Treating Our Wounded Warriors for Mental Health and Traumatic Brain Injuries

The Wounded Warrior Project® (WWP) began some 10 years ago when some fellow veterans and friends took action to provide comfort items at Walter Reed Army Medical Center to wounded service members returning home from Afghanistan and Iraq. Ten years later, with a stated mission to honor and empower our wounded warriors, WWP has grown into a holistic rehabilitative effort to assist wounded warriors recover and transition back to civilian life. Tens of thousands of wounded service members, their family members, and caregivers receive support each year through 19 separate WWP programs.

Some of you may know of the WWP through its national fund raising efforts, such as the Billy Casper Golf’s (BCG) fourth-annual “World’s Largest Golf Outing” – a simultaneous event played at more than 110 BCG-managed golf courses in 28 states on Monday, August 11 – which raised more than $875,000, a record high, for WWP. Over 12,000 golfers, including 439 injured service members, participated in this largest, single-day golf fundraiser in the history of WWP. Former President Bill Clinton, the 2014 recipient of the PGA of America’s Distinguished Service Award, supported the World’s Largest Golf Outing in his suburban New York City community.

Several WWP programs provide assistance for veterans who are suffering with mental health problems or traumatic brain injuries (TBI). They include:

  • Combat Stress Recovery Program addresses mental health needs of injured service members through innovative programming and therapeutic options for the stages of the readjustment process.
  • Project Odyssey® uses the healing power of nature, along with support from mental health professionals and staff, to help wounded service members gain perspective on life through outdoor activities and retreats.
  • Restore Warriors® (org) is a website for warriors and families looking for information and practical advice about living with combat stress and post-traumatic stress disorder (PTSD).
  • The Independence Program offers the opportunity for warriors who have suffered TBI, spinal-cord injury, or other neurological conditions to engage in social, recreational, wellness, education, volunteer, and other activities.
  • Physical Health & Wellness programs serve all Alumni (including those with amputations, spinal cord injuries, burns, visual impairments, TBI, PTSD, and other cognitive or mental health conditions) and are designed to optimize the physical and psychological well-being of Alumni through comprehensive recreation and sports programs, physical rehabilitation, and nutrition programs.

 Mental Health Needs

The WWP has provided testimony at 16 congressional hearings on mental health issues since 2011. As part of its government advocacy efforts, on July 10, 2014, WWP Alumnus Josh Renschler, testified before the House Committee on Veterans Affairs on the VA’s mental health care programs. Renschler, Sergeant U.S. Army (Retired), served as an infantryman for five and half years before being medically retired following a mortar blast in Iraq in 2004, where he sustained severe back injuries and subsequently developed PTSD. Renschler testified that “access” to mental health care alone will not solve the problems facing injured service men and women. According to Renschler, “Access to a system where I go to three different buildings to see three different providers for health issues that are all related to my mental health – pain, lack of sleep, and relationship issues – is a real problem when those providers aren’t working as a team, and aren’t even given the time needed to coordinate their observations and treatment approaches with one another. In other words, access to mental health care isn’t enough unless that mental health care is also effective.”

Renschler also cautioned that proposals to expand veterans’ access to non-VA mental health care provide no “silver bullets,” given a national shortage of mental health care providers. While he believes “there are VA facilities that are providing veterans’ timely access to effective, patient-centered mental health care, that is not the case systemwide. Unfortunately there are no measures in place to assess patient outcomes.”

Renschler’s claim that there are “no measures in place [at the DoD and VA] to assess patient outcomes” is supported by a June 20, 2014 Institutes of Medicine (IOM) Report Brief. The IOM brief notes that between 2004 and 2012, the percentage of all active-duty service members with a diagnosis of PTSD increased from 1 to 5 percent. In 2012, more than half a million veterans of all eras sought care for PTSD through VA health care services—making up 9.2 percent of all VA users. Almost 24 percent of these veterans (119,500) had served in the Afghanistan and Iraq conflicts.

The IOM brief found that neither DoD nor VA has a mechanism for the systematic collection, analysis, and dissemination of data for assessing the quality of PTSD care. The report also found that: (1) many of the DoD and VA PTSD care programs and services are under different commands and authorities, which makes it difficult to identify and evaluate them; (2) neither DoD nor VA is in a position to provide high value care, primarily because of the lack of outcome data, but also due to the absence of cost information for certain treatments; and (3) although the DoD and VA have taken the important first step to increase access to care, the referral process to purchased care providers appears to be ad hoc rather than thoughtful clinical decision making, questions remain about providers’ adherence to the VA/DoD Clinical Practice Guideline for Management of Post-Traumatic Stress, adequacy of training in evidence-based treatments for both direct care and purchased care providers, and the ability of providers to deliver that treatment.

