July 20, 2007

Senate Veterans Affairs Committee
412 Russell Senate Office Building
Washington D.C. 20510

Dear Comittee Members,

Thank you for the opportunity to present testimony to the field hearing of the United States Senate Committee on Veterans Affairs in Great Falls, MT concerning the Needs of Veterans in Rural Areas.  I am the Commanding General of the Montana National Guard, the Director of the Montana Department of Military Affairs, and a member of the Governor's cabinet.  As the Commanding General, I am responsible for the medical readiness of the state's National Guard.  As Director of the Montana Department of Military Affairs, I am a member of the Montana Board of Veterans Affairs which is responsible for statewide service to veterans. 

The Montana National Guard consists of over 3,700 members who live in virtually every corner of the state.  Since 2001, over 80% have been mobilized for federal active duty; and since release from this duty are now eligible for enrollment in the VA health care system. 

The medical readiness and health care of our post-deployment Guardsmen are of extreme importance to both the Governor and me.  Recently, the Montana National Guard's Post-Deployment Health Reassessment (PDHRA) program's scope, execution and adequacy were brought to the forefront when Montana Army National Guard member, Specialist Christopher Dana, tragically committed suicide on March 4, 2007.  Specialist Dana was federally activated as part of the Montana-based 1-163rd Infantry Battalion, and deployed to Iraq where he served honorably in an intense combat environment. 

When the battalion's tour of duty ended in late 2005 - after 18 months away from home - Specialist Dana was rapidly processed through Department of Defense demobilization facilities to expedite both his return home and reintegration into the civilian environment.  This expedited approach is standard operational procedure for Reserve Component (National Guard and Reserve) units whose tour of duty supporting Operation Iraqi Freedom or Operation Enduring Freedom has ended.

However, Chris Dana's suicide - as well as the many others that have occurred nationwide in the aftermath of National Guard and Reserve combat veterans' return to mainstream civilian life - has prompted Montana's critical assessment of the PDHRA program's effectiveness in reintegrating combat veterans into civilian society.  Active component military members that return to a base or fort can readily access the installation's mental and physical health services infrastructure. On the other hand, reserve component combat veterans are transitioned very rapidly into the civilian environment - an environment that does not necessarily understand what the veteran has been through, and does not necessarily have readily identifiable or available mental health services.

A task force of  mental health professionals, state and federal healthcare personnel, state legislators, and veterans service organizations representatives were assembled to review the PDHRA process (as mandated by the Department of Defense) and provide recommendations to use in improving the overall reintegration and reconstitution process of the state's reserve component military members.  Their findings and recommendations, contained within the attached report, envision a statewide network of education, support services, and resources that will meaningfully assist Montana's veterans cope with the emotional and mental health issues resulting from serving in combat; and who - once home - are expected to smoothly reintegrate into a civilian lifestyle. 

The Task Force report validated that the Montana National Guard is following the established Department of Defense (DOD) guidance and standards for Post Deployment Health Reassessment.  However, the report points out that the DOD guidance is inadequate to sufficiently support Soldiers and Airmen returning from theater operations.  Specifically, the report lists 10 findings with 16 recommendations suggesting corrective action