Oct. 11, 2004 – In the wake of a July studyâ€™s revelation of a "significant risk" of increased mental disorders for soldiers returning from active combat duty in the Middle East, some veterans' groups voiced their concerns that Congress has allocated insufficient funds to effectively address this problem. The July 1 report, published in the New England Journal of Medicine, was the product of a 2003 study by a group of doctors from the Department of Psychiatry and Behavioral Sciences at the Walter Reed Army Institute of Research.
Participants answered questions that evaluated symptoms of generalized anxiety, major depression, post-traumatic stress syndrome and alcohol misuse. Results were obtained via anonymous questionnaires given to 2,530 soldiers awaiting deployment to Iraq and 3,671 soldiers who had been in the US for three or four months after returning from Iraq or Afghanistan. The study reported that between 11 and 17 percent of returning troops, depending on branch of military and country assignment, suffered from one or more symptoms of a mental illness compared to 9 percent of soldiers awaiting deployment.
Of those with symptoms of mental disorders, only 23 to 40 percent, depending on branch of military and country of deployment, requested mental health care. The report found that troops who had symptoms of mental disorders were twice as likely as other respondents to perceive obstacles for military personnel who wish to seek mental health care, including risking stigmatization.
The report found that troops who had symptoms of mental disorders were twice as likely as other respondents to perceive obstacles for military personnel who wish to seek mental health care, including risking stigmatization.
"There's a lot of peer pressure and pressure from military authorities [not to report mental illnesses]," said Dave Collins, Austin, Texas spokesperson Veterans for Peace, a member and foundation funded peace group founded by American veterans. "Guys kind of absorb the mentality that, 'If I say anything, I'm a wimp.'"
NEJMâ€™s report recommended that military brass and lawmakers ensure increases in confidentiality and access to mental health services become a top priority in future planning.
The "attitudes of a warrior culture when it comes to seeking help" aside, said Dave Collins, "what's within our power is the funding [of veteran's care.]"
"All this is occurring within a context of rapidly increasing health care for all of us," Collins said. Countrywide, health care costs rose at 2.6 times the rate of inflation in 2003 according to numbers from the Bureau of Labor Statistics.
"There's going to be a lot of health issues for veterans," he says. "The bottom line is we're going to see a lot of psychiatric problems," he said, noting the study did not include soldiers who had been injured. "We don't look at those costs when we look at the costs of the war."
The Veteran's Administration (VA) needs mandatory funding, Collins said. "What happens now is every year itâ€™s a political football," he said. "But this is an ongoing program that's expected to last many, many, many years."
"All categories of spending that are considered discretionary become fair game for arm twisting and debate and compromise," Collins said. "The political process overwhelms the question of need."
Every year, the President and the Congress must decide how much is spent on discretionary funding and what programs that funding will cover. Mandatory spending is authorized by permanent laws, not by annual appropriations bills, and accounts for about two-thirds of all government spending. It includes entitlement programs, like Social Security, Medicaid, Medicare, as well as interest on the national debt and government securities and bonds.
"When it comes to the VA, you are really talking about matters of life and death," Collins added. Unlike building roads, which are subject to the push and pull of discretionary funding, he said, the VA should be a program that is fully backed by mandatory government spending.
Right now, about half of the VA budget, primarily health care costs and general administrative costs, come out of discretionary spending.
"The Pentagon's got as big a budget as it had at the height of the Cold War," says Veterans for Common Sense (VCS) Director Charles Sheehan-Miles. According to the group's website, the member and foundation funded VCS was founded by veterans in 2002 in response to what they describe as an abrupt turn towards unilateralism in American foreign policy.
"But we're spending [too much] money on things like missile defense. The money's there [to provide additional support to vets], but it's being spent elsewhere." However, even with increases in funding to the VA, Sheehan-Miles says, more veterans are using its services, so spending is not keeping up with demand.
Last year, a Congressional Budget Office (CBO) report also noted that at least 23 percent of the growth in veterans health care costs are due to the rise in the number of dependents being added to vetsâ€™ health care plans, as well as the increasing number of veterans entering retirement. In terms of funding the VA, said Collins, "The general trend is up. The reason the trend is up is because the general trend of health care [expenses are] up."
According to a summary of the VA-HUD FY 2005 budget put out by the House Committee on Appropriations, the House budgeted an increase in VA discretionary spending of $1.9 billion up from 2004, for a total budget of $30.3 billion, less than 10 percent of the Pentagonâ€™s overall military budget.
But maneuvering on the VA budgetsâ€™ periphery can shield millions of dollars in reductions from the public eye. Vets groups have also been critical of the Bush Administrationâ€™s plans to include additional user fees tacked onto services for some veterans, while trying to sell vetsâ€™ out-of-pocket expenses for services as budget increases. This summer, Appropriations Committee members backed the presidentâ€™s proposed fee increases in the FY 2005 budget
In 2003, a CBO report estimated DoD medical budgets could see an annual increase of $7 billion, or 15 percent of the total "operations and support" budget by the year 2020 if benefits are extended to retirees under 65 and reservists - many of whom are serving on the frontlines in Iraq.
Since embarking on the invasion of Iraq, the Department of Defense has experimented with different types of health care modifications for reserve members and their families, notably waiving deductible payments for reserve families. The Bush Administrationâ€™s unprecedented use of reservists since 2001 â€“ what some critics have referred to as part of a backdoor draft -- has stirred grievances among reserve members and their loved ones, especially among reservists who may have lost their jobs as a result of extended service.