Non-Clinical Topics   /   TBI

Congress Asks: In Wake of Court Ruling, Should VA Do More to Push Troubled Veterans Into Treatment?

USM By U.S. Medicine
July 13, 2011

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WASHINGTON — Does VA need to employ more aggressive tactics when it comes to getting veterans struggling with PTSD, depression and s

ubstance abuse into treatment?  Should some of those tactics involve using disability benefits as an incentive to receive treatment instead of as a simple entitlement?

These are a few of the many questions that have arisen in the wake of the California court decision that ruled VA’s delay in getting mental health care and benefits to veterans is a violation of due process under their 5th Amendment rights.

The idea of coercing veterans into care is controversial and runs up against both political and ethical objections. However, veterans’ advocates, VA advisors, and many veterans agree that, when it comes to getting veterans mental health care, VA’s position should not be as passive as it has been.

More Aggressive Care

“Though the VA were there and they were supportive, they never said, ‘this is what’s going to happen if you don’t get any help,’” veteran Daniel Hanson told legislators last month at a House VA Committee hearing. “VA needs to be more assertive in their treatment of veterans. They need to say, ‘It’s time to get help, or find somewhere else to get help.’”

Hanson has told his story to Congress before — the first time at a Senate hearing in March 2010. In February 2004, Hanson was deployed with the 2nd Battalion, 4th Marines to Ar-Ramadi, Iraq. His first experience with death on that tour was a fellow marine shooting himself in the head. By October 2004, 34 more marines in his battalion suffered combat-related deaths.

“I started drinking pretty heavily [after that tour],” Hanson said. “I was dealing with things I wasn’t prepared to deal with.”

By the time Hanson returned from his second tour — this one to Okinawa, Japan — he was drinking regularly, getting into fights and battling depression. In January 2007, he left the Marine Corps. By that time, the deaths of fellow marines — either in combat for those still in Iraq or by suicide at home — was a regular part of his life. In March 2007, his brother Travis, also a marine, hanged himself in the basement of his home.

Hanson began working with the St. Cloud VAMC in Minnesota on an outpatient basis. During that time, his marriage disintegrated and he was racking up a string of DUIs, spending some time in jail. At St. Cloud, he went through the Dual Diagnosis Program for PTSD and alcohol abuse. However, Hanson said, while the program taught patients about the dangers of drugs and alcohol, it had little real-life application. Eventually, he tried to kill himself by swallowing pills, resulting in a 72-hour suicide watch at St. Cloud.

Following that suicide attempt, there was little contact from VA, Hanson said, and he went back to his life, still abusing alcohol. While in jail for another DUI, he found a flyer for Minnesota Teen Challenge (MNTC) — a 13- to 15-month faith-based treatment and recovery program.

Hanson entered the yearlong program. He visited VA once a week for military-specific mental health issues, then returned to MNTC where, he said, he received the kind of discipline that was lacking at VA. That treatment came at a cost, though — about $10,000 a year, which VA would not help fund, because MNTC was not an approved VA partner.

Remarried with children, Hanson now acts as a liaison for MNTC, telling his story to other veterans and how the program helped him. “A big part of it was that the program wasn’t filled with people who had been through the same things I had. I didn’t have to put on this macho [act],” Hanson said. “And the structure was almost like the military. They tell you when to get up and go to bed. And if you want to get in a fight, you’re gone.”

Hanson asserted that he “could have gotten better, quicker” if the relationship that VA had fostered with him over the years had been less that of a concerned friend and more like that of an assertive parent or commanding officer.

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