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HEARING ON MENTAL HEALTH ISSUES

HEARING

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

UNITED STATES SENATE

ONE HUNDRED TENTH CONGRESS

FIRST SESSION

APRIL 25, 2007

Printed for the use of the Committee on Veterans’ Affairs

(

Available via the World Wide Web: http://www.access.gpo.gov/congress/senate 

(II)

COMMITTEE ON VETERANS’ AFFAIRS 

DANIEL K. AKAKA, Hawaii, Chairman 

JOHN D. ROCKEFELLER IV, West Virginia 

PATTY MURRAY, Washington 

BARACK OBAMA, Illinois 

BERNARD SANDERS, (I) Vermont 

SHERROD BROWN, Ohio 

JIM WEBB, Virginia 

JON TESTER, Montana 

LARRY E. CRAIG, Idaho, Ranking Member 

ARLEN SPECTER, Pennsylvania 

RICHARD M. BURR, North Carolina 

JOHNNY ISAKSON, Georgia 

LINDSEY O. GRAHAM, South Carolina 

KAY BAILEY HUTCHISON, Texas 

JOHN ENSIGN, Nevada 

WILLIAM E. BREW, Staff Director 

LUPE WISSEL, Republican Staff Director 

(III)

C O N T E N T S 

APRIL 25, 2007

SENATORS 

Page 

Akaka, Hon. Daniel K., Chairman, U.S. Senator from Hawaii ........................... 1

Craig, Hon. Larry E., Ranking Member, U.S. Senator from Idaho ..................... 2

Murray, Hon. Patty, U.S. Senator from Washington ........................................... 3

Tester, Hon. John, U.S. Senator from Montana .................................................... 5

Rockefeller, Hon. John D., IV, U.S. Senator from West Virginia ........................ 5

Brown, Hon. Sherrod, U.S. Senator from Ohio ..................................................... 6

Webb, Hon. Jim , U.S. Senator from Virginia ....................................................... 7

WITNESSES 

Bailey, Tony Bailey, Father of Justin Bailey ........................................................ 8

Prepared statement .......................................................................................... 10

Omvig, Randall, Father of Joshua L. Omvig; accompanied by Ellen Omvig, 

Mother of Joshua L. Omvig ................................................................................. 11

Prepared statement .......................................................................................... 13

Attachment, newspaper articles: 

Pair Help Iraq Veterans ‘Survive Peace’ ................................................. 15

Grundy Center Couple Who Lost Soldier Son Visit Capitol Today ....... 17

Parents Push for Soldier’s Story to Continue Beyond Suicide .............. 18

Family of Dead Soldier Wants Government to Do More to Treat 

Post-Traumatic Stress ........................................................................... 22

Campbell, Patrick, OIF Veteran, Legislative Director, Irag and Afghanistan 

Veterans of America ............................................................................................. 24

Prepared statement .......................................................................................... 27

Best, Connie Lee, Ph.D., Senior Faculty Member, National Crime Victims 

Research and Treatment Center, Medical University of South Carolina ........ 29

Prepared statement .......................................................................................... 31

Oslin, David, M.D., Director, VISN 4 Mental Illness Research, Education 

and Clinical Center, Department of Veterans Affairs ....................................... 48

Prepared statement .......................................................................................... 49

Kemp, Jan, R.N., Ph.D., Associate Director for Education, VISN 19 Mental 

Illness Research, Education and Clinical Center, Department of Veterans 

Affairs .................................................................................................................... 50

Prepared statement .......................................................................................... 52

Resick, Patricia, Ph.D., Director, Women’s Division, National Center for Post 

Traumatic Stress Disorder, Department of Veterans Affairs ........................... 54

Prepared statement .......................................................................................... 55

Ibson, Ralph, Vice President for Government Affairs, Mental Health America 56

Prepared statement .......................................................................................... 59

APPENDIX 

Female Soldiers and Sexual Trauma: Operation Iraqi Freedom (OIF), submitted by SGT Carolyn Schapper, Virginia National Guard ........................... 67

(1)

HEARING ON MENTAL HEALTH ISSUES 

WEDNESDAY, APRIL 25, 2007

U.S. SENATE, COMMITTEE ON VETERANS’ AFFAIRS, Washington, DC. 

The Committee met, pursuant to notice, at 9:11 a.m., in Room 

418, Russell Senate Office Building, Hon. Daniel K. Akaka, Chairman of the Committee, presiding. 

Present: Senators Akaka, Rockefeller, Murray, Brown, Tester, 

Webb, and Craig. 

OPENING STATEMENT OF HON. DANIEL K. AKAKA, CHAIRMAN,

U.S. SENATOR FROM HAWAII 

Chairman AKAKA. This hearing will come to order. Good afternoon, everyone. I will be brief as I am eager to hear the testimony 

of the witnesses before us. 

The very real truth of the war is that the toll will be felt by 

servicemembers and their families for years to come. We have focused much attention recently on the physical wounds sustained in 

combat. Today, we are taking a long overdue look at the invisible 

wounds, wounds which cannot be seen but are every bit as devastating as physical wounds. 

We know that many of the men and women who are currently 

serving in Iraq and Afghanistan will require treatment for mental 

health issues. We do not know yet if we will see the widespread 

chronic PTSD that followed Vietnam. I hope we do not, but veterans will need help readjusting back into society, and unfortunately, many will abuse drugs and alcohol to ease their pain. Some 

will commit suicide because of their pain. Still others will quietly 

suffer with PTSD and the profound wounds caused by sexual trauma. 

Without question, the Administration should have been taking 

the necessary steps at the start of this war to ensure that VA was 

prepared for the growing demand for mental health care. We know 

that the VA mental health system has long suffered from funding 

cuts and long waiting lines for care. Indeed, VA’s own advisory 

groups and high-level officials have pointed out the shortcomings. 

A former high-level official charged that waiting lists rendered VA 

mental health care virtually inaccessible. Now, we know that demand is increasing. The latest numbers from VA indicate constant 

growth in mental health, with PTSD and abusive drugs as the top 

two conditions. 

Let me be clear about my goal. VA needs to have the finest mental health care available. The demand is too great and the manVerDate 0ct 09 2002 13:32 Jul 18, 2007 Jkt 000000 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 H:\RD41451\DOCS\36191.TXT SENVETS PsN: ROWENA
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power and expertise are just too broad to relinquish this to the private sector. When partnering with community programs makes 

sense, I am open to that. But I do not believe VA should shy away 

from its direct responsibilities in this area. 

A special thanks to our witnesses. We are so glad you are here 

with us today. I especially want to say thank you to those who are 

here to share personal stories. I also want to thank our staff, who 

have worked hard to put this together, and others, as well. I want 

to tell our witnesses that we are deeply in your debt. 

So let me, at this point in time, call on Senator Craig for his 

statement. 

STATEMENT OF HON. LARRY E. CRAIG, RANKING MEMBER,

U.S. SENATOR FROM IDAHO 

Senator CRAIG. Mr. Chairman, thank you, and thank you for focusing on this most important issue. I also want to extend a warm 

welcome to our panelists today, particularly to Tony Bailey, certainly to Randall and Ellen Omvig. We are truly grateful for your 

willingness to share with the Committee your stories and you have 

my deepest condolences for the loss of your loved ones. This country owed them a debt of gratitude for their sacrifices and their 

services and that debt we now owe to you. 

Just as the Committee is concerned about the bodies of returning 

servicemembers, we want to be sure that those troubled in mind 

by what they experienced protecting our freedoms receive the same 

kind of care. We must ensure that all are aware of their access to 

care and are not afraid to seek that care. 

I first made this statement in a series of seamless transition 

hearings over two years ago and it remains true today, that healing 

the veteran’s mind is as equally important to this Committee as 

healing the veteran’s body. The goal is to be sure that those with 

mental illness can return to live, work, learn, and participate fully 

in their communities. That means we must identify unmet needs 

and barriers to services or accepting the services available. 

We must identify innovative treatments and services that are demonstrably more effective. We must improve coordination amongst 

case managers and providers at DOD and at VA. And we must 

focus on the desired outcome of mental health care, which is to provide for each individual an opportunity to attain a full and productive life through employment, self-care, interpersonal relationships, 

and community participation. 

These are tough goals and they require that we ask tough questions, questions such as whether our servicemembers are prepared 

to manage the stress of combat before they set foot on the battlefield, questions such as have we created a barrier to wellness by 

compensating for mental illness without requiring a focus on recovery and rehabilitation from it? Are we setting appropriate benchmarks to evaluate the effectiveness of prescribed treatments? 

These are very difficult questions that are going to be required 

of us in taking the appropriate actions necessary. But the price for 

not addressing these questions and this issue are simply too high. 

To our two witnesses, to the fathers who have lost their sons, you 

know that price better than any of us. For the loved ones attending, you know that price better than any of us. 

3

As VA continues to implement its mental health strategic plan 

and its mental health initiative, including efforts at suicide prevention, I am committed to addressing these very difficult questions 

with my colleagues, but we owe a great deal to all of you for coming today to put a face on this issue and for sharing with us the 

reality of it. 

I thank you, Mr. Chairman, for convening this hearing. 

Chairman AKAKA. Thank you very much, Senator Craig of Idaho, 

for your warm message. 

Senator Murray from the State of Washington? 

STATEMENT OF HON. PATTY MURRAY,

U.S. SENATOR FROM WASHINGTON 

Senator MURRAY. Well, Mr. Chairman, thank you very much for 

holding this really important hearing on mental health care issues 

that are affecting our veterans. I want to thank all of our witnesses 

especially today who are here to share their very personal and very 

painful stories. You need to know that all of you are speaking out 

for many others who can’t be here, and I and all the Members of 

this Committee are really committed to using your experiences to 

help us help other veterans. 

Mr. Chairman, we all know that going to war has a profound effect on those who are sent to fight, and the wars in Iraq and Afghanistan are no exception to that. As the Iraq War now enters its 

fifth year, it is pretty clear that the fighting overseas has taken a 

tremendous toll on the lives of our troops who have served this Nation so honorably and on their families who have supported them 

so fully. 

We do know that more and more of our veterans from Iraq and 

Afghanistan are seeking care for mental health care problems 

when they return home. In fact, according to the VA itself, onethird of all returning Iraq veterans who have enrolled in the VA 

are seeking treatment for mental health problems. That is a pretty 

astounding statistic, and tragically, it is probably too low. We know 

that many of our returning servicemembers and veterans aren’t 

looking for care because of the stigma surrounding treatment or because they fear that mental health diagnosis might negatively impact their military or civilian careers, and those veterans aren’t 

being factored into the VA’s own statistics and all too often we are 

finding those soldiers self-medicating their mental wounds. 

We have also heard reports of servicemembers being shipped 

back to war after doctors did recognize PTSD symptoms. Last 

month, in fact, the mother of an injured soldier sat right here at 

this table and told us about her son, who was not given medication 

to treat PTSD because if he was, then he would be called unfit to 

redeploy. 

Mr. Chairman, we also know that troops are deployed overseas 

for the third or now even the fourth time, a tour of duty, and the 

risk of positive screening for PTSD and other mental health care 

conditions increases with each deployment. 

So to me, it is really clearly time for the VA to really redouble 

their efforts to fight the PTSD stigma and increase their screening, 

their outreach, and their treatment. 

4

We also know that the Iraq War has created challenges for the 

VA to provide care for all of the veterans who are seeking mental 

health care treatment, and we have known about these problems 

for some time. Last year, the GAO issued a report that indicated 

the VA did not spend all of its mental health care funding that it 

was provided by us and that unclear directions from the VA central 

office likely resulted in mental health care funds being used for 

other health care priorities. 

Last spring, a VA under secretary said that VA mental health 

care was, he called it, virtually inaccessible because of the long 

waiting lines. And then this past February, the American Psychological Association released a report that servicemembers and their 

families are not receiving mental health care because of limited 

availability and difficult access. 

Our National Guard and Reserve members aren’t faring any better. These are citizen soldiers who leave their families and their 

jobs to serve our Nation overseas and they often live, as we know, 

in very far-away areas which makes it very difficult for them to receive care when they come home. I hear, and I know my colleagues 

do, as well, from Guardsmen and Reservists and their families all 

the time about the problems they are encountering trying to get access to the VA, and to me, that is really unacceptable and we need 

to change. 

Mr. Chairman, now we are hearing that Vet Centers, which are 

an integral part of our VA’s mental health care network, don’t have 

enough staff to meet the growing numbers of veterans who are accessing these centers. 

And finally, according to this USA Today article that was just 

out, ‘‘Staffing at VA Centers Lagging,’’ it says that the number of 

returning veterans from Iraq and Afghanistan has gone up by more 

than 100 percent since 2004—100 percent since 2004, and yet the 

staffing levels at our Vet Centers has only gone up by 10 percent. 

So, Mr. Chairman, we have some real challenges, and we are 

making progress and I want to commend you and others for working with us in the Senate budget to increase the number for VA 

to $43.1 billion, and the money in the emergency supplemental that 

is going to come to the Senate, and I hope that the President signs, 

that will increase by $1.8 billion for veterans. 

But this hearing is really important for us to hear personally 

about this issue of post-traumatic stress syndrome and how we as 

a Committee can really start to focus on making sure that those 

men and women who fight for us don’t have to fight a health care 

system when they come home. 

So thank you very much for holding this hearing. I really appreciate it. 

Chairman AKAKA. Thank you very much, Senator Murray from 

Washington State. 

Now I would like to call on the Senator from Montana, Senator 

Tester.

5

STATEMENT OF HON. JON TESTER,

U.S. SENATOR FROM MONTANA 

Senator TESTER. Thank you, Mr. Chairman. I want to thank 

Ranking Member Craig and all the other Senators that are here 

today, and I especially want to thank the panel, Dr. Best, Mr. 

Campbell, the Omvigs, and Mr. Bailey. Thank you very much for 

being here today. 

I can tell you that, as from the testimony that has already been 

given and the opening statements, we have got a problem. I look 

forward to each and every one of your testimonies on this panel 

and the next one to help further delineate ways by which we can 

fix this problem. 

Tony, I have got a daughter who is 27 years old. I cannot imagine what each one of you have been through. When the Members 

of this Committee talk about us being indebted to you, it is right 

on. But we have got a problem here. We have come to this Committee to try to get the testimony and get the kind of input necessary so we can solve this problem by working together. And I 

really do appreciate the fact that you are willing to take the time 

out of each and every one of your busy schedules to talk about a 

subject that, for some, is very, very difficult. 

Thank you very much. 

Chairman AKAKA. Thank you very much. 

Now I would like to call on Senator Rockefeller for your statement. 

STATEMENT OF HON. JOHN D. ROCKEFELLER IV,

U.S. SENATOR FROM WEST VIRGINIA 

Senator ROCKEFELLER. Thank you, Mr. Chairman. I almost don’t 

know where to start, and so I probably shouldn’t, but let me just 

say that for those of us who have been on this Committee and who 

care about it and who understand that this Nation has sort of a 

tendency—I don’t hold ill will toward the Nation, but I hold ill will 

toward the results—of honoring the warfighter while the 

warfighter is fighting, and then the warfighter gets hurt, visibly or 

invisibly or both, comes back, and gets subject to a budget which, 

as Senator Murray pointed out, is entirely inadequate because it is 

within the budget of the United States as opposed to the 

warfighter’s war, which is subject to the loans of China, Japan, and 

South Korea. So one gets everything they want, although that did 

not happen, but the second definitely doesn’t. 

I think that you will not find a group of people around here who 

approach you with more respect, more sadness, more desire to help, 

more frustration, more anger at our own government, both Democratic and Republican Administrations, it doesn’t make any difference. It seems that we never seem to give people their due. 

And then something comes along like Building 18, which in some 

ways is a gift to the Nation because it tells us how little we know, 

how little attention is paid to this and how much we have to do. 

I don’t think there is anybody on this Committee on either side 

who doesn’t have a heart full, a full heart. 

I know a little bit of something about suicide. I know nothing 

about suicide, Mr. Omvig. It has happened in my family. I don’t 

know anything about it from the point of view of a parent. I don’t 

6

know what I would do. I don’t know what brings it on. I don’t know 

if it is sudden. 

I do know that I talk almost every weekend I go home to West 

Virginia, which is not a big and powerful State but has unbelievable people, and I just sit down with 12 or 13 wounded veterans, 

visibly, invisibly, for 2 or 3 hours, no staff allowed, no press—they 

never know that it happens, no pencils. It is just—and then you 

start. And then people begin to say things that you could never 

imagine that people could say unless you were in there and the 

rhythm of the whole thing, their bonding, their anger, their need 

to leave the room sometimes just to vent and then come back in 

and join or not join. 

So I feel like Senator Murray, who has just been unbelievable on 

all of these things, as have our Chairman and Vice Chairman, but 

we aren’t doing the job, and I think the beauty of your being here 

is that finally, there is a call to conscience on the part of the American people and I think you have helped cause this to happen. 

When the American people are really stirred and angry and emotional about a subject, they will not take excuses. 

Most Americans don’t know that the Chinese, the Japanese, and 

the South Koreans pay for our war. Most of them don’t know that 

we fail to pay for the results of that war in human terms because 

it is under something called a government budget, which is always 

inadequate no matter what the Administration is. It is always inadequate. 

Patty Murray talks about the mental health. There is just so 

much to learn. There is so much to do. We have to start and you 

have to understand that we are trying, whether we are beginning 

to try or however you want to interpret it. 

But take us as real people and let us make that our beginning 

point, that we sit here and you sit there. It is all a table. We are 

all human beings and we want things to work out for you and people who have served and people who are hurting, people who have 

passed, some people who are wounded who maybe wish they had 

passed because the agony is so deep. So those are my words. 

Chairman AKAKA. Thank you very much, Senator Rockefeller 

from West Virginia. 

Now from Ohio, Senator Brown. 

STATEMENT OF HON. SHERROD BROWN,

U.S. SENATOR FROM OHIO 

Senator BROWN. Thank you, Mr. Chairman and Senator Craig. 

Thank you. My comments will be brief. I would just echo the words 

of Senator Rockefeller. I don’t have the breadth of experience he 

does but have seen and heard so many of these stories and have 

been increasingly overwhelmed by the failure of our government to 

do what it needs to do for the families of our soldiers. We cheer 

them on as they go to war and do so little in so many cases when 

they come back. 

To take the issue of the polytrauma centers, we hear so much 

about they are doing tremendous work. However, the four 

polytrauma centers around the country have 48 beds among them. 

Ohio State University at the medical center treats brain injury patients in its world class facility, Dodd Hall. They have 60 beds in 

7

that one facility, 12 more than the four polytrauma centers around 

the country. That tells me how very much we need to do. 

The numbers are staggering. As we know, one-third of soldiers 

from the wars in Iraq and Afghanistan will seek some kind of mental health treatment. We have not done what we should for the 

next year or two or three or five. We should be talking even more 

years into the future for what we need to do for the next four or 

five decades and what we are going to need to do to serve the men 

and women who have returned from these two wars. 

I so much appreciate the families being here and their sacrifice 

and their candor and their courage, so thank you all. 

Chairman AKAKA. Thank you very much, Senator Brown from 

Ohio. 

From Virginia, Senator Webb. 

STATEMENT OF HON. JIM WEBB,

U.S. SENATOR FROM VIRGINIA 

Senator WEBB. Thank you, Mr. Chairman. I would say to our 

witnesses here that this is really your chance to talk to us. We 

have a chance to talk to each other every day and I don’t want to 

take much time from your opportunity to discuss your issues. 

I would say a couple things. One is that I first started working 

in this area in 1977 after I got out of the Marine Corps and attended law school. I came up here as a Committee counsel working 

on the Veterans Committee on the House side. One of the constants of American history in terms of when we send people off to 

war is that they do have readjustment needs when they come back. 

A lot of people are kind of surprised by that when we look at all 

the films about World War II and all the rest of that. But one of 

the first studies I worked on in 1977 was a National Academy of 

Sciences study on these sorts of issues and 25 percent of the people 

coming back from World War II had similar difficulties. Each one 

of these experiences has a different pattern to it. In the Vietnam 

era, we basically pioneered a lot of this post-traumatic stress research and this sort of thing. 

I have been intimately involved with people who have been serving since 9/11, a lot of it through my friends, a lot of it through 

my own family. I have two daughters who are engaged to enlisted 

veterans. You may know my son is currently in Iraq as an enlisted 

Marine. We need to stay on these. 

And I think, Mr. Chairman, what happened at Virginia Tech last 

week, I think at bottom when we examine it, we are going to see 

that we are not paying enough attention to these sorts of issues in 

our society, issues of mental health and how to talk about them 

openly and how to help people. 

I am looking forward to doing what we can in these situations 

and am grateful for all of you being here today. 

Chairman AKAKA. Thank you very much, Senator Webb from 

Virginia. 

I welcome the first panel. We have asked each of you here for 

your personal and your particular perspective on VA mental health 

care. 

First, I welcome Tony Bailey. Mr. Bailey is the father of Justin 

Bailey, who served as a Marine in the first wave of troops on the 

8

ground in Iraq. Mary Kay Bailey, Justin’s mother, is here today, 

as well. 

I also welcome Randy Omvig, Joshua Omvig’s father. Randy is 

accompanied by his wife, Ellen. 

To the Baileys and the Omvigs, you have traveled long distances 

to be here today to speak of your sons, both of whom died far too 

young. You have my deepest sympathy for your loss. You also have 

my gratitude for being willing to share your stories in the hope 

that things will be better for other young servicemembers. 

I welcome, as well, Patrick Campbell. Patrick represents Iraq 

and Afghanistan Veterans of America and served in Iraq as a combat medic. He currently serves with the Washington, D.C. National 

Guard. 

Finally, I welcome Dr. Connie Best. Dr. Best is a senior faculty 

member at the National Crime Victims Research and Treatment 

Center at the Medical University of South Carolina and served for 

20 years in the Navy Reserve. 

I want to thank each of you for being here today. I want you to 

know that your full statements will appear in the record of the 

Committee. 

Before we move to testimony, I should tell you that I received a 

submission by a woman veteran who served in Iraq describing her 

service and that of other women. I ask unanimous consent to put 

it in the hearing record as it provides valuable insights on the experience of some women who have or are serving in combat zones. 

That will be added to the record. 

Chairman AKAKA. Mr. Bailey, will you please begin with your 

testimony. 

STATEMENT OF TONY BAILEY,

FATHER OF JUSTIN BAILEY 

Mr. BAILEY. Mr. Chairman and Members of the Committee, I 

would like to tell you about my son who died on January 26, 2007, 

at the West L.A. VA Hospital. He was 27 years old and Justin was 

seeking treatment for PTSD and drug abuse. 

Justin joined the Marine Corps in December 1998, approximately 

6 months after graduating from high school. Justin was in the infantry and was due to separate from the Marines in January of 

2003, but was involuntarily extended due to the impending war. 

Justin was with the first wave of troops that arrived in Iraq when 

the war started in 2003. He fought in Nasarija and returned to 

Camp Pendleton in June of 2003. 

While Justin was in Iraq, he sustained an injury to his groin. He 

underwent two different surgeries about 6 months apart. In between these surgeries, he waited around, basically doing nothing, 

until he was discharged in April of 2004. After his discharge, Justin still complained of pain from his injuries and he was diagnosed 

with PTSD. He began taking prescription drugs that were prescribed by the VA and were not monitored. He was also using illegal drugs. 

In November of 2006, Justin checked himself into the West L.A. 

VA Hospital. According to his medical records, Justin went in taking Xanax and a pain medication and 2 weeks later was on Xanax 

and four other different prescription drugs. Justin had been on 

9

Xanax since 2004. We were later told by the medical staff after 

Justin’s death that Xanax is inconsistent with the treatment of 

PTSD. Justin’s pain medication had been changed to methadone, 

which received an FDA alert in November of 2006 and had been 

highly publicized due to its addictive and unpredictable nature. 

After 2 weeks in the hospital, Justin was sent to the domiciliary, 

which is described by the VA as a residential substance abuse 

treatment program. On the night of January 26, I learned that Justin was being taken to the ER at the hospital. He had just received 

his new prescriptions the day before and now he had died of an apparent overdose of his prescription drugs. 

Looking back, I was very happy for Justin that he made the decision to get help and that he was going to the VA for help. I assumed that being a large VA facility, that they would be the best 

equipped and would have the best experience with PTSD and related drug abuse issues. I was wrong. 

Despite warnings from friends, family, and notations in his medical records that Justin had a tendency to over-medicate himself on 

prescription drugs, the L.A. VA Hospital determined that after a 

mere 2 weeks at their hospital, that he had the ability to self-administer his medication. 

Two days after Justin died, my wife and I visited the hospital 

and were greeted with a total lack of sympathy and faced bureaucratic hassles to get basic information. And despite the VA’s touting of its electronic medical records, we were sent on a wild goose 

chase throughout the hospital looking for Justin’s records. We met 

with his medical staff. They indicated that Justin had missed several of his PTSD appointments but they did nothing but reschedule 

a new appointment. They should have made face-to-face contact 

with him. Patients with PTSD and substance abuse are notoriously 

difficult to reach. 

We left the hospital with unanswered questions. We went from 

place to place and got nowhere. I can only imagine what a veteran 

with mental illness would go through. 

Other than some classes required by the domiciliary program, it 

functioned as a residential facility, and while many veterans need 

a place to stay as they are transitioning to civilian life, Justin was 

there primarily for drug treatment and he needed more. 

I will tell you that after our experiences with the hospital, they 

are making some changes, including reducing dosages, surprise inspections, increased weekend staffing. It is my hope that these 

changes will remain in effect and that these changes will occur

systemwide. 

I cannot express the emotion that I feel over Justin’s death and 

the thought that all of this could have been prevented. I don’t believe that this facility is equipped to deal with PTSD and drug 

abuse problems, which are so prevalent. I believe with some veterans, that there is a lag between the return from war and their 

acknowledgement and/or diagnosis of PTSD and we have yet to see 

our VA hospitals overwhelmed with mental illness from this war. 

It would help to increase the budget of the VA hospitals, but not 

before a thorough evaluation of these facilities is conducted. Adding 

money to facilities that have systematic issues is not going to increase their effectiveness. 

10

When I spoke to Justin on the Sunday before he died, he said, 

‘‘Dad, I know this is my last chance and I want to get better.’’ He 

was very positive about what he was going to do when he got out 

of the program. He had plans for his career and wanted to do something with his life. His stepmom and I were very happy for him, 

and for once in a long time, we had hoped that he would be able 

to lead a happy and healthy life. 

Thank you for allowing me to speak to you today. 

[The prepared statement of Mr. Bailey follows:]

PREPARED STATEMENT OF TONY BAILEY, FATHER OF JUSTIN BAILEY

Mr. Chairman and Members of the Committee: 

I would like to tell you about my son, Justin Bailey, who died on January 26, 

2007, at the West LA VA Hospital. He was 27 years old. Justin was seeking treatment for PTSD and drug abuse. 

Justin joined the Marine Corps in December 1998, approximately 6 months after 

graduating from high school. He was in the infantry and was due to separate from 

the Marines in January 2003, but was involuntarily extended due to the impending 

war. Justin was with the first wave of troops that arrived in Iraq when the war 

started in 2003. He fought in Nasarija and returned to Camp Pendleton in June 

2003. While Justin was in Iraq, he sustained an injury to his groin. He underwent 

two different surgeries at the Naval Hospital at Camp Pendleton about 6 months 

apart. In between surgeries, he waited around basically doing nothing until he was 

discharged in April 2004. 

After his discharge, Justin still complained of pain from his injury, and he was 

diagnosed with PTSD. He had trouble sleeping, nightmares, and short term memory 

loss. He began taking prescription drugs that were prescribed by the VA. Over approximately the last two and a half years, the VA prescribed the following different 

drugs: alprazolam (xanax), diclofenac, quetiapine fumarate, buspirone, benztropine 

mesylate, aripiprazole, hydrocone, acetaminophen, olanzapine, hydroxyzine 

pamoate, divalproex, magnesium hydroxide, clonazepam, lithium carbonate, 

trazodone, prazosin, bupropion, levalbuterol tart, lorazepam, oxycodone, omeprazole, 

ibuprofen, doxepin, amitriptyline, temazepam, mirtazapine, and methadone. It 

doesn’t appear as if the drugs were monitored effectively and in my opinion he was 

given drugs and sent on his way instead of being properly diagnosed and treated. 

