by Elizabeth Hart

This week, I had the opportunity to attend a House Committee on Veterans’ Affairs hearing titled “Service should not lead to suicide: Access to VA’s Mental Health Care.”  Witnesses included the parents of three veterans who tragically committed suicide while seeking mental health care to address their PTSD and a retired Army veteran who now serves other veterans through the Wounded Warrior Project. Witnesses shared heartbreaking testimony of veterans with PTSD and TBI who faced wait times up to 9 months long for mental health care that was often inadequate to address their complex needs. While all the witnesses spoke about the difficulty of accessing mental health care through the VA system, they also highlighted some larger issues that occupational therapists are well-situated to address:

 Need for Better Transition Services

One committee member stated, “We prepare our soldiers to go to war, but we don’t prepare them to transition back home.” Several witnesses spoke of the challenges veterans face when returning home, particularly when they have PTSD and/or TBI. One mother spoke of her son, who had severe short-term memory deficits and cognitive challenges as a result of repeated TBIs suffered over the course of multiple deployments. She described the functional challenges her son faced returning to work and engaging in routine tasks like keeping track of his medical appointments. Her testimony highlights the importance of occupational therapy in helping veterans with these injuries gain the skills and tools they need to participate in their day-to-day routines, and in helping them reestablish their own role within their community. AOTA has more information on occupational therapy’s role in treating PTSD and community integration for people with traumatic brain injury.

Interdisciplinary Team-Based & Veteran-Centered Care

A veteran spoke highly about a pilot program he participated in at one VA medical center that used an interdisciplinary team-based approach to treat veterans from our country’s most recent conflicts. He emphasized how important it was for veterans to get to know their providers and build trust over time, and how an interdisciplinary team model may make it easier for health care professionals to address problems before they become crises. He also emphasized how this model was better suited to veterans who may have complex physical and psychological injuries. Occupational therapy is uniquely suited to address both physical and psychological injuries and could be a key part of these types of interdisciplinary teams. Unfortunately, the pilot program that this veteran participated in was eventually cancelled due to lack of funding. Several witnesses advocated for the VA to transition to a veteran-centered medical home model, based on the patient-centered medical home model which provides primary care services with a focus on interprofessional team-based care to improve patient satisfaction and clinical outcomes while reducing costs. AOTA is working on developing new roles for occupational therapy practitioners within these new patient-centered models of care (read more here).

Shortage of Mental Health Care Professionals

To ease the demand on VA medical centers, some lawmakers have proposed allowing veterans to access mental health care through the private system, like many active duty members do through TRICARE. But several witnesses pointed out that due to the nationwide shortage of mental health care professionals, returning service members may still not be able to access mental health care services in their communities. One witness cited reimbursement as a reason for this shortage and advocated for programs that would encourage medical professionals to enter the field of mental health. AOTA federal affairs is addressing this shortage by working to ensure that the two mental health bills under consideration in the House and Senate include language from the “Occupational Therapy in Mental Health Act” defining occupational therapists as mental and behavioral health professionals under the National Health Services Corps loan forgiveness program.

 Non-Pharmacological Treatment Options for PTSD

While veterans with PTSD often receive medication as a first-line treatment, one witness pointed out that while drugs may suppress the symptoms, they do not address the underlying issues. Consequently, all of the witnesses emphasized the need for non-pharmacological treatments for PTSD. Several committee members and panelists spoke of the therapeutic benefit of occupation, including gardening, motorcycle riding, cycling, and playing guitar. One committee member spoke about the importance of “having something to do” when returning home from deployment. While all of this made my OT heart sing (and reminded me of this recent study), I was disappointed that occupational therapy didn’t enter into the conversation as an evidence-based, non-pharmacological treatment for PTSD. Particularly because during my fieldwork at a VA medical center, I had the chance to work with several excellent occupational therapists who made a difference in the lives of veterans with PTSD and TBI.

Though there are many dedicated occupational therapy practitioners already working to improve the lives of our veterans and active duty service members, this omission from yesterday's conversation highlights the importance of educating legislators on occupational therapy’s critical role in mental health care. There is no easy solution to the VA’s mental health care crisis, but occupational therapists hold an important piece of the puzzle. As the only health profession focused on the living skills necessary to return to everyday life, occupational therapy is uniquely situated to help our returning veterans resume their lives.

Update:  After holding this hearing, both chambers of Congress introduced the Clay Hunt Suicide Prevention for American Veterans Act to help address the issue of suicide among America's service members and Veterans.  This bill included a reference to occupational therapy as a mental health profession and would have paid for Veterans to receive a degree in occupational therapy and then work at the VA in mental health.  The bill did not pass in the 113th Congress, but was the first bill to be signed into law by the President in the 114th Congress.  Unfortunately the section of the bill that would have paid Veterans to receive degrees in mental health fields (including occupational therapy) was taken out of the second version of the bill.  You can read the AOTA letter of support for the Clay Hunt SAV Act  (pdf) below.

Elizabeth is an occupational therapy student at the University of North Carolina – Chapel Hill completing a Level II fieldwork at the American Occupational Therapy Association this summer.