Statements on Introduced Bills and Joint Resolutions

STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

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By Mr. DURBIN (for himself and Mrs. Boxer):

S. 1448. A bill to improve the treatment provided to veterans suffering from post-traumatic stress disorder; to the Committee on Veterans' Affairs.

Mr. DURBIN. Mr. President, seventy-five years ago today, President Herbert Hoover created the Veterans Administration by signing Executive Order 5398 for the ``Consolidation and Coordination of Governmental Activities Affecting Veterans.''

Of course, the commitment of America to the care and welfare of the Nation's veterans goes back to the earliest days of our Republic. In 1789 George Washington said, ``The willingness with which our young people are likely to serve in any war, no matter how justified, shall be directly proportional as to how they perceive the Veterans of earlier wars were treated and appreciated by their country.''

The care of veterans was a central theme in Abraham Lincoln's second inaugural address. He said, ``With malice toward none; with charity for all; with firmness in the right, as God gives us to see the right, let us strive on to finish the work we are in; to bind up the nation's wounds; to care for him who shall have borne the battle, and for his widow, and his orphan--to do all which may achieve and cherish a just, and a lasting peace, among ourselves, and with all nations.''

Today, this important work of caring for our veterans is carried on by the Department of Veterans Affairs at a time when American troops are engaged in combat under very trying circumstances overseas.

In order to address the clearly emerging needs of the newest veterans, I am today introducing the ``Post-Traumatic Stress Disorder Treatment Improvement Act.''

This bill requires the Department of Veterans Affairs to hire the number of mental health professionals which the Department's own internal panel of experts has for years recommended as that required to provide an appropriate level of treatment for veterans suffering from post-traumatic stress disorder or PTSD.

PTSD is a fairly new term but it is by no means a new problem. People exposed to extremely traumatic stressful events can suffer lasting and long-term mental health problems as a result. Soldiers who have endured the horrors--of the battlefield--who've experienced and had to participate in deeply troubling events--have long been susceptible to this problem. Among Civil War veterans it was called ``the soldier's heart.'' Among World War I veterans it was called ``shell shock.'' In World War II it was called ``battle fatigue.'' Many people will remember the incident during World War II in which General George Patton slapped a soldier hospitalized with battle fatigue. The American public reacted angrily to Patton's action because they understood that Patton was wrong; needing medical treatment to help recover from the psychological trauma of war was not any sign of weakness or cowardice but rather simply one of the understandable hazards of the very violent modern battlefield. In the aftermath of Vietnam, our understanding of what is today known as post-traumatic stress disorder or PTSD has grown tremendously and so has our ability to treat it. Today, as a result of its work with Vietnam Veterans, the Department of Veterans Affairs is the world leader in diagnosing and treating PTSD.

While the quality of the expertise in the VA is high, we need to improve the quantity. The Department of Veterans Affairs needs more mental health professionals to meet the needs of the coming influx of new veterans from Iraq and Afghanistan.

Two articles in the July 2004 issue of the New England Journal of Medicine indicate that the nature of the war in Iraq is producing a new generation of American veterans who will require treatment for PTSD. The data gathered from recently returned troops suggests that about 1 in 6 of our Iraq veterans will develop this serious problem. One of the articles cautions that the actual numbers will probably be even higher because the data of the reported study was collected from soldiers and marines who served in the theater before the Iraqi insurgency rose to its current level of intensity. The conditions are now made even more stressful by the hidden enemy, frequently concealed among civilians and attacking suddenly with roadside explosions and suicide bombers. The uncertainly, the shock, the blood and destruction of this type of warfare understandably takes a toll on the feelings of even the toughest of our warriors. We know from experience that roughly 30 percent of Vietnam veterans suffered from PTSD sometime in their lifetime.

Senators don't have to read the New England Journal of Medicine to know that our returning veterans will need a little help to overcome some terrible memories and troubling mental images. We can hear it from the veterans in our own States.

Several weeks ago I traveled across my State of Illinois to five different locations for roundtable discussions about this subject. I invited veterans as well as medical counselors from the Veterans' Administration to tell me about former service members who were trying to come to grips with this torment in their minds over what they had been through and what they had seen. I was nothing short of amazed at what happened. At every single stop, these men and women came forward and sat at tables before groups in their communities, before the media, and told their stories of being trained to serve this country, being proud to serve, and going into battle situations which caused an impact on their mind they never could have imagined. They talked about coming home with their minds in this turmoil over the things they had done and seen. Many of them told of having to wait months and, in one case, a year before they could see a doctor at a VA hospital.

