Dr. Sally Satel dumps on PTSD Vietnam Veterans.....AGAIN!

[Gimpy]

"THINK-TANKER" DUMPS ON PTSD VETERANS -- DR. SALLY SATEL'S
OPED PIECE IN THE NEW YORK TIMES


She states, and I quote:

"...some...who have filed claims in recent years did so not out of medical need but out of a desire for financial security in their retirement years."


"Only in rare instances should veterans be eligible for lifetime disability...there should be a deadline of years after service by which claims must be submitted...Decades after a war is too late to make sense of [PTSD]"

Dr. Sally Satel is a "pay for opinion" writer for the arch-conservative American Enterprise Institute (AEI).

Her anti-veteran and anti-PTSD agendas are well-known. She was employed by the American Enterprise Institute as a "hired gun" to bolster their efforts to reduce government spending on so-called "social programs" which they consider Veterans Benefits and programs to be a part of. They will go to any lengths and use any dirty tactics and/or unscrupulous methods they can to undermine whatever they consider to a "target" for 'downsizing' government insititutions.

Here's some background on Satel...

http://www.vawatchdog.org/old%20news...-27-2005-2.htm

On the same day that the Pentagon releases a study about mental health issues with our troops who are coming home, Satel and the American Enterprise Institute manage to get their anti-veteran agenda published. Timing is everything. A look at the Pentagon study here... http://www.vawatchdog.org/old%20news...-01-2006-4.htm

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Op-Ed Contributor

For Some, the War Won't End


By SALLY SATEL
Published: March 1, 2006

THE NEW YORK TIMES

Washington

ACCORDING to a report from its inspector general, the Department of Veterans Affairs is now paying compensation for post-traumatic stress disorder to nearly twice as many veterans as it did just six years ago, at an annual cost of $4.3 billion. What's more surprising is that the flood of recent applicants does not, for the most part, consist of young soldiers just returned from Iraq and Afghanistan. Rather they are Vietnam veterans in their 50's and 60's who claim to be psychologically crippled now by their service of decades ago .

This leads to an obvious question: Can it really take up to 40 years after a trauma before someone realizes he can no longer cope with the demands of civilian life? The answer: possibly, but it is often hard to know which applicants can be helped with short-term psychiatric care, which are seeking a free ride and which are truly deserving of the diagnosis of post-traumatic stress disorder and thus long-term care and payments of up to $2,300 a month for life.


Medically speaking, there is some evidence to support what psychiatrists call "reactivated" post-traumatic stress disorder. The literature is dotted with cases of veterans of World War I, World War II and the Korean War who, after briefly showing signs of stress disorders in the immediate aftermath of their ordeals, led productive lives for decades before breaking down in their 60's and 70's. Little is known about the treatment of reactivated symptoms, but there is reason to be optimistic that patients will recover nicely in view of their having functioned well for so long.


But it's also very likely that some of the veteran baby boomers who have filed claims in recent years did so not out of medical need but out of a desire for financial security in their retirement years. Indeed, 40 percent of last year's claimants had been out of the military for 35 to 49 years.

(That's US she's talikng about fellas!..........I don't paticularly like being accused of lying and cheating.........do YOU!?.....---Gimp)

In any case, the rush of applications for long-term disability entitlements reflects the extent to which the culture of the Department of Veterans Affairs since Vietnam has become fixated on post-traumatic stress disorder. While claims for all other forms of mental illness, like schizophrenia and bipolar illness, have declined by about 12 percent of patients at veterans' hospitals over the last decade, the number of veterans receiving compensation for post-traumatic shock has nearly tripled.


Having worked as a psychiatrist at a Veterans Affairs hospital, I can attest to the good intentions with which the department created its post-traumatic stress disorder programs. But as the bureaucracy has become entrenched ? and politicians and veterans' groups have applied pressure ? a culture of trauma has blossomed. If a veteran can demonstrate service in Vietnam and simply list a few symptoms of the disorder (terrifying nightmares, bad memories, anxiety, survivor guilt and so on), there is a good chance he will be granted the diagnosis and a tax-free monthly stipend.


The problem in giving a diagnosis so long after a patient saw combat is that it can be very difficult to know whether traumatic exposure was the true cause. Yet many Veterans Affairs doctors and officials simply assume that participation in war results, de facto, in post-traumatic stress disorder. Whatever other problems a veteran may have ? alcohol abuse, erratic employment, domestic violence ? are seen as a product of the war experience.