He also began using illicit drugs. 

In November 2006, Justin checked himself into the West LA VA Hospital. According to his medical records, Justin went in taking xanax and hydrocone for pain, and 

2 weeks later was on xanax, buproprion and trazodone, which are antidepressants, 

prazosin, and methadone, which he was given for pain. Justin had been on xanax 

since 2004. We were later told by medical staff after Justin’s death that xanax is 

inconsistent with the treatment of PTSD. Justin’s pain medication had been 

changed to methadone, which received an FDA alert in November 2006 and has 

been highly publicized due to its addictive and unpredictable nature. The FDA alert 

explained the risks of methadone and cautioned the medical community to ensure 

that the benefits of prescribing methadone outweigh the risks. 

After his 2 weeks in the hospital, Justin was sent to the domiciliary, which is described by the VA as a residential substance abuse program. 

On the night of January 26th, I learned that Justin was being taken to the ER 

at the hospital. He had just received his new prescriptions the day before. And now 

he had died of an apparent overdose of his prescription drugs. 

Looking back, I was very happy for Justin that he made the decision to get help 

and that he was going to the VA for help. I assumed that being a large VA facility 

they would be best equipped and would have the most experience with PTSD and 

related drug-abuse issues. I also assumed that Justin would only receive his prescriptions in small individually controlled dosages. I was wrong. 

Despite warnings from friends and family and notations in his medical record that 

Justin had a tendency to over-medicate himself on prescription drugs, the LA VA 

hospital determined that after a mere 2 weeks at their hospital that he had the ability to self administer medications. The day before he died, he was given five different prescriptions in dosages of 14, 15 and 30 days. 

Two days after Justin died, my wife and I visited the hospital and were greeted 

with a total lack of sympathy and faced bureaucratic hassles to get basic information. And despite the VA’s touting of its electronic medical records, we went on a 

wild goose chase throughout the hospital looking for Justin’s records. 

11

We met with his medical staff. The PTSD professionals indicated that Justin had 

missed several of his PTSD appointments, but they did nothing but reschedule a 

new appointment. They should have made face-to-face contact with him. Patients 

with PTSD and substance abuse are notoriously difficult to reach. They also indicated that although they knew that Justin had problems with over-medicating on 

prescription drugs, they had to listen to the patient when it came to his care. And, 

they told us that Justin had not seen a psychiatrist since being in the domiciliary. 

He had been there approximately 6 weeks already, and a psychiatrist had not yet 

been assigned to him. We found it disturbing that the primary care physician and 

RN continued to give Justin prescriptions that he had been prescribed in the hospital, without evaluating him to see if the drug interactions were OK or the drug 

treatment was even effective. 

We left the hospital with unanswered questions. We went from place to place and 

got nowhere. I can only imagine what it must be like for a veteran with mental illness. Every office that we visited seemed to act independently without knowledge 

of what others were doing. There was obviously inadequate communication between 

offices and medical staff, but yet that seemed to be the norm and didn’t concern the 

people that we spoke to. The only communication network that did seem to function 

well in this hospital was the communication to the organ donation people. I received 

a phone call 4 hours after my son died at 2:30 in the morning in which I was asked 

questions about the condition of my son and specifically about his eyes. 

Other than some classes required by the domiciliary program, it functioned as a 

residential facility. And while many veterans need a place to stay as they transition 

to civilian life, Justin was there primarily for drug treatment, and he needed more. 

I will tell you that after our experience with the hospital, they are making some 

changes, including reducing dosages, surprise inspections, and increased weekend 

staffing. It is my hope that the changes will remain in effect and that these changes 

will occur system-wide. 

I cannot express the emotions that I feel over Justin’s death and the thought that 

all of this could have been prevented. I don’t believe that this facility is equipped 

to deal with PTSD and drug abuse problems, which are so prevalent. 

I believe with some veterans, there is a lag between their return from war and 

their acknowledgment and/or diagnosis of PTSD, and we have yet to see our VA hospitals overwhelmed with mental illness from this war. I have a concern that our 

Iraqi veterans with mental illness will give up on our VA hospitals, because of the 

complexity and apathy. We can do better than that. We send them to war to fight 

for our country and it is our responsibility to take care of them when they return. 

It would help to increase the budgets of the VA hospitals, but not before a thorough evaluation of these facilities is conducted. Adding money to facilities that have 

systemic issues is not going to increase their effectiveness. 

When I spoke to Justin on the Sunday before he died, he said, ‘‘Dad, I know this 

is my last chance and I want to get better.’’ He was very positive about what he 

was going to do when he got out of his program. He had plans for his career and 

wanted to do something with his life. His step-mom and I were very happy for him 

and for once in a long time, we had hope that he would be able to lead a happy 

and healthy life. 

Thank you for allowing me to speak to you today.

Chairman AKAKA. Thank you very much, Mr. Bailey. 

Now, Randall Omvig. 

STATEMENT OF RANDALL OMVIG, FATHER OF JOSHUA L. 

OMVIG; ACCOMPANIED BY ELLEN OMVIG, MOTHER OF

JOSHUA OMVIG 

Mr. OMVIG. Ellen and I would like to thank you for the opportunity to address the Senate Veterans’ Affairs Committee. We have 

submitted two newspaper articles from the Des Moines Register

and the Waterloo Courier from Iowa for your examination. We also 

hope that you have had time to look at Josh’s memorial Web site, 

which was created by Josh’s aunt, Julie Westly. This site was created to help others with as much information as we could find on 

PTSD, post-traumatic stress disorder. 

There is no way we could go through in 5 minutes the events 

leading up to and the day Josh took his life in front of his mother. 

12

We would like to voice our strong support of the Joshua Omvig 

Veterans Suicide Prevention Act, S. 479, reintroduced by Senator 

Harkin and Senator Grassley. This bill has Josh’s name on it, but 

it represents so many men and women before and after Josh who 

were unable to live with the physical, mental, and psychological effects of their service. 

One of the most important issues we see in the past and today 

is the way we are bringing our troops back, regular service and especially the National Guard and Reserve units who are going back 

to civilian life. Josh’s company went from Iraq to Thanksgiving dinner with their families in less than 1 week. One or 2 weeks of decompression or defusing is not enough. This, however, is more the 

rule than the exception. A few days later, Josh was back to his civilian job. 

All the troops know how to fill out the form asking if they are 

having any problems. They know if they say yes, they will be held 

back, won’t be able to see their families and loved ones. The one 

thing they have been thinking and dreaming about is the homecoming and they won’t do anything to delay that. 

Josh’s company was put on a 90-day call-up period when they got 

back, whereby if they were needed, they would be called back to 

active duty. During this time, there is no drill, no contact with the 

people he spent such an intense time with. There was no one 

around him to talk over things with. After a week or two of being 

home, reality starts to set in. Things are not the same. 

Why didn’t Josh and so many others seek help when they got 

back? We train our soldiers well, mentally and physically, to handle any situation that comes up, to survive, the ‘‘I can do,’’ ‘‘I can 

handle it’’ attitude. When we would ask Josh how he was doing, 

it was, ‘‘I am OK. I can handle it.’’ When we hear that now, we 

know there is a soldier that is having problems. 

Josh wouldn’t tell us very much about what he did in Iraq. He 

had to sign secrecy papers that they would not say where they 

were or what they did. Josh tried to keep his promise. Little things 

here and there in conversations would come out. He would tell us, 

‘‘We couldn’t tell anyone.’’ How can you seek help if you couldn’t 

tell anyone what his service experiences were? And we have heard 

this from other veterans, too. 

When Josh got back, he was always sick with some type of upper 

respiratory or gastrointestinal problem. We finally got him to go to 

our family doctor, who he was friends with. We told him to talk to 

her about some of the problems he was having. She later told Ellen 

to get him some help. We tried to get Josh to go to the VA hospital, 

but he wouldn’t go. He said it would affect his military and personal career. We told him we would set up an appointment with 

a private doctor, but he said the Army would find out. We even told 

him that we would set up an appointment under our name so the 

Army wouldn’t find out. He couldn’t believe we would really do 

such a thing. It wasn’t right. 

It is usually a crisis or a tragedy that brings the veteran to see 

that they can’t handle it alone and they need help, or the family 

that finally pushes the situation of seeking help. This is why it is 

so important to have the appropriate support, training, and counseling for family members before their soldiers come home. This 

13

will help them to understand the changes that may happen, what 

to look for, where to go for help, what action can be taken to help 

their soldier. 

We received the present information families get before Josh got 

home. Give them space. Don’t push them to talk. Give them time 

to acclimate. It didn’t work. Peer training and counseling is needed 

to help the veteran and their families. The VA delivery system, 

presentation, and implementation of mental health and psychological services hasn’t changed much. It is still mainly up to the 

veteran and their family to identify the problem and go seek help. 

There is still no comprehensive prevention program during the 

defusing or decompression time to start dealing with the emotional 

and psychological effects of their service, to provide group peer 

counseling, training, coping mechanisms, and strategies. 

The first counseling of Josh’s company had come at the first drill 

after Josh’s death. They brought in chaplains and counselors to 

have group and private sessions, to talk over what happened with 

Josh. Something amazing happened. The conversation went from 

what happened to Josh to what troubles some of the other soldiers 

were having. Some of them went on to get more counseling and 

treatment after that. 

We feel the decompression time should take place after the soldiers have left to see their families. After the experience of homecoming and being with their families, the soldier will be able to 

deal with the paperwork and assimilation training to civilian life. 

When back home, we must assure that there are accessible, timely 

services, education, and outreach programs for the veterans and 

their families. 

The day after Josh’s suicide, the Grundy Center Police Department and Fire Department had a defusing time where a professional counselor was brought in to help them cope and deal with 

what happened that day. Do we as a Nation take the same humanitarian measures for our troops who have served for us for months 

in a combat area? Are we providing our military men and women 

with the appropriate services to help them assimilate back to civilian life? Are we providing them with what they need to survive the 

peace? 

Ellen and I have to say, no, not at this time. 

We can and we must do more. This is no time to bury our head 

in the sand, to take a defensive posture, to try and justify or explain the problems of the past. It is time to make a major process 

check in the implementation of preventative programs. Research 

has proven that if treated early, the chance of coping with mental 

and psychological problems is better and may keep them from 

going to the chronic stage. 

We have and we will have brave men and women serving for us. 

It is our duty to see that they receive the best services possible so 

they can once again have good lives. As we see it, they are the ones 

who have actually earned this right. 

[The prepared statement of Mr. Omvig follows:]

PREPARED STATEMENT OF RANDALL OMVIG, FATHER OF JOSHUA L. OMVIG

Ellen and I would like to thank you for the opportunity to address the Senate Veterans’ Affairs Committee. We have submitted two newspaper articles from the Des 

Moines Register and the Waterloo Courier from Iowa for your examination. We also 

14

hope you have had the time to look at Josh’s memorial Web site, http://joshuaomvig.memory-of.com/about.aspx which was created by Josh’s Aunt, Julie Westly. 

This site was created to help others with as much information as we could find on 

Post Traumatic Stress Disorder (PTSD). There is no way we could go through in 

5 minutes the events leading up to and the day Josh took his life in front of his 

mother. 

We would like to voice our strong support of the Joshua Omvig Veterans Suicide 

Prevention Act, S. 479, reintroduced by Senator Harkin and Senator Grassley. This 

bill has Josh’s name, but it represents so many men and women before and after 

Josh who were unable to live with the physical, mental and psychological effects of 

their service. The major points of the bill are the following:

1. De-Stigmatizing Mental Health 

2. Training of employees and other personnel on suicide and suicide prevention. 

3. Family education and outreach. 

4. Peer support program. 

5. Health assessments of Veterans 

6. Counseling and treatment of Veterans 

7. Suicide prevention counselors 

8. Research on the best practices for suicide prevention among Veterans. 

9. Substance abuse treatment 

10. 24-hour mental health care. 

11. Telephone Hotline.

One of the most important issues we see in the past and today is the way we are 

bringing our troops back, regular service and especially the National Guard and Reserve Units who are going back to civilian life. Josh’s company went from Iraq to 

Thanksgiving dinner with their families in less than a week. One or two weeks of 

decompression or defusing is not enough. This however, is more the rule than the 

exception. A few days later Josh was back to his civilian job. 

All the troops know how to fill out the form asking if they are having any problems. They know if they say yes they will be held back and won’t be able to see 

their families and loved ones. The one thing they have been thinking and dreaming 

about is the homecoming and they won’t do anything to delay that. 

Josh’s company was put on a 90 day call-up period when they got back whereby 

if they were needed they would be called back to active duty. During this time there 

is no drill, no contact with the people who he had spent such an intense time with. 

There was no one around for him to talk over things with. After a week or two of 

being home reality starts to set in, things are not the same. 

Why didn’t Josh and so many others seek help when they got back? We train our 

soldiers well, mentally and physically, to handle any situation that comes up to survive. The Can Do, I Can Handle It attitude. When we would ask Josh how he was 

doing it was ‘‘I’m OK, I Can Handle It.’’ When we hear that now we know there 

is a soldier that’s having problems. 

Josh wouldn’t tell us very much about what he did in Iraq. They had to sign secrecy papers that they would not say where they were or what they did. Josh tried 

to keep his promise. Little things here and there in conversations would come out 

and he would tell us we couldn’t tell anyone. How could he seek help if he couldn’t 

tell anyone what his service experiences were. We have heard this from other veterans too. 

When Josh got back he was always sick with some type of upper respiratory and 

gastro-intestinal problem. We finally got him to go to our family doctor whom he 

was friends with. We told him to talk to her about some of the problems he was 

having. She later told Ellen to get him some help. We tried to get Josh to go to 

the VA hospital but he wouldn’t go, he said it would affect his military and personal 

career. We told him we would set an appointment with a private doctor but he said 

the Army would find out. We even told him we would set up an appointment under 

our name so the Army wouldn’t find out, he couldn’t believe we would really do such 

a thing it wasn’t right. 

It is usually a crisis or tragedy that brings the Veteran to see they can’t handle 

it alone and they need help or the family that finally pushes the situation of seeking 

help. This is why it is so important to have the appropriate support, training and 

counseling for family members before their soldier comes home. This will help them 

to understand the changes that may happen. What to look for, where to go for help 

and what action can be taken to help their soldier. We received the present information families get before Josh got home. Give them space, don’t push them to talk, 

give them time to acclimate—it didn’t work. Peer training and counseling are needed to help the Veteran and their families. 

15

The VA delivery system, presentation and implementation of mental and psychological services hasn’t changed much. It is still mainly up to the Veteran and their 

family to identify the problem and go seek help. There still is no comprehensive preventative program during the defusing or decompression time to start dealing with 

the emotional and psychological effects of their service. VA and DoD need to provide 

group peer counseling, training, coping mechanisms and strategies. 

The first counseling Josh’s company had came at the first drill after Josh’s death. 

They brought in chaplains and counselors to have group and private sessions to talk 

over what happened with Josh. Something amazing happened. The conversation 

went from what happened to Josh to what trouble some of the other soldiers were 

having too. Some of them went on to get more counseling and treatment after that. 

We feel the decompression time should take place after the soldiers have leave 

to see their families. After the experiences of homecoming and being with their families, the soldier will be able to deal with the paper work and assimilation training 

for civilian life. When back home, we must assure that there are accessible, timely 

services, education and outreach programs for the veterans and their families. 

The day after Josh’s suicide, the Grundy Center police department and fire department had a defusing time where a professional counselor was brought in to help 

them cope and deal with what happened that day. Do we as a Nation take the same 

humanitarian measures for our troops who have served for us for months in a combat area? Are we providing our military men and women the appropriate services 

to help them assimilate to civilian life? Are we providing them with what they need 

to survive the peace? Ellen and I have to say ‘‘No’’ not at this time. We can and 

must do more! 

This is no time to bury our head in the sand, to take a defensive posture, to try 

and justify or explain the problems of the past. It is time to make a major process 

check to implement preventative programs. Research has proven that if treated 

early the chance of coping with mental and psychological problems is better and 

may keep them from going to the chronic stage. We have and will have brave men 

and women serving for us. It is our duty to see that they receive the best services 

possible so they can once again have good lives. As we see it, they are the ones who 

have actually ‘‘earned’’ this right. 

[From the Des Moines Register, May 12, 2006] 

PAIR HELP IRAQ VETERANS ‘SURVIVE PEACE’

(By Jennifer Jacobs) 

GRUNDY CENTER, IA.—The secrets that troubled veterans confide to Randy and 

Ellen Omvig weigh heavily on their shoulders. 

Their son, Joshua, a 22-year-old Iraq veteran, was so anxious to clear his mind 

of the trauma of war that he killed himself in front of his screaming mother. A Web 

site they created in his memory: http://joshua-omvig.memory-of.com/About.aspx

has become a whispering wall of sorts, a safe place where other soldiers confess 

their silent suffering. 

‘‘It’s been hundreds a day—so many heartbreaking stories,’’ Ellen Omvig said, 

holding on her lap the note her son left, explaining his own torment. ‘‘It’s like the 

same story over and over again, just different names, different towns. A lot of them 

will make you cry, there’s so much pain.’’

The Omvigs, of Grundy Center, will be at the State Capitol Rotunda today with 

Congressman Leonard Boswell and Gen. Wesley Clark, who will speak at 3:30 p.m. 

on the need for better services for troops with post-traumatic stress disorder, returning from Iraq and Afghanistan. 

‘‘You know the phrase you’ve got to be careful of?’’ Randy Omvig said. He paused, 

his breathing ragged. ‘‘When they say: ‘I’m fine. I can handle it.’ That means: ‘I’m 

having trouble.’ ’’

It took 4 months for the Omvigs, who are intensely private, churchgoing Republicans, to agree to share Josh’s story publicly. 

Randy Omvig, a wrestling coach with a rock-like stature and stoic personality, 

nearly skipped his son’s funeral in December because, he told himself, he couldn’t 

have everyone see him break down. His wife has been unable to work full time since 

a semi hit her car 8 years ago, and these days she is even more fragile. 

‘‘The time to help Josh is over,’’ Randy Omvig said, and this time his bass voice 

was unwavering. 

‘‘But we can’t ignore the others. They’re coming back here safe. We’ve got to help 

them survive the peace.’’

16

MESSAGES OF TORMENT

The messages come in the dead of night, from insomniacs who tell the Omvigs 

that they nurse a deep need to be alone. They trust no one but their combat buddies. They can’t kick the flashbacks and nightmares. They lose their temper at 

work. A few have admitted they expect to divorce soon. Some have lashed out with 

their fists. Some say getting drunk seems to be their only relief. 

And some have felt the scratch of rope around their neck or the chill of a gun 

muzzle on their head. 

‘‘Instead of killing themselves, they’d rather re-enlist and get shot,’’ said Josh’s 

aunt, Julie Westly of Sioux City, who helps the Omvigs keep up with the 15 to 50 

e-mails that arrive daily from soldiers and families in Iowa and elsewhere. ‘‘They’d 

rather die with honor,’’ Westly said. 

That was Josh’s plan, his family said. He thought diving back into the war zone 

would ease his restlessness—and spare some other soldier from being separated 

from family. 

The kid known as the joker who cracked everyone up barely cracked a smile after 

he got home in November after 11 months of high-level security work north of Baghdad. 

Josh, who was with the U.S. Army Reserve 339th Military Police Company of 

Davenport, said he felt honored to defend his country, and he knew why he had to 

do the things he did. But he was never able to recover from them. 

‘‘He’d say, ‘Mom, I don’t want you to hate me,’ ’’ Ellen Omvig recalled, her eyes 

red and tired behind delicate glasses. ‘‘I’d say, ‘How could we hate you? You were 

in the war.’ ’’

Every time he left the house, he hugged his parents fiercely and said he loved 

them. 

Unable to sleep, he would work himself into exhaustion, pulling double shifts as 

a security guard in the skywalks of Des Moines before driving 90 miles to Grundy 

Center. Then he’d hide out in his bedroom, playing war video games with loud 

music in his headphones. 

At least his hands had stopped shaking. For a while, he couldn’t button his clothing or grasp items in his pockets. He’d see something on the side of the road and 

for a few seconds his racing heart told him it could be a bomb. He was startled by 

sudden movements, like a bird landing on a stop sign. 

A FINAL NOTE

The shaking stopped, but the hyper-vigilance didn’t. And his mood worsened. 

He refused to go to counseling. He was certain the Army would find out, and that 

there would be repercussions. He figured that with his symptoms, his goal to be a 

police officer was ruined. 

Four days before Christmas, Josh went out drinking. A friend whose car had slid 

into a ditch in Black Hawk County called him for help, and Josh was arrested for 

first-offense operating while intoxicated. 

When he got home in the morning, he shaved, changed into his desert uniform, 

and told his mom the recruiter had asked him to tag along to meet some possible 

recruits. 

Ellen Omvig detected nothing unusual about his behavior, and told him she was 

going to hop in the shower. Josh casually handed her a note, saying, ‘‘You can read 

it later,’’ and walked out the door. 

‘‘Mom & Dad,’’ she read. ‘‘Don’t think this is because of you. You did the best you 

could with me. The faces and the voices just won’t go away.’’ He’s re-enlisting, she 

thought. 

‘‘ . . . I will always love you. Josh.’’

She sprinted after him, figuring she could persuade him not to sign anything until 

he talked it over with his father. 

And then the realization hit her, and she was yelling for Josh to stop, stop, stop, 

stop. She fumbled for the locked door handle of his pickup, grabbed the side-view 

mirror, pleading. 

‘‘Terry’s coming,’’ Josh told her. ‘‘He’ll take care of it.’’

Ellen Omvig saw the handgun. As supervisor of his security crew, Josh was permitted to carry one. 

She was screaming, and Josh kept telling her she didn’t understand. His battle 

buddy had been killed, he said. 

His parents aren’t sure how he knew that. Maybe he got a letter. Neither parent 

has entered his bedroom since he died. 

Josh kept repeating that he should have been there taking care of him. He had 

to be with him now. He said he’d been dead ever since he left Iraq. 

17

‘‘His eyes were just dark, and it was like he wasn’t really there,’’ Ellen Omvig 

recalled, her hands hugging her sides, not touching the tears sliding down her face. 

‘‘I said, ‘No! Your dad’s counting on you to take care of me if anything happens to 

him.’ And that’s when he broke and the pain and the anguish was so clear and he 

said, ‘How can I take care of you when I can’t take care of myself?’ ’’

Then a squad car rolled up, Ellen Omvig said. Josh had telephoned police officer 

Terry Oltman and asked him to be at the Omvig house in 10 minutes. Josh, a reserve officer and volunteer firefighter, knew every cop in town. ‘‘Go!’’ Josh ordered 

his mother. 

Oltman was shouting for Ellen Omvig to get away, but she wouldn’t leave her son, 

and Josh angled his head so the bullet’s path wasn’t aimed at his mother. 

That was December 22, 2005. 

HELPING THE LIVING

It never hit Ellen and Randy Omvig until later that Josh’s problems were classic 

symptoms of post-traumatic stress disorder. After posting information at http://

joshua-omvig.memory-of.com, they’ve heard from military families worldwide who 

say the problem is extensive. 

‘‘It’s a terrible thing,’’ Ellen Omvig said. ‘‘There are a ton of things that can be 

done so that people can live with it and at least put it on the back burner in their 

lives instead of letting it be the driving force in their lives and being permanently 

disabled.’’ The Omvigs think the U.S. military isn’t doing enough to address veterans’ mental health or to ease the stigma of getting treatment. 

Officials with the Veterans’ Administration and Department of Defense said they 

have taken steps to offer more mental health services, but servicemembers are not 

always receptive to that. 

A Government Accountability Office report issued Thursday states that of returning troops found to be at risk for PTSD, 88 percent were not referred by government 

health care providers for further help. 

‘‘We’re not political one way or another about should we be over there, should we 

not be over there,’’ Randy Omvig said. ‘‘We hear they’re on a ‘humanitarian mission.’ 

There must also be a humanitarian mission when they get home. We can’t let another generation suffer the way the Vietnam generation suffers.’’

Now the Omvigs write to politicians and military officials, applying pressure. 

When Boswell’s office called Wednesday, they agreed to come to the Capitol. 

‘‘I’m willing to talk to anybody I have to,’’ Randy said. ‘‘This isn’t going to end 

in a year.’’

[From the Waterloo-Cedar Falls Courier, May 12, 2006] 

GRUNDY CENTER COUPLE WHO LOST SOLDIER SON

VISIT CAPITOL TODAY

(By Dennis Magee) 

GRUNDY CENTER.—Randy and Ellen Omvig will go public this afternoon with 

their grief. They would rather not. 

‘‘Truth be told, we’d rather go fishing,’’ Ellen said. 

But then, many things in their life are not as they would wish. 

The couple’s son, Josh, killed himself in December. He was 22 years old and a 

veteran of the war on terrorism. He managed for about a year after his return to 

Iowa. 

Randy and Ellen Omvig blame post-traumatic stress disorder for their son’s 

death. As the name suggests, the psychological condition is triggered by horrific 

events that overwhelm a person’s ability to cope. 

In a series beginning Saturday, the Courier will examine issues related to posttraumatic stress and what the disorder will mean to soldiers, their families and the 

state of Iowa. 

The Omvigs will appear at 3:30 p.m. in the State Capitol Rotunda with Rep. Leonard Boswell, who will talk about proposed legislation. Boswell, a Democrat representing Iowa’s 3rd District, will appear with Gen. Wesley Clark, a onetime and 

possibly future Democratic candidate for president. 

Boswell served for 22 years in the U.S. Army and completed two tours in Vietnam. He is expected to talk about House Resolution 1588, a bill introduced by Rep. 

Lane Evans, D-Illinois in April 2005, but still stuck in the first stages of the legislative process! The measure calls on the Federal Government ‘‘to improve programs 

for the identification and treatment of post-deployment mental health conditions, including post-traumatic stress disorder, in veterans and members of the armed 

18

forces, and for other purposes,’’ according to a Web site maintained by the Library 

of Congress. The bill also suggests a requirement to study factors that decrease the 

likelihood of developing chronic post-traumatic stress disorder related to combat. 

The [bill] is backed by more than 100 congressmen, almost exclusively from the 

Democratic side of the aisle, but including Rep. Jim Leach, a Republican from Iowa. 

Boswell signed on as a co-sponsor May 9 of this year. Last legislative action on the 

bill came April 25, 2005, when it was forwarded to the House Subcommittee on 

Health. 

During a recent interview, the Omvigs talked about their reluctance to become 

public figures—and their commitment to do so. 

Burying their heads and hearts would be easier and safer than speaking out. 

‘‘But it wouldn’t have been just to Joshua,’’ Randy said. 

‘‘Or to anybody,’’ Ellen added. 

The couple view their participation with trepidation. 

‘‘Exciting is not the word we think of. Frightening is the word we speak of to each 

other,’’ Ellen said Thursday. 

Not of anyone or anything in particular. Or of the probable media horde and 

crowd. 

‘‘We feel ill-suited, not qualified, to speak on the behalf of others,’’ Ellen said. ‘‘I 

do not have the right words to explain how we feel.’’

She has a powerful message nonetheless. 

[From the Waterloo-Cedar Falls Courier, May 13, 2006] 

PARENTS PUSH FOR SOLIDER’S STORY TO CONTINUE

BEYOND SUICIDE

(By Dennis Magee) 

First in a series 

GRUNDY CENTER.—He always intended to be a policeman. To get there—with his 

parents’ guidance—Josh Omvig became a soldier. 

‘‘He was a nice young man,’’ Ellen says. 

A mother’s pained love. 

‘‘He was a pretty straight arrow,’’ Randy says. 

A father’s wounded joy. 