I heard from veterans from Iraq, Vietnam, Korea and World War II. One veteran in southern Illinois who was in the Philippines couldn't come to my meeting because ``I just can't face talking about it.'' This was 60 years after his experience. Veterans of Vietnam, coming home, facing animosity from others, then being unable to address their emotional and psychological anguish and difficulty because they were afraid to even acknowledge they were veterans. They were left tormented by this for decades.

The ones that gripped my heart the most were the Iraqi veterans. I will never forget these men and women. The one I sat next to at Collinsville, a bright, handsome, young Marine, talked about going into Fallujah with his unit and how his point man was riddled with bullets, and he had to carry the parts of his body out of that street into some side corner where the remains could be evacuated. Then he took over his friend's job as point man and went forward. A rocket-propelled grenade was shot at him, and it bounced off his helmet. One of the insurgents came up and shot him twice in the chest. This happened just this past November.

When he came home, he said he couldn't understand who he was because of what he had seen and been involved in. He had problems with his wife--difficult, violent problems, and he turned to the VA for help.

I said to this young Marine: I am almost afraid to ask you this, but how old are you? He said, ``I am 19.''

Think of what he has been through. Thank goodness he is in the hands of counselors. Thank goodness he is getting some help and moving in the right direction.

But in another meeting in southern Illinois, another soldier said, in front of the group, ``As part of this battle, I killed children, women. I killed old people. I am trying to come to grips with this in my mind as I try to come back into civilian life.''

A young woman, a member of the Illinois National Guard, said when she returned to the United States, still in distress over what she had seen and done, she was released from active duty through Fort McCoy in Wisconsin where the Army sat her down and asked, ``Any problems?'' Of course, that should have been the time for her to come forward and say: I have serious problems. She didn't. She'd heard that if you said you had a problem, you had to stay at Fort McCoy for several more months. She was so desperate to get home she said, ``No problems.''

She came home and finally realized that was not true. She had serious psychological problems over what she had been through. When she turned to the VA and asked for help, they said: You can come in and see a counselor at the VA in a year.

What happens to these veterans, victims of post-traumatic stress disorder, without counseling at an early stage? Sadly, many of them see their marriages destroyed. One I met was on his fourth marriage. Many of them self-medicate with alcohol, sometimes with drugs, desperate to find some relief from the nightmares they face every night. These are the real stories of real people, our sons and daughters, our brothers and sisters, our husbands and wives who go to battle to defend this country and come home with the promise that we will stand behind them.

So, in addition to the Vietnam, Gulf War and other veterans already being treated, it is clear that we will soon see large numbers of Iraq veterans coming to the VA for help with PTSD. What is our capacity to help them? Unfortunately, it does not look good.

Disturbingly, the Department of Veterans Affairs may lack the capacity to treat those with PTSD. The Government Accountability Office recently concluded, and the Department of Veterans Affairs concurred, that the Department has not kept adequate accounting of the numbers of patients it currently treats for PTSD. Without any reliable numbers of patients currently receiving treatment, the VA cannot deliver to us any assurance about having the facilities or staff needed to treat the coming influx of new veterans.

The VA has demonstrated an inability to forecast the number of patients it must be ready to treat. In three of the past four years, the Department of Veterans Affairs has submitted budget requests that included patient estimates which turned out to be too low in four different areas. In three of the past four years, the VA has underestimated its number of acute hospital care patients, the number of medical visits, the dependents and survivors' hospital census, and the numbers of dependent and survivor outpatients that it would see.

Now, just a couple of weeks ago, the VA had to acknowledge that its budget for the current fiscal year was going to be $1 billion short because they got their estimate of Iraq veteran patients wrong. The VA had forecasted a 2.3 percent growth in healthcare demand this year but the actual increase turned out to be 5.2 percent--more than twice the VA estimate. The VA budget assumed that 23,553 VA patients would be veterans of the Global War on Terrorism. The number of these patients in 2005 is now estimated to be 103,000--more than four times what VA had estimated.