Surely some of these applicants have "never been right," as their spouses often say, since their discharge from the military. Over the years they drifted further away from their families and communities. By the time they come to a veterans' hospital for treatment, they are seen as having "malignant P.T.S.D." ? that is, severe symptoms of post-traumatic stress disorder complicated by drug and alcohol abuse and other mental problems like depression.


The Veterans Affairs Department has to begin differentiating between several categories of delayed-benefit applicants. First are the chronically afflicted veterans who were probably damaged by the war but never got adequate treatment after discharge. These veterans fit the description of war casualties; their long-standing problems make them hard to treat, and thus they are good candidates for long-term care and subsidies.


The second group consists of those who are experiencing genuine "reactivated" symptoms from war trauma. Such patients will probably respond to therapy and not require long-term support.

Third are the veterans who managed to get diagnoses of post-traumatic stress disorder decades after their military service. They have made use of a system that has coalesced around the idea that combat is the root of all anguish. They deserve treatment to the extent that it can help, but rarely long-term disability payments.


As the department tries to distinguish among these groups, verification of exposure to trauma is vital. The inspector general's office found that for one-quarter of Vietnam veterans claiming post-traumatic stress, the department could not confirm any incidents of traumatic stress. A study in a leading psychiatric journal last year could not verify such history in 59 percent. True, military personnel records are not perfect ? a cook who endured a terrifying rocket attack on an airbase at which he was stationed may be unable to produce documentation of it. However, such records could indeed disprove the fabrications of a cook who claimed he was traumatized by a firefight on infantry patrol.


Most important, more rigor in diagnosing will conserve resources for veterans who are truly deserving. With a new generation of soldiers returning from Iraq and Afghanistan, the Veterans Affairs Department needs to look at post-traumatic stress disorder in a new way: the department must regard it as an acute but treatable condition. Only in rare instances should veterans be eligible for lifetime disability; and perhaps there should be a deadline of years after service by which claims must be submitted.


Someday, the diagnostic techniques may be sophisticated enough to help us parse the varieties of claimants; but for now we must be skeptical of veterans who file claims as retirement approaches. The Veterans Affairs Department should be spending its time and money helping our newest veterans now, when the psychological consequences of war have fresh meaning and patients have an excellent chance at recovery. Decades after a war is too late to make sense of post-traumatic stress disorder.

**Sally Satel, a psychiatrist and resident scholar at the American Enterprise Institute, is a co-author of "One Nation Under Therapy."


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Evidently the American Psychiatric Association (APA), which has recently spoken out about mental health services at the VA, is NOT in agreement with Dr. Satel.

And they are not happy.----Gimp

####START####

Statement of the
American Psychiatric Association
Presented to the
House Committee on Veterans? Affairs
Subcommittee on Health
February 14, 2006


The American Psychiatric Association (APA) would like to thank the members of Subcommittee and your House colleagues for your commitment to providing the highest quality medical care for our nation's veterans and to supporting necessary research to advance the quality of their care.

The APA is the national medical specialty society representing more than 37,000 psychiatric physicians nationwide who specialize in the diagnosis and treatment of mental and emotional illnesses and substance use disorders. At the federal level, the APA advocates for access to quality medical care, necessary supports to those living with mental illnesses and their families as well as investment in biomedical research.

The APA commends President Bush for adding $339 million to the FY07 budget for mental health inpatient, partial hospitalization and other services. Even with these additional funds, however, the budget is not adequate to meet the growing needs of veterans with mental illnesses. According to a recent article published in the New England Journal of Medicine, 15 to 17 percent of returning combatants from Iraq met the screening criteria for major depression, generalized anxiety or PTSD using the National Center on PTSD?s measurement scale. In addition, the Veterans Administration?s own researchers have published data in journal Psychiatric Services that documents the rise in mental health problems among its current patients, particularly younger veterans.


MENTAL HEALTH CARE NEEDS OF VETERANS

? Over 470,000 veterans are service-connected for mental disorders.
? Over 130,000 of these veterans are service-connected for psychosis.
? In 2003 alone more than 77,800 veterans received specialized care for PTSD with tens of thousands more receiving some type of care through their primary care clinic.
? More than 185,000 are service-connected for PTSD, a disorder most often directly
related to combat duty.
? Veterans with mental illnesses also have significant medical comorbitities and are therefore difficult and expensive to treat.
? Over 30% of the homeless population in this country are veterans with mental disorders and substance use conditions.