They knew Josh experienced combat in Iraq as an Army reservist. By connecting 

the dots, they concluded their son probably participated vigorously. Too late, they 

realized the person they got back from the war on terrorism was not the young man 

they sent. 

Sadly, they say, post-traumatic stress disorder was only a vague concept until 

they saw Josh’s world unravel. 

‘‘In retrospect, we probably should have pushed harder,’’ Randy says. 

His tone conveys little confidence the couple actually believe they could have 

saved their boy. As they see it, odds weighed heavily against their son. 

‘‘I keep thinking about it,’’ Randy says. ‘‘But it was a no-win situation for Josh.’’ 

The soldier told his mother once he died in Iraq. But he kept living for another year. 

BURNING DESIRE

Josh, a former Boy Scout with a newspaper route, wanted to join the military 

early. His parents refused to sign paperwork required of a 17-year-old and made 

him wait. 

‘‘ ‘It is an adult decision. It is 7 years of your life,’ ’’ Randy remembers telling his 

son. 

Later, the couple insisted their son investigate several branches of the armed 

forces before making a commitment. And they helped. 

‘‘Josh was pretty focused,’’ Randy says. 

He enlisted with the 339th Military Police Company based in Davenport. 

‘‘When he signed up they hadn’t been activated in more than 30 years,’’ Randy 

says. 

The choice was logical for an aspiring policeman or sheriff’s deputy. 

‘‘He figured the best way to get some experience was to go into the reserves,’’ 

Randy says. 

Josh graduated a semester early from Grundy Center High School. Within 2 days 

he was training at Fort Leonard Wood in Missouri. 

19

The company deployed to Guantanamo Bay, Cuba, guarding suspected members 

of al Qaida. But Josh was not yet ready. Meanwhile, he enrolled in law enforcement 

courses at Hawkeye Community College. 

‘‘But sitting in the classroom was kind of tough on him,’’ Randy says. 

Josh seemed to enjoy much more the ride-alongs he arranged with sheriff’s deputies in Tama, Grundy and Hardin counties. 

‘‘He liked the action part of it,’’ Randy says. 

Josh started working for a security company in Des Moines and became a supervisor. He moved to Altoona. 

In 2003, the soldiers in the 339th—back from Cuba—and Josh and his parents 

anticipated what lay ahead. 

‘‘They kept telling them all summer, ‘You’re going to be activated real 

soon . . . ,’ ’’ Ellen says. ‘‘That went on for months.’’

Josh got ready, had his teeth checked and deposited DNA samples with the military. Officials activated the 339th once again in December 2003 and the company 

deployed to Iraq in February 2004. 

The soldiers’ mission included guarding people and enemy munitions. They at 

times also protected convoys. Shifts were 15 hours long. Their camp at one point 

was mortared daily. 

Temperatures inside tents exceeded 100 degrees at night, Josh said, and soldiers 

resorted to flea collars on their beds and around ankles to stop the pests. But that 

didn’t work too well, Ellen says, because the toxic chemicals irritated the soldiers’ 

skin. 

‘‘It was pretty rough conditions for them,’’ Randy says. 

At the time, the couple didn’t know where their son was. They later learned he 

served in the Sunni Triangle, a region northwest of Baghdad and home to many of 

Saddam Hussein’s most loyal followers. 

The 339th worked out of a ‘‘forward operating base,’’ according to the Omvigs. 

There were no showers and only sporadic electrical service, Josh said. Telephone reception was poor and calls were frequently interrupted. 

Soldiers in the company encountered close combat in urban conditions. Josh mentioned tall buildings crowding streets narrower than H Avenue where his parents 

lived in Grundy Center. Gunmen would pop up in windows a few feet away from 

convoys. Josh indicated a handgun might have been more effective than the grenade 

launcher he manned. 

Josh never talked about killing anyone but said the 339th came under fire. He 

was usually in the company’s lead vehicle and ‘‘he was their best shot,’’ Randy says. 

The couple received one letter from their son in 11 months. Josh later said he was 

firing off notes every month. Josh also occasionally skipped opportunities to call 

home, at least in part to allow fellow soldiers with spouses and children access to 

available phones. 

‘‘Another reason was he said it was too hard talking to us,’’ Ellen says. 

BREAK IN THE ACTION

In early September 2004, Josh returned to Grundy County for a few days of rest 

and relaxation. He found little of either, according to his parents. 

‘‘He shook for 3 days,’’ Randy says. 

He remained vigilant and seemed unable to let down his guard. 

‘‘He was in pretty bad shape when he got back,’’ Randy says. 

The effects were apparent enough that others noticed. One of Josh’s first desires 

was a meal at McDonald’s. While there, the family encountered a veteran of the 

Vietnam War. 

The older man saw the jitters and addressed Josh. 

‘‘ ‘I know. It will get better. Thank you for your service,’ ’’ Ellen remembers the 

man saying. 

Josh only shared information about Iraq in one or two-sentence fragments at a 

time. But as they spent time together, his parents learned driving presented perceived threats to the veteran. Deer along the road. Headlights in the rear view mirror. Ordinary items, like culverts, that to Josh represented hiding places. 

‘‘His head was on a pivot,’’ Randy says. 

While home, Josh withdrew periodically from family festivities. 

‘‘ ‘You’ve got to forgive me. But I can’t be around people too much,’ ’’ Ellen remembers him saying. 

But he was glad to be in Grundy Center. 

‘‘He kept saying, ‘I’m so happy to be home,’ ’’ Ellen says. 

20

Randy remembers Josh taking time to smell flowers and touch leaves still hanging on trees. He talked little about what he had experienced. Peace eluded Josh, 

especially at night. 

‘‘Of course, you heard him. The bad dreams,’’ Ellen says. 

Their son would call out while sleeping, usually ‘‘No’’ or ‘‘Stop’’ or some other military command. 

‘‘He didn’t really want to go back. But he didn’t want to leave his buddies either,’’ 

Randy says. 

Josh fulfilled his obligation. He returned to Iraq after about 10 days. 

‘‘We just got him pretty well rested and fed,’’ Ellen says. 

The couple was concerned. Looking back, they realize they witnessed the serious 

effects of combat-stress reaction. 

‘‘ ‘I’m fine. I can handle it. I’ve got it under control,’ ’’ Ellen remembers Josh repeating several times. 

‘‘I didn’t know enough,’’ she adds. 

‘‘And he was putting on a pretty good act for us,’’ Randy says. 

HEADED HOME

Josh completed his tour of duty in Iraq on his 21st birthday in November 2004. 

He later told his parents the company expected to spend 3 weeks in Kuwait. At another point, Josh believed he would be at Fort McCoy in Wisconsin for 3 months. 

In reality, the soldiers were in Iowa within a week. 

As the Omvigs explain the transition, Josh ‘‘went from fifth gear to first gear’’ in 

a few days. 

For many troops returning to the United States, the fastest way out is the preferred path. Though sick, Josh declined an opportunity to visit the infirmary in Wisconsin. 

Randy explains a soldier’s option at that point. 

‘‘Do I say yes and have to stay, or do I say no and go home to my family? ’’

When he arrived in Iowa, the next day was Thanksgiving. On Friday, Josh returned to work in Des Moines. 

Ellen and Randy knew their son was suffering. Josh, however, continued to assert 

he could handle the situation. He expressed concern that talking with an Army 

counselor, admitting a mental health issue, conceding he needed help would damage 

his career. 

‘‘We even tried to get him to go get private help that we would pay for,’’ Ellen 

says. ‘‘He said, ‘Nope. They will find out.’ ’’

Ellen suggested seeking therapy by using an assumed name. Josh rejected the 

idea, shocked his mother might condone lying. 

The specifics about what troubled their son and to what extent remained a mystery. 

‘‘You get short conversations,’’ Ellen says. ‘‘Loving and kind. But short.’’ Other 

veterans later told Randy and Ellen that Josh at times appeared to want to discuss 

something. The veterans did not press the issue, giving the soldier space to proceed 

at his pace. Josh inevitably let the moments pass, the veterans said. 

The security firm put out pink slips and Josh was out of work. He moved into 

his parents’ home in Grundy Center and—still considering a career in law enforcement—enrolled at Ellsworth Community College. 

While waiting for classes to begin, Josh commuted to a part-time job in Des 

Moines. At one point, he shared a conversation with his father, notable because of 

its length and content. 

‘‘ ‘Dad, I just want to be happy like you,’ ’’ Randy remembers. 

Josh repeated the thought several times. 

An aunt, Julie Westly of Sioux City, and others in the family also knew about 

Josh’s ‘‘deep, deep depression.’’

‘‘We all encouraged him to get help. But he was so afraid because he thought his 

career would be over,’’ Westly says. 

Weeks played out, and casual observers in Grundy Center might not have noticed 

any change in Josh. He started helping as a crossing guard for the elementary 

school, setting out stop signs. He volunteered with the Grundy Center Fire Department, bounding out of the Omvigs’ home when his pager sounded. 

‘‘He loved it. He loved to help people,’’ Randy says. 

Getting up in the night for an emergency hardly seemed an inconvenience. 

‘‘ ‘Well I don’t sleep anyway, Mom,’ ’’ Ellen remembers him saying. 

Josh altered his career goal slightly. He still wanted to be a policeman, but in 

a small community. 

‘‘Mostly, he wanted to be happy,’’ Randy says. ‘‘I knew what he meant.’’

21

Besides restless nights, Josh experienced flashbacks. Unfamiliar sounds sparked 

an undeniable urge to examine his parents’ property—in military terms, to secure 

the perimeter. 

Ellen and Randy know Josh would circle their lot. He may have gone farther into 

the neighborhood. 

‘‘I don’t know. We didn’t follow him,’’ Ellen says. 

Josh occasionally shared thoughts that his mother did not understand. 

‘‘ ‘I don’t want you to hate me,’ ’’ she remembers him saying. 

At the time, Ellen interpreted the comment as a reflection on tasks performed in 

combat. Attempts to reassure that she would never hate her son were only marginally effective. 

‘‘ ‘What you had to do over there is what you had to do to survive,’ ’’ Ellen remembers saying. 

Josh admitted another problem. 

‘‘He talked about hearing voices, seeing faces,’’ Randy says. 

Ellen pressed her son on one occasion about what he meant. 

‘‘He said Iraqi people.’’

BAD TO WORSE

Josh had an ally in Iraq. Ellen and Randy know him only as Ray. 

The soldiers were assigned to each other as battle buddies during boot camp because they were standing in line together. 

‘‘They ended up good friends,’’ Ellen says. 

Toward the end of December, Josh apparently learned Ray had been killed in 

Iraq. The soldier’s death followed unfortunately close to the funeral for Jimmie 

Kitch, Ellen’s mother. 

On December 21, Josh went out drinking, an uncharacteristic event, according to 

his father and others. 

‘‘I’ve never seen him drink a beer,’’ Westly says. 

At some point during the evening, Josh’s truck and another vehicle went into a 

ditch along Orange Road and got stuck in snow. Josh and the other driver left the 

area. When they returned in a third car with two other people, a police officer from 

Hudson and Black Hawk County sheriff’s deputies were at the scene. 

According to their report, the deputies smelled alcohol on Josh’s breath and he 

failed two of three field sobriety tests. They arrested Josh for operating a vehicle 

while intoxicated. 

Josh got out of the Black Hawk County Jail at 9 a.m. Ellen remembers by 11 he 

was home in Grundy Center. It was a Thursday. 

He shaved and put on his desert fatigues. He said he wouldn’t be going to work. 

At the time, Ellen remembered a conversation about visiting a friend and didn’t 

think anything unusual. There was also mention of helping a recruiter talk with 

prospective young men and women, which Josh had done in the past. 

He asked his mother for their pastor’s telephone number. And a sheet of paper. 

He wanted to write a few things down. 

Ellen tore a piece out of a spiral notebook, shearing off one corner. Josh said the 

damaged page was good enough. Ellen remembers her son’s demeanor as calm. 

Josh later handed his mother a note and went out a back door. Ellen read the 

words but didn’t understand. Josh described joining his buddies. She at first 

thought that meant re-enlisting, a possibility Josh had entertained. 

She went after him. 

‘‘I wanted him to talk to his dad,’’ Ellen says. 

‘‘Then it finally hit her what he was talking about,’’ Randy adds. 

Josh was in his truck. The doors were locked. Ellen pleaded with her son to not 

do what he was contemplating. Her appeals turned to screams. 

Ellen did not [know at] the time Josh had already called a friend, police officer 

Terry Oltman. He asked Oltman to stop by the house in a few minutes. 

Seeing what was developing, Oltman ordered Ellen away from the car, she remembers. Ellen refused to leave her son. 

Josh raised a handgun and fired a single shot. He turned his head slightly to 

avoid possibly injuring his mother. 

‘‘I just can’t believe how much can happen in one minute,’’ Ellen says. 

Father and mother want information in their son’s suicide note held privately. 

Save for the closing thought: 

‘‘I will always love you. Josh.’’

22

POSTSCRIPT

The family buried their soldier with help from the U.S. Army Reserve 339th Military Police Company. Josh Omvig was 22. 

‘‘He thought it would get better because he was home,’’ Westly says. ‘‘And it never 

got better. It got worse.’’

Josh told his mother once he died in Iraq. But he kept living for another year. 

[From the Waterloo-Cedar Falls Courier, May 13, 2006] 

FAMILY OF DEAD SOLDIER WANTS GOVERNMENT TO DO MORE

TO TREAT POST-TRAUMATIC STRESS

(By Dennis Magee) 

DES MOINES.—He served in Iraq. He came home. Then Army Spc. Josh Omvig 

killed himself. His parents blame post-traumatic stress disorder. 

Only reluctantly did Randy and Ellen Omvig agree to share their son’s story. 

‘‘We already live with what happened to Josh,’’ Randy says. ‘‘Every day.’’

‘‘And night,’’ Ellen adds. 

Friday afternoon—against their impulse to maintain private lives—the couple was 

near center stage in Iowa. They participated in a press conference organized by Rep. 

Leonard Boswell, a Democrat seeking re-election in Iowa’s 3rd District. Gen. Wesley 

Clark, a onetime and possible repeat Democratic candidate for president, also addressed a small crowd and a few television cameras. 

The Omvigs sat in the State Capitol Rotunda in the front row, introduced late 

in the hour-long event. Hearing the words ‘‘he took his own life’’ moved the couple 

near to tears. 

‘‘We know our deep feelings will never replace Joshua,’’ Boswell said. 

The event served as both campaign stop for Boswell and an opportunity for the 

candidate to address the Federal Government’s response to its returning soldiers. 

‘‘We’re trying to stir up a little tension. Others are, too,’’ Boswell said. 

Specifically, he said, the time for action on House Resolution 1588 is well-past. 

The measure would boost benefits for veterans and address issues related to posttraumatic stress disorder. 

Rep. Lane Evans, D-Illinois, introduced the bill in April 2005. Boswell signed on 

as one of more than 100 co-sponsors last week. 

‘‘I didn’t want to come out here and tell you I support it if I wasn’t on it,’’ he said. 

The last action on the bill was referral to the House Subcommittee on Health toward the end of April 2005. 

‘‘I can’t believe they’ve had that for more than a year,’’ Ellen Omvig said. 

Boswell suggested part of the hang-up is related to the cost, a notion he rejected. 

‘‘And we can’t find the money? In the United States of America? It’s absurd,’’ he 

said. 

He also emphasized the bill’s intent to strengthen cooperative efforts between the 

U.S. Department of Defense and the U.S. Department of Veterans Affairs. 

Clark later attacked President George W. Bush, saying the administration needs 

‘‘to get its priorities right.’’

The retired four-star general, who was severely wounded in Vietnam, also shared 

his experience with life after combat. Nine years after his service in Southeast Asia, 

Clark said he experienced flashbacks. 

‘‘It takes a long time for these feelings to surface and for veterans to be able to 

vocalize what they went through,’’ he said. 

‘‘I was lucky. I didn’t suffer much,’’ Clark added. 

Josh Omvig did. 

The young man from Grundy Center suffered through nightmares, difficulty sleeping, involuntary shaking, physical health concerns, intrusive memories and a sense 

that he must be hypervigilant to supposed dangers. 

‘‘He never was well,’’ Ellen says. 

She and her husband witnessed their son’s struggle for about a year. They and 

other family members tried to intervene but their suggestions were rejected. Josh 

was in a place—had been to a place—his parents could not reach. 

‘‘We always thought we had a pretty good rapport, that he could tell us anything,’’ 

Randy says. ‘‘But he couldn’t tell us about that.’’

Toward what turned out to be the end, they attached a name to Josh’s condition—

post-traumatic stress disorder. 

‘‘We didn’t associate it with Josh until he started talking about the voices and 

faces,’’ Randy says. 

23

‘‘Nobody gave us any reason to know about it,’’ Ellen adds. 

Josh used a handgun to end his pain. His parents buried him in December. He 

was 22. 

‘‘It’s hard to just get up in the morning,’’ Randy says. ‘‘ . . . As a matter of fact, 

it’s getting harder. The numbness is wearing away.’’

The couple’s other son is in the Army. Their daughter is in high school. 

‘‘People ask, ‘How can you go on?’ I have other children,’’ Ellen says. 

In their grief, the Omvigs sensed a need early on to address issues they believe 

vitally important to soldiers and their military families. Randy’s sister, Julie Westly, 

created a Web page devoted to her nephew and to post-traumatic stress disorder. 

‘‘We tried to research post-traumatic stress disorder and it was so hard to even 

find out what it was called,’’ Westly says. ‘‘I was searching for ‘military suicide’ and 

it took a good week to even find out it even had a name.’’

Their sad experience spawned what the family says will be an extended commitment to spreading the word about post-traumatic stress disorder. 

‘‘What we can do for Josh is over. But we don’t want what we went through to 

happen to any other families,’’ Randy says. 

But it apparently is, though the extent of the problem is difficult to quantify. The 

National Veterans Foundation, a private nonprofit organization, reports at least 65 

soldiers and 32 Marines have taken their own lives, either while serving in Iraq or 

after returning to the United States. 

‘‘It’s the worst thing for any parent—to see your child die—let alone suicide,’’ 

Westly says. 

HELP NEEDED

Josh’s parents have a short list of items they maintain returning troops deserve. 

• Guarantees those who seek medical care, physical or mental, do not face reprisals in their military or civilian careers. 

One of Josh’s stated reasons for not seeking counseling was fear an admission he 

needed help would damage his professional life. 

• Transition periods between active duty and their return to civilian lives. 

‘‘We want to make sure the troops coming back have time to decompress, have 

this down time,’’ Randy says. 

The Omvigs stipulate the time should be spent on ground that troops consider 

safe. A month in Kuwait will not serve. The transition, in their view, would be most 

effective on U.S. soil. But not in their homes and hometowns, either. 

• Intact units until ultimate release from duty. 

The Omvigs advance—and research supports—the notion that soldiers should be 

surrounded by their colleagues. After returning to home bases or reserve centers, 

soldiers should be required to check in periodically and maintain contact with other 

troops. 

• Mandatory counseling with fellow soldiers with similar backgrounds. 

Veterans tell the Omvigs they prefer to talk with people who understand conditions on the battlefield. 

‘‘Because they won’t talk or listen to someone who hasn’t been there,’’ Ellen says. 

That includes relatives, including parents and spouses. 

‘‘Their family is the one safe place that hasn’t been affected by their service,’’ 

Ellen says. 

Home is a good place, set aloft on an idealistic pedestal. 

‘‘They don’t want it to change that. . . If they tell you anything, it will soil it,’’ 

Ellen says. 

• Information for families. 

The couple also believes spouses and parents should receive more training on how 

to cope with returning soldiers. Information on how to recognize symptoms and 

treatment options should be readily available. 

‘‘They don’t prepare the families for what comes home,’’ Ellen says. 

ROLE MODEL

The Omvigs draw comparison to how soldiers in World War II returned from Europe or the Pacific—on very slow ships over the course of weeks and months. And 

all the while, the troops were surrounded by fellow fighting men and women, who 

knew the score on the battlefield. 

‘‘You had a chance to wind down. There was nothing from the outside world you 

had to deal with. Indeed, there was no way you could,’’ Ellen says. 

The Omvigs adamantly resist entering the debate about the war in Iraq. The Web 

site in Josh’s honor refers only to his life, offering hundreds of resources related to 

24

post-traumatic stress disorder. There are also dozens of links to additional Internet 

sites they believe veterans and their families will find helpful. 

Those who would argue the merits of the conflict should go elsewhere. 

‘‘This is not the platform or the forum for that discussion,’’ Ellen says. The after 

effects of combat cross boundaries between countries, between political parties and 

between religious convictions. 

The political arena is relevant to the Omvigs for one reason only: They want state 

and Federal legislators to address issues related to post-traumatic stress disorder. 

‘‘This is isn’t politics. This is humanitarian,’’ Randy says. 

If government officials continue to deploy military units, including guardsmen and 

reservists, they should also prepare for their return. 

‘‘OK. Take him as a citizen-soldier. But how are you going to bring him back as 

a citizen? ’’ Randy asks. 

‘‘From the Revolutionary War on down, the attitude has been, ‘Buck up. Be tough. 

Deal with what you’ve got,’ ’’ Ellen adds. ‘‘But that doesn’t work.’’

The Omvigs understand proposals to hold soldiers longer, to provide mandatory 

therapy sessions, carry a price tag But, they reason, paying now will cost less than 

paying later. 

‘‘Can we afford to have these people—who served so heroically—to have problems 

for the next 10, 20, 30, 40, 50 years? ’’ Randy asks. ‘‘. . . How much is it going to 

cost in the future if they can’t be productive citizens, if they can’t hold a job? ’’ They 

also cite as possible—even likely side effects—alcohol and drug abuse, divorce and 

child abuse. And suicide. 

According to the National Veterans Foundation, the post-traumatic stress disorder 

cases treated within the Veterans Administration system increased by tenfold within the last year. More than 16,000 veterans of Iraq and Afghanistan already carry 

the diagnosis. 

‘‘We’re expected to be humane to the rest of the world. Well how about being humane to these soldiers?’’ Randy says. 

Ellen and Randy, however, view the public stance their taking as ‘‘a necessary 

evil.’’ Dealing with their grief privately is the preferred course. 

‘‘That’s really what their goal is, to get the word out,’’ Westly says. 

Burying their heads and hearts would be easier and safer than speaking out. 

‘‘But it wouldn’t have been just to Joshua,’’ Randy says. 

‘‘Or to anybody,’’ Ellen adds. 

Josh’s Web site on at least one occasion attracted a hurtful comment about his 

abilities and courage—and though they state no political viewpoint—about the family’s sense of patriotism. 

Five months after their son’s funeral, the Omvigs and Westly are speaking out 

anyway. They want others to know about the danger to soldiers posed by post-traumatic stress disorder. 

‘‘We are ready to make a lifelong commitment to this, until it doesn’t exist any 

more,’’ Westly says. ‘‘We don’t want to see this happen to any other families.’’ Ellen 

says the family has no choice. 

‘‘We know now. We’ve been enlightened. It’s our responsibility.’’

‘‘So now it’s your responsibility,’’ Ellen adds to those who hear her words. 

‘‘There’s other families. There’s other moms.’’

Chairman AKAKA. Thank you very much, Mr. Omvig. 

Patrick Campbell? 

STATEMENT OF PATRICK CAMPBELL, OIF VETERAN,

CONGRESSIONAL LIAISON, IRAQ AND AFGHANISTAN

VETERANS OF AMERICA 

Mr. CAMPBELL. Thank you very much for having this opportunity 

to speak. I am here with the Iraq and Afghanistan Veterans of 

America and I am not the only Iraq veteran here. If I could have 

the other Iraq veterans in the crowd please stand up. I know there 

are at least four of them here. 

[Applause.] 

Mr. CAMPBELL. They might not be standing because they are a 

humble group. 

The system that the Department of Veterans Affairs employs to 

treat servicemembers with mental health issues suffers from a funVerDate 0ct 09 2002 13:32 Jul 18, 2007 Jkt 000000 PO 00000 Frm 00028 Fmt 6633 Sfmt 6601 H:\RD41451\DOCS\36191.TXT SENVETS PsN: ROWENA
25

damentally fatal flaw. It is a system that waits. It is a system that 

waits for a servicemember to acknowledge that they have a problem. It is a system that waits for a servicemember to ask for help. 

The system is broken and we must fix it before we lose this generation of heroes. 

I know everyone in this Committee has heard the statistic that 

one in three Iraq veterans and one in nine Afghanistan veterans 

will suffer a mental health problem as a result of their service. As 

you have heard here today, every statistic like this represents both 

a name and a tragic story. 

I am here to tell you what my counselor at the D.C. Vet Center 

told me on my very first counseling session when I finally admitted 

that I had a problem a year later. No one goes to war and comes 

home the same person they were before they left, no one. 

In preparation for this testimony, I exhibited a classic symptom 

of post-traumatic stress disorder, denial. I wrote this whole entire 

testimony wanting to talk about someone else because I was too 

embarrassed to admit to you, even though I have done it numerous 

times, that I personally have post-traumatic stress disorder. I have 

been diagnosed. I wrote this testimony about someone else because 

it was easier to tell their story than my own. I am still going to 

tell theirs because I think his is better, but I know that I am fooling myself when I think that I am healed. 

I did use this as an opportunity to talk to my brothers who I patrolled with in Iraq. What I found not only disturbed me, it scared 

me. Two years later, there is a picture in each of your folders. The 

Alpha Company Killas, my brothers, are now struggling to find 

their place in the world. From my lieutenant all the way down to 

the gunners, no one has been spared. I heard stories about strained 

marriages, ruined engagements, methamphetamines, alcohol, and 

sleepless nights. These are just some of the stories. 

I want to talk about the icon of this war, the gunner, the guy 

who has to make life or death decisions every day. Three out of our 

four gunners are suffering from severe post-traumatic stress disorder and substance abuse. The fourth one is on active duty because he could not stand the idea of being surrounded by civilians. 

All of them desperately need help but are too proud to ask. 

One story in particular breaks my heart. We call him Manimal, 

and he is the picture on the bottom, half-man, half-animal. He has 

a smile like Clark Kent, a contagious hearty laugh, and a deadly 

right hook. He is a simple giant who the kids loved in Iraq. On 

more than one occasion while we were serving in Iraq, a car would 

come too close. They would either ignore or not hear the warning 

shots and Manimal would have to do his job. On three or four occasions, I saw Manimal put a hundred rounds in a car, because when 

it came down to choosing between us and the unknown face in the 

car coming toward us, he was the most loyal friend you could ever 

possibly have. 

I remember finding Manimal in the corner of a tent one day. He 

was sitting by himself. He never sits by himself. He is the center 

of attention. I said, ‘‘Hey, Manimal, what is up?’’ He started talking, but he never made eye contact with me. He said, ‘‘I saw that 

bullet hit that man in the chest. I saw his face as he lost control 

of the car. I watched that car hit the wall as we drove by. I couldn’t 

26

say anything because—well, because we just kept on driving.’’ This 

man watched this man die that he just shot and we just kept driving. 

As a medic, I had to make life and death decisions when an 

emergency arose. Manimal had to make them every time we got on 

the highway. When he got home, he never could keep a job for 

more than 2 weeks. He couldn’t stand being told what to do by an 

18-year-old who never saw what he saw. He drank too much and 

once was caught, got a DUI and had his license suspended. He 

would call me late at night, usually at two or three in the morning, 

just to talk, to talk to someone whom he trusted. 

Finally, I was able to work with Manimal and we decided a profession for him. He would become a medic like myself. He finished 

the EMT class and passed the test, which was a bit step for someone who never graduated high school, only to be told because he 

didn’t have his driver’s license, he couldn’t start his job. As he 

waited to start his job, he spent all his money on a woman who 

said she loved him, but when the money ran out, so did she. 

Now a man who finally found his path after coming home is still 

being held back by his past. Currently, he is living on his mother’s 

couch, still drinking too much, and is up to his ears in debt. And 

the last phone call—he has been calling me. He called me seven 

times in the last month asking for the phone number on how to 

volunteer to go back to Iraq. He will not stop calling me because 

he says to me it is the only way he can get out of debt and Iraq 

is the only place that makes sense. It is the only place where he 

can be someone again. 

