnel who have served in Iraq or Afghanistan have symptoms of the disorder, which can sometimes lead to suicide. The report found tragedies closely linked to the development of PTSD: Half of the 1.6 million troops who spent time in the two war zones had friends who were seriously wounded or killed, while about 45% saw dead or wounded civilians.

The purple heart is a recognition for being wounded, and PTSD is a recognized in the military as a wound worthy of disability pay. Given that, this honor should catch up with current policy, because we know the military isn’t going to wake up tomorrow and say, “Well, PTSD isn’t actually that bad.”

What I’m trying to say is that this will happen and I’m glad to hear the conversation has started. Now it’s only a matter of time.

The title says it all.

USA Today has the details:

More than 43,000 U.S. troops listed as medically unfit for combat in the weeks before their scheduled deployment to Iraq or Afghanistan since 2003 were sent anyway, Pentagon records show.

This reliance on troops found medically “non-deployable” is another sign of stress placed on a military that has sent 1.6 million servicemembers to the war zones, soldier advocacy groups say.

“It is a consequence of the consistent churning of our troops,” said Bobby Muller, president of Veterans For America. “They are repeatedly exposed to high-intensity combat with insufficient time at home to rest and heal before redeploying.” [...]

According to those statistics, the number of troops who doctors found non-deployable but who were still sent to Iraq or Afghanistan fluctuated from 10,854 in 2003, down to 5,397 in 2005, and back up to 9,140 in 2007.

So how “unfit” were they?

The Pentagon records do not list what — or how serious — the health issues are, nor whether they were corrected before deployment, said Michael Kilpatrick, a deputy director for the Pentagon’s Force Health Protection and Readiness Programs.

A Pentagon staffer examined 10,000 individual health records last year to determine causes for the non-deployable ratings, Kilpatrick said. Some reasons included a need for eyeglasses, dental work or allergy medicine and a small number of mental health cases, he said.

Listen, those things may seem small, but we’re talking about going into war zones. Anything can affect your readiness, and the difference between having eyeglasses and not having them could be incredibly significant. Same with an aching tooth or intense allergies.

One last sad example of how this played out…

At Fort Carson, in Colorado, Maj. Gen. Mark Graham ordered an investigation into deployment procedures for a brigade deployed to Iraq late last year. At least 36 soldiers were found medically unfit but were still deployed, Graham told USA TODAY.

For at least seven soldiers, treatment in the war zone was inadequate and the soldiers were sent home, he said, and at least two of them should never have been deployed.

I suppose these are things we force ourselves to do when we get into wars with little planning, poor strategy and no discernible way to declare victory.

Folks, let’s NEVER put ourselves in this situation again, okay?

FYI, if you ever want to do additional research on veteran health issues, you can check out IssueLab’s list of studies and quick facts. It’s a good resource.

Some sobering news about how many of our young men and women are dying from wounds they suffered on the battlefield that nobody could see until it’s too late.

From Bloomberg:

The number of suicides among veterans of wars in Iraq and Afghanistan may exceed the combat death toll because of inadequate mental health care, the U.S. government’s top psychiatric researcher said.

Community mental health centers, hobbled by financial limits, haven’t provided enough scientifically sound care, especially in rural areas, said Thomas Insel, director of the National Institute of Mental Health in Bethesda, Maryland. He briefed reporters today at the American Psychiatric Association’s annual meeting in Washington.

Insel echoed a Rand Corporation study published last month that found about 20 percent of returning U.S. soldiers have post- traumatic stress disorder or depression, and only half of them receive treatment. About 1.6 million U.S. troops have fought in the two wars since October 2001, the report said. About 4,560 soldiers had died in the conflicts as of today, the Defense Department reported on its Web site.

Based on those figures and established suicide rates for similar patients who commonly develop substance abuse and other complications of post-traumatic stress disorder, “it’s quite possible that the suicides and psychiatric mortality of this war could trump the combat deaths,” Insel said.

