By Ralph Ibson

No one disputes that the mental health needs of veterans who have served in Iraq and Afghanistan must be a high priority. But relying on old formulas will not meet urgent mental health needs of returning veterans.

The Department of Veterans Affairs health care system (VA) still relies on the veteran seeking care and on providing that care almost exclusively in VA-operated facilities. That paradigm should be changed to train a cohort of combat vets to provide outreach to their peers.

The VA could certainly adopt the model proposed in House-passed HR 2874 which calls for a national program reaching into rural and small town America through partnerships with community mental-health providers. This would update the current care provided in VA facilities (some with only limited mental-health staffing) as included in the bipartisan measure introduced by Rep. Mike Michaud (D-ME) and passed last July.

To get the prescription right, we’ve got to connect the dots. Consider that --

A DoD-conducted longitudinal assessment of mental health problems among soldiers returning from Iraq (published in the Journal of the American Medical Association, Nov. 2007) found that 42.4 percent of National Guard and reserve-component soldiers screened by the Department of Defense required mental health treatment;

Our military operations in Iraq and Afghanistan have relied heavily on the National Guard and Reservists, “citizen-soldiers” who often live in communities remote from health care facilities operated by the Departments of Defense and Veterans Affairs;

These veterans face very formidable barriers in getting needed care – often hours-long travel to distant healthcare facilities, and the stigma still associated with seeking mental health care;

Experts warn that it’s critical to provide help for returning veterans early-on before mental health conditions become chronic.

The VA is surely providing excellent mental health care to many returning veterans, particularly at its medical-school-affiliated centers. But VA-provided care that is hours away is not a viable option for veterans who have responded to sleeplessness or combat-nightmares with a gun under their pillows or a bottle to ease the pain. Many Reservists and Guardsmen reject the idea of VA care out of fear that information regarding mental health treatment might somehow get to their commanders. In short, many veterans have gotten treatment, but many others have not. And while early treatment can help resolve post-traumatic stress disorder, depression, and other problems common in combat veterans, those who fail to get needed help too often self-medicate (using alcohol or drugs), develop chronic health problems, and experience interpersonal difficulties and even family breakup. Alarming numbers of returning veterans have even taken their lives.

Veterans themselves are pointing the way to a better answer. Testifying before the Senate Veterans’ Affairs Committee last year on behalf of the Iraq and Afghanistan Veterans of America, Sergeant Patrick Campbell, a combat medic, described the VA system as flawed because “it is a passive system that waits for service members to acknowledge they have a problem and ask for help.” Campbell warned that we must change that mindset “before we lose this generation of heroes.” One answer, he testified, is having veterans help other veterans. That approach – employed in some pockets of the VA system -- has profoundly changed lives.

We can fix the system through some modest re-engineering, and reach vets who can’t or won’t seek VA care. First, we must mount a national program to train a cadre of vets who have gotten help to work as peer-outreach and peer-support specialists. In those areas of the country that are remote from VA medical centers, VA could contract with community mental health centers and other qualified entities to provide peer outreach and support services, readjustment counseling and mental health services. Requiring any contract-provider to hire a trained peer specialist to provide outreach and peer-support could help identify vets in need of counseling or services, overcome resistance to treatment, and navigate and support vets through the treatment process. The House of Representatives has already adopted this approach. A pending Senate bill, S. 38, show the Veterans’ Mental Health Outreach and Access Act, introduced by Senators Pete Domenici (R-NM) and Barak Obama (D-IL), would as well.

But, as VA’s Under Secretary for Health Dr. Michael Kussman acknowledged, in testifying before the Senate Committee on Veterans’ Affairs in October (in opposition to the Senate bill), the VA already has authority to initiate such policies. Indeed the Department does have a broad statutory foundation to institute these changes.

Ralph Ibson is Vice President for Government Affairs, Mental Health America. He previously served as staff director of the Subcommittee on Health of the Committee on Veterans Affairs in the House of Representatives and as a deputy assistant general counsel at the Department of Veterans Affairs.