Manimal has a GED and I go to law school. We have very different backgrounds, but we are so incredibly similar. We both got 

home and we drank too much. We made impulsive decisions. We 

shut the world out and tried to fill that gaping hole in our souls 

with women. We are both too proud to ask for help and too scared 

to admit that we have a problem. Two years later, the only difference between Manimal and I is the fact that I have a friend who 

intervened and said, ‘‘I will not be your friend anymore unless you 

go get help, because you are not the man I knew. You are not the 

man who I was friends with.’’ Sadly for Manimal, his support network collapsed under the weight of his problems. 

The answer to the problems that Manimal and I face require 

face-to-face counseling. Every servicemember who comes home from 

a combat zone deserves this. Only then will we be able to remove 

the stigma and fear of asking for help. Don’t misunderstand me. 

The soldiers will complain, just like a kid complaining about taking 

a bath after playing in the dirt all day. Everyone knows we just 

need to do it. 

Now, just getting into the door is not enough. We need to make 

sure that once they get in that door, they spend more time in the 

counseling room than they do in the lobby waiting for help. As Senator Murray already said, the USA Today article says the number 

of Iraq veterans who are using the Vet Centers has almost tripled 

and the staff has only increased by less than 10 percent. We must 

fully staff these facilities. 

Lastly, Manimal only has a few months left to enroll in the VA 

to be treated for conditions that potentially can be related to his 

27

combat service, such as his readjustment issues. The 2-year eligibility window is unrealistic and confusing for a National Guard soldier who thinks that being in the Reserves means that they are not 

a veteran, especially those who are in a unit that are planning on 

redeploying in a couple months. A 5-year eligibility period would 

let our servicemen and women have the opportunity to settle back 

into their lives before they start losing their benefits. 

I am sorry I didn’t tell you my personal story, but I appreciate 

you listening to what little pieces I did tell you. Thank you for listening to Manimal’s story, and I know Manimal is at home watching this right now. Thank you, Manimal, for letting me tell yours 

because it was much easier to tell yours than it was to tell mine. 

I have been here for a year. I have been doing this job for a year 

and I can tell you that we, as a Congress, and we, as a veteran 

community, have come a long way. I appreciate that we are speaking first, the people who have had to pay the price of this war. I 

know that each one of the veterans sitting behind me, especially 

the ones who wouldn’t even stand up, and the veterans watching 

this right now, they are counting on you because they will never 

ask for help. It is not in our culture. We have got to get the help 

to come to them. Thank you again. 

[The prepared statement of Mr. Campbell follows:]

PREPARED STATEMENT OF PATRICK CAMPBELL, OIF VETERAN, LEGISLATIVE DIRECTOR, IRAQ AND AFGHANISTAN VETERANS OF AMERICA

Mr. Chairman and Members of the Senate Committee on Veterans’ Affair, on behalf of the Iraq and Afghanistan Veterans of America (IAVA), thank you for this 

opportunity to address, ‘‘The VA’s response to the mental health needs of today’s 

veterans.’’

My name is SGT Patrick Campbell and I am a combat medic for the DC National 

Guard, an OIF vet and the Legislative Director for the Iraq & Afghanistan Veterans 

of America. IAVA is the Nation’s first and largest organization for veterans of the 

wars in Iraq and Afghanistan. IAVA believes that the troops and veterans who were 

and are on the front lines are uniquely qualified to speak about and educate the 

public about the realities of war, its implications on the health of our military, and 

its impact on national security. 

Everyone on this Committee has heard the statistic that one in three Iraq veterans and one in nine Afghanistan veterans will suffer from a mental health problem as a result of their service. Every statistic like this represents a name and a 

heart wrenching story. I am here today to tell you what my counselor at the DC 

Vet Center told me in my first session, ‘‘No one goes to war and comes home the 

same person they were when they left.’’

The system that the Department of Veteran Affairs employs to treat 

servicemembers with mental health issues suffers from a fundamentally fatal flaw. 

It is a passive system. It is a system that waits. It waits for servicemembers to acknowledge that they a problem. It is system that waits for servicemembers to ask 

for help. The system is broken and we must fix it before we lose this generation 

of heroes. 

In preparation for this testimony, I decided that rather than searching my heart 

for another dark shadow to bring into the light, I would use this as an opportunity 

to check in with my 20 brothers from Iraq. What I found not only disturbed me, 

but scared me. Two years later with redeployments looming on the horizon, the once 

proud Alpha Company Killas are now struggling to find their place in the world. 

From my Lieutenant down to the gunners, no one has been spared. Strained marriages, ruined engagements, methamphetamines, alcohol and sleepless nights are 

just some of the stories I have heard. 

Three out of the four gunners are suffering from severe PTSD and substance 

abuse. The fourth went on active duty because he could not think of being surrounded by civilians again. All of them are desperately in need of help, but too 

proud to ask. One story in particular breaks my heart. We call him Manimal (half 

man, half animal). He had a smile like Clark Kent, a contagious hearty laugh, and 

deadly right hook. He was a simple giant, whom the kids in Iraq loved to play with. 

28

On more than one occasion while serving in Iraq a car would come too close, 

would ignore warning shots and Manimal would have to do his job. I personally witnessed him light up three or four cars essentially riddle them full of bullets because 

when the choice was between us and them, Manimal was the most loyal friend one 

could ever have. I remember one day finding Manimal alone in a corner and I asked 

him how he was. He whispered but never made eye contact with me and stated, 

‘‘I saw my bullet hit that driver in the chest. I saw his face as he lost control of 

his car. I watched the car hit the wall as we drove by. I couldn’t say anything 

because... well because. We just kept driving.’’ As a medic I had to make lifeand-death decisions when an emergency arose, Manimal made them every time we 

crossed on to a highway. 

When Manimal got home he never kept a job longer then 2 weeks. He couldn’t 

stand being told what to do by an 18-year high school graduate who never saw what 

he saw. He often drank too much and one night he got caught. He was charged with 

a DUI and lost his driver’s license. 

He would call me late in the night, just to talk... just to talk with someone 

who understood. Finally Manimal decided he wanted to be a medic. This profession 

would be his penance for the lives he took. He finished Emergency Medical Technician (EMT) classes and passed the test (a huge step because he never graduated 

high school) only to be told he couldn’t start till he got his driver’s license back. As 

he waited to start his job he spent all his money on a woman who said she loved 

him, but when the money ran out so did she. Now a man who found his path after 

coming home is still being held back by his past. Currently, he is living on his mother’s couch, still drinking too much, and is up to his ears in debt. He only sees one 

solution out of this mess, to go back to Iraq and be someone again. 

Although we come from different backgrounds Manimal and I are very similar. 

When we got home we both drank too much, made impulsive decisions, shut the 

world out and tried to fill that gaping hole in our souls with women. We are also 

too proud to ask for help and too scared to admit when we have a problem. Two 

years later, the only difference between Manimal and I is that I am blessed with 

friends who forced me to get counseling. I was given an ultimatum, ‘‘Go to counseling or lose another friend.’’ Sadly, Manimal’s support network broke under the 

weight of his problems. 

The answer to the problems Manimal and I face requires face-to-face counseling 

with a licensed mental health professional for every servicemember returning home 

from a combat zone. Only then will we remove the stigma and fear of asking for 

help. Don’t misunderstand me, because the soldiers will complain, but just like a 

kid complaining about taking a bath after playing all day in the dirt... everyone 

knows we just need to do it. 

Once we get these servicemembers in the VA’s door we need to make sure they 

are in the counseling room and not waiting for hours in the lobby. A recent USA 

Today article stated that although the number of Iraq and Afghanistan veterans 

using the Vet Centers has nearly tripled over the past 3 years, the number of staff 

has been increased by only 9.3 percent. We cannot wait for the storm to come to 

start preparing, we must fully staff these facilities and look to expand them to new 

communities. 

Lastly, Manimal has only a few months left to enroll in the VA to be treated for 

conditions ‘‘potentially related to his combat service’’ such as his readjustment 

issues. The 2-year eligibility window is unrealistic and confusing for a National 

Guard soldier who thinks that being in the Reserves means they are not yet a veteran, especially those in a unit that will probably be redeployed in a matter of 

months. A 5-year eligibility period would let our servicemen and women have the 

opportunity to settle into their lives before they start to lose their benefits. 

Thank you for listening to my story. Thank you for listening to Manimal’s story. 

And thank you for listening to all of our stories. This Congress has come a long way 

over the past 4 months, as evidenced by the fact that Veterans and not administrators are the first to speak at these hearings. Going forward, we have an obligation 

to create a culture where veterans’ needs also come first, and returning troops do 

not have to beg for help because the help is already there.

Chairman AKAKA. Thank you, Patrick Campbell. 

Dr. Connie Best? 

29

STATEMENT OF CONNIE L. BEST, PH.D., SENIOR FACULTY 

MEMBER, NATIONAL CRIME VICTIMS RESEARCH AND 

TREATMENT CENTER, MEDICAL UNIVERSITY OF SOUTH 

CAROLINA 

Dr. BEST. Good afternoon, Senators. It is indeed an honor to address this Committee and to sit on this panel. I have been asked 

to discuss the ability of the Department of Veterans Affairs to meet 

the needs of veterans who have experienced military sexual trauma 

with particular attention to the Guard and Reserve. 

I am a clinical psychologist and a professor in the Department 

of Psychiatry and Behavioral Sciences at the Medical University of 

South Carolina. Today, I am speaking to you from several perspectives. First, I am a psychologist who has treated victims of rape 

and sexual assault for more than 25 years. Second, I am someone 

who spent more than 20 years in the Navy Reserve, retired in 2004 

at the rank of captain, which is an 06. Finally, I am a civilian psychologist who has served in a variety of consulting and advisory capacities and positions for the Department of Defense. 

According to the VA term, military sexual trauma, or MST, refers to both sexual harassment and sexual assault that occurs in 

the military. It can be experienced by both men and women. Numerous studies have documented in varying numbers the number 

of rapes in the military in the veteran population. One study of 

users of the VA health care system found that 23 percent of them 

had reported experiencing at least one sexual trauma while in the 

military. 

There are aspects of sexual trauma that are unique to the military. MST occurs on military installations where the victim both 

lives and works, and so often the victims remain in close proximity 

to their perpetrators. The perpetrators are frequently their supervisors or a higher-ranking peer who would be responsible for making decisions about their promotion and their duty assignments, so 

the risk of re-victimization is quite real. These factors combined 

with the value placed on unit cohesion, particularly in combat theaters, add to the reluctance of victims to come forward. 

The devastating effects of military sexual trauma are clear. As 

any veterans or their family members can tell you, victims may 

suffer for years. They may develop post-traumatic stress disorder, 

major depression, substance abuse problems, and functional impairment in social, vocational, interpersonal situations. The effects 

of military sexual trauma do not stop once the servicemember 

leaves the military. 

With approximately 76,000 Reservists currently deployed worldwide in support of the War on Terrorism—and actually, in 2005, 

that number was 120,000 higher—members of the Guard and Reserve face their own unique sets of challenges when they experience MST. Once released from active duty recall, they do not remain on military bases. They return to their hometowns. This is 

an understandable urge to return as quickly as possible to their 

spouses, children, jobs, and their normal lives. Once returning 

home, they are away from their unit members and from other military support systems. 

During their post-deployment health assessment, which is conducted immediately after returning from deployment, they are 

30

given the opportunity to indicate if they have experienced MST or 

that they might be experiencing other mental health issues related 

to that trauma. Reservists are acutely aware that if they do endorse a serious mental health concern such as post-traumatic 

stress disorder, they will likely be retained on active service and 

not allowed to return to their civilian lives. 

A 2006 study by mental health professionals at Walter Reed 

Army Institute of Research found that the prevalence rates of reporting a major mental health problem among servicemembers returning from Iraq and Afghanistan are 19 and 11 percent, respectively, with combat experience being the most frequently cited reasons for their problems. If a servicemember was unfortunate 

enough to have experienced both combat-related trauma and military sexual trauma, the risk for developing significant mental 

health problems would increase exponentially. 

One study found that members are also twice as likely to report 

mental health problems at the three or four-month time period 

after returning from deployment. That is a time that the postdeployment health assessment has been over with and that the 

Guard members and Reserve members are typically at home. 

I believe that the VA is staffed by some of the best mental health 

care providers that there are and some have excellent expertise in 

working with military sexual trauma. However, I believe the problem facing the VA is one of sheer numbers. The significant number 

of veterans who may be experiencing MST or a combination of MST 

and combat-related trauma, compounded by the fact of the longlasting nature of PTSD, means that the VA must be prepared to 

meet the needs of a growing number of victims and of veterans 

over the years to come. 

To quote a line from a well-known movie, ‘‘Jaws,’’ when one of 

the characters saw the shark go under the boat for the very first 

time, he uttered in understated and prophetic words, ‘‘We’re gonna 

need a bigger boat.’’ That is what I would say to the VA. We are 

going to need a bigger boat. That means more qualified and appropriately trained providers must be available. Those clinicians must 

be able to provide specialized services, sexual assault services, and 

understand sexual trauma in addition to combat-related trauma. 

They must be sensitive to the issues of the Guard and Reserve 

communities. Perhaps now it is time to consider some

of the following: 

1. The addition of specialized training programs for current providers in the treatment of MST; 

2. Adding additional training program and internship sites for 

psychologists and psychiatrists. Internship training sites are very 

cost effective and it is a good way to ensure that you will have 

mental health providers in the pipeline to address the needs of our 

veterans in the years to come; 

3. Collaborations with academic medical centers with expertise in 

sexual trauma who can assist the VA in their training of their own 

clinicians; and 

4. The creation of specific outreach programs to address the 

needs of returning Guard and Reservists who face significant barriers to treatment. 

31

Thank you for this opportunity to address you and for the pleasure of sitting on this panel. 

[The prepared statement of Dr. Best follows:]

PREPARED STATEMENT OF CONNIE LEE BEST, PH.D., SENIOR FACULTY MEMBER,

NATIONAL CRIME VICTIMS RESEARCH AND TREATMENT CENTER, MEDICAL

UNIVERSITY OF SOUTH CAROLINA

Good Afternoon Senators. It is indeed an honor to address this Committee. I have 

been asked by this Committee’s Chairman, the Honorable Senator Akaka, to discuss 

with the Committee the ability of the Department of Veterans Affairs to meet the 

needs of veterans who have experienced military sexual trauma, with particular attention to the National Guard and Reserve. 

I am Dr. Connie Lee Best, a Clinical Psychologist and Professor in the Department of Psychiatry and Behavioral Sciences at the Medical University of South 

Carolina. Today I am speaking to you from several perspectives. First, as a psychologist who has spent more than 25 years treating victims of sexual assault. Second, 

as someone who spent twenty years in the United States Navy Reserve, retiring in 

2004 at the rank of Captain (06). Third, as the Director of an office at the Medical 

University responsible for responding to complaints of sexual harassment within the 

University. Finally, as a civilian psychologist who has served in a variety of consulting and advisory positions, both paid and unpaid, for the Department of Defense. 

According to the VA, military sexual trauma (MST) refers to both sexual harassment and sexual assault that occurs in military settings. It can be experienced by 

both men and women. Sexual harassment is defined as repetitive, unwanted sexual 

attention or sexual coercion. Sexual assault is sexual activity against one’s will. 

Numerous research studies have documented rates of rape ranging from lows of 

6 percent for active duty women and 1 percent for active duty men to rates that 

are significantly higher. One study found that 23 percent of female users of VA 

healthcare reported experiencing at least one sexual assault while in the military. 

There are aspects of sexual trauma that are unique to the military. MST most 

frequently occurs where the victims live and work so that often the victims remain 

in close proximity to the perpetrators. The perpetrators are just as frequently their 

supervisors or higher ranking peers who will be responsible for making decisions 

concerning the victim’s promotion or duty assignments. The risk of re-victimization 

by the same perpetrator is real. These factors, combined with the value placed on 

unit cohesion, especially in the combat theaters, add to the reluctance for victims 

to come forward. Even given the relatively new system in the military that allows 

victims to seek medical and psychological care without required reporting to law enforcement, the unique aspects of MST have the effect of reducing the likelihood that 

victims will seek psychological services. 

The devastating affects of MST are clear. As any veteran or their family members 

will tell you, victims may suffer the effects for years. Those who have experienced 

MST often develop post traumatic stress disorder (PTSD), major depression, substance abuse problems, and functional impairment in social, interpersonal, and employment settings. The effects of MST do not stop once the servicemember leaves 

the military. 

As of April, 2007, there are approximately 76,000 Reservists deployed worldwide 

to support the War on Terrorism. In 2005, that number was 120,000 higher. Members of the Guard and Reserve face their own unique sets of challenges when they 

experience MST. Compared to their regular active duty counterparts, many members of the Guard and Reserve may not be as familiar with the resources available. 

Once released from active duty recall, they do not remain on a military base; they 

return to their hometowns. There is an understandable urge to return as quickly 

as possible to their spouses, children, jobs, and their ‘‘normal’’ lives. Once returning 

home, they are often far away from needed resources, away from other unit members, and away from their military social support systems. Although during their 

Post-Deployment Health Assessment conducted immediately after returning from 

deployment, they are given the opportunity to indicate if they had experienced a 

MST or are experiencing mental health effects associated with that trauma, Reservists are acutely aware that if they do endorse serious mental health concerns such 

as PTSD, they will likely be retained on active status and not be allowed to return 

to their civilian lives. Furthermore, the victims of sexual trauma may feel that if 

they could just return home to their families and jobs, they will be able to overcome 

this experience on their own. 

32

For Guard and Reserve members who have also experienced combat-related trauma, the suffering can increase exponentially. A 2006 study by mental health professionals at Walter Reed Army Institute of Research, found that the prevalence rates 

of reporting a mental health problem among servicemembers returning from Iraq 

and Afghanistan were 19 percent and 11 percent respectively, with combat experiences as the most frequently cited reason for their problems. If a servicemember 

was unfortunate enough to have experienced combat-related traumas and was also 

a victim of sexual trauma, the risk would be expected to be great for the development of significant mental health problems. 

Another group of military researchers found that servicemembers are twice as 

likely to report mental health concerns 3 or 4 months after returning from deployment rather than immediately afterwards. This time of greater reporting of PTSD 

and other mental health concerns is a time well beyond when the Post Deployment 

Health Assessment screening typically would occur. Members of the Guard and Reserve would already likely be demobilized and at home. 

I believe that the VA is staffed by some of the best mental health providers and 

by some with exceptional expertise in MST. However, I believe that one of the problems facing the VA in their responsibility to meet the needs of today’s veterans who 

have experienced MST is one of sheer numbers. The significant number of veterans 

who may well be experiencing MST, in addition to those who may also be experiencing both sexual and combat-related trauma, combined with the long-lasting nature of PTSD, means that the VA must be prepared to meet what is expected to 

be a growing number of veterans in need of mental health services in the years to 

come. To quote a line from a well known movie, Jaws, when one of the characters 

saw the shark for the very first time he uttered the understated and prophetic 

words—-‘‘we’re gonna need a bigger boat.’’ That is what I would say to the VA—

we are going to need a bigger boat. 

That means more qualified and appropriately trained providers must be available. 

Those providers must be able to provide specialized sexual assault services and understand the interaction of sexual trauma with combat-related trauma. They must 

also be sensitive to the special issues of the Guard and Reserve communities. Perhaps now is the time to consider some of the following: adding specialized training 

programs for providers in the treatment of MST; adding additional training internship sites for psychologists and psychiatrists which are both cost-effective and will 

ensure that there will be a sufficient number of providers in the pipeline to meet 

the ever-increasing numbers and needs of veterans; collaborations with academic 

medical centers with expertise in sexual trauma; and the creation of specific outreach programs to address the needs of returning Guard and Reservists who face 

significant barriers to treatment. 

Thank you.

Chairman AKAKA. Thank you very much for your testimonies. 

Let me tell you that according to our schedule, we are expecting 

a vote to be called, or a series of votes, on the floor. So as a result, 

I am going to ask each Member to ask one question and then we 

will move it along quickly. If we have time here for whatever reason, we will have a second round for this panel. We have a second 

panel waiting here. 

So let me ask my first question. Mr. Bailey and Mr. Omvig, what 

would each of you tell families of those with servicemembers in 

Iraq about what to watch for when the servicemember comes home, 

and what to do if symptoms arise? Mr. Bailey? 

Mr. BAILEY. The biggest thing I would tell anybody is to not assume and to always ask questions. Do not assume the VA is there 

to help without somebody who is going to be there to guide them 

through every step because there are too many walls at the VA. 

Just do not assume. Nothing will get done if you do. 

Chairman AKAKA. Thank you. Mr. Omvig? 

Mr. OMVIG. One of the points that we have brought up before is 

peer counseling for families. As far as peer counseling, we are talking about people that have been through situations like ourselves 

being able to talk to families before the soldiers come home, being 

able to give them a little bit of the insight that took us too long 

33

to find out because it starts very slowly and builds and builds up 

to the perfect storm, and then it is almost too late. 

Mrs. OMVIG. I might just like to say that it is really important 

for, and it has been discussed before, other veterans to be peer 

counselors, because they understand and so many of the veterans 

or even active duty service people do not feel safe or have various 

trust issues and only wish to speak or wish to listen to somebody 

else that they know really does understand what they have been 

going through or what they are dealing with and they don’t want 

to have to be educating somebody about something they may not 

even be understanding themselves. So they need another peer 

counselor. 

Mr. OMVIG. One thing that helped us tremendously early on, and 

when we got into talking to other veterans, is that the Vietnam 

veterans who have been struggling with PTSD so long, dealing 

with their own problems, started helping us understand what was 

going on with Josh. These guys who are fighting for their lives 

right now are trying to help us understand what happened to him, 

and they are some tremendous people. 

Chairman AKAKA. Thank you for your response, Mr. Omvig and 

also Josh’s mother, Ellen Omvig. 

Senator Craig? 

Senator CRAIG. Well, again, I thank all of you for your testimony. 

Possibly to you, Patrick, and to the Omvigs and to the Baileys, 

do any of you know what stress management training or preparations your sons may have received from the Marine Corps or the 

Army, respectively, prior to the entry into combat that might have 

helped them cope with what they experienced coming out of it? 

That is also directed at you, Patrick. 

Mr. BAILEY. To my knowledge, the only thing my son talked 

about was urban warfare training. No stress management training. 

He was prepared to go fight in an urban combat environment, but 

there were no personal well-being classes that I am aware of. 

Senator CRAIG. OK. 

Mr. CAMPBELL. Actually, I was very blessed. The thing that 

saved me was right before we got into theater in Kuwait, we had 

a police officer who does police officer training that talked about 

what happens when you are in a stressful situation and the physiological reactions. At the very end of that, they talked about secrets 

and how the secrets that you keep are the secrets that kill you. I 

remember thinking that was my mantra when I got home, that was 

the only thing that saved me, because the more I buried a story 

in my head, the more it just grew like a cancer and made it harder 

for me to function. 

That training is something that they give to police officers all 

across the country as part of their academy training, and I remember thinking, this needs to be told to everyone, what you should expect when you fire your weapon, but also what you should expect 

when you come home. And that is why we believe that whenever—

normally, a police officer, when they fire their weapon and they see 

a weapon, they go through this type of counseling. I was fired at, 

shot at, blown up 16 times while I was there and I never once was 

required to get that type of counseling. The police officer training 

34

that we have in place already throughout this country would serve 

as an excellent model for pre- and post-deployment. 

Senator CRAIG. Thank you. Thank you, Mr. Chairman. 

Chairman AKAKA. Thank you very much, Senator Craig. 

Let me do this by seniority. Senator Rockefeller, your question, 

and we will follow with Senator Murray. 

Senator ROCKEFELLER. Mr. Chairman, I am going to depart from 

the usual and suggest that—I looked at the votes that we have 

coming up. I don’t think they are going to change the future of the 

world. As for myself, I have made the decision I am just going to 

miss them because I think what we are doing here is far more important than what they are going to be doing on the floor of the 

Senate. So if you want to go on to somebody else, I will be here 

until you all come back for the next panel. 

Chairman AKAKA. Senator Murray? 

Senator MURRAY. Let me just say that no apology or excuse can 

ever make up for the loss that you have endured. We are very 

grateful for you to have the courage to come here before this Committee and share your story, especially because anybody listening 

to this will hear something in it for them. 

One of my deepest concerns is the men and women who have 

separated from the service, gone home a year and a half ago, and 

feel like nobody knows what is going on in their head and don’t get 

the help. So your words have made a difference for us, for the policies that we need to put in place, but hopefully for some soldiers 

out there that hear you, as well. So I really appreciate it. 

And Dr. Best, I wanted to thank you in particular for talking 

about the really hidden, unspoken story of sexual trauma from this 

war. It is a difficult issue because I have heard personally from 

many women I know— and men, as well—who don’t want to talk 

about it for obvious reasons, but also for the unspoken reason that 

they don’t want to put at risk women in the military in general and 

we have got to figure out how to walk through this. So I hope that 

at a future time, you and I can sit down and talk about what we 

can do better to help really bring that into the public and help 

those people who have been traumatized, but do it in a way that 

provides them the dignity that they really deserve for what they 

are doing. 

So I only have time for one question and there are many I think 

I would ask. Patrick Campbell, because you were in the Guard and 

Reserve and came home, when the war started, and talking to our 

own Guard and Reserve, they said the most important thing was 

for the soldiers to get home and have that 90-day waiting period 

before they were called back to their unit. I heard you say that is 

too long of a time, that getting back and having the camaraderie 

of those that you served with was absolutely critical for a number 

of reasons. Do we need to relook at that for our Guard and Reserve 

and think about bringing them back sooner, as hard as that is, 

when we want them to get home to their families? 

Mr. CAMPBELL. No, I actually wasn’t the one that said it. It was 

Mr. Omvig. 

Senator MURRAY. Oh. 

Mr. CAMPBELL. But I will say this, that there was nothing more 

that I wanted to go than go and just disappear. I think the idea 

35

is that the 90-day period is before you go and work again. That 

makes complete sense. The idea that you don’t come back and just 

interact and have forced fun time or time where you have to just 

decompress. That is completely different than having to go clean 

your vehicles, start checking in the weapons. Those are times that 

we can talk about. 

I think that what Mr. Omvig said was exactly right on. 

Let them go see their families. Let them have those moments. 

Then have them there just during the day. Give them a job for a 

couple weeks where they go in during the day, they get to meet 

with their buddies, but at night, they get to go see their families, 

and that makes all the difference. 

Senator MURRAY. Mr. Omvig, I assume that meeting with their 

buddies is an important way for them to be able to open up? 

Mr. OMVIG. It has to be, because they have to start talking about 

the experiences that they shared together. You know, going in and 

talking one-on-one with a counselor, they are not going to share 

their deep thoughts of what went on. But as a group, in group sessions, they are more likely to open up into what actually went on 

there, and as it starts, it gets to be a snowball and that snowball 

gets bigger. 

Senator MURRAY. Yes. 

Mr. OMVIG. And the reason that it has to be during this 90-day 

period is that the earlier we address the issues of mental health, 

the faster we can start correcting the problems and keeping them 

from growing chronic. Once to the chronic stage, it is difficult to 

treat and deal with. And we need to give all of our veterans the 

best opportunity to live the best life they possibly can. They need 

to come back and be able to live the American dream that they are 

over there fighting for——

Senator MURRAY. Yes. 

Mr. OMVIG [continuing].—not being affected and unable to live 

the American dream because of what they did for our service. 

Senator MURRAY. Thank you, Mr. Chairman. I think there are 

two issues. I think one is the stigma of this, and we have got to 

all be talking about it more and working with our communities and 

everybody involved to make sure that people understand that we 

have to all understand this is part of the cost of war. 

And second, Mr. Chairman, I heard loud and clear what one soldier said to me, and that is they trained me to go to war. They 

never trained me to come home. And I think we seriously have to 

look at how to train these men and women to come home. 

