The NYSPA Report – Report on the Veterans Mental Health Training Initiative

In response to the severe shortage of mental health professionals skilled in combat related mental health issues, the New York State Psychiatric Association (NYSPA), the National Association of Social Workers – New York State Chapter (NASW-NYS) and the Medical Society for the State of New York (MSSNY) have partnered over many months to develop and now conduct the Veterans Mental Health Training Initiative (VMHTI) — a series of education and training institutes focusing on the mental health needs of combat veterans and their families.

As service members return to New York (estimated at seventy-seven thousand), they and their families are often in need of expert mental health care; yet there is a short supply of mental health professionals who are adequately trained in veterans-specific mental health issues. The situation has prompted New York State executive agencies to engage in various collaborative efforts aimed at coordinating veterans’ health and mental health care across agency jurisdictions. Likewise, the Veterans Administration has taken extraordinary steps to assure appropriate health and mental health services are available to veterans and their families.

However, despite the attention and resources government has provided to the mental health needs of combat veterans, an ever increasing number of veterans with combat-related mental and substance abuse disorders are seeking care in their communities through emergency rooms, mental health clinics, social services agencies, primary care physicians and clinicians in private practice. It is in these settings where the aforementioned workforce shortages are most acute and thus the VMHTI target audience.

Clearly, the State of New York and the country at large are facing a formidable challenge in serving the mental health needs of veterans returning from active duty in Iraq and Afghanistan. Since the beginning of Operation Enduring Freedom and Operation Iraqi Freedom, over one and a half million active duty and reserve members of the U.S. military have been deployed to Iraq or Afghanistan, and nearly half have been redeployed. With each deployment, our service members encounter extreme strains on their physical and mental health, which, in many cases has resulted in unprecedented rates of health and mental health problems, most notably posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI). Equally alarming, are numerous reports of increased suicide, addiction and homelessness among our returning soldiers. Further, family members are struggling with the ramifications of extended and / or multiple deployments, resulting in serious emotional and psychological tolls.

As evidenced by a number of reports, including the recent landmark study in the Journal of the American Medical Association, posttraumatic stress disorder rates are reportedly as high as 24.5 percent for National Guard and Reserve troops serving in Iraq. In addition to high rates of posttraumatic stress disorder, providers in the mental health community have also begun reporting increased cases of traumatic brain injury sustained while in combat in Iraq and Afghanistan due in large part to the use of Improvised Explosive Devices (IED). Equally disturbing is the rate at which TBI has been misdiagnosed as PTSD. Numerous reports have told the story of soldiers returning from Iraq and Afghanistan with brain trauma, but because there are no visible head wounds, symptoms such as memory loss and confusion are often mistaken as indicators of PTSD.

Recent Post Deployment Health Reassessment (PDHRA) data show that up to 38 percent of soldiers and 31 percent of Marines are suffering from negative psychological symptoms. In addition, the Department of Defense Task Force on Veterans’ Mental Health recently reported elevated rates of major depression and substance abuse. Untreated psychological symptoms all too often result in self-medication, leading to unprecedented spikes in substance abuse rates among soldiers. According to the American Forces Press Service, 21 percent of service members admit to drinking heavily; significantly higher than in the civilian sector. Reports of drug abuse among returning service members have also increased since the beginning of the Afghanistan and Iraq wars. Moreover, a recent Harvard study on the long-term costs of the Iraq war stated that the current VA waiting lists for substance abuse treatment “render care virtually inaccessible.” As such, it is vitally important that community mental health providers recognize and screen for symptoms of self-medication among our returning soldiers.

Given this increased need for community mental health services, it is critical that we heed the findings of recent reports by the Department of Defense, and the President’s Commission on Care for America’s Wounded Warriors, which cited an overwhelming need to train mental health providers in mental illnesses with unique etiological roots to combat situations. In addition, providers need to be well-versed in the distinct context of mental health within the military culture. As Dr. Edward Tick, Executive Director of Soldier’s Heart, a New York State based agency serving veterans, stated in recent testimony, war-related trauma has particular characteristics for which practitioners must have expert and specific training. In that same hearing, Dr. Yuval Neria of the New York State Psychiatric Institute also noted the restricted access veterans and their family members face when seeking mental health care in New York and beyond, suggesting that mental health consumers require training in accessing systems of care.

The first VMHTI Institute, entitled “Symposium on Enhancing Community Capacity to Meet the Needs of Returning Service Members and their Families,” was held on Thursday, September 17, 2009, at Hofstra University on Long Island. The day-long program included presentations and workshops for providers on assessing and treating combat-related mental health disorders, such as post-traumatic stress disorder, traumatic brain injury and substance abuse disorders, as well as family issues related to deployment and re-entry.

VMHTI Institutes are offered free of charge and are open to mental health professionals, members of the military, veterans and their families.

Future Institutes will be held on the following dates: November 19, 2009 Rochester at the Radisson Hotel Rochester Riverside; April 23, 2010 in NYC at Fordham University; May 21, 2010 in the Hudson Valley at SUNY New Paltz.

The VMHTI brochure and institute registration information can be accessed at:

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