But let’s not forget that those who commit suicide aren’t the majority. Many suffer in silence and the numbers prove that out…

The psychiatric association reported last week that a survey of 191 military members and their spouses found 32 percent said their duty hurt their mental health, and six in 10 believed seeking treatment would damage their careers.

It’s pretty sad when you think that 60% think treating a mental wound would jeopardize their livelihood. It obvious we’ve got a long way to go yet when it comes to mental health in the military.

From the AP:

The killings of three U.S. soldiers in separate attacks in Baghdad pushed the American death toll for April up to 47, making it the deadliest month since September.

One soldier died when his vehicle was struck by a roadside bomb. The other died of wounds sustained when he was attacked by small-arms fire, the military said Wednesday. Both incidents occurred Tuesday in northwestern Baghdad.

A third soldier died in a roadside bombing Tuesday night in the east of the capital, the military said.

For some additional perspective, here’s how the last year has broken down as far as troop deaths/wounded.

• April – 102/776
• May – 121/591
• June – 98/669
• July – 75/654
• August – 77/658
• September – 62/347
• October – 37/376
• November – 35/244
• December – 23/193
• January – 40/216
• February – 29/216
• March – 37/357
• April – 47/?

And since the war began on 3/19/03…
Total dead: 4,059
Total wounded: 29,829

Also, 152,669 veterans have filed for disability after fighting in Iraq or Afghanistan…

Washington DC, October 10, 2006 – One in four veterans of the Iraq and Afghanistan Wars are filing disability claims, according to records released by the U.S. Department of Veterans’ Affairs (VA) under the Freedom of Information Act after nine months of denying their existence and posted today on the National Security Archive Web site.

The VA responded to the Archive’s original January 2006 FOIA request for documents about the number of disability benefits claims filed by veterans from the current war in Iraq by claiming that no documents existed, apparently because the reports concern the Global War on Terrorism (GWOT) rather than being limited to the Iraq War. Notably, one of the reports (PDF) indicates that GWOT is the “military name for the current wars in and around Afghanistan and Iraq.” A similar report was released in December 2005 detailing Gulf War veterans’ benefit activity. An updated copy (PDF) of this report was released in March 2006.

Only after the Archive administratively appealed the VA’s “no documents” claims and advised the VA that it was prepared to file a lawsuit did the agency manage to locate the records. One is a January 30, 2006, document: “Compensation and Pension Benefit Activity Among 464,144 Veterans Deployed to the Global War on Terror.” (PDF) It reports that more than 150,000 deployed Operation Enduring Freedom (Afghanistan) and Operation Iraqi Freedom (Iraq) veterans, out of more than 560,000 veterans of the Global War on Terrorism (GWOT), filed disability compensation and pension benefits claims with the Veterans Benefits Administration (VBA). The other is a July 20, 2006, document: “Compensation and Pension Benefit Activity Among Veterans of the Global War on Terrorism.” (PDF)

Do note this last information was from March 2006. No telling how many have filed for disability since then.

I saw this in the comments from my post today, Nearly 1 In 5 Soldiers Have PTSD:

I’m the Vet who contacted Carissa Piccard and Liz Dozier at CBS. Jonathan & I talked for over an hour today. He agrees that both Carissa & Liz totally rock. So do I – in spades. Jonathan is still waiting for a medical discharge, wants to get productive again and realizes he has some new limitations with which to deal.

Time constraints for Liz’s piece left out a couple of details. Jonathan Norrell is one hell of a kid. A goof-off in High School, he got a GED to get into the service. He did so well that he got to be a medic. This day & age – that’s unheard of in the Army.

In Iraq you heard about the IED’s he encountered, but not all the firefights. Traumatic Brain Injury is strongly suspected & hasn’t been checked out by the DOD yet.

You didn’t hear that he endured demeaning treatment from his Commanding Officer for “faking it”. There’s more, but Jonathan’s prime concern is that he is only the most vocal one at Ft. Hood. His unit will return to Iraq. He tells me only a fraction are mentally up to the challenge.

My thoughts are with Norrell and all those who have fought for us and suffer from this awful condition. Let’s hope we bring them all home soon.