Chairman AKAKA. Thank you very much. 

Senator Webb? 

Senator WEBB. Thank you, Mr. Chairman. 

First of all, I would like to say just very quickly that a number 

of you mentioned the difficulty with things such as readjustment 

deadlines for people coming back and sort of the delay fuse that 

often exists with PTSD. We did the pioneer studies on this literally 

29 years ago. I really want to make sure that in terms of the way 

we look at PTSD that it is an ongoing exercise by government. 

I have seen in the people that I served with in Vietnam cycles. 

It was like an 8-year cycle, and then there was like a 20-year cycle, 

and then there is a period when your regular career starts to end 

36

when you start to reflect more. We can’t lose sight of that when we 

build these artificial deadlines into when we administer benefits 

and this kind of thing. 

But the question that I would have for all of you is given what 

has happened and the different situations that you described, how 

would you describe the reaction of the Department of Veterans Affairs people that you have dealt with after these incidents occurred? Do you feel they are being responsive, or do you feel like 

we are not getting anywhere here? 

Mr. BAILEY. Well, sir, when my wife and I were at the L.A. VA 

Hospital, nobody would talk to us. Nobody cared. But they sure 

cared when the ABC reporter got a hold of me and we were on the 

news We were going to be on the news at 5:30 that night. I got a 

call at 5:15 from the public affairs guy wanting to know if he could 

be of any service. So without—I mean, the media takes a big hit, 

but without the media, my son’s story would not have gotten out 

there. 

Mr. OMVIG. At the present time, there is nothing what they call 

a CO officer assigned to military suicides that are not active, and 

if this happens to a Guard or Reserve individual that is not on active status, the parents basically take care of everything that is 

going on. If they were a casualty, then there would be a casualty 

officer with them for 10 days, taking care of all the paperwork, all 

the things that may be presented to them for help and everything 

else. We basically, and I know it was a very difficult time for his 

unit, his company, but we were given his Honorable Discharge and 

the papers at the public viewing, the family viewing. 

Mrs. OMVIG. Which we lost. 

Mr. OMVIG. And I still don’t know where they are. 

I was not in the frame of mind. I don’t know where they were. 

So I think it is extremely important that we are looking at this aspect, also, of helping families deal with a crisis, the time where 

they are not thinking logically. They don’t know what is out there 

to assist them. We heard from the chaplain once, but basically we 

have heard very little from his Reserve unit since Josh was buried. 

Mr. BAILEY. I just want to say one more thing. I spent 20 years 

in the military, also, and the day we finally got to talk to family 

services there, the one thing I really expected more from my VA 

and my government was the man who came to give me my son’s 

flag, but it was in a box, just like they just had bought it from WalMart. It was in a box. It was just, like, oh, by the way, here is your 

flag. Take care. Have a nice day. And getting my son’s flag in a 

box was the biggest insult to my son. 

Mr. CAMPBELL. And just so we can tell a full picture, for me, I 

am very blessed that I go to the D.C. Vet Center, which of the Vet 

Centers is one under-utilized because people around here are definitely the type of people who don’t like to admit that they have 

problems. At the Vet Center, I get great care. You walk in and you 

say, welcome home. But I have a very—when you go to a VA hospital, you might have a very different experience. 

Senator WEBB. Thank you very much. Thank you, Mr. Chairman. 

Chairman AKAKA. Thank you. 

Senator Tester? 

Senator TESTER. Thank you, Mr. Chairman. 

37

Tony, you spoke of improvements in reducing dosages and staffing increases and you made a statement at the end that we are 

going to have to follow up on later, and that is evaluation of the 

systematic problems and where to start there, because that is no 

easy undertaking, but I appreciate that perspective. 

I have a question that revolves around the bill that the Omvigs 

have got the delegation from Iowa to put forth, and I don’t know 

if anybody else at the table has had a chance to look at it, but 

there are 11 points on it. 

Senator Murray talked about not only training to go to war, but 

also training to come home. I am going to make two assumptions 

and then I just need to get your opinion. The first assumption is 

that it would pass. The second assumption is that the things you 

talked about, the 11 points, would be implemented fully. Is there 

anything else that we are missing that we might want to take a 

look at that this bill doesn’t address that would solve or, at least, 

go a long ways in solving the kinds of difficulties we are talking 

about with mental trauma? 

Mr. OMVIG. Toward solving, no. As far as identifying, yes. If you 

look at what has been going on with the bill, they talked about 

1,000 veterans being treated by the VA are dying of suicide each 

year. Josh wouldn’t have been one of those numbers, and there are 

so many others that wouldn’t have been in those numbers. So we 

really don’t know the magnitude of the problem that is really out 

there. And until we know the magnitude, it is going to be hard to 

address it one way or another unless we address it right when it 

comes home. 

Senator TESTER. OK. 

Mr. CAMPBELL. I mean, just what I said in my testimony, that 

every soldier who comes home gets a face-to-face—I mean, this is 

beyond what is in this bill and that is that it is a required faceto-face mental health screening with a licensed professional. It is 

the only way to take away the stigma. 

Chairman AKAKA. At this time, I would like to call on the second 

round of questions here. 

Mr. Bailey, after Justin died, you and your wife visited the domiciliary where he was staying following his 2-week hospital stay. 

What can you tell the Committee about the level of staffing there? 

Mr. BAILEY. Well, the day we got there, we were met by what 

is called the dom assistant, who made a good effort. He was the 

only one working and he made a good effort to get a hold of his 

supervisors. One of his supervisors wouldn’t talk to us on the 

phone. The other one told him to stop talking to us. 

Oh, and by the way, we were let in a side door, because we didn’t 

know where the front door was, by a resident, so we could have 

been there to cause any sort of damage possible. There was no 

staffing, except for the one dom assistant. This was on a Sunday. 

Residents packed up my son’s belongings and we got them in garbage bags. You know, there was no respect given. We got all of his 

stuff in a garbage bag. 

Chairman AKAKA. Thank you very much. 

I should apologize to you in advance. There are a series of votes 

that have been called and this is why the Members have left, to 

go to the floor to vote. Senator Rockefeller feels so strongly about 

38

this hearing, he will remain here and conduct the hearing. Following this panel, we have a second panel that will be testifying, 

and so I would like to pass the gavel to Senator Rockefeller and 

add my thanks to you for your testimony. Following the series of 

five votes, we hope to come back again to this hearing. 

Thank you very much, Senator Rockefeller. 

Senator ROCKEFELLER [presiding]. The question comes about people not wanting to seek help, and I think that is true of all people. 

Mr. Campbell, you spoke about a state of denial. I am not a psychologist. I am not trained in anything in particular. But I think 

that is the nature of the human being. 

So let us say that you are over in Iraq or Afghanistan, or let us 

say that you have just come back. Your every instinct is not to go 

find somebody, and what you have all said in different ways is 

somebody is going to find you. 

But I have also heard you say that it isn’t easy to talk about 

PTSD or any other subject—mental health, trauma, sexual trauma, 

anything—alone with a counselor, so that if a counselor comes to 

you, if that was the situation, which gets into the whole Vet Center 

thing, which I really do want to talk about because I really do believe in that. I think that is the closest thing to making it easier 

for you to get somewhere where you feel comfortable, which isn’t 

a huge building. But you have also said that you really aren’t comfortable with other people, I mean, just doing it all by yourself. 

So what is a possible way in your own thinking, if we could get 

the right kind of money into the Veterans’ Administration, that 

people could reach out to you but still allow you to be able to make 

that a valuable contact by telling them what you could only tell 

them when you feel like telling them? It isn’t just that they find 

you and that you meet, it is that they find you and that you begin 

to disgorge and begin to tell them what they need to know. I am 

not sure of the conflict of that. Can any of you speak to that? 

Mr. CAMPBELL. I have talked about this actually a lot recently 

with some of the veterans we have in the D.C. area. I remember 

a couple of weeks ago, I took a veteran who just got off active duty 

into the D.C. Vet Center, and when he got out, he said, ‘‘I wish 

that he hadn’t told me I had PTSD. I wish he told me that I had 

a suit of armor that said I was impervious to PTSD and I was just 

having some type of issues.’’ About a week later, he called me back 

and he said, ‘‘I can’t believe you made me go. I don’t have PTSD.’’ 

Another week later, he called me back and he said, ‘‘Thank you.’’ 

And a week later, he called me back. I mean, all these calls when 

he tells me, ‘‘I don’t have it, but thank you for sending me.’’

The biggest obstacle for a veteran is going in that first time and 

seeing that counselor, getting over the idea that you are going to 

talk about it and just learning where it is. The D.C. Vet Center is 

at 13th and Taylor. I don’t know if you know where that is, but 

that is nowhere near Metro. It shares a place with a Montessori 

school. If you don’t know what you are looking for, you are not 

going to see it. 

The fact that I went in there and I saw it, I was now able to take 

people in there. Once people have gone once, it is so much easier 

to go a second, a third, a fourth time. To be honest with you, what 

I said in my first session did not help me at all. It was the fact 

39

that I went is what caused me to break down. And about 3 days 

later—I didn’t say anything in that first session that helped me, 

but 3 days later, I am in a movie theater and I am crying my eyes 

out because I realized I finally admitted that I have a problem to 

someone other than my journal. I broke free and all of a sudden 

I felt like I was a full human being again. Now, I had to face the 

fact that I was in a lot of pain, but I was feeling for the first time 

in a year since I got back. 

So to answer your question specifically, it is getting people to 

where they would be asking for help so they train—just like we say 

in the military, muscle memory, so that you keep doing it and you 

keep doing it so the next time when you actually really need to do 

it, your muscles automatically do it. When you know you have a 

problem, you automatically know the phone number to call or the 

place to go, because otherwise, I mean, if you have ever tried to 

navigate the VA, there is a form you have got to fill out. You already know that. You go in. I need to fill out this form. I need to 

talk to so-and-so. It makes it so much easier. 

Senator ROCKEFELLER. Any other thoughts? Yes, sir? 

Mr. OMVIG. When he brought up the thoughts of forms, just 2 

weeks ago, I was talking to a Guard member and he has a 40-houra-week job. He was in an IED attack in Afghanistan and was suffering from a TBI. He went to the Iowa City VA Hospital to get 

some help. While there, they gave him nine forms to fill out to get 

services. He said, if it wouldn’t have been for a VFW individual in 

the hallway to help him fill out that paperwork, he would have 

gave the paperwork back and walked away. 

One of the big stumbling blocks we have—if a person has got 

PTSD, if they have got TBI, if they have got any type of disorder 

that they are having problems with, how are they going to be able 

to fill out the paperwork themselves? 

There is a big difference between advocacy and case workers. We 

don’t need more case workers. We need more advocates for the veteran when they go in there to see that they get all the benefits 

they absolutely deserve when they finally break down and they finally go to the office to try to get services, because if you don’t fill 

out the paperwork right, you don’t cross all the ‘‘T’’s, you don’t dot 

all the ‘‘I’’s, services are delayed and sometimes I have heard two, 

3 months before they are even able to get in again. 

So we need advocates, advocates that are going to be there for 

the veteran, not case workers that are looking out to keep the costs 

down for the company. There is a big difference there and we have 

heard a lot in the news about having more case workers and calling them advocates. Those are not advocates. Advocates are people 

that are looking after veterans’ interests, not the company’s interest in providing service. 

Senator ROCKEFELLER. And who might those advocates be? The 

veterans service organizations? There are a lot of other volunteer 

groups——

Mr. OMVIG. Excuse me, I am sorry——

Senator ROCKEFELLER. No, please go ahead. 

Mr. OMVIG. You have got great advocates right here. You have 

got advocates in the DAV who absolutely know how to fill out all 

the paperwork. You have the VFW that is in many of the facilities 

40

that will help fill out the paperwork. But these guys are doing it 

on a voluntary basis. They are all volunteers, and they are doing 

a wonderful job for all of us. It is that we need more of those advocates in every single facility today. We don’t have a veteran that 

is having problems that can’t hardly describe what is happening to 

himself try to go in there and fill out nine to ten pages of paperwork before he can even see somebody about his problem. We need 

to streamline things and we need to get advocacy better. 

Mrs. OMVIG. I would like to also say, for outreach in that not 

every place has a close veterans’ clinic or VA hospital and not all 

the veterans can either get transportation to get to a place, or in 

the time frame, or to go and wait, have somebody that will drive 

them somewhere, they wait for 4 or 5 hours to get in, and then 

drive them the 3 hours back to their home. Not everyone has people that can do these things. There are a lot of places in this country that are not accessible, physically, geographically accessible, 

and that is saying then if they do have a place that it is a good 

place, because not all of them are good places. So for both of those 

things, you need a lot of help. 

Mr. BAILEY. You know, talking about the parts of the country, we 

have recruiters that get our young men to sign up. We could have 

an outfit or a unit designated for helping when they get back. Put 

the unit in a truck, tell them Iowa or Idaho is your district, and 

here is a list of your veterans. You are on temporary duty. You 

drive around and you go to every one of their houses and knock on 

their door and say, ‘‘Hi, Bob. How are you doing?’’

And as far as the paperwork, there is no excuse for nine different 

copies. When we went to the L.A. VA Hospital, the first form we 

were given, the next day, we were told it was an outdated form and 

was no good. And this is by employees of the VA. 

But I am saying, you know, we get a truck. You have an active 

duty unit or a Guard unit, and that is their job, to drive around 

to these veterans in the rural areas, and even in the cities. You can 

get lost in the city probably almost easier than you can in a small 

town. Touch them. Say hi. Ask what can I do, or, how can I help 

you? Asking for help or having help offered to you, maybe you 

might make that first visit. 

Senator ROCKEFELLER. A couple more questions. I come from 

West Virginia, which is not exactly San Francisco, OK? It is very 

rural. We have an enormous number of people who sign up to 

serve. One of the biggest things that they tell me when they come 

back, and this also—you could go all the way back to the testing 

of the atomic bomb way out in the Pacific on instances of this 

sort—they don’t want to go somewhere, even if they know it is for 

their own benefit. 

For example, I will just use one that occurs to me now, spinal 

cord injury, sort of a scary thing. It is not up here, but it is up here 

as well as down there. If they have to go to Salem, Virginia, which 

in West Virginia is where you have got to go if you are going to 

get spinal cord injury service, many veterans will make the decision not to go because people in rural areas, in Appalachia, with 

all the mountains and the winding roads and the psychology of Appalachia in general, don’t like to have to travel. They don’t like to 

have to go make that journey, even to a Vet Center. 

41

I want to shift to that for a moment. I am a passionate believer 

in Vet Centers for the sole reason that my very small State of West 

Virginia has four huge veterans hospitals, and they are, as you 

would expect, sort of distributed around the State. Most of them 

have pretty good reputations, up until all of this started. So what 

we have tried to work on is setting up the system of Vet Venters, 

exactly what you are talking about, which are userfriendly. They absolutely—they may not be next to a Montessori 

school, because I am not sure we have many of those in West Virginia——

[Laughter.] 

Senator ROCKEFELLER [continuing].—but they are on the street. 

You walk from the street into the building and then there is 

somebody, a Vietnam veteran or somebody who is sensitized and 

they are in it because they believe in helping their fellow veterans. 

And I don’t know the state of their training, but I do know that 

they are independent and I know they are not under the control 

of the Veterans’ Administration. 

And what I want to ask you is if outreach is the deal when you 

get back, forgetting the complexity of when does it come, time with 

the family first then 3 weeks later or a month later or whatever. 

Forget that for a moment. Are Vet Centers something which, if proliferated, could, in fact, help when people go there? Now, if they go 

there, they will find less service professionally, but they will find 

more fellow veterans to talk with because it becomes a gathering 

place, really the only place that veterans can go and be together 

because they are informal, comfortable buildings. But they are not 

under the control of the Veterans’ Administration. They run themselves. Is that a formula for something that is useful, or is it a good 

idea? But it is wholly inadequate to what we are going to be facing. 

Mr. CAMPBELL. I think the Vet Centers are the model that we 

need to go to, and the reason why is when I would go into the Vet 

Center, the form that I need to fill out, it is a quarter-sheet of 

paper. It asks my name and why I am there. There is a little check 

box. So I have to write down two things and turn it in and they 

call Mr. Phillip, who is my psychologist. It is so personal. 

I mean, you want that first experience with the VA to be a positive one, because once you have that positive experience and then 

you need help and they say, where do I go to get such-and-such 

from the VA, they know the answer to that question. They say, this 

is the VA hospital. This is the person you need to talk to. This is 

a good person. Or if they are having trouble with their case, they 

would be, like, this is the number to the local VFW, DAV, American Legion. Those are the types of things. If close to their house, 

they will go if it is close, and if they have a good, positive first experience, they will continue to go, and that will be their gateway 

into the VA, not these monolithic hospitals where you get buried 

in forms. 

Dr. BEST. Senator, I think that we can have a variety of things 

that we should offer veterans. There is not one-size-fits-all. I think 

Vet Centers can serve a purpose. They certainly can be an entre 

where they can get some help, maybe not at the level of care they 

could in a hospital, but they can also interact with veterans. I 

think the hospitals that are staffed by psychologists and psychiaVerDate 0ct 09 2002 13:32 Jul 18, 2007 Jkt 000000 PO 00000 Frm 00045 Fmt 6633 Sfmt 6601 H:\RD41451\DOCS\36191.TXT SENVETS PsN: ROWENA
42

trists can offer very specific behavioral kinds of interventions that 

some people with PTSD are certainly going to need that level

of care. 

The one thing we have not mentioned today is the use of the 

Internet. Our young folks are very savvy. They are very used to 

doing that. Wonderful things could be done that could be intervention-based, not just a reciting of what PTSD is, but actually you 

can do assessments online, and then you can tailor things to that 

and you can make that available to places that are rural that they 

don’t even want to drive—it is 20 miles or 30 miles down winding 

roads to the next city that might can support a Vet Center. 

So I think one of the things we can do is literally have an array 

of options to offer veterans, because some might want to go to Vet 

Centers. Some might be near hospitals. Some of the flagship VAs 

have some great programs and that would be good. But we also 

need Internet. We need lots of different things, and to make it 

available so that veterans can pick and choose what suits them, 

what helps them, and you can have things that are specific for family members that are available online and can address the family 

needs and answer questions for them. 

So I just think that we need to sort of be creative in our thinking. Now is the time to do it. The numbers are already there and 

they are only going to get more with each passing day and month. 

And so we owe it to our veterans to think out of the box, to be creative, to have an array and offer it and let them decide what might 

most work for them. 

Senator ROCKEFELLER. Let me come back to you with a question 

that you brought up earlier, and that is psychiatrists and psychologists. One of the magnificent things about VA health care training 

is that 50 percent of all physicians in this country intern or do residency at VA hospitals. So automatically, 50 percent of all doctors 

everywhere in this country, of all kinds, have trained at VA centers. Now, some of them, yes, are doing research and that research 

is very, very important. 

My question for you is, I have never actually heard somebody say 

that psychologists and psychiatrists are part of that physician 

group. Do they also get residency training at VA hospitals and thus 

have a chance to experience as they are going into their professions 

what happens? 

Dr. BEST. We certainly have people here from the VA system, but 

health care providers, psychologists and psychiatrists, do not have 

to do an internship at a VA in order to become a VA employee. 

Some of them that do participate in internships there can remain 

on staff, but it is not a requirement. So you may have a professional, a doctoral-level professional join the VA system as a health 

care provider who has not done an internship at the VA. 

Senator ROCKEFELLER. OK. Let me just understand that. I am 

not saying that they have to—I am going back to my 50 percent 

of all physicians. Do they fit into that category or do they not, the 

psychologists and psychiatrists? 

Dr. BEST. I do not believe that 50 percent of the psychiatrists 

and psychologists—are you talking about in this country? 

Senator ROCKEFELLER. Yes. 

Dr. BEST.—have had internships at a VA. 

43

Senator ROCKEFELLER. That sounds like something to think 

about. Please. 

Mr. OMVIG. Speaking for the Guard and the Reserve when we 

bring them back and a possible changing of that defusing time, a 

good idea would be to bring in a team from the VA during the drill 

period when you are going to be able to get everybody there as a 

group and start the initial process of dealing with what they have 

all been through. And if you bring the team in and give them a 

good first appearance and that you are really going to try to handle 

what has gone on with them and create a process here, not just a 

one-time deal and we are gone, here deal with it, but that we are 

going to continually work with you to try to help you deal with it, 

it is easier if you are with the group that you were actually with. 

You can talk about like experiences. I understand what happened 

to you. I saw it, too. I am also having problems with it. 

Mrs. OMVIG. I would like to also explain that even—I think a lot 

of people are under the false assumption that all the Guard goes 

as a group or all the Reserve go as a group. They cherry-pick out 

to fill in their ranks. One thing we got asked, well, why didn’t your 

son drop by after work and tell them that he needed to talk to 

someone? Well, when my son decided the way to cope was to be a 

workaholic. So he worked all the double shifts because it kept him 

very busy and thought that was going to serve his purpose. 

Another thing is his base was over 3 hours away from his home 

and thus he couldn’t drop by after work on their hours at the base 

to say something to someone. And he wouldn’t have done it anyway 

because it would have, not just the stigma, but the way the laws 

are written up now, it would have affected his military and his personal career choice of being a police officer. I mean, he wasn’t just 

dreaming that one up. It was real. 

So I wanted to discuss that kind of thing. There were people that 

were brought in also that were from other States into his company 

to fulfill how many people they needed to have in their company. 

So his Reserve company, they spread out all over Iowa, they spread 

out all over Illinois because it is right there on the river, Davenport. They brought in people from other States besides those two 

main States to fill them in, so they were gone. Everybody was gone. 

There was nobody close, a few that did live in the area, but other 

than that, they were just far-flung. Guard also do that type of 

thing, too. So contrary to what you think, they don’t all go over as 

a unit and all come back as a unit. It is all different. 

Mr. CAMPBELL. I just want to add one real quick thing if you 

don’t mind me, Senator. The VA has a great program that they are 

implementing as a pilot where they go into a Guard unit, they 

show a couple of videos and use that as an opportunity to have discussions. Sadly, the day that they did that with my unit back in 

Louisiana, they did it for 40 soldiers, which happened to be my platoon. But the guy who I lived next door to was in another platoon 

and he decided that day he was going to take his life because he 

didn’t get to go to the training. 

For me, I mean, these tools exist. We have created them and we 

are really good at this. It is just about implementation. We can 

go—we know what we need to do when we go into these units. I 

remember when I called my lieutenant about this, when he told me 

44

that this soldier had committed suicide, that everyone was laughing about—this is before we knew—they were laughing, oh, you are 

going to cry, or you are going to tell some story. As soon as the 

video came on, it wasn’t some cheesy DOD movie where everyone 

is happy, it was a serious look at post-traumatic stress disorder 

and kinds of the experiences people have, everyone got quiet and 

then people started telling their story. 

I remember my lieutenant saying, this is the most amazing thing 

ever, and then he called me an hour later and said, I can’t believe 

what I have to tell you. I just think if it just had been First Platoon 

as opposed to Second Platoon, that guy would still be here today. 

That was a pilot program. We know it works well. Why aren’t we 

doing it? 

The only last thing is that you have three different types of Reservists. You have the Reservists who stay in their unit. You have 

the Reservists like myself who volunteer as a filler. I have never 

been back to Louisiana since then. And then you have the people 

who get out. We have a whole different population of people we 

have got to worry about, the people who separate the day they get 

home. 

They say, ‘‘I am done with the military.’’ We have still got to go 

after those people because they are almost in more danger. 

Senator ROCKEFELLER. Sure. Let me ask a final question of this 

panel and then we have to move on. I don’t want to, but we have 

to. 

I am going to start this off with my very first experience on this 

Committee 24 years ago, when I was very junior and I remember 

right back there were the television cameras. They had a guy who 

I think had come back from Bimini and it was the time before the 

Second World War when the United States was testing different 

things in places where possibly nobody would know about or whatever. His testimony, he said, ‘‘I want you to understand what it is 

to have been given cancer by your government and to be dying 

from that cancer,’’ which he was fairly close to doing, ‘‘because I 

want you to understand how I feel.’’

OK, now we skip forward. It is very hard to skip by World War 

II, North Korea. What people went through in North Korea is unbelievable, but you get to the Vietnam War and there was this 

thing called Agent Orange. We used that to defoliate so we could 

find the enemy and in the process thousands of our people were 

getting cancer and dying. But the government and the military 

would never admit that. And the only thing that made it possible 

for people who were dying from cancer or who had been exposed 

to Agent Orange and therefore might be but might not know it yet 

was when an admiral’s son—remember Admiral Zumwalt? His son 

died of cancer of Agent Orange. He came and testified before some 

Committee, and all of a sudden, Agent Orange compensation was 

made available. It is a pretty horrible way of conducting government policy. 

Skip one war forward, Gulf War and something called the Gulf 

War Syndrome. I was Chairman of this Committee at that time 

and I absolutely knew the DOD said that this problem did not exist 

and I was just making up stuff. But every soldier was required to 

take a pill in Kuwait called pyridostigmine bromide, and that pill—

45

I talked to some people back home in West Virginia and they said 

they took one and they knew it was just going to tear them apart. 

They just stopped. But that is what you had to do every morning. 

So you wander around West Virginia, and obviously around the 

rest of the country, and the country is full of tens and tens and 

tens of thousands of people who cannot read, who cannot sleep, 

who cannot keep a marriage, who break out in rashes. I remember 

one woman who was absolutely normal, except if you touched her 

on her right arm, she would start screaming in just unbelievable 

ways, and everything else about her was perfect. 

The military to this day denies any such thing ever happened. 

And now we have this. The story really of all of you is, whether 

it was the garbage bag, which is horrible beyond description to 

hear you even say it, the flag in a box, the papers which became 

outdated the next day, it is almost like you went over there to fight 

for the country and you ended up fighting the people that you were 

fighting for, which is why it always troubles me when people talk 

about not standing up for the troops. Everybody salutes the troops. 

It is the policymakers, the civilian policymakers who make the policy that get the troops in trouble or the VA, whatever it is. They 

are the ones. 

My question to you is philosophical. We are a generous and a 

great country. We are not particularly generous to the rest of the 

world. We don’t do foreign aid. We don’t worry about Africa. We 

don’t worry about all kinds of places where the War on Terror is 

building. What, in your view, is it that makes it like this? Is it 

something as simple as a lack of money? Why does this happen in 

America? 

Mr. BAILEY. Well, sir, my answer is pretty simple. Apathy and 

complacency, which is what I ran across at the VA. They could 

have a wonderful program. Apathy, complacency, and just not caring. That is what I ran across, and I am sure there are people who 

do care, but I didn’t run across them. 

Senator ROCKEFELLER. I am sort of talking about people at the 

top level, to be honest with you, the people that run the VA hospitals locally, the people that run the VA in Washington, the people 

who make military policy wherever it is made, DOD, the White 

House, all the rest of it. They don’t get it. We have this hearing. 

Will they get it after this hearing? Will they take up the budget? 

I think we will, and I think we will for one reason, because of 

a building which I have now come to cherish called Building 18 at 

Walter Reed Hospital, which has caused an explosion of anger here 

in Washington and across the country, which has suddenly delineated the difference between the warfighter and the warfighter 

who comes back, maybe shot through with some of those Iranian 

shards of metal so that they can’t remove them surgically without 

cutting an organ or cutting an artery, so the person is in a wheelchair, probably wondering whether it would have been better for 

him to have been shot and killed rather than sit in a wheelchair 

in agony for the rest of his life. Why? 

Mr. OMVIG. At one point, you talked about money, and I want 

to ask you, who in our society in the United States deserves more 

the appropriations and the funds to take care of them than our

veterans. Who? 

46

Senator ROCKEFELLER. Nobody. 

Mr. OMVIG. Then we should take care of them. 

Senator ROCKEFELLER. But you see, the problem is——

Mrs. OMVIG. You all have to decide that you are going to do it, 

and if you don’t think that your constituency is going to vote for 

you, then you have a job of helping to sell this, and there are a lot 

of people that would be glad to help you to help sell this idea, that 

the veterans earned their right, implied or contractually, and that 

they deserve this. 

