Hey, Mr. President: Here’s How to Really Help Hurting Vets

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white house photo / lawrence jackson

President Obama announced expanded access to military mental-health care last Friday at Fort Bliss, Texas.

I was initially excited by President’s Obama executive order entitled Improving Access to Mental Health Services for Veterans, Service Members, and Military Families. But then I was disappointed as I read the details.

The order calls for the Department of Veterans Affairs to add mental-health professionals and expand crisis-line capacity to ensure that any veteran who says he or she is in crisis connects with a mental-health professional within 24 hours.

No offense, Sir, but big deal. There is so much more that should be done.

The VA is already trying to hire 1,600 more mental-health professionals. They’re having a tough time helping vets in crisis. Mental-health professionals are in short supply – I get job offers daily, as do my psychiatry colleagues.

What more could an executive order do? Here are some suggestions from military mental-health professionals, including me. While there are no simple solutions to the triple threat posed by post-traumatic stress disorder, traumatic brain injury and suicide, these big problems require thinking big:

— We need a national effort which includes the nation, not just the VA.

— We need to expand work force development, which includes paying for education for people to enter psychiatry, psychology, social work and related fields in mental health.

— We need to educate civilian mental-health workers on dealing with veterans. There are a number of grassroot efforts in this arena, but a Presidential push would really help.

— We need to educate police officers, correctional officials and others in working with veterans. Again, there are a number of grassroot efforts in this arena, but a Presidential push would really help.

— We need to train more college counselors in working with veterans. Not to be repetitive, there are a number of grassroot efforts in this arena, but a Presidential push would really help.

— We need to re-look at gun laws, and ensure that gun safety is emphasized.  This is the “third-rail” of suicide prevention, and I fear that no Presidential candidate will discuss this.

— We need to re-look at the requirement to reveal counseling on a security clearance, and decide whether that question (Question 21) is helpful in reducing security threats.  The question is clearly a barrier to seeking treatment.

— We need to promote help-seeking methods that the veteran finds attractive such as animal-assisted therapy, virtual reality, and complementary and alternative therapy. We also need robust research to evaluate these methods of treatment.

— We need to get more medications that mitigate PTSD and suicidal thoughts into the pipeline. This may involve pharmaceutical companies, the National Institute for Mental Health, or others.

— We need to fully endorse the Substance Abuse and Mental Health Services Administration (SAMHSA) strategy of going state by state, and fixing the gaps in economic security (jobs and benefits). health care, educational support, ending homelessness, and criminal justice for veterans.

— We need a federal task force to develop a national strategy.

Mr. President: you are the commander-in-chief. Be bold. Go beyond “more shrinks” and “more hotlines” to a sustained national effort. Veterans will support you on this larger national mission.

Thanks to the many who proposed and discussed these added initiatives with me, including Dr. Larry Ronan of Massachusetts General Hospital, and the folks working with the SAMHSA policy academy.