MENTAL HEALTH SERVICES FOR VETERANS


While the Administration?s budget does allow for increases in spending over FY06, the APA is concerned that the budget assumptions, such as the reliance of legislative proposals to collect user fees and copays from priority level 7 and 8 veterans, might be overly ambitious. The Friends of the VA advocacy group estimates that up 200,000 vets will drop out of the VA system with the proposed copays. While level 7 and 8 veterans are not service-connected for disability, we are concerned that the VA has not considered the impact on those 200,000 who rely on the VA to pay for psychiatric medications such as anti-depressants that keep them well and employable.


We urge Congress to require clarification of the Administration?s ?medical usage? projections which indicates the number of psychiatric patients drops as well as the number of vets in residential care. This projected decrease in care is troubling given that the VA?s mental health data shows the number of patients seeking psychiatric care will increase. We request that Congress also require further information from the VA on the discrepancy between the budget estimate for 2006 which cites the average daily census of inpatients and outpatients as significantly higher than the FY2007 budget request currently reflects.


For too long, mental health care has not been a priority for VA. Virtually every entity with oversight of VA mental healthcare programs ? including Congressional oversight committees, the GAO, VA?s Committee on Care of Veterans with Serious Mental Illness, and other groups such as The Independent Budget ? have documented both the extensive closures of specialized inpatient mental health programs and VA?s failure in many locations to replace those services with accessible community-based programs. The resultant dearth of specialized inpatient care capacity and the failure of many networks to establish or provide appropriate specialized programs effectively deny many veterans access to needed care. We continue to receive troubling reports suggesting that mental health funds may be re-allocated by the VA for other purposes. The APA requests that Congress task the Government Accountability Office with tracking the FY05 and FY06 funding allocated for the diagnosis, treatment and recovery of mental illness and substance use disorders as well as monitor VA compliance with Congressional recommendations.


Veterans with substance use disorders are drastically underserved. The dramatic decline in VA substance use treatment beds has reduced physicians? ability to provide veterans a full continuum of care, often needed for those with chronic, severe problems. Funding for programs targeted to homeless veterans who have mental illnesses or co-occurring substance use problems does not now meet of the demand for care in that population. Additionally, despite the needs of an aging veteran population, relatively few VA facilities have specialized geropsychiatric programs.


The APA is concerned that VA mental health service delivery has not kept pace with advances in the field. State-of-the-art care requires an array of services that include intensive case management, access to substance abuse treatment, peer support and psychosocial rehabilitation, pharmacologic treatment, housing, employment services, independent living and social skills training, and psychological support to help veterans recover from a mental illness. The VA?s Committee on Care of Veterans with Serious Mental Illness has recognized that this continuum should be available throughout the VA. However, at most, it can be said that some VA facilities have the capability to provide some limited number of these services to a fraction of those who need them.


PHARMACY AND MEDICATION RESOURCES

The issue of pharmacy resources and medication availability for mental illness is also important. There have been reports, including one by the GAO, that some networks have established either rigid limits for the use of some medications (for instance, atypical antipsychotics) or have simply insisted on the use of generics, together with other restrictions. The APA has joined with other advocacy organizations in opposing the implementation of the new treatment guidelines for atypical antipsychotic medications for veterans with schizophrenia. Of particular concern is the ?fail first? policy that veterans with schizophrenia go through a minimum 6-8 week trial on specified medication, with access to any alternative medication limited to case failure after the end of the 6-8 week period. Patients respond differently to medications and physicians must be allowed to best respond to the health needs of their patients. This policy directly interferes with the clinical judgment of the treating psychiatrist and may put patients? lives at risk.

As a practical matter the current VA computerized patient record system (which has been highly touted as a health information technology (HIT) model) ? does not provide hyperlinks to the list of medications on the VA formulary. Such a link could assist with efficiency and patient care by speeding up medical necessity reviews for non-formulary drugs. This is especially important for patients who need psychiatric medications, because switching patients from medication to medication can have deleterious effects.


POSTTRAUMATIC STRESS DISORDER (PTSD)


Patients with severe PTSD increased 42% from 1998 to 2003 , while expenditures increased only 22% during that same time. Veterans who are service-connected for PTSD use VA mental health services at a rate at least 50% higher than other mental health user groups. It is essential that identified PTSD programs be maintained consistent with the provision of P.L. 104-262, so that veterans may reap the benefits of specialized treatment delivered by clinicians who are experts in addressing the unique needs of veterans with PTSD and its associated co-morbid conditions. The APA appreciates the President?s special attention to the growing problem of post-traumatic stress disorder and the resulting need in a seamless continuum of care. Again, we would request that funds designated for PTSD services be tracked by the GAO to insure fidelity.