Senator ROCKEFELLER. Doesn’t it strike you as odd that we are 

fighting in Afghanistan and we are fighting in Iraq, and forget 

what one thinks about Iraq, and we are doing it all on borrowed 

money, so there is no budget. We have borrowed off of the Chinese, 

the South Koreans, and the Japanese, and a few others. So there 

is no end to what you can spend. 

But then you come home injured or you come home uninjured or 

you come home thinking you are uninjured—I don’t know how people come home who aren’t injured after an experience like that—

and then all of a sudden you fall under a national budget which 

has a limit. It is a national health care system, the only one in the 

country. No borrowing of money, but a budget. To me, that is obscene, where you can endlessly spend and borrow to fight, but you 

are under a tight budget when it comes to the pain at the end. 

Mr. OMVIG. My question is, what does this tell the rest of the 

world about the United States of America and our policies——

Senator ROCKEFELLER. Well——

Mr. Omvig [continuing].—how we are dealing with the people 

that are serving for us when we—these are our people. These are 

our people, and how we are dealing with them. How does the rest 

of the world look at that? 

Senator ROCKEFELLER. I suspect that the rest of the world looks 

at that as pretty unimpressed. On the other hand, what I am trying to find out is what we can do about it right here, right now. 

I mean, if anybody has anything else they want to say on this——

Mr. CAMPBELL. You know——

Senator ROCKEFELLER. We are a good people. Americans are a 

good people. And yet how many people know that we are borrowing 

all that money to fight, that there is no end to the amount that we 

can do? And how many know that you are under a budget? And 

people can use that as an excuse, can’t they? Well, we don’t have 

the money. We don’t have the personnel. 

Mr. BAILEY. The only thing—I only have one question, really, 

and I guess you could call it the intersection question. Building 

18—how long was Building 18 there before the Washington Post

brought it to light? 

Senator ROCKEFELLER. You have got it. You said the same thing 

about your son. 

Mr. BAILEY. How long was it there? And now it is on TV. Now 

people care. It is like the intersection. How many car wrecks does 

it take to get a stoplight? 

Mr. CAMPBELL. For me——

Senator ROCKEFELLER. From my point of view, to end on a hopeful note, I think the climate, and I think the Chairman would agree 

with me, has been profoundly changed in these square acres and 

47

across this country about veterans because of something called 

Building 18, which people will never understand and its mold, but 

it had nothing to do with it. It was the fact that veterans were not 

being respected. I think, I pray, and I hope that we will—not everything can be solved by money, but you know what? It is not a bad 

place to start. 

I mean—Mr. Chairman, I apologize, I have talked too much—the 

average nurse in the VA system has served for 27 years. Now, you 

can say, oh, that is because the benefits are great. I don’t think so. 

I think it is because the average nurse in the VA system believes 

in trying to help people, and that is a life cause for them. So they 

do it for their life. I think that is the way we are as people. It is 

just that we don’t seem to be able to function

that way. 

I think that we are 6 years into this now and I think America 

has been changed in many ways, many, many ways, some for the 

better, some for the worse. I am deciding this is a way that we are 

going to change for the better. 

Thank you, Mr. Chairman. 

Chairman AKAKA [presiding]. Thank you, Senator Rockefeller. I 

want to thank you for continuing with the panel here. 

I want to thank this panel for your testimony. It will help us 

make decisions as to what can be done to improve the services that 

we can provide for returning patriots and soldiers to this country. 

Thank you for journeying this far to testify here today. So on behalf of the Committee, let me say thank you very, very much. 

Thank you. 

I would like to welcome our second panel of witnesses. We have 

asked VA to provide three of these witnesses to discuss some of the 

VA’s very best mental health programs in suicide prevention, 

PTSD, substance abuse, and sexual trauma. 

Let me call a brief recess at this time for just a couple of minutes. 

[Recess.] 

Chairman AKAKA. This hearing will come to order. 

We welcome our second panel of witnesses. Dr. David Oslin is 

the Director of the Network 4 Mental Illness Research, Education 

and Clinical Center. Dr. Jan Kemp is Associate Director for Education of the Network 19 Mental Illness Research, Education and 

Clinical Center. Dr. Patricia Resick is the Director of the Women’s 

Division of the National Center for Post-Traumatic Stress Disorder. 

They are accompanied by Dr. Ira Katz, VA’s Deputy Chief Patient Care Services Officer for Mental Health. 

I also welcome Mr. Ralph Ibson, Vice President for Government 

Relations of Mental Health America. Mr. Ibson testified before this 

Committee in 2002. We have asked him to pull it all together again 

for us so that we can focus on bridging the gap between the very 

best programs and the utter lack of services. 

I thank all of you for being here today and want you to know 

that your full statements will appear in the record of the Committee. 

Now, I ask Dr. Oslin to begin with your statement. 

48

STATEMENT OF DAVID OSLIN, M.D., DIRECTOR, VISN 4

MENTAL ILLNESS RESEARCH, EDUCATION AND CLINICAL 

CENTER, DEPARTMENT OF VETERANS AFFAIRS 

Dr. OSLIN. Thank you, Mr. Chairman, and thank you, Mr. Rockefeller, for being here today and doing this important work. We 

want to express our condolences to the families that were here earlier. This is a very important issue, indeed, and we really want to 

work with the families and you in moving this issue forward. 

I am a physician at the Philadelphia VA. I am the Director of 

the Mental Illness Research, Education and Clinical Center, 

MIRECC. I am very proud to be a physician in the VA. I was one 

of those 50 percent that trained during my residency in a VA and 

stayed in the VA since that time. 

I am here today to talk to you about our substance abuse program in Philadelphia and how we are reaching out to veterans. 

Our MIRECC supports research on the treatment of addiction. It 

also runs the integrated care service for our facility. 

As a start, I would like to remind the Committee Members of the 

devastation that addiction brings to patients and families in our 

veterans. Simply put, addiction is a very deadly illness. As an example, alcohol misuse in this country creates more financial burden 

to our society than any other health behavior, including smoking 

and obesity, and it is often neglected. The toll on families, friends, 

and coworkers is incalculable, as we have heard today. 

Despite that devastating nature of the illness, research such as 

that conducted in our center has clearly demonstrated that addiction is an illness not unlike hypertension or diabetes and that 

through good care, it is treatable. Our program, we have intentionally built a program that encompasses a broad spectrum of care 

and incorporates treatments that have an evidence base

behind them. 

We particularly start in the primary care setting, realizing that 

a lot of the veterans won’t come to us in the specialty care setting. 

The VA currently and, has for the past several years, annually required screening of all veterans for alcohol misuse. Our integrated 

care program, called the Behavioral Health Laboratory, provides 

systematic follow-up for those veterans that screen positive for alcohol misuse as well as PTSD or depression. 

That follow-up actually starts with a structured telephone call. 

We call the veterans in their homes and don’t require them to necessarily show up to a clinic visit or the burden of having to deal 

with the transportation hassles. After that telephone assessment, 

we determine the level of need of services and reach out to the veteran, including those that are OEF and OIF veterans, who will 

have particular concerns, as we have heard here today, about the 

stigma associated with coming to a mental health clinic. 

Based on the assessment, we can begin to provide treatment in 

that primary care setting outside of the stigmatizing setting of 

mental health, and the variety of services will include things like 

brief alcohol interventions, psycho-education or education, as well 

as referral into our specialty care programs. There is pretty clear 

evidence that these proactive public health initiatives can be very 

effective in reducing the addiction process and reducing the burden 

downstream. The effective use of brief interventions also keeps our 

49

veterans from the specialty care services that they so often

fear to use. 

This part of the program has also brought education and training 

to our internists, family therapists, family practitioners, and other 

primary care staff to approach mental health just like another 

health disorder, just like the diabetes or hypertension. 

Moving up the ladder of our program, the next component would 

be our Addiction Recovery Unit. Here, veterans are assessed using 

a multidisciplinary team to assist in treatment planning. We offer 

a wide variety of outpatient treatments, including 12-step programs, pharmacotherapy, opiate substitution therapy, individual 

psychotherapy, and group therapy. We also have access to inpatient rehabilitation services in our Coatesville and Lebanon facilities and acute inpatient psychiatric care in Philadelphia. 

Additionally, another critical element to our program is the integration of physical, emotional, social, as well as addictive components that are afflicting the veterans’ lives, the assessment of those 

issues. Many of our veterans have a multitude of problems, including PTSD or post-traumatic stress, depression, psychosis, and bipolar illness. We have to assess each veteran for their needs in order 

to provide an appropriate therapeutic environment. 

We are particularly proud that our program has integrated primary care within our addiction program so veterans don’t have to 

go to a multitude of different places to get support. We also integrate homeless programs, peer support, family therapy, and the recovery model into the services. 

It is clear that the treatment of addiction has changed substantially in the last decade and now includes a wide variety of effective treatments. We are striving in our program to provide the best 

available treatments to our veterans. In order to accomplish this, 

we stress the importance of effectively engaging patients in treatment, which entails listening to and honoring their preferences in 

their treatment, as well. This emphasis is coupled with continually 

evaluating the program and adapting to a growing evidence base 

for treatment. 

We are also keenly aware, though, that our treatments are not 

universally effective and we emphasize ongoing research in our facility to develop new treatment options and new opportunities for 

interventions. 

In closing, I would welcome the Committee Members to visit our 

facility at any time, meet with our staff and the veterans we so 

proudly serve. Thank you. 

[The prepared statement of Dr. Oslin follows:]

PREPARED STATEMENT OF DAVID OSLIN, M.D., DIRECTOR, VISN 4 MENTAL ILLNESS

RESEARCH, EDUCATION AND CLINICAL CENTER, DEPARTMENT OF VETERANS AFFAIRS

I would like to thank you for this opportunity to describe our substance abuse 

treatment program at the Philadelphia VA Medical Center. I am a physician at the 

Philadelphia VA Medical Center and the Director of the Mental Illness Research 

Education and Clinical Center or MIRECC. Our MIRECC not only supports research on the treatment of addiction but also runs our integrated care program for 

the treatment of addiction. 

I would first like to remind Committee Members of the devastation caused when 

the disease of addiction goes untreated. Alcohol misuse creates more financial burden to our society than any other health behavior, including smoking and obesity. 

Addiction is also a deadly disease. The toll on families, friends, and coworkers is 

50

incalculable. Despite the devastating nature of the illness, research such as that 

conducted in our center has clearly demonstrated that addiction is an illness not unlike hypertension or diabetes. The critical implication of such research is that addiction is a treatable condition, with a growing evidence base for an array of effective 

treatments. 

In our program, we have intentionally decided to build a program that encompasses the broad spectrum of severity and incorporates treatments that have an evidence base supporting their effectiveness. 

We start in the primary care settings. Throughout the VA system all veterans are 

screened annually for alcohol misuse. Our integrated care program, the Behavioral 

Health Laboratory, provides systematic follow-up for veterans who screen positive 

for alcohol misuse. The follow-up begins with a structured telephone assessment 

that includes questions about a range of mental health symptoms, including illicit 

drug use and suicidality. It is important to note here that this program has been 

very effective in reaching OEF/OIF veterans who may be particularly worried about 

the implications or stigma of going directly to a mental health clinic. Based on both 

the assessment results and the veterans’ preferences, patients are triaged to the 

most appropriate level of care. We offer a broad array of services including brief 

interventions, education, and referral to our specialty care clinics. There is a clear 

evidence base that this type of broad-based public health initiative can identify veterans earlier in the addiction process and prevent substantial burden in the future. 

The effective use of brief interventions also keeps many veterans from needing specialty care services. This part of the program also provides education and training 

to internists, family practitioners and the other staff in primary care and approaches addiction just like any other health problem. 

The next component of our program is our addiction recovery unit. Here veterans 

are assessed by a multidisciplinary team to assist in treatment planning. We offer 

a wide array of outpatient treatments including traditional 12-step programs, 

pharmacotherapy, opioid substitution therapy, individual psychotherapy, and group 

therapy. We also have access to inpatient rehabilitation services at the Coatesville 

and Lebanon facilities and an acute inpatient program in Philadelphia. 

Additionally, another critical element of our program is the integration of assessments of the physical, emotional, social, and addictive components of veterans’ lives. 

Many of our veterans not only have addictive disorders but also suffer from posttraumatic stress, depression, psychosis, and bipolar illness. Assessing each veteran 

for all their health needs is crucial to providing a therapeutic environment. We are 

particularly proud that our addiction program integrates primary care, homeless 

programs, peer support, family therapy, and the recovery model for those veterans 

in need of these services. 

The treatment of addiction has changed substantially in the last decade and now 

includes a variety of effective treatments. We are striving in our program to provide 

the best available treatments to our veterans. In order to accomplish this goal, we 

stress the importance of effectively engaging patients in treatment, which entails 

listening to and honoring their preferences for treatment. This emphasis is coupled 

with continually evaluating the program and adapting the growing evidence base for 

treatment. We are also keenly aware that our treatments are not universally effective and we emphasize ongoing research as a mechanism for developing new treatment options. 

In closing, I would welcome any of the Committee Members to visit our facility 

and meet our staff and the veterans we so proudly serve.

Chairman AKAKA. Thank you very much, Dr. Oslin. 

Dr. Kemp? 

STATEMENT OF JAN KEMP, R.N., PH.D., ASSOCIATE DIRECTOR

FOR EDUCATION, VISN 19 MENTAL ILLNESS RESEARCH, 

EDUCATION AND CLINICAL CENTER, DEPARTMENT OF

VETERANS AFFAIRS 

Dr. KEMP. Mr. Chairman and Senator Rockefeller, thank you for 

the opportunity to be here. I am one of those 20-year-plus nurses 

who is not with the VA because of the benefits and I am very glad 

to have this opportunity. 

The VA recognizes that suicide prevention requires a comprehensive plan that involves integrated strategies, coordinated efforts, 

and a steadfast commitment to implementation and evaluation. 

51

Based on CDC data and not controlling for VHA population-specific 

factors, it is estimated that there are up to 1,000 suicides per year 

among veterans receiving care within the VHA and as many as 

5,000 per year among all living veterans. 

Various strategies have been put into place in order for the VA 

to understand the problems associated veteran suicide, assess veterans under their care for suicide risk, and provide treatment 

strategies aimed toward suicide prevention. In addition, the Mental 

Illness Education Research and Clinical Centers are involved in 

several clinical research endeavors in the areas of various treatment strategies and neurophysiological approaches to the management of suicide and are working closely with the NIH-funded Suicide Prevention Centers to understand and disseminate current information. 

The VISN 19 MIRECC in Denver has implemented a template 

tracking system which allows identification of suicide attempts 

within our network in order to provide follow-up care for these veterans as well as to identify system issues that could be resolved in 

order to improve the care that veterans receive. 

To date, we know that over 250 veterans in the Rocky Mountain 

Network have attempted suicide since October 1, 2005. We have 

learned a great deal about this particular group of veterans. Thirty-two of them have died as a result of their attempt. A vast majority have been diagnosed with various mental illnesses, including 

PTSD and major depression disorder. Many have substance abuse 

problems and many have chronic pain issues. 

While knowing the numbers and tracking the statistics is critically important to our work, we are also very cognizant of the fact 

that we are dealing with individual lives and that each life is invaluable. Implementing treatments that we know are useful with 

suicidal patients has become our mission across the country. We 

have begun an extension education and awareness campaign aimed 

first at mental health and primary care providers. We know that 

increased awareness of the possibility of suicide will lead to better 

identification of those who are at risk and improve our ability to 

implement appropriate suicide prevention treatments. 

In March of this year, I was giving a program in Battle Creek, 

Michigan. A psychologist who was taking urgent care calls that day 

was pulled from the program because a veteran was on the phone 

asking for an appointment. She came back to the program and 

stated since suicide was forefront in her mind, she had asked the 

right questions and was able to determine that this patient was at 

extreme risk and had gotten him immediate help. We need to keep 

suicide in the forefront of all of our providers’ minds. 

We are currently in the process of implementing demonstration 

projects that will allow us to gather effectiveness data while providing veterans with the most current treatments in suicide. These 

include training therapists in cognitive behavioral therapy techniques and the collaborative assessment and management of 

suicidality problem developed by Dr. David Jobes. 

Through the newly established Center of Excellence in 

Canandaigua, we will initiate intensive suicide prevention programs in VISN 2 and in VISN 7, with national implementation 

soon after. 

52

We have also begun to use alternative treatment options with 

those veterans who require enhanced monitoring and management 

of their cyclic and persistent suicide ideation. This includes the use 

of our Health Buddy, a tele-health unit that we give to veterans 

that they use to track their health care concerns and get immediate 

education and advice. 

In Denver, we have seven chronically suicidal patients currently 

using the depression module on the Health Buddy. Each of these 

chronically suicidal patients has had several serious suicide attempts. Since they have been working with the Health Buddy, none 

of them have attempted. One patient told us that he followed the 

Health Buddy protocols late one night with a gun in his lap. By 

the time he got to the directions to call for help, he had realized 

that help was really only a phone call away and that the urge to 

kill himself had passed. He came into the facility the next day, was 

admitted, and is currently receiving ongoing treatment and has 

been doing well with no attempts for over a year. 

Another patient said that he feels the Health Buddy is the missing piece of the puzzle he needed to know that his depression and 

PTSD are manageable. 

Each veteran’s story is compelling and each treatment success a 

valuable lesson. It is by working with individuals, assessing their 

risk, and providing them with appropriate treatment that we will 

reduce the number of suicides among our Nation’s veterans. 

New concerns are constantly emerging. Our newer veterans are 

coming to us with risk factors such as PTSD and traumatic brain 

injury that both carry with them a high suicide risk rate. We have 

developed a manual to help the providers who care for patients 

with traumatic brain injuries understand their patients’ risk for 

suicide. 

We are in the process of placing suicide prevention coordinators 

at each facility that will carry on these approaches in their own 

local communities. We are developing awareness programs to reach 

all of our staff and community partners who work with veterans. 

Mechanisms to share best practices and ideas will be put into place 

through the Center of Excellence. 

We have a large task in front of us. Awareness, training, and access to appropriate mental health care continue to be the major 

components of our multi-faceted approach to reaching and helping 

these individuals while we continue our research programs to determine and refine our treatment strategies. 

Thank you again, Mr. Chairman, for inviting me today. 

[The prepared statement of Dr. Kemp follows:]

PREPARED STATEMENT OF JAN KEMP, R.N., PH.D., ASSOCIATE DIRECTOR FOR

EDUCATION, VISN 19 MENTAL ILLNESS RESEARCH, EDUCATION AND CLINICAL

CENTER, DEPARTMENT OF VETERANS AFFAIRS

Mr. Chairman and Members of the Committee, good afternoon. 

VA recognizes that suicide prevention requires a comprehensive plan that involves 

integrated strategies, coordinated efforts, and a steadfast commitment to implementation and evaluation. Based on CDC data and not controlling for VHA population 

specific epidemiologic factors, it is estimated that there are up to 1,000 suicides per 

year among veterans receiving care within VHA and as many as 5,000 per year 

among all living veterans. Various strategies have been put into place in order for 

the VA to understand the problems associated with veteran suicide, assess veterans 

under their care for suicide risk and provide treatment strategies aimed toward suiVerDate 0ct 09 2002 13:32 Jul 18, 2007 Jkt 000000 PO 00000 Frm 00056 Fmt 6633 Sfmt 6621 H:\RD41451\DOCS\36191.TXT SENVETS PsN: ROWENA
53

cide prevention. In addition, the Mental Illness, Education, Research and Clinical 

Centers (MIRECC) are involved in several clinical research endeavors in the areas 

of various treatment strategies and neurophysiological approaches to the management of suicide and are working closely with the NIH-funded suicide prevention 

centers to understand and disseminate current research information. 

The VISN 19 MIRECC in Denver has implemented a template tracking system 

which allows identification of suicide attempts within the network in order to provide follow-up care for these veterans as well as to identify system issues that could 

be resolved in order to improve the care that these veterans receive. To date we 

know that over 250 veterans in the Rocky Mountain Network have attempted suicide since October 1st of 2005. We have learned a great deal about this particular 

group of veterans. Thirty two of them died as a result of their attempt. A vast majority have been diagnosed with various mental illnesses (including PTSD and major 

depression disorder). Many have substance abuse problems and many have chronic 

pain issues. The VISN 3 MIRECC is installing and implementing an evidence-based 

risk assessment tool which is linked to the alerts and clinical reminders sections of 

our electronic medical record. 

While knowing the numbers and tracking statistics is critically important to our 

work we are also cognizant of the fact that we are dealing with individual lives and 

each life is invaluable. Implementing treatments that we know are useful with suicidal patients has become our mission across the country. 

We have begun an education campaign aimed first at mental health and primary 

care providers. To date, over 750 VA clinicians have been provided with up-to-date 

information on suicide. This includes two regional evidence-based intervention conferences co-sponsored by VISNs 3, 4 and 19. One was held in Atlantic City in June 

2006 and one in Denver this past February. At both of these conferences experts 

from across the country were brought in to share the latest developments in assessing suicide risk and providing care for those at risk for suicide in our population. 

National satellite programs have been offered and a Web-based program is in development. VISN 19 has held individual face-to-face programs at over 30 medical centers at this point and several others are planned. VISNs 3 and 4 have also extensively trained their providers at regular conferences and programs. 

We know that increased awareness of the possibility of suicide will lead to better 

identification of those who are at risk and improve our ability to implement appropriate suicide prevention treatments. We will continue our awareness campaign. In 

March of this year I was giving an education program in Battle Creek, Michigan. 

A psychologist who was ‘‘taking urgent care calls’’ that day was pulled from the program because a veteran was on the phone asking for an appointment. She came 

back to the program and stated that since suicide was forefront in her mind, she 

had asked the right questions and was able to determine that this patient was at 

extreme risk and had gotten him immediate help and he was being admitted. We 

need to keep suicide in the ‘‘forefront’’ of all of our provider’s minds. 

We are currently in the process of implementing demonstration projects that will 

allow us to gather effectiveness data while providing veterans with the most current 

treatments in suicide. These include training therapists in Cognitive Behavioral 

Therapy techniques and the Collaborative Assessment and Management of 

Suicidality (CAMS) program developed by Dr. David Jobes. Through the newly established Center of Excellence in Canandaigua we will be initiating intensive Suicide Prevention Programs in VISNs 2 and 7 with national implementation soon 

after. 

We have also begun to use alternative treatment options with those veterans who 

require enhanced monitoring and management of their cyclic and persistent suicide 

ideation. This includes the use of our Health Buddy, a tele-health unit that we give 

to veterans that they use to track their health care concerns and get immediate education and advice. In Denver, we have 7 chronically suicidal patients currently using 

the depression module on the Health Buddy. Each of these chronically suicidal patients has had several serious suicide attempts. Since they have been working with 

the Health Buddy none of them have attempted. One patient told us that he followed the Health Buddy protocols late one night with a gun in his lap. By the time 

he got to the directions to call for help he had realized that help was really only 

a phone call away and the urge to kill himself had passed. He came into the facility 

the next day, was admitted, and is currently receiving on-going treatment and has 

been doing well with no attempts for over a year. Another patient said that he feels 

the Health Buddy is the missing piece of the puzzle; he needed to know that his 

depression and PTSD are manageable. 

Each veteran’s story is compelling and each treatment success a valuable lesson. 

It is by working with individuals, assessing their risk, and providing them with appropriate treatment that we will reduce the number of suicides among our Nation’s 

54

veterans. New concerns are constantly emerging. Our newer veterans are coming to 

us with risk factors such as PTSD and traumatic brain injuries that both carry with 

them a high suicide risk rate. We have developed a manual to help the providers 

who care for patients with traumatic brain injuries understand their patients risk 

for suicide. 

We are in the process of placing Suicide Prevention Coordinators at each facility 

that will carry on these approaches in their own local communities. We are developing awareness programs to reach all of our staff and community partners who 

work with veterans. Mechanisms to share best practices and ideas will be put into 

place through the Center of Excellence. We have a large task in front us. Awareness, training, and access to appropriate mental health care continue to be the 

major components of our multi-faceted approach to reaching and helping these individuals while we continue our research programs to determine and refine our treatment strategies. 

Thank you again, Mr. Chairman for inviting me today. At this time, I will answer 

any questions you or other Members may have.

Chairman AKAKA. Thank you very much, Dr. Kemp. 

Dr. Resick? 

STATEMENT OF PATRICIA RESICK, PH.D., DIRECTOR,

WOMEN’S DIVISION, NATIONAL CENTER FOR POST

TRAUMATIC STRESS DISORDER, DEPARTMENT OF

VETERANS AFFAIRS; ACCOMPANIED BY IRA KATZ, M.D., 

PH.D., DEPUTY CHIEF, PATIENT CARE SERVICES OFFICER 

FOR MENTAL HEALTH, DEPARTMENT OF VETERANS

AFFAIRS 

Dr. RESICK. I would like to thank the Committee for the opportunity to discuss best practices today. I was asked to speak on two 

separate topics. The first is the National Training Initiative I am 

currently conducting to train therapists, along with my colleagues, 

in an effective therapy for PTSD. The other topic I was asked to 

speak about is the women’s programs at the VA Boston Health 

Care System as an example of best practices for women veterans. 

We have effective therapies, particularly cognitive behavioral 

therapies, such as cognitive processing therapy, that can significantly reduce symptoms of PTSD and can cure it in many cases. 

Cognitive processing therapy, which I developed almost 20 years 

ago, is a 12-session treatment for PTSD which can be implemented 

in groups or individually. It has been shown to be effective for combat, sexual assault, and other traumas. Once cured, we have not 

found relapse in PTSD over long periods of time that have been assessed in research, and that is 5 to 10 years we have

tracked people. 

Therapies such as cognitive processing therapy for PTSD require 

1-hour weekly therapy for 13 to 14 sessions, including intake appointments. In order to conduct this therapy, therapists have to be 

trained and provided support, such as case consultation with experts in the therapy. In order to implement cognitive processing 

therapy effectively, therapists should have no more than 25 cases 

in their caseload at any given time. 

VA’s central office has funded an initiative that I am conducting 

to train and support 600 VA therapists nationally in cognitive processing therapy. To this end, my colleagues and I have written a 

treatment manual with everything needed to conduct the therapy, 

have trained qualified trainers for 2-day workshops and case consultation, which will be available 50 hours a week across time 

zones. Over the next 2 years, we will be providing 22 workshops 

55

throughout the country followed by these support efforts, and that 

will also include online supports, as well. 

On the second topic, VA Boston is a good example of best practices for services for women, because in addition to being able to 

receive services from any clinical program, women can receive services from specialized women’s programs that represent a continuity 

of care. Like all VA hospitals, we had a Women Veterans Program 

Manager and a Military Sexual Trauma Coordinator who serve as 

advocates for information and referrals to appropriate programs. 

We have a separate Women’s Health Center that provides primary 

care, gynecological care, osteoporosis assessment and treatment, 

urgent care, and social services. 

The Women’s Stress Disorder Treatment Team, located in its 

own wing of the hospital, offers outpatient mental health treatment 

for post-traumatic stress disorder and other trauma-related mental 

health problems. A full line of services, including psychiatry, individual and group therapy, psychological assessment, and consultation are available. 

There is a separate wing of the Acute Inpatient Psychiatric Program designated for women to provide them security and privacy. 

We will soon open a residential program for women with cooccurring PTSD and substance abuse disorders. It will be the first 

of its kind in the country. 

The goal is to help women develop skills to maintain abstinence, 

manage PTSD symptoms, and address their traumas. The program 

offers assessment, group, individual, and psycho-pharmacological 

treatment and psycho-educational programs while supporting participants in the development of their own long-term recovery plan. 

The Women’s Homelessness Program provides an array of services to homeless women and women who are at high risk for becoming homeless. Our transitional residence, called the TRUST 

House, specializes in the treatment of women with post-traumatic 

stress, mood and substance use disorders. Up to seven women can 

live at this residence at a time. The treatment program involves individual therapy, case management, group therapy, house meetings, and paid work experience through the Veterans Industries 

Vocational Program. Women are assisted in making the transition 

from VA-supported employment to employment in the community. 

