The wars, both recent and past, have been the cause of significant visible and invisible injuries to military personnel serving in these conflicts. As the number of returning veterans with psychological issues increases, the Veterans Administration (VA) is devoting more attention to resources, programs and services to address the problems they, and their families, face.
The National Center for PTSD reports that between 11 and 20 veterans out of every 100 from the Iraq and Afghanistan wars return with this diagnosis; 10 percent of Gulf War veterans and 30 percent of Vietnam veterans also carry a PTSD diagnosis.
According to Terence M. Keane, Ph.D., president of Division 56 (Trauma Psychology), associate chief of staff for research and development at the VA Boston Healthcare System and director of the Behavioral Science Division at the National Center for PTSD, the VA has made a major commitment to mental health research and clinical psychology, as evidenced by its activities during the last five or six years. “Training has been dramatically expanded, both in size and availability of programs for interns and post-docs regarding PTSD and mild traumatic brain injuries (TBIs) – what we call the ‘silent wounds of war’,” he says.
Keane notes that in the last month alone, the Department of Defense announced two requests for application – the largest grants he has ever seen – for the investigation and training of the next generation of researchers. He points out that these efforts will enable program expansion and, more importantly, the dollars to support key initiatives.
“We’ve been using real time information since 2004 regarding the psychological impact of deployment. Congress and the president have created initiatives to try to do the best possible thing in the areas of treatment and understanding,” he says, applauding these “top down” programs for raising awareness. He notes specifically the “Joining Forces Community Challenge,” spearheaded by Michelle Obama and Jill Biden to create stronger connections between the American public and the military. “To see how these initiatives have emerged at the highest level of the country is heartening.”
Locally, the VA Boston Healthcare System has teamed up with Harvard University and the Boston University School of Medicine to provide educational opportunities for medical students in PTSD and TBIs. Keane points out that leadership at these academic institutions reached out to the VA to form partnerships. “VA faculty are the ones, in part, addressing the needs at the medical schools,” he says.
Last summer, three medical students worked at the VA conducting research on chronic traumatic encephalopathy (CTE), which results from successive concussions leading to brain injury. During their research, investigators conducted laboratory experiments demonstrating that exposure to a single blast equivalent to a typical improvised explosive device (IED) results in CTE and long-term brain impairments that accompany the disease.
Additionally, they discovered that the forceful wind from an IED leads to TBI and other long-term consequences, including CTE. Keane points out that the results of this research may have some impact on a more global scale, particularly for athletes, especially football players, who suffer multiple concussions. He says, “This experience will stay with these young doctors and will increase their understanding of health during deployment and post-deployment.”
Farther north, the VA is expanding efforts through the Veterans Education and Research Association of Northern New England (VERANNE), one of a fairly large network of VA non-profit corporations. According to Priscilla West, VERANNE’s executive director, this is the first multi-site non-profit and includes the VA Medical Center at White River Junction, Vt.; the VA in Manchester, N.H.; and the VA Maine Healthcare System in Augusta, Maine. The creation of this multi-site operation opens up a world of possibilities, West asserts. “There are rural issues and special challenges for those with mental health problems, such as travel and isolation,” she says. “With the three-center, three-pronged approach, we can start addressing those issues.”
West says that Manchester’s research program has been “quiet” of late, but efforts will be made to reinvigorate it. The Maine location has never had a research program, but recently hired a physician to act as part-time research coordinator. “There is a lot of energy and quite a bit of interest. Newer clinicians have a lot of emphasis on research during their training. They already have a good general orientation,” she says.
VERANNE has been the recipient of several grants from the National Institutes of Health, Homeland Security and the Department of Defense. “We’ve also received corporate funding in the form of industry sponsored clinical trials and some pharmaceutical money for studying dual diagnoses,” says West. “We also take private donations and have gotten some bequests.”
While 90 to 95 percent of the funding is used for research projects, West is trying to enhance the program’s educational side. “Last month, we received $4,000 from the Vermont VA Foundation to train veterans as volunteers in our palliative care suite,” she says and adds that financial support has helped sponsor Healthy Living Workshops and bi-annual Adaptive Sports Clinics.