As you know, the Institute of Medicine is undertaking a review of PTSD diagnosis, treatment and disability determination within the VA and Department of Defense. We believe that care must be taken to distinguish between the underlying diagnostic criteria in DSM-IV and the way in which the DSM may ? or may not ? be used appropriately. We would be pleased to brief members of the Subcommittee and staff on the DSM.


MIRECCs AND RESEARCH


The APA wishes to compliment the VA for initiating Mental Illnesses Research, Education and Clinical Centers (MIRECCs). The MIRECCs serve as infrastructure supports for psychiatric research into the most severe mental illnesses. However, less than 12% of the VA health research budget is dedicated to mental illness and substance use, even though 35-40% of VA patients need mental health care. The APA strongly encourages the establishment of additional MIRECCs.


The APA supports the VA Research Office?s decision to initiate the Quality Enhancement Research Initiative (QUERI), which has funded two new field centers focused on putting into clinical application what is known about schizophrenia, depressive disorders, and substance use disorders. However, the nominal increase in the research budget is likely to limit the implementation of this farsighted plan.


In addition to funding MIRECC?s the APA is recommending an overall FY07 appropriation of $460 million for medical and prosthetic research. This recommendation is consistent with a similar recommendation by the Friends of VA (FOVA).


WORKFORCE SHORTAGE

The shortage of physicians and other mental health professionals has compromised the delivery of healthcare and has endangered patient safety.


Many veterans with mental illnesses are medically fragile ? with diabetes, liver or kidney failure, or cardiac disease, for example. Their care requires a specially trained physician. A revision of salary schedules, recognition of the contributions of International Medical Graduates and minority American Medical Graduates, and the availability of Continuing Medical Education (CME) courses and other professional opportunities for advancement need to be addressed. We understand there is a significant shortage of nursing staff, especially psychiatric nurses, and we request that the VA address this shortage area.

RECOMMENDATIONS

The APA is deeply concerned about veterans living with mental illnesses and their families.

We believe it is important to secure: 1) additional and specifically allocated funding and ensure accountability mechanisms; 2) immediate implementation of clinical programs mandated within the system; 3) compliance with legislation aimed at maintaining capacity; and 4) enhanced recruitment and retention of personnel who will improve the care and lives of veterans with mental illnesses and substance abuse disorders.


Above all, a profound respect for the dignity of patients with mental and substance use disorders and their families must be duly reflected in serving the needs of veterans in the VA system.

The American Psychiatric Association thanks the Subcommittee for the opportunity to submit a statement.

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Don't look like we're gonna get much of that "profound respect" from that "quack" of a so-called "doctor" Sally Satel, huh?????

[Packo]

Now here is what gets me. I first recieved treatment, not through the VA but the DAV because the VA did not recognize nor treat PTSD in the 70's. Congress finally had to force them to do it once PTSD got in the DSM in 1980 and ask the VA why they haven't been treating it....leaving it up to the DAV. Anyway, thanks to the treatment I got by the DAV's Forgotten Warrior Project I was able to turn my life around and dedicate it to helping others like me. I eventually burned to a cinder working in the Vet Center seeing 40 to 60 patients a week for PTSD. It was killing me. My own stuff mixed with the stuff of hundreds of other veterans was taking an unbelievable toll on me and my soul. I had to leave or literally die. I went to work for the Marine Corps working in child and spouse abuse which was also stressful but did ok for awhile. Suffering from a stress disorder and other reasons had me leave that program and go to work in the Naval Hospital. Since 9-11 and our War against Terror, I have had to begin to see patients with combat related disabilities again and it is again taking it's toll on me. I had to once again go back into treatment with a very wonderful VA Psychiatrist who states that not only should I have filed for PTSD years ago, I need to do it now. PTSD is a life long disorder and although I have always thought I was doing ok, I can see where it has affected me in oh, so many ways. I can see that I may have to leave my basically lifelong work as I don't know how much longer I am going to be able to do this....yet, can't seem to stop because I also believe I'm the best one around here to treat them. Now, if I do file a claim, what this woman is saying is that I'm just doing it for finacial and economic security? No, I could have really used that in the 70's and 80's before I got my shit together. If I do it now, it's because I have fucking earned it with my life and it will also secure that I can continue to recieve treatment for it incase they ever try and take away benefits we've earned but not filed claims on.....i.e. being 70% for my wounds gives me PTSD treatment but who says for how long? It could all change in a moments notice.

