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Date: March 31, 2010
Contacts: Christine Stencel, Senior Media Relations Officer
Luwam Yeibio, Media Relations Assistant
Office of News and Public Information
202-334-2138; e-mail <firstname.lastname@example.org>
for immediate release
Unanswered Questions, Lack of Data Hinder Agency Efforts to Meet
Needs of Iraq, Afghanistan Service Members, Veterans, and Families
WASHINGTON -- To help current and former military personnel of the wars in Iraq and Afghanistan and their families readjust to post-deployment life, the U.S. departments of Defense and Veterans Affairs need to gather information to answer many uncertainties, including how many mental health care providers are needed and where, what works best in treating traumatic brain injury (TBI) over the long term, and whether giving service members time to decompress before returning home would be beneficial, says a new report from the Institute of Medicine. VA also needs to institute a process of forecasting the amount and types of resources necessary to meet the needs of the veterans and their families in the next 30 years or more when their demand for health care and disability compensation is likely to peak.
In addition, VA and DOD should oversee coordination and communication among the dozens of public and private programs created to serve current and former Iraq and Afghanistan service members, veterans, and their families, said the committee that wrote the report. The agencies should organize an independent evaluation of the programs, given that it is unclear whether they are all effective and whether redundancy among the programs helps ensure the needs of service members, veterans, and their families are met.
This report presents preliminary findings of a two-phase study of the readjustment needs of current and former service members deployed to Iraq and Afghanistan and their families. In this first phase, the committee sought to identify the most pressing needs of this population through an initial review of the limited scientific literature available as well as media reports and testimony from veterans and their families at town-hall meetings. The second-phase report will present more detailed findings and recommendations based on an in-depth review of additional information, including data anticipated from several ongoing studies.
"DOD and VA deserve credit for what they have done thus far to respond to the readjustment needs of individuals who have served in Iraq and Afghanistan and their families, but in some instances the response has fallen short," said committee chair George Rutherford, Salvatore Pablo Lucia Professor and vice chair, department of epidemiology and biostatistics; and director, prevention and public health group, Global Health Sciences, University of California, San Francisco. "For example, we heard repeatedly that there are not enough mental health providers to meet the demand. Job training and job loss due to multiple deployments are other serious issues facing these individuals, as is doctors' ability to diagnose and treat traumatic brain injuries. Our goal in the next phase of this study is to describe in more detail the educational, health, rehabilitation, and other services needed by military personnel, veterans, and their families as they transition back into life in the United States."
Many wounds suffered in Iraq and Afghanistan will persist over veterans' lifetimes, and some impacts of military service may not be felt until decades later. Requests for disability care and compensation by veterans of previous wars did not peak until 30 years or more after their service ended, suggesting that the maximum demand on support services for Iraq and Afghanistan military personnel and their families may not occur until 2040 or later, the report notes. VA lacks a mandate and resources to forecast future health care and disability needs of veterans and their families, limiting the agency's ability to plan for the infrastructure, work force, and other needs when demand is likely to be greatest. VA should institute an annual process of projecting the future health and disability benefits for this population, and Congress should provide the agency the necessary funds to conduct these forecasts, the committee said.
TBI has been called the signature wound of the fighting in Iraq and Afghanistan. VA established a comprehensive system of rehabilitation services for polytrauma, including TBI, focused on needs that arise in the initial months and years after injury. However, it lacks protocols to manage the lifetime effects of TBI because this issue has not been studied in either military or civilian populations. VA should sponsor research to determine the efficacy and cost effectiveness of developing protocols for the long-term management of polytrauma and TBI, the report says.
The process of third-location decompression -- sending service members to an interim place between the country where they served and their home nation to rest and prepare themselves for going home -- has anecdotally resulted in other nations' troops experiencing smoother transitions to civilian life than an immediate return home, the committee found. Since little research has been conducted to support these accounts, however, the committee stopped short of recommending the practice for U.S. personnel and called on DOD to conduct a formal assessment of third-location decompression.
DOD and VA need to ensure there are enough mental health professionals in the health care systems serving current and former military personnel and their families to provide treatment to those who suffer from post-traumatic stress disorder, substance abuse, and other mental health problems, and that these providers are located where they are needed, the report says. Reports from health care providers as well as service members indicate that providers are overwhelmed and wait times for services are long. DOD also needs to deal with service members' reluctance to report mental health problems and seek treatment, which may arise from agency policies to report these problems up the chain of command. DOD should review how it handles confidentiality and the relationship between seeking treatment and advancement in the armed services.
The report was requested by Congress and sponsored by the U.S. Department of Defense. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies. A committee roster follows.
Copies of Returning Home From Iraq and Afghanistan: Preliminary Assessment of Readjustment Needs of Veterans, Service Members, and Their Families are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at http://www.nap.edu. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).
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[ This news release and report are available at http://national-academies.org ]
INSTITUTE OF MEDICINE
Board on the Health of Select Populations
Committee to Initial Assessment of Readjustment Needs of Military Personnel,
Veterans, and Their Families
George W. Rutherford, M.D. (chair)
Salvatore Pablo Lucia Professor and Vice Chair
Department of Epidemiology and Biostatistics, and
Prevention and Public Health Group
Global Health Sciences
University of California
Margarita Alegria, Ph.D.
Department of Psychiatry
Harvard Medical School; and
Center for Multicultural Mental Health Research
Cambridge Health Alliance
Dan G. Blazer, M.D., Ph.D.
J.P. Gibbons Professor of Psychiatry
Duke University Medical Center
Ibolja Cernak, M.D., M.E., Ph.D.
Biomedicine Business Area
National Security Technology Department
Johns Hopkins University Applied Physics Laboratory
John D. Corrigan, Ph.D.
Professor and Director
Division of Rehabilitation Psychology
Department of Physical Medicine and Rehabilitation
Ohio State University
Ryan D. Edwards, Ph.D.
Assistant Professor of Economics
Queens College and the Graduate Center
City University of New York; and
Faculty Research Fellow
National Bureau of Economic Research
New York City
Sandro Galea, M.D., Dr.P.H.
Gelman Professor and Chair
Department of Epidemiology
Columbia University Mailman School of Public Health
New York City
Janice L. Krupnick, Ph.D.
Professor and Director
Trauma and Loss Program
Department of Psychiatry
Richard A. Kulka, Ph.D.
Group Vice President, Survey Research
Abt Associates Inc.
Bennett L. Leventhal, M.D.
Nathan Kline Institute for Psychiatric Research
Department of Child and Adolescent Psychiatry
New York University Child Study Center
New York City
Shelly M. MacDermid Wadsworth, Ph.D.
Professor of Family Studies,
Director, Center for Families, and
Director, Military Family Research Institute
Department of Child Development and Family Studies
West Lafayette, Ind.
Alair MacLean, Ph.D.
Department of Sociology
Washington State University
Samuel J. Potolicchio, M.D.
Professor of Neurology
Department of Neurology
George Washington University Medical Center
Scott L. Rauch, M.D.
Partners Psychiatry and Mental Health,
President and Psychiatrist in Chief
McLean Hospital; and
Professor of Psychiatry
Harvard Medical School
William E. Schlenger, Ph.D.
Abt Associates Inc.
Albert W. Wu, M.D., M.P.H.
Professor of Health Policy and Management
Bloomberg School of Public Health, and
Professor of Medicine
School of Medicine
Johns Hopkins University
Carolyn Fulco, M.S.
Naoko Ishibe, Ph.D