The WWP’s 2013 Annual Alumni Survey further supports the existence of a problem in providing access to and adequate mental health care for our veterans. For example, the survey shows that 75.4 percent of WWP alumni reported having experienced PTSD, but only 55.2 percent of WWP alumni said they had visited a professional to get help. The survey also found that 34.2 percent of WWP alumni said they had difficulty in getting mental health care, put off getting such care, or did not get the care they needed. The reasons reported included inconsistent treatment or lapses in treatment, and feeling uncomfortable with existing resources within the DoD or VA. In fact, only 9.8 percent of WWP alumni reported they have not had any mental health concerns since deployment.

 Traumatic Brain Injuries

On July 29, 2014, after lobbying by WWP, the U.S. Senate and House Committees on VA Affairs included a three-year extension of the VA’s Traumatic Brain Injury (TBI) Assisted Living pilot program in their compromise VA legislation. This extension provides a reprieve for wounded veterans who would have otherwise been evicted from their rehabilitation programs and reopens the program for those who were locked out since February 2014. Specifically, H.R. 4276, the Veterans Traumatic Brain Injury Care Improvement Act of 2014 – amends the National Defense Authorization Act for Fiscal Year 2008 to extend the VA’s Traumatic Brain Injury (TBI) Assisted Living pilot program to assess the effectiveness of providing assistance to eligible veterans with traumatic brain injury to enhance their rehabilitation, quality of life, and community integration.

On August 7, 2014, when President Obama signed into law the $16.3 billion landmark reform of the troubled VA (the Veterans Access, Choice and Accountability Act (H.R. 3230)), it included the provisions of H.R. 4276 in Title V of the Act.

WWP has announced that it is pleased not only with the VA bill’s extension of the TBI Assisted Living Pilot Program, but also the emergency funding for VA staff and facility expansion, and the prospect that “wounded warriors will benefit from a requirement that public colleges and universities limit the tuition costs to post-9/11 GI-bill beneficiaries to in-state tuition rates regardless of the veteran’s state of residence.”

However, while the WWP is pleased with the congressional compromise and passage of the VA overhaul bill, it continues to be concerned that with a “national shortage of primary care physicians and mental health providers, and a culture that allows access issues and cover-ups to fester, the promise of this legislation may not be realized.”

 Other WWP Programs

Fourteen additional WWP programs also focus on engagement of the wounded warrior, the nurturing of his or her mind and body, and encouraging economic empowerment. These WWP programs include:

  • The Alumni program offers assistance, communication, and camaraderie for injured service members through educational sessions, sporting, and social events.
  • Benefits Service provides Alumni and their families with information and access to government benefits and a full range of programs and the community resources necessary for successfully transitioning to life after injury.
  • International Support supports warriors at Germany’s Landstuhl Regional Medical Center (LRMC), the Ramstein Air Base, and those in the Warrior Transition Battalion (WTB) in Europe.
  • WWP Packs contain essential care and comfort items designed to make wounded service members’ hospital or poly-trauma center stay more comfortable.
  • The WWP Resource Center responds to specific internal and external resource requests and proactively reaches out to Alumni and their family members to engage them in available programs and services.
  • Peer Support mentors are trained to be resources and listeners who can share their understanding and perspective with Alumni and their family members.
  • Family Support reaches out to the family members who suddenly find they are serving as full-time supporters or caregivers.
  • Soldier Ride® is an initiative that provides adaptive cycling opportunities across the country to help Alumni restore their physical and emotional well-being.
  • Education Services provides outreach, information, and self-advocacy skills training to Alumni interested in attending or returning to school or who need support while in school. WWP also provides information and resources to help colleges, universities, and vocational programs support, accommodate, and retain student warriors.
  • TRACK™ is the first whole-life approach to education for Alumni. This one-year program focuses on academic and vocational needs, including the ability to earn up to 24 credit hours at a local college, health and wellness training, and individualized performance and goal-setting training.
  • Transition Training Academy™ (TTA) provides the opportunity for WWP Alumni to learn valuable information technology (IT) career skills with future employment opportunities. TTA has perfected a unique, blended learning environment designed expressly for wounded service members, and allows WWP Alumni to explore the IT field as a career.
  • Warriors to Work™ provides career guidance and support services to wounded service members interested in transitioning to the civilian workforce. Warriors to Work specialists assist Alumni with individualized goal setting, building an effective resume, preparing for an interview, networking, access to internships, and assistance with job placement.
  • Policy & Government Affairs provides a voice to the thousands of wounded service members we represent at the Federal level. WWP creates, advocates for, and helps to implement legislation that will maintain wounded service members and their families far into the future and keep them informed about changes in laws and programs that will impact them.
  • Community Integration Grants provide grants to organizations dedicated to honoring and empowering Wounded Warriors. By providing these grants, WWP is able to increase the breadth and scope of programs and services offered to wounded service members while continuing to reach out on a local level.