Sorry I am rambling but things like this really piss me off. I've been saving those bastards money for over 20 years and now that I've finally come to terms with myself about my PTSD and claims.....she's going to say that I'm a liar and a charlatin? Up yours, baby!

Pack

PACO you have every right to complain about this. There was an spot on the news last night about over 70,000 veterans from Iraq returning home with mental disorders and mental health problems, the beast is alive well.

[MORTARDUDE]

I was privileged to meet and talk to a WW 2 veteran at our Vet Center when I started there. He was on a destroyer in the Pacific near the end of the war. His ship was under constant attack by kamikazes...he told me how he suffered over the years, losing jobs and relationships..he said many times he wished that he could have gotten help after the war. He would sit in on our groups and he was a wonderful person. I would like this know-it-all to meet someone like that who is grateful for help. He filed a claim over 50 years after he was out of the service....

Larry

Love the way she "forgets" to mention that no help was offered when it was so badly needed.

"Doctor" my ASS!

Got waay more to say but that's all I can squeeze out now. Keep gettin kinda tight-jawed.

[locksly]

Love the way she "forgets" to mention that no help was offered when it was so badly needed.
Doc.2/47


Now here is what gets me. My father never got any treatment for PTSD AS THE M/F V. A. did not recognise it and no treatment was offered , no claims could be filed as it was not a disorder through the VA because the VA did not recognize nor treat PTSD in the 1950's 60's 70's.and when he died in the 1990's he still was not getting treatment as they kept turning him down.
We give our all but these politicians give money to every other country but don;t give veterans shit. I can;t say any more as I am so tired of this crap.

[sn-e3]

Talking to the VA shrink and asking for help was the hardest thing I ever did in my intire life. I stuggled for years being angry for no aparent reason. I couldn'nt make friends because I didn't trust anyone but now I think I just didn't want to get close to someone and have them taken away again. The whole world was f%#ked up except me. but I thank God that I found you men and women on the old History channel. My first hope was knowing I wasn't the only one and there is help out there you just have to be man enough to ask for help. I've been a giver all my life and it is very hard to take help. I found out if it feels good to you to give it feels good for someone to give back to you. Its hard but its part of life too. sorry some Land with a degree feels different but I don't agree with her and think she should really visit a veterans group session before she spouts off. I have a few friends that are too proud to ask for help. My friend George is a walking basket case and I took him to the VA three different times for treatment but he dosen't go back . I was told you can't help or save everone but its hard to let them slip by when you know there is help and they earned it. sorry to rattle on but i had too.chris

[MORTARDUDE]

same here Chris. if I hadn't found you wonderful folks I would have never made that first trip to the Vet Center some 4 years ago.

Larry

[melody1181]

I so strongly dislike people like her.

If she had any idea of what its like. SHe should know that my grandpa still can't get the sounds of bones crushing out of his head and that my uncle struggled with his memories everyday till the day that he died. They should walk up to me and tell me in the face that PTSD isn't real then I could hel "inform" them.

People who think PTSD is some make believe stuff or just flat isn't real can kiss my a$$. They are full of $hit and themselves.

[Gimpy]

Hear ya loud and clear fellas (and lady).

This bitch Satel needs a great big extraction tool to remove her oversized, egotistical crainum out of her ass!

I do volunteer work at my VA hospital a couple of days a week down here in Tampa and I see more and more guys our age (and older) coming in seeking treatment for PTSD or stress related ailments that they have had for years but were either afraid to ask for help or ashamed to ask for it because they felt they didn't deserve it. Many of these guys have been slipping in and out of main stream society for years and were not able to carry on relationships and hold down jobs for any length of time due to their illness and most of them weren't able to "connect the dots" to their causes.

And now we have these so-called "experts" spouting their so-called "theories" to do further damage to a system that is in dire need of increased funding and expanded treatment to a population of ever growing older vets in need of help, not to mention the younger warriors coming back from Iraq and Afganistan.

I don't know about you guys, but I think we ALL (as many as we can get) should write letters to the editor of the New York Times, The American Enterprise Institute and our Senators and Congressman to show just how fed up and pissed off we are that folks like Salley Satel are out there spreading lies, half-truths and misinformation about a serious illness that has destroyed and/or terribly injured not ONLY many of us veterans, but the lives of our loved ones, families, co-workers and friends!


One PISSED OFF GIMP!