From AP:

A recently completed survey showed 18.5% — or 300,000 people — said they have symptoms of depression or PTSD, the researchers said. Nineteen% — or 320,000 — suffered head injuries ranging from mild concussions to penetrating head wounds. [...]

The 500-page study is the first large-scale, private assessment of its kind — including a survey of 1,965 service members across the country, from all branches of the armed forces and including those still in the military as well veterans who have left the services.

Here’s one story of the pain PTSD causes, and the ignorance that can sometimes be the response to it…

(CBS) Twenty-two year old combat medic Jonathan Norrell volunteered for every mission during his year in Iraq.

He was bombed, ambushed, treating wounded under fire – and the memories still haunt him, CBS News correspondent Kimberly Dozier reports.

“The things that affected me the most weren’t the IEDs, which I went through six or seven of, and all the firefights, and all the combat,” Norrell said. “It was the psychological stuff, the people I failed to help.”

By the time he came off his tour of duty he was diagnosed with Post-Traumatic Stress Disorder: anxiety, sleeplessness, flashbacks. Military doctors recommended immediate discharge and treatment but the command refused.

Instead they forced him into combat training exercises. He turned to drugs and alcohol.

“I just lost it,” Norrell said. “I didn’t wanna do it anymore.”

So the Army he served so well in Iraq threatened to expel him without medical benefits.

Folks, we’re not fighting a war in Iraq anymore…we’re being their police. Meanwhile, people like Norrell are coming home with invisible wounds that are easily dismissed by those who don’t understand his condition and think he should just “suck it up.”

Well, PTSD is obviously real and we can’t keep this up with an all volunteer force and expect the best from our brave men and women. That’s just the reality, and I’d suggest that anybody who tells you different is more in love with the idea of spreading freedom than the practical application.

It’s real, it’s damaging and the Army is openly talking about it.

From NY Times:

WASHINGTON — Army leaders are expressing increased alarm about the mental health of soldiers who would be sent back to the front again and again under plans that call for troop numbers to be sustained at high levels in Iraq for this year and beyond.

Among combat troops sent to Iraq for the third or fourth time, more than one in four show signs of anxiety, depression or acute stress, according to an official Army survey of soldiers’ mental health.

The stress of long and multiple deployments to Iraq is just one of the concerns being voiced by senior military officers in Washington as Gen. David H. Petraeus, the senior Iraq commander, prepares to tell Congress this week that he is not ready to endorse any drawdowns beyond those already scheduled through July.

Folks, we can be in Iraq indefinitely because of some assumed threat that will happen if we leave, but we do so at a very steep cost. To say our military is overstretched is an understatement, and I can’t help but think that this is the Army saying, “We need to go…soon.”

The Army study of mental health showed that 27 percent of noncommissioned officers — a critically important group — on their third or fourth tour exhibited symptoms commonly referred to as post-traumatic stress disorders. That figure is far higher than the roughly 12 percent who exhibit those symptoms after one tour and the 18.5 percent who develop the disorders after a second deployment, according to the study, which was conducted by the Army surgeon general’s Mental Health Advisory Team.

The Army and the rest of the service chiefs have endorsed General Petraeus’s recommendations for continued high troop levels in Iraq. But Adm. Mike Mullen, chairman of the Joint Chiefs, and Gen. George W. Casey Jr., the Army chief of staff, and their top deputies also have warned that the war in Iraq should not be permitted to inflict an unacceptable toll on the military as a whole. “Our readiness is being consumed as fast as we build it,” Gen. Richard A. Cody, the Army vice chief of staff, said in stark comments delivered to Congress last week. “Lengthy and repeated deployments with insufficient recovery time have placed incredible stress on our soldiers and our families, testing the resolve of our all-volunteer force like never before.”

Our fighting men and women are some of the finest in the world, but they aren’t machines, and yet we’re treating them like they are. For me the message is clear. Time to start drawing down the troops. I’m not talking about yanking them out all at once, but we need to be ready to fight the next time and our troops are just plain worn out, both physically and mentally. And if we ask them to fight for our freedom again, we at least owe them some reasonable amount of time to recover from these hidden wounds.