Thank you again, Mr. Chairman, for inviting me today, and at 

this time, I can answer any questions that you or any other Members may have. 

[The prepared statement of Ms. Resick follows:]

PREPARED STATEMENT OF PATRICIA RESICK, PH.D., DIRECTOR, WOMEN’S DIVISION, NATIONAL CENTER FOR POST TRAUMATIC STRESS DISORDER, DEPARTMENT OF

VETERANS AFFAIRS

I would like to thank the Committee for the opportunity to discuss our program. 

I was asked to speak today on two topics. First, the national training initiative I 

am currently conducting to train therapists in an effective therapy for PTSD and 

the women’s programs at VA Boston Healthcare System as an example of best practices for women veterans. 

We have effective therapies, particularly cognitive behavioral therapies, such as 

cognitive processing therapy (CPT), that can significantly reduce symptoms of PTSD 

and can cure it in many cases. Cognitive processing therapy, which I developed almost 20 years ago, is a 12-session treatment for PTSD which can be implemented 

in groups or individually. It has been shown to be effective for combat, sexual assault, and other traumas. Once cured, we have not found relapse in PTSD, over long 

56

periods of time that have been assessed in research (5–10 years). Therapies such 

as CPT for PTSD require 1-hour weekly therapy for 13–14 sessions (including the 

intake appointments). In order to conduct this therapy, therapists have to be trained 

and provided support such as case consultation with experts in the therapy. In order 

to implement CPT effectively, therapists should have no more than 25 cases in their 

case loads at any given time. VA Central Office has funded an initiative that I am 

conducting to train and support 600 VA therapists nationally in cognitive processing 

therapy. To this end, my colleagues and I have written a treatment manual with 

everything needed to conduct the therapy, and have trained qualified CPT trainers 

for 2-day workshops and case consultation available 50 hours a week across the 

time zones. Over the next 2 years, we will be providing 22 workshops throughout 

the country followed by these support efforts. 

VA Boston is a good example of best practices for services for women because, in 

addition to being able to receive services from any clinical program, women can receive services from specialized women’s programs that represent a continuity of 

care. Like all VA hospitals, we have a Women Veterans Program Manager and a 

Military Sexual Trauma (MST) coordinator who serve as advocates for information 

and referrals to appropriate programs. We have a separate Women’s Health Center 

that provides primary care, gynecological care, osteoporosis assessment and treatment, urgent care and social services. The Women’s Stress Disorder Treatment 

team, located in its own wing of the hospital, offers outpatient mental health treatment for post traumatic stress disorder and other trauma-related mental health 

problems. A full line of services including psychiatry, individual and group therapy, 

psychological assessment and consultation are available. There is a separate wing 

of the acute inpatient psychiatric program designated for women to provide them 

security and privacy. We will soon open a residential program for women with cooccurring PTSD and substance abuse disorders. The goal is to help women develop 

skills to maintain abstinence, manage PTSD symptoms, and address their traumas. 

The program offers assessment; group, individual and psycho-pharmacological treatment and psycho-educational programs while supporting participants in the development of their own long-term recovery plan. The Women’s Homelessness Program 

provides an array of services to homeless women and women at high risk for homelessness. Our transitional residence, TRUST House, specializes in the treatment of 

women with post traumatic stress, mood and substance use disorders. Up to seven 

women live in the residence. The treatment program involves individual therapy, 

case management, group therapy, house meetings, and paid work experience 

through the Veteran Industries Vocational Program. Women are assisted in making 

the transition from VA supported employment to employment in the community. 

Thank you again, Mr. Chairman, for inviting me today. At this time, I will answer 

any questions you or other Members may have.

Chairman AKAKA. Thank you very much for your testimony. 

Now we will hear from Ralph Ibson. 

STATEMENT OF RALPH IBSON, VICE PRESIDENT FOR

GOVERNMENT RELATIONS, MENTAL HEALTH AMERICA 

Mr. IBSON. Thank you, Mr. Chairman. I am pleased to be here 

testifying today on behalf of Mental Health America, which is the 

country’s oldest and largest nonprofit organization addressing all 

aspects of mental health. I appear before you today as a veteran, 

a veteran of the United States Army, of the staff of the House Veterans’ Affairs Committee, and of the VA. I want to commend you 

and the staff for putting together an extraordinary panel of witnesses who I think have framed the central issues that confront 

both the VA and the Congress, and let me try and highlight what 

I think has emerged from the testimony today. I think it has been 

exceptional. 

First of all, it strikes me that our military operations in Iraq and 

Afghanistan differ markedly from prior combat engagements in at 

least two important respects. 

First is the extensive reliance on the National Guard and the Reserves, and second, the reliance on multiple tours of duty, repetitive tours of duty. I think both are critically important in terms 

57

of their implications for the mental health of our veterans and the 

way we approach these issues. 

To clarify the point, deploying to a combat zone can be enormously stressful for a soldier and for that soldier’s family members, 

and that stress increases markedly with each subsequent deployment. 

Secondly, as I think many of the witnesses emphasized today, 

members of the Guard and Reserve who make up such a large percentage of our fighting forces overseas are largely returning to 

rural America and to small towns and communities often very distant from the network of VA facilities and DOD facilities that 

might otherwise be there to serve them. 

I think experts agree, and you heard the same from many of the 

panelists today, that virtually all returning veterans face readjustment problems and that it is advisable to provide counseling and 

support to veterans and their families to ease in that transition. I 

think this Committee historically has laid an extraordinary foundation with the Vet Center program and there are powerful lessons 

to be learned and opportunities to build on that success. The preventive approach of the Vet Centers, I think, has helped avert the 

development of serious mental disorders, like depression and substance use disorder, and we should employ such a preventive approach today. 

I think a third point is that the prevalence of mental health 

problems among these OIF/OEF veterans appears to be significantly higher than was anticipated. One statistic that was not 

aired today that I find compelling is relatively recent DOD data on 

those who have served in Iraq which show that some 50 percent 

of Army National Guard members and some 45 percent of Army 

and Marine Reservists have reported mental health concerns—half 

of all Army National Guard members report mental health concerns! 

A fourth point, certainly heavily emphasized by many of the witnesses, is the profound stigma associated with mental health care 

and the deterrent effect that has, particularly among the Guard 

and Reserves, on help-seeking. 

Further, family members of OIF/OEF veterans are experiencing 

mental health problems related to the veterans’ service. Research 

has shown that PTSD, for example, can have a profound impact on 

members of the veteran’s family. We certainly have particular concern for the family members of Guard and Reservists who have 

faced repeated deployments and, again, who tend to be isolated 

from the community support systems that may be available to family members of active duty members who live on or close to military 

bases. 

And sadly, despite many outstanding programs and best practices at individual VA facilities, and we certainly have heard about 

them just now, I think VA as a system can still do more and ought 

to be doing more. I think the earlier testimony reinforces that 

point, but let me offer a few examples or recap points made by earlier witnesses. 

I think it is true of VA as it is true of most health systems that 

they are largely passive, and we heard today of the importance of 

outreach, the importance of the use of peers, the importance of 

58

drawing veterans into readjustment, into care systems, into screening, into help. While VA’s 207 Vet Centers play an important role 

in providing much-needed readjustment counseling assistance to 

veterans, it strikes me that the Department’s more far-reaching 

network of medical centers, clinics, and other facilities really don’t 

have the opportunity or take the opportunity to provide the kinds 

of preventive services that experts say all returning veterans need 

as we heard from several previous witnesses. 

Helping these veterans readjust or overcome PTSD often requires 

working with that individual’s family, but there are both fiscal disincentives to that in VA medical centers and what I believe are 

outright statutory barriers to that kind of engagement. There, too, 

I think changes are in order. 

VA’s resource allocation methodology and its decentralized decision-making, it strikes me, give no assurance that the kind of targeted mental health funding that Congress has so carefully dedicated itself to will not be offset by cuts to other VA mental health 

programs and similarly give no assurance at the facility level 

where there are such extraordinary pressures competing for scarce 

dollars that mental health will get the priority it needs as against 

high-tech medicine or the many other services that lay claim on 

those dollars. 

And although efforts have been made to improve services, it is 

not clear, at least from my vantage point, that VA’s substance use 

services have been fully restored from the cuts that have been sustained over the years and that this Committee has so carefully 

sought to reinstate. 

And finally, notwithstanding excellent programs and outstanding 

practices that we see at Boston and other VA facilities, I think the 

jury is out in terms of women veterans and their perceptions, regardless of the reality, but their perceptions of VA as a welcoming, 

caring set of institutions, given the breadth of issues we have 

heard today ranging from the extraordinary combat trauma to 

which women are exposed in Iraq to the tragic sexual assaults that 

we learned about earlier. 

What does all this tell us? I think I would go a step further than 

Dr. Best, who called for a ‘‘larger boat.’’ I think we need to think 

about some redesign or reconfiguration of that boat to address 

some of these issues. 

Again, several witnesses stressed outreach, and I believe there 

would be great value and we heard discussion of the role of peers. 

I see an opportunity for a robust national VA program of training 

a cadre of OIF/OEF veterans, veterans who have come back with 

these kinds of problems—with PTSD, anxiety, other readjustment 

problems—training those veterans in perhaps week-long sessions. 

Such programs do exist. After undergoing such training, such individual could be employed in VA and by community providers to do 

the kind of outreach and to provide the kind of support that Patrick Campbell and others spoke about as so necessary to make VA 

a help-without-hassles, welcoming place in which the stigma they 

anticipate is diminished and in which care can be furnished and 

successfully so. As Sergeant Campbell testified, some veterans just 

need to talk to someone who will understand, and certainly Josh 

Omvig and Justin Bailey needed a person like that. 

59

Secondly, I believe there is also a need for time-limited—I would 

stress time-limited—service-delivery mechanism that would enable 

OIF/OEF veterans who are returning to those small towns and 

rural areas that are remote from VA facilities, and remote from 

DOD facilities, to get the kind of care that they need. I see an opportunity for that in the network of Community Mental Health 

Centers. Under a carefully designed program, VA can contract for 

those services and set requirements. It can require, for example, 

that those centers hire trained peers, and that they meet criteria 

that VA set. A time-limited program like that can be a very important stop-gap measure to reach veterans who are now not only underserved, but not served at all. 

I would concur certainly with Sergeant Campbell in recommending that the 2-year eligibility window for combat veterans is 

far too short and should be extended to 5 years. 

And lastly, I would urge the Committee to consider legislation, 

again, on a time-limited basis, to authorize VA to provide immediate family members with both support services and, when needed, mental health services to help foster the veterans’ readjustment 

or recovery. 

We would certainly be happy to work with the Committee and 

its outstanding staff to develop those recommendations further, 

and I would be pleased to join others in answering any questions 

you might have, Mr. Chairman. 

Thank you. 

[The prepared statement of Mr. Ibson follows:]

PREPARED STATEMENT OF RALPH IBSON, VICE PRESIDENT

FOR GOVERNMENT AFFAIRS, MENTAL HEALTH AMERICA

Mr. Chairman and Members of the Committee: 

Mental Health America (MHA) is the country’s oldest and largest nonprofit organization addressing all aspects of mental health and mental illness. In partnership 

with our network of 320 state and local Mental Health Association affiliates nationwide, we work to improve policies, understanding, and services for individuals with 

or at risk of mental illness and substance-use disorders. Established in 1909, the 

organization changed its name last November from the National Mental Health Association to Mental Health America in order to communicate how fundamental mental health is to overall health and well-being. MHA is a founding member of the 

Campaign for Mental Health Reform, a partnership of 17 organizations which seek 

to improve mental health care in America, for veterans and non-veterans alike. 

Mr. Chairman, we commend you for scheduling this important, timely hearing, 

and in doing so, providing visibility and focus for critical questions that must be answered if we are to avoid mistakes of the past. While we know that servicemembers 

have experienced mental health problems in every war, our operations in Iraq and 

Afghanistan differ markedly from prior combat engagements, with critically important implications for veterans’ readjustment and recovery. 

UNIQUE ASPECTS OF OPERATIONS IRAQI FREEDOM

AND ENDURING FREEDOM (OIF/OEF)

Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) are 

unique in their heavy reliance on the National Guard and Reserves who make up 

a large percentage of our fighting forces. Reserve forces alone have made up as 

much as 40 percent of U.S. forces in Iraq and Afghanistan, and at one point, more 

than half of all U.S. casualties in Iraq were sustained by members of the Guard 

or Reserves. These operations are also unique in their reliance on repetitive deployments. Deploying to a combat zone is necessarily enormously stressful to a soldier 

AND his or her family; that stress increases markedly with each subsequent deployment. 

The impact of those deployments on servicemembers has already been profound. 

The prevalence of mental health problems among OIF/OEF veterans appears signifiVerDate 0ct 09 2002 13:32 Jul 18, 2007 Jkt 000000 PO 00000 Frm 00063 Fmt 6633 Sfmt 6621 H:\RD41451\DOCS\36191.TXT SENVETS PsN: ROWENA
60

cantly higher than had earlier been anticipated. To illustrate, recent data from the 

Defense Medical Surveillance System (reflecting post-deployment health self-assessments since June 2005 of servicemembers who had served in Iraq) show that 50 percent of Army National Guardsmen and some 45 percent of Army and Marine reservists have reported mental health concerns. Unexpectedly high percentages of OIF/

OEF veterans are receiving VA mental health services, many with very serious 

problems like PTSD and depression. According to VA data, more than 35 percent 

of OIF/OEF veterans who accessed VA care from 2002 through November 2006 were 

diagnosed or being evaluated for a mental health disorder. 

The high percentages of Guard and Reservists among the OIF/OEF cohort creates 

unique challenges that VA has not previously faced. First, these ‘‘citizen-soldiers’’ 

often live in communities remote from VA medical centers. Yet they are as likely 

to have readjustment issues or to experience anxiety, depression or PTSD as veterans who have good access to VA health care. Long-distance travel is a very formidable barrier to a veteran’s seeking (and continuing) needed treatment. That barrier 

is likely to be even higher for veterans with mental health needs, given the lingering stigma surrounding mental health treatment. Second, with activation to and 

from active duty associated with multiple deployments, health care responsibility for 

these servicemembers shifts from DOD to VA to DOD, with each shift in responsibility inviting confusion. 

VETERANS’ MENTAL HEALTH NEEDS

OIF/OEF veterans are experiencing a broad range of post-deployment mental 

health issues—some of which require treatment, while others call for some combination of education, support and counseling. VA data identify PTSD (seen in 15 percent of those evaluated at VA facilities), drug abuse (13 percent) and depression (10 

percent) as the most prevalent disorders being treated in its facilities. Importantly, 

another 5 percent were diagnosed with a psychosis, reflecting severe mental illness. 

A recent study on the mental health status of Iraq veterans in the Maine National 

Guard provides another illuminating snapshot. That survey found that 25 percent 

of these veterans reported significant problems with PTSD, alcohol or depression. 

But the study data also indicate the extent to which these veterans are experiencing 

readjustment problems. For example, more than 43 percent had problems with 

anger (compared with 16 percent in Guard members who had not been deployed), 

more than 35 percent had relationship problems (vs. 15 percent among the nondeployed), and 22 percent reported sexual problems (vs. 10 percent among the nondeployed). Significantly, only 15 percent of those Maine veterans had sought help 

from a mental health professional. 

VA’s Special Committee on Post-Traumatic Stress Disorder (a statutorily created 

panel of clinicians which reports annually to VA and to Congress) has provided a 

helpful assessment of the wide range of post-deployment mental health issues confronting veterans and their families. Its February 2006 report advised that ‘‘VA 

needs to proceed with a broad understanding of post deployment mental health 

issues. These include Major Depression, Alcohol Abuse (often beginning as an effort 

to sleep), Narcotic Addiction (often beginning with pain medication for combat injuries), Generalized Anxiety Disorder, job loss, family dissolution, homelessness, violence toward self and others, and incarceration.’’ The Committee advised that ‘‘rather than set up an endless maze of specialty programs, each geared to a separate 

diagnosis and facility, VA needs to create a progressive system of engagement 

and care that meets veterans and their families where they live... The 

emphasis should be on wellness rather than pathology; on training rather than 

treatment. The bottom line is prevention and, when necessary, recovery.’’ Importantly, the Special Committee also advised that ‘‘Because virtually all returning 

veterans and their families face readjustment problems, it makes sense to 

provide universal interventions that include education and support for veterans and their families coupled with screening and triage for the minority 

of veterans and families who will need further intervention.’’ [Emphasis 

added.] 

Certainly our perspective is too general when we speak globally and without distinctions of ‘‘veterans’ needs.’’ Of particular significance surely are the contributions 

that women are making in these ongoing operations. Women represent some 15 percent of those in the OIF/OEF theaters. And while not serving in infantry units, they 

are more exposed to trauma—driving in convoys, serving in security assignments, 

and even flying aircraft—than in any other military engagement in our history. It 

should also be acknowledged that the range of trauma to which women in service 

are being exposed ranges from the threat of IED’s to marital and family stresses. 

61

FAMILY ISSUES

While there is widespread recognition of the prevalence of post-traumatic stress 

disorder (PTSD) and other war-related mental health problems among veterans of 

service in Iraq and Afghanistan, less attention has been given to the toll these military operations have had on the mental health of our veterans’ families, and the 

implications of those problems on the veteran’s readjustment and health. Research 

on PTSD, for example, has shown that it has had severe, pervasive negative effects 

on marital adjustment, general family functioning, and the mental health of partners, with high rates of separation and divorce and interpersonal violence. PTSD 

can also have a substantial impact on veterans’ children. Not surprisingly, in a military engagement that has required multiple tours of duty of many servicemembers 

and in which the burden has fallen heavily on citizen-soldiers of the National Guard 

and military Reserves, the impact on families has been particularly hard, and may 

be implicated directly in mental health problems in family members of the veteran. 

Despite recognition in the VA regarding the mental health needs of returning veterans’ families and the importance of engaging family members in the veteran’s readjustment, current law and practice limit VA’s assistance to, and work with, family 

members. The Special Committee on PTSD reports that ‘‘the strength of a war fighter’s perceived social support system is one of the strongest predictors of whether he/

she will or will not develop PTSD.’’ VA is an integrated health care system which 

offers a relatively full continuum of care and services for eligible veterans. Family 

therapy is often a component of the readjustment counseling provided at VA ‘‘Vet 

Centers’’ that are usually located in population centers and operated independently 

of VA medical centers and clinics. But veterans and family members who live far 

from a Vet Center and who rely instead on a VA medical center or clinic routinely 

encounter a system that discourages family therapy. Most VA health facilities focus 

exclusively on the veteran-patient (rather than on the veteran as part of a family 

unit) and provide incentives through measures of ‘‘workload’’ that fail to provide any 

workload credit for helping the veteran’s family. This patient-centered workload system effectively discourages medical-center clinicians from providing family therapy 

and support services that are routine in a parallel system of VA facilities. There is 

no sound programmatic rationale for encouraging family support at one set of VA 

facilities (the Vet Centers) and discouraging it at others. VA health care, and particularly mental health care, would often be more effective if barriers to family involvement were eliminated. 

Current law compounds the difficulty. While the law (38 U.S.C. 1710(e)(3)(C)) authorizes VA to provide medical care and services (subject to a 2-year time limit) to 

a veteran who served in a combat theater, section 1782(b) of title 38 of the U.S. 

Code would limit counseling for a family member of a combat veteran receiving 

treatment to circumstances where the counseling had been initiated during a period 

of hospitalization and continuation is essential to hospital discharge (while family 

members of veterans receiving treatment for a service-connected condition can receive counseling as needed in connection with the veteran’s treatment). Insofar as 

the law effectively treats the veteran who served in a combat theater on a presumptive service-connected basis for a time-limited period, we recommend that VA be authorized to provide immediate family members with both support services AND 

(when needed) mental health services to help foster the veteran’s readjustment or 

recovery. And, to ensure that the benefits of such family support and mental health 

services are realized, we recommend that legislation require the Department to revise its workload measurement system to eliminate the disincentive to, and provide 

credit for, working with family members of veterans where such education, counseling, or therapy would help foster the veteran’s readjustment or recovery. Yet additional consideration should be given to the mental health needs of survivors of 

those who have lost their life in Iraq and Afghanistan, including parents who generally are not even eligible for VA grief-counseling. 

STIGMA SURROUNDING MENTAL HEALTH TREATMENT

There is wide recognition of the importance both of preventing readjustment problems from worsening and of treating behavioral disorders as early as possible. Left 

untreated, mental disorders like PTSD and depression are likely to become chronic 

and severely disabling. 

The stigma surrounding mental health disorders—and the degree to which that 

stigma deters help-seeking—has profound implications for the long-term health and 

recovery of OIF/OEF veterans. Data do show some decline in the stigma associated 

with seeking behavioral health care (as reported in DOD’s May 2006 report of its 

Mental Health Advisory Team on Operation Iraqi Freedom (MHAT III)), but the 

level of stigma among these servicemembers remains troublingly high. The MHAT 

62

III report indicates, for example, that among those who met criteria for mental 

health problems and were asked to identify factors that might affect their decision 

to receive mental health counseling or services, 53 percent thought they would be 

seen as weak. High percentages of OIF/OEF veterans responded affirmatively to 

concerns that seeking mental health assistance might (a) lead unit leadership ‘‘to 

treat me differently’’ (29 percent); (b) result in ‘‘members of my unit [having] less 

confidence in me’’ (26 percent); and (c) ‘‘would harm my career’’ (17 percent). 

While substantial numbers of OIF/OEF veterans are being seen at VA facilities 

with behavioral health problems, there are compelling reasons to question how 

many are not seeking needed treatment. Congress and VA could learn much from 

an independent study on the numbers of OIF/OEF veterans who have mental health 

needs but elect not to seek treatment because of stigma. 

VA’S CAPACITY TO PROVIDE FOR VETERANS’ NEEDS

This hearing provides an important opportunity to question whether the VA 

health care system—with all its strengths—is adequately staffed, adequately configured, and operating with appropriate incentives—to meet the mental health needs 

of returning servicemembers. VA’s health system has great strengths, and many 

centers of excellence within it. But we should be mindful of the gaps in that system, 

especially with respect to mental health needs, and find ways to fill those gaps. 

VA is a facility-based system that does not necessarily provide good access to care 

for veterans in rural America or in other areas remote from its healthcare facilities. 

As noted above, these gaps are particularly pronounced in light of the pressing mental health needs of OIF/OEF veterans, many of whom are citizen soldiers of the National Guard and Reserves who have returned from overseas deployments to communities far from VA facilities. Those distances are all the more formidable in the 

face of the stigma still surrounding mental health care. 

VA facilities themselves do not necessarily provide a full range of needed mental 

health services. To illustrate, experts believe that most servicemembers returning 

from a combat deployment face readjustment issues during what is essentially a 

transition from the trauma and horrors of war to reintegration to their communities 

and families. That need for readjustment should not be seen as a pathology that 

requires treatment; rather, readjustment counseling, education and support are a 

preventive, health-promoting measure. Most returning veterans could benefit from 

readjustment counseling, and the failure to make that these services available can 

lead to behavioral health problems. But VA’s current capacity to provide this important service is generally limited to its array of approximately 200 readjustment 

counseling centers (Vet Centers). The department’s extensive network of medical 

centers and clinics, which provides a range of intensive treatment services, generally do not provide the largely preventive services furnished by the Vet Centers. 

While the unique circumstances of the Vietnam era help explain the development 

of these parallel systems (with their own separate administrative structures), there 

is no statutory barrier to VA medical centers providing readjustment counseling 

services, and—given the need—no obvious reasons not to make such services more 

widely available through other health-care facilities. We urge the Committee to explore having VA medical centers provide readjustment counseling services to OIF/

OEF veterans and immediate family members. In that regard, it is important to remember that the Vet Center program was established with a ‘‘help without hassles’’ 

philosophy. For veterans struggling to readjust, and needing help with anger, feelings of grief, or problems with relationships, for example, there is great value in a 

‘‘help without hassles’’ approach. And we find no requirement in law that OIF/OEF 

veterans must enroll for VA care in order to be eligible to receive readjustment 

counseling in a VA medical center, and urge that such a precondition not

be instituted. 

Another gap in the VA health care system is the still uneven distribution of treatment resources for veterans who have substance-use problems. VA’s arsenal of resources for treating substance-use disorders was profoundly diminished a decade 

ago with the closure of inpatient programs. It is our understanding that the department’s substance-use treatment capacity has grown in subsequent years, but does 

not appear to have been fully rebuilt. There is also need to question the breadth 

of the gap between women veterans’ mental health needs of women veterans and 

VA’s capacity to meet those needs, consistent both with expectations of privacy and 

of a welcoming climate. It would be most helpful in this connection to survey women 

OIF/OEF veterans, in order to understand their experiences and perceptions regarding care in a system long seen as an enclave for treating an almost exclusively male 

population. 

63

To its credit, Congress has appropriated additional funds in recent years to upgrade VA mental health and substance-use services. It is difficult, however, to gauge 

the adequacy of mental health staffing and capacity in this large health system. VA 

is unquestionably seeing more patients with PTSD, for example. But is that due to 

increased staffing or some contraction in the intensity of service-delivery? The complexities associated with distributing and allocating funding in the VA health care 

system invites question as to whether new funding finds its way, dollar for dollar, 

into increases in mental health staffing. Are there medical centers that receive new 

money for a specific mental health initiative, but offset such increases in part by 

cutting staffing of other mental health programs? It should be possible to monitor 

and measure the net gain in staff associated with efforts to expand mental health 

funding, and we urge the Committee to direct such action. But unless such monitoring is done with rigor and with consequences, one cannot be certain that the system’s capacity will reflect congressional expectations. 

In that connection, we also recommend that the Committee examine the incentives and disincentives in VA’s resource allocation methodology (VERA) as it relates 

to mental health service-delivery. To its credit, VA leadership embraced the recommendations of the President’s New Freedom Commission on Mental Health with 

its emphasis on the importance of fostering recovery from mental illness rather than 

simply managing symptoms. Many fine VA mental health programs are essential to 

fostering veterans’ recovery from mental illness, and should be encouraged. But 

among those programs, valuable initiatives, like supported employment and peer 

supports, do not add to ‘‘workload’’ and therefore are not rewarded by VA’s resource 

allocation methodology. We urge the Committee to explore avenues to ensure that 

VA fiscal incentives reward efforts to foster recovery from mental illness, not simply 

efforts to increase numbers of patients served. 

Finally, anecdotal data suggest that some veterans are encountering barriers in 

getting needed VA mental health services. How many more veterans would get VA 

services if travel distances were not so great, or if stigma were not so pervasive, 

or if VA staff were perceived as more welcoming, or if VA conducted active outreach 

efforts using peer outreach workers? It would not be difficult to conduct an independent survey of OIF/OEF veterans to gauge the relative ease of access to VA mental health care, to determine the percentages who are not able to get services, and 

to identify the factors, if any, that discouraged veterans from getting needed help. 

We urge the Committee to consider directing the conduct of such a survey. 

CLOSING GAPS IN VA SERVICE-DELIVERY

The principle that a veteran with a service-incurred health problem should have 

equitable access to treatment (that is, that a veteran should not be barred from getting needed care) regardless of where he or she lives is well-established. In our view, 

there is a growing need to establish a time-limited mechanism that could be implemented relatively quickly to provide high quality mental health and readjustment 

services to OIF/OEF veterans who do not have reasonable access to VA care. Specifically, we see great benefit for veterans in the development of a targeted mechanism 

(in areas distant from VA medical centers) that would combine (a) outreach and ongoing support from trained OIF/OEF peers with (b) provision of mental health services by clinicians knowledgeable about PTSD, the combat experience and the unique 

circumstances of military service and veteran status. Such a mechanism could be established through VA contracts with community mental health centers for provision 

of needed services for OIF/OEF veterans who live far from VA mental health centers 

under which such centers would be required to (1) participate in a VA-conducted 

national training program; (2) employ an OIF or OEF veteran who has completed 

a peer outreach/support training and certification program; (3) secure prior approval 

from VA (in accordance with a VA-provided protocol) before the Department would 

incur any liability for provision of services for an OIF/OEF veteran; and (4) provide 

VA with annual summary data on numbers of veterans served, diagnosis, course of 

treatment, and demographics. We recommend further that VA contract with a notfor-profit national mental health organization to train OIF/OEF veterans for employment as ‘‘stigma-busting’’ peer outreach workers and peer counselors. (The use 

of peer-counselors and support specialists is a well-established, cost-effective modality in mental health care that has been employed with success at a number of VA 

centers.) Instituting such a training/employment program is a step that would not 

only help participating OIF/OEF veterans further their own recovery, but pave the 

way to overcoming the stigma that remains a formidable barrier to needed counseling and treatment. 