In the absence of reliable patient information and patient estimates from the Department of Veterans Affairs, how can we know that the VA healthcare system lacks the capability to treat the incoming number of veterans needing PTSD treatment? That's easy--we can simply listen to the VA medical professionals who provide the treatment.

In the course of conducting its investigation, the Government Accountability Office asked officials at VA facilities if they would be able to meet this coming demand. The answer they received was very disturbing. Fully six out of these seven VA healthcare officials stated that their facilities may be unable to handle the influx of new veterans needing PTSD treatment. Six out of seven!

In addition, another set of internal VA mental health professionals has repeatedly recommended that VA expand its capability to treat PTSD. The Department's own Special Committee on Post-Traumatic Stress Disorder has issued a long list of recommended improvements. When the Government Accountability Office studied the progress on implementing these expert recommendations, it found that the Department of Veterans Affairs hadn't fully implemented any of them.

Enough is enough!

When the VA fails to count its current PTSD patients; when the VA consistently underestimates its number of future patients; when the VA ignores the improvement recommendations of its own internal mental health professionals it is time for Congress to step in, demonstrate the leadership that is required, and take action to provide the treatment capability that our veterans deserve.

The bill I am introducing today accomplishes this by requiring the Department of Veterans Affairs to implement three of the key treatment improvement recommendations made by the Department's own Special Committee on Post-Traumatic Stress Disorder.

The bill requires the Secretary of Veterans Affairs to do three things. First, it requires the Secretary to establish a Post-Traumatic Stress Disorder Clinical Team at every Medical Center within the Department of Veterans Affairs. Second, it requires the Secretary to provide a certified family therapist within each Vet Center. Finally, the bill requires the appointment of a regional PTSD Coordinator within each Veteran Integrated Service Network (VISN) and Readjustment Counseling Service region to evaluate programs, promote best practices and make resource recommendations.

Let me explain the importance of these three provisions.

The majority of the major VA hospitals already have a clinical team of mental health experts focused on providing treatment for post-traumatic stress disorder. These teams include psychiatrists, psychologists, and psychotherapists who bring their varied skills together. However, approximately 60 of our VA hospitals currently do not have a PTSD clinical team. This bill requires that these teams be established.

Nationwide, the Department of Veterans Affairs operates 207 ``Vet Centers.'' The community-based, informal atmosphere of these centers has proven to be a highly effective way to provide counseling and other services to veterans who might not want or be able to go to a formal VA hospital for help. The Special Committee has recognized the importance of family relationships in helping veterans deal with their PTSD and has recommended that there be a certified marriage and family therapist at each Vet Center.

Currently only 17 centers have these specialists on staff. This bill helps keep families strong for our veterans by adding 190 family therapists to Vet Centers nationwide.

Finally, the bill ensures that PTSD treatment capability gets the attention and management needed to keep it strong by requiring the appointment of PTSD coordinators at the regional level.

Altogether, this bill will add about 400 mental health professionals to the Department of Veterans Affairs' capability to treat those of our veterans whose wounds are not visible, whose thoughts are continually troubled by the horrors of war, who need just a little help to get past the nightmares and get their life back on track.

Even the toughest of warriors can have troubled feelings following the stress of combat. It is no sign of weakness--it is no sign of failure to ask for a little help in getting past some of those feelings. That message must be clearly conveyed to all of our veterans.

By acting now, we can ensure that this help is available to our veterans when they return. This is crucial because the effects of post-traumatic stress disorder are sometimes left undiagnosed and untreated for years. If we delay, we virtually guarantee a future shortage of treatment capability and, in so doing, we lay the groundwork for the plague of drug abuse, domestic violence, homelessness, unemployment and even suicide that so often is the result of post-traumatic stress disorder which is left untreated.

America's newest generation of young veterans certainly deserve better than that!

We in the Congress can step up and require that the Department of Veterans Affairs hire a full staff of mental health professionals that can help our veterans to move past the psychological trauma of war and to lead healthy, happy and productive lives.

I encourage my colleagues to join me in supporting our returning veterans by supporting the Post-Traumatic Stress Disorder Treatment Improvement Act.

There being no objection, the bill was ordered to be printed in the RECORD, as follows:

S. 1448

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