64

NEXT STEPS

VA and DOD have unquestionably taken important steps to understand and address the mental health needs of OIF/OEF veterans, and Congress has played a 

vital role in mounting much-needed oversight and providing needed funding. Yet 

there remains much to be done, and, in our view, compelling reason to pursue new 

directions: (a) to work to fill the wide mental health service-delivery gaps in the VA 

health care system, (b) to address (in at least a time-limited way) the war-related 

mental health needs of veterans’ family members, (c) to make peer-outreach and 

support in VA service-delivery the norm rather than the exception, (d) to develop 

better data to support Committee oversight and VA mental health management, 

and (e) to align fiscal incentives with clinical imperatives. 

Such steps, in our view, will go a long way toward fostering the readjustment and 

reintegration of returning veterans, and the recovery of those who have experienced 

mental health problems as a result of their service to their country. 

We look forward to working with the Committee to help achieve those goals.

Chairman AKAKA. Thank you very much for your testimony, Mr. 

Ibson. 

I want to welcome Dr. Katz here on the panel. Dr. Katz, Mr. 

Ibson’s testimony points to, among other things, shortages of informal counseling services in VA clinics and a substance abuse program which has not been fully rebuilt since the reductions were 

made several years ago. My question to you is, how do you respond 

to the previous panel and Mr. Ibson’s testimony? 

Dr. KATZ. Well, let me focus. I was, as everyone else in the room, 

profoundly affected by what we heard. I want to say with respect 

to the issues that the Bailey family raised that my colleague from 

the Office of Mental Health Services is in Los Angeles now looking 

very carefully at that program and looking for lessons to be learned 

to improve residential and other forms of care in the VA. 

I have been struck by the Omvig family’s work and I admire and 

applaud their willingness to talk about it. VA is grateful for the 

House, Mr. Boswell, and for Mr. Grassley and Mr. Harkin for raising that bill, the Omvig’s veteran suicide prevention bill. We are 

implementing it already. The suicide prevention coordinators called 

for in the bill are being hired as we speak throughout our system. 

There will be one in each medical center. We are working hard to 

take the lessons that we have learned from hearing about Joshua 

Omvig to make sure it doesn’t happen, or to decrease the rates of 

suicide among veterans. 

We are expanding and enhancing mental health services 

throughout VA, not only in the specialty care setting, but by making mental health an important part of primary care. 

It is a way of easing the stigma, making it easier for veterans 

to receive care. We call this an in-reach approach. At the same 

time, Dr. Butteriss, my colleague, is working very hard to expand 

the veterans center program through outreach and now at most 

post-deployment health reassessment, there is a veterans center 

outreach person there to meet veterans and to talk about the VA. 

There is no wrong door. The Vet Centers are often the only mental health care that is needed. When it is not, it is an important 

point of entry to mental health services. It is what we often call 

stepped care. If the Vet Centers work, wonderful. If not, a referral 

to mental health services in medical centers and clinics is helpful. 

In the same way, the integration of mental health and primary 

care is another important way to facilitate access. We are making 

care available. 

65

About substance abuse, the number of beds in inpatient substance abuse care settings has decreased, but the overall number 

of beds, including other forms of residential care and homeless programs focusing on substance abuse, have actually increased. What 

we have done in large part is to work to overcome the siloing of 

care that is often a problem. Let me give you an example of that. 

If I, as a middle-aged man, were to have a heart attack tomorrow, I would get depressed over it and I would probably drink to 

treat my depression. With three related problems like that, I would 

have to get care in three different settings and I probably couldn’t 

manage it. We need to fix that and we are working for it. 

So 40 percent of substance abuse care in VA is in specialty substance abuse care. About 30 percent is in other mental health services, and about 30 percent is in primary care. We want accountability. We should be held accountable for serving these veterans 

with substance use problems. But the way we look at this has to 

go beyond the narrow silos that characterize care in the past. 

I see time is up. So much has been said. These have been some 

first thoughts in response. 

Chairman AKAKA. Thank you, Dr. Katz. 

Dr. Katz, the National Center continues to give VA the best tools 

to deal with PTSD. Has funding and has staff for the center increased in recent years? 

Dr. KATZ. Our look at the budget for the National Center for 

PTSD includes a number of components. There is the core funding 

for the National Center and a number of additional mechanisms for 

funding other components of their activities. 

So, for example, Dr. Resick receives funding for the Women’s Division of the National Center that she directs. 

She also receives funding for the implementation and dissemination of the cognitive processing therapy she talked about. Dr. Friedman receives funding for his division and for the overall direction 

of the National Center. He also receives funding for studies, for example, of the primary care treatment of PTSD. 

So if one looks at the entire VA support of the National Center, 

including both its core funding and its project-specific funding, it 

is increasing over time. 

Chairman AKAKA. We have been trying to increase the budget of 

the Department of Veterans Affairs and have been able to do that, 

as you know. Of course, the hope is that it will give you license to, 

if needed, increase personnel wherever it is necessary and deal 

with some of these complaints, let me say, and shortfalls that have 

occurred. So we look forward to working this with you, as well, to 

try to bring this about and give the best kind of service we can to 

all veterans. This is what it is all about. 

Dr. KATZ. Yes. 

Chairman AKAKA. I want to thank all of you for being here, for 

your testimony. We truly appreciate your taking the time to give 

us all a better understanding of the challenges facing VA mental 

health care and of efforts to meet those challenges. I look forward 

to continuing to work with you on that.

66

My expectation is that VA will adapt to meet the mental health 

needs of the newest generation of veterans and to prevent the tragic stories we have heard today from happening again. 

So again, thank you so much for all of this. This hearing is now 

adjourned. 

[Whereupon, at 4:53 p.m., the Committee was adjourned.] 

(67)

1Submitted by SGT Carolyn Schapper of Virginia National Guard. She served as an Interrogator/HUMint Collector in Iraq from October 2005 to September 2006 with the 221 st MI BN.] 

A P P E N D I X 

FEMALE SOLDIERS AND SEXUAL TRAUMA: OPERATION IRAQI FREEDOM (OIF) 1

Define ‘‘sexual trauma.’’ When one hears the phrase sexual trauma it is natural 

to quickly assume we are talking about rape and physical confrontation. Rape is 

universally understood as wrong, so with its easy definition it is what one focuses 

on. Although it is a problematic crime in the Army, I do not know if statistics would 

tell you that it is more of a crime in the Army and/or the military in Iraq, than 

in society in general. What I do know is that when I asked my fellow female soldiers 

about it and thought of my experiences and, the experiences of those I served with, 

I realized sexual trauma has a much broader and murky definition, and everyone 

had a story. Rape is not the crux of this issue, nor the prevalent issue in my opinion. True sexual trauma in Iraq involves ambiguous Equal Opportunity (EO)/gender 

issue situations that always exist within Army culture. However, EO violations are 

exacerbated in the Iraqi environment where males, are supposed bastions of sexual 

frustration and are in constant and close proximity to limited female soldiers. This 

close proximity disallows female soldiers the ability to ‘‘walk-away’’ when they find 

themselves in a situation they would rather not be in. 

Furthermore, upon discussing this topic with fellow female soldiers I realize 

women serving in Iraq get put into categories, as defined by their male counterparts, based on the females’ reactions to daily exposure to questionable situations. 

Army women in a war situation must overlook, on a daily basis, statements against 

their gender as well as a plethora of images that objectify women, all that would 

be legally unacceptable in the civilian world. More than once have I heard, ‘‘all 

Rules go out the window in War,’’ and many people believe that justifies violations 

of the standards. Thus the true sexual trauma in wartime Iraq is when the character of the female soldiers is determined by their male soldiers. I have tried to 

work out how to paraphrase some of the definitions so I do not offend anyone, but 

the reality is I cannot, nor should I, because these are the labels female soldiers 

are given everyday in Iraq and they are not easy to live with and they cannot be 

sugar-coated. The following are the loose categories for female soldiers that I have 

come up with: the weak and emotional female who cannot hack it, or the poor sport; 

the bitch; the good sport or the ‘‘pal’’; the flirt which will ultimately evolve into 

‘‘slut’’; and/or certain combinations of the above. 

Following are five brief stories of five different women who have served in Iraq 

between September 2005 and present-day: 

STORY ONE

My story. I was assigned to a small Infantry base where very few female soldiers 

lived, or had ever been. Aside from lack of female only facilities (i.e., showers and 

latrines) I lived in a house with 20 males. Nearly every living space in the house 

was covered with photos of scantily clad women from FHM and Maxim magazines. 

More than one conversation was an inappropriate conversation of a sexual nature. 

But these are the things I overlooked in order to be a ‘‘soldier’’ and not a ‘‘female 

soldier.’’ However, mainly due to my mature age (usually at least 10 years older 

than those I was serving with) I found it easy to steer clear of immature conversations and chose not to participate. Nor did I flirt with them as other females did, 

in order to boost their egos. I quickly became the ‘‘poor sport’’ and/or ‘‘bitch.’’ When 

they mocked me about my age and my appearance, I was deemed a weak female 

that could not hack it when I took offense at being called unattractive and old. 

As the deployment progressed my Team Leader took liberties with my personal 

space. We were only separated by a thin wooden wall and a curtain for a door. He 

would routinely bust into my living space without knocking, under the premise that 

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I was a ‘‘soldier’’ and not a ‘‘female.’’ I began to weigh my curtain down with heavy 

items to discourage him, it did not work, he only pulled harder. More than once I 

was lying on my bed with headphones on only to look up and see he had already 

made it into my room and was staring at me. I began to dress in the shower room 

for fear he would walk in at any moment. 

In addition, my objection to my Team Leaders included his aggressive actions on 

missions. My objections got me deemed a weak and emotional female. My Team 

Leader would act aggressively on the roads and run Iraqi drivers off the road, more 

for sport, than for safety. One day, it became an almost deadly situation. A male 

team member who outranked me, said he would speak to our Team Leader about 

it. Nothing changed. I once found an article about how poor soldier road behavior 

creates enemies among the civilian populations of Iraq/Afghanistan. I showed my 

Team Leader. Afterwards, I found out he went to a training weekend that had representatives from several teams with varying ranks in our Area of Operations and 

was mocking me openly because I was upset when he ran non-threatening Iraq civilians off the road. He made no mention of the male team members who objected, 

but blamed my emotional predisposition as a female for my protests. 

Aside from my Team Leader, I felt safe with those I served with when we went 

out on missions into the villages. It was only when I returned back to base did I 

feel ostracized and thus did I isolate myself more and more in the ‘‘safety’’ of my 

room as the mission progressed. According to the males I served with I was, at the 

same time, overly emotional and a bitch, two ideas that would seem naturally contradictory. 

STORY TWO

Another female that was on my base did play at the game of flirtation to get what 

she wanted from her male counterparts. She told me once she enjoyed her celebritylike status on the small base and used it to her advantage. Many guys liked her 

because she was a ‘‘good sport’’ and would joke around with them. Eventually they 

turned against her. By the end of our deployment her picture had been posted on 

a wall in an open office environment with the phrase ‘‘Slut of Bayji (our base location),’’ underneath it. With only two weeks left in Iraq, her work environment had 

become so hostile that she asked me if I could convince my team leaders to let her 

work from our office instead, even though it was further away from her living quarters and her chain of command. We allowed her to work with us. Her demeanor had 

changed completely, she barely talked to anyone in the carefree manner she had before and could rarely be found. She has since left the Army. 

STORY THREE

Female Three was to be transferred to our team because her Team Leader had 

exposed himself to her. When word got out that another female was coming to our 

house many of the guys I was living with kept saying they hoped she would be put 

into their room because she was ‘‘hot.’’ Similar comments even came from those who 

knew why she was being transferred. They did not see her as another soldier that 

would assist our mission capabilities, but as an opportunity for flirting, and perhaps, sex. Fortunately, mission focus changed and she was never transferred to us. 

STORY FOUR

The next case I hesitate to bring up because I know the female will be judged 

before most people get passed the immediate description of her case and will pass 

judgment on her and may not look beyond it to determine whether she was treated 

fairly or not, and/or subjected to gender specific punishment. I will set up the situation and then let her own words make her case, she is still currently serving in Iraq 

under this command. 

Female Four is a friend of mine and I have not worked with her in Iraq, but know 

her personally and feel I can describe her and her likely conduct in Iraq with some 

authority. Female Four is an attractive, petite and friendly female. Because of her 

self-confidence she can hold her own in many a ‘‘questionable’’ conversation and 

would likely overlook these conversations and other aforementioned scenarios as 

most female soldiers would in order to focus on the mission. She is fully capable 

of her position as an Arabic-trained interrogator. 

Unfortunately, Female Four unknowingly became pregnant during the mobilization process in the States, but it was such an early pregnancy it was missed at the 

mandatory pregnancy test administered before deploying to Kuwait/Iraq. While conducting missions in Iraq she became very ill. It took several weeks to determine that 

the cause was morning sickness. It turned out she was pregnant. From here I will 

let her tell her story in her own words:

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‘‘I deployed August 11, 2006 to Kuwait, and found out September 26, 2006 

that I was pregnant, 10 weeks pregnant. I informed my First Sergeant [1SG] 

the same day and told him that it was my intent to have an abortion and return 

to Iraq as soon as possible. 

My immediate chain of command was supportive. Within a few days I had 

my stuff packed and was in Baghdad, I thought, waiting for a flight. Turns out 

I was wrong. They did a 15–6 investigation into the incident, which makes 

sense. During the investigation the officer in charge told me, ‘‘you can write 

whatever you want in your statement but there is nothing in general order 

number one that says you can not have sex.’’ No matter how many times I said 

it happened before I got here, I am pretty sure no one outside of the people who 

know me, believed me. (Note: some females get pregnant on purpose to get out 

of deployment, in which case an investigation would be warranted, however, a 

soldier who did it on purpose would not likely get an abortion and request to 

return to duty.) 

I was stuck in Baghdad for over a week and worried because I thought I had 

only until my 12th week to have an abortion legally. Anyway, I finally got notified that I had a flight and was called into the Battalion Commander’s (BN 

CDR) office the afternoon prior. I assumed it was for encouraging words. 

Instead I was read the most horrifically offensive, insensitive, immature letter 

of reprimand I could imagine. The letter promised that the Brigade (BDE) 

would personally make sure I was barred from reenlistment, among other downright nasty insults, insults of a personal, not a professional letter. 

I was furious. I went to JAG immediately but was pretty much told—see JAG 

when you get back to the States. All I was able to do was apply for an extension 

so that I could write my rebuttal (the timing was such that I would most likely 

get back to the States the day my rebuttal was due, without having had time 

to go to JAG). My request for a ten-day extension was denied—I was granted 

five. 

Two days after I got back to the States I had my abortion. 

I went the next day to JAG, wrote a letter of rebuttal, outlining all of the 

facts, that clearly showed I became pregnant through normal sexual behavior, 

clearly had no intention of becoming pregnant, and clearly had no knowledge 

that I was pregnant. Moreover, I had chosen the mission first and would be returning. 

A day later my rebuttal was rejected. My rejection letter reiterated that the 

Brigade Commander, COL XXXXX had already initiated my bar to reenlistment. 

I had to wait in the U.S. five weeks until I finally passed a pregnancy test. 

I came back to my unit and was welcomed back by everyone. I was told that 

I was to return to my team in a few days. 

A few days later I was told that my team was changing locations and would 

be moving all of their things to Baghdad, so I would just wait in Baghdad, get 

my interrogation certification training done, then move out with them to Tikrit. 

I was in Baghdad for two more weeks when I was told that COL XXX XX had 

picked me to move to the HARC [a military intelligence office position]. I would 

be transferring battalions the next day, but they were barely expecting me, they 

had not been looking for someone to fill the slot and they were shocked to find 

out that I was a 97E Arabic linguist, an interrogator not an intelligence analyst. 

They were even more shocked to find out that I did not have a Top Secret clearance and so could not take the job ‘‘hand-picked’’ for me. 

When they took this up the chain of command, they were told that they had 

to keep me and to put me to work in the orderly room. The 1SG, a friend of 

my original 1SG, said he had no work for me. This saved me. 

I got transferred a few days later back to the 502d MI BN. I was put into 

HHS and told that I would be working in the S3, a logistics position and I had 

no choice. I met my new NCOIC (Non Commissioned Officer In Charge) and 

was told that I would be the Air Movement Request person. I would work at 

the TOC 12 hours a day, and put in flight requests for any of the S02d line 

companies. 

I was freaking out. I went to EO, IG (Inspector General) and JAG. Everyone 

told me the same thing—it sounds like this is personal, but a commander had 

leeway to move his assets however he wants. I even asked—so if I do not get 

an EOT (Equal Opportunity Treatment Complaint), I do not get promoted and 

I am shuffled around to worse and worse jobs by him personally for the rest 

of the tour—I have no recourse? The answer was ‘‘yes.’’ I asked, ‘‘who has oversight?’’ ‘‘No one’’ was the answer, unless I wanted an open door with a one-star 

70

General who would probably not get a chance to see me until the end of my 

tour, if ever. 

So I went to the logistics position. The CSM (Command Sergeant Major) actually told me to come to his office. He said, I bet you are wondering why you 

are here. I asked. I asked a lot. And he told me, ‘‘the BOE commander had 

issued a direct order that you will not be on any [Tactical HUMint Team], nor 

will you have any soldiers under you. Period. We had to fight hard to even get 

you in the S3—this was the best we could get for you. It is personal from him 

to you.’’

Yes, the CSM actually told me this. 

So that is my story. Is it sexual trauma—no. But is it harassment of the 

worst form? Yes. Is it applying a ludicrous series of emotionally fueled assumptions about ‘‘female behavior’’ in general onto one person, with no eye to the circumstances and no attempt to behave professionally? Yes. This man has power, 

but he uses it when he does not need to. 

The only way that I am not barred from reenlistment is that he tried to order 

my company commander to initiate it and my commander, after going to JAG, 

refused. 

My old team leader even went to the BOE COR and asked for me back. When 

he said my name the COL got all red in the face and yelled NO WAY!

STORY FIVE

Female Five is the most extreme of cases. She is young, petite, pretty and friendly, all things that would prove to work to her disadvantage. I have worked with her 

in the past and know her to be of a strong character that does not use her appearance to take advantage of her situation. When she got to Baghdad-area she was separated from the Military Intelligence (MI) command she came with and placed with 

a group of Military Police (MP) who had specifically requested a female interrogator. 

She was the lowest ranking of those she served with and the only female. Highly 

inappropriate conversations of the sexual nature followed her wherever she went. 

Unlike myself, who felt safe and insulated from derogatory commentary while on 

missions, for her, her harassment continued. For example, a Senior NCO that outranked her by three ranks would call out over the radio, while on mission, and ask 

her about her preferred sexual positions. Everyone would hear this and laugh. She 

was decidedly embarrassed. Other MPs that she worked with would routinely graze 

her breasts or touch her thigh in fictional scenarios that involved them reaching 

across her. The following is her story in her words:

As a female in the military, you are considered either a ‘‘bitch’’ or a ‘‘slut’’. 

A female that keeps to herself, who works hard at her job, and who demands 

that people take her seriously as a soldier is considered a bitch. Whereas a female that is friendly, outgoing, and that enjoys having fun is thought of as a 

slut. In a military environment, there is no in-between; both carry stigmas and 

neither title is avoidable or reversible. I have been both a ‘‘bitch’’ and a ‘‘slut’’ 

at different times throughout my military career. 

I quickly learned that by being the social butterfly that I am gave me ‘‘slut’’ 

status. I felt like flypaper for freaks. Although having ‘‘slut’’ status meant I 

could be myself, I was insulted that my guy friends never really viewed me as 

just a friend. I was not taken seriously and was constantly being disrespected. 

The general opinion that I was ‘‘easy’’ followed me from my second training station to my third, and when I was finally handed my 00214 release from active 

duty I vowed to not be quite as personable the next time. So when I was mobilized a year later, I built a wall around myself and reentered active duty with 

my guard fully up, allowing myself to quickly obtain ‘‘bitch’’ status. 

At first I was relieved; no more unwanted attention, no more random guys 

trying to get my number, nobody knocking on my door at night trying to get 

me to go out so they could attempt to get me drunk. I was a bitch, and I intended to keep it that way. 

Upon arrival in Iraq, I was assigned to a military police (MP) brigade, and 

my team of two other guys were given a squad of nine MPs to escort us on our 

missions throughout Baghdad. Each of the men on our squad detested three 

things in particular: Military Intelligence, ‘‘bitches,’’ and above all, taking instructions from ‘‘bitches’’. They had wanted a ‘‘slut’’ as the only female on their 

squad, and they were beyond disappointed when they got me. I had no intention 

of taking my guard down; I was there to do a job, and that’s all I was going 

to do. 

As the assistant team leader of my tactical human intelligence team, I often 

planned my team’s missions for our squad to escort us out on. My job was to 

71

then inform our squad leader of our plans and it was his job to prepare a convoy 

plan. But my squad hated taking instructions from me, not only because I was 

a female but because I was about 10 years younger than each of them. Often 

times they disregarded my plans and caused our team to lose access to valuable 

intelligence. I ended up having to have one of my male teammates present my 

mission plans to our squad just to avoid their disrespect. But that plan backfired on me when they started rumors that I was no longer doing my job planning missions. However, that was the least of my problems. They slowly began 

breaking me down with their words, each day bringing me closer and closer to 

giving up completely. 

In the Army, they brief you every six months on sexual harassment. They tell 

you that you should first confront the person bothering you, and if that does 

not work, utilize your chain of command. So I confronted the two guys that harassed me the most. I told them the things they were saying made me uncomfortable and that they were egging the other guys on. They were surprisingly 

cool about it; they said they would cut it out. The next day I arrived at our 

headquarters only to have every guy on my squad making fun of me; cracking 

jokes and then sneering at me saying, ‘‘I’m sorry, did I offend you, Smith? Are 

you uncomfortable?’’

The harassment worsened; I endured countless rude comments, filthy jokes, 

and inappropriate questions from the MPs. I was disgusted with myself for even 

coming forward and telling them to quit it in the first place. So disgusted, in 

fact, that when my First Sergeant got wind of what was going on, I denied everything, saying they were just being playful and they did not bother me in the 

least. I feared that if my chain of command investigated the situation, the MPs 

would deny everything and the harassment would only get worse. 

My fears came true when my First Sergeant finally went to speak to the MPs. 

I told him later what had gone on because of his interference in the situation, 

and asked if I could be removed from the team. I was told there was no other 

place for me; that a female was necessary on that specific team, and I was the 

only one available for the job. I was devastated; not only had my situation worsened, but the person who had seemingly been on my side a day earlier was now 

leaving me to be preyed upon by my harassers. 

As a soldier, you are trained to ‘‘drive on’’, no matter the circumstances. 

‘‘Adapt and overcome!’’ they say. For 6 months I ‘‘drove on’’. I thought, ‘‘Maybe 

they are right, maybe I am just being sensitive.’’

But in reality, the harassment was killing me; I lost my appetite, stopped exercising, did not socialize, rarely called home, and was crying on a regular basis. 

I began to wonder what it would have been like had I obtained ‘‘slut’’ status 

instead. Would my deployment have been easier? Would my squad respect me? 

Could any female soldier, bitch or slut, ever have her male counterparts actually respect her? If respect was impossible to attain, should I have strived for 

their admiration instead? Upon realization that I was beginning to justify the 

harassment, I decided that I desperately needed help; I needed a way out of this 

situation. 

So I reluctantly went to my unit’s Chaplain, who listened to each of my woes 

without a word. ‘‘Should I beg for them to let me off the squad? Go to my chain 

of command about the harassment? Or see a psychiatrist because maybe I am 

just crazy and none of this is really happening? ’’ My mind was full of questions, 

and what I wanted was an answer to my problems. 

I finished speaking and was staring at the Chaplain with a look of desperation on my face. He nodded his head slowly like he understood completely, as 

if he knew exactly what I should do. I was practically on the edge of my seat 

when he finally answered. ‘‘Smith’’, the chaplain said, ‘‘I’ve known some great 

guys that were MPs. Great guys. . . My best friend was an MP. But those guys 

were exceptions, because MPs are scumbags.’’

This was hands-down the best piece of information I had ever received. This 

was better than any therapy session or anti-depressant. It was so simple, yet 

it made so much sense. These guys were not even worth worrying about. They 

were scum. 

The Chaplain continued to explain that I would meet many more scumbags 

in both my military and civilian life, and these guys were like practice for the 

future. If I let these scumbags get the best of me that was like letting them 

win on behalf of scumbags everywhere. 

With that, I left his office feeling not so lucky to be tested by a bunch of 

scumbags under such stressful conditions, but still feeling a whole lot better. 

72

The next day I woke up half an hour earlier than usual. I was the first one 

at headquarters, and had my vehicle cleaned and fully maintained before the 

rest of my squad even showed up. 

Every day, I arrived a little earlier and worked a little harder than my male 

colleagues. If they made a filthy comment or cracked a rude joke, I would roll 

my eyes and shrug it off. I did not try to crack one back; I did not want to lower 

myself to their scumbag level. I went out and collected more Intel than ever, 

and produced 75 percent more reports than my male teammates. This was not 

a competition; I was not trying to prove myself to them or anyone else. I was 

showing them that they could not break me. That I was not backing down. I 

made it nearly impossible for them to give me any grief. By not appearing uncomfortable by their crude talk, their harassment even began to subside. They 

had nothing on me. 

Before I knew it, my deployment was ending. I had had 17 Intel reports published nationally since my talk with the chaplain, several more than the 6 

months prior. I had accomplished more than some people accomplish in their 

lifetime. I had not been able to be myself for a whole year, but I had not gone 

to Iraq to be myself. I had gone there to accomplish a mission, and that is exactly what I did. I cannot say my squad respected me much more than before, 

but I can say that I was no longer disrespected like the ‘‘sluts’’ were. 

Being considered a ‘‘bitch’’ really sucks, but it has more pay-offs than being 

considered a ‘‘slut’’. I left Iraq with something way more precious than a long 

list of admirers. I left Iraq with more courage, greater confidence in myself as 

a soldier, and most importantly, self-respect.

Female Five now holds the strongest opinion against females serving in a warzone. She does not think any female should be sent to a war-zone unless she specifically volunteers because the hostile work environment is so severe that it is debilitating. What I found most troubling about her story was that the Chaplain told her 

scumbags were everywhere. When I told her that in my 13 years of civilian employment I had never been treated poorly due to my gender and that the civilian world 

is 180 degrees different than the military she was relieved that the severity of 

issues she experienced would not likely be repeated on the civilian side. She has 

since gone through therapy to work through these issues. 

To conclude, we do our female military personnel serving in Iraq and Afghanistan 

a great disservice by focusing on rape as the definition of sexual trauma. Respective 

chains-of-command can often be the problem or fail to offer a solution to harassment 

at its most basic levels, so why would female soldiers trust them when the stakes 

increase? As these stories have shown a woman enters war often at a disadvantage 

that she will never overcome no matter what her behavior. This is sexual politics 

and trauma of the most extreme kind. Every soldier, female and male, needs their 

head in the game when at war and female soldiers should not be suffering from 

physical or emotional trauma from their fellow soldiers simply because they were 

born female while they deal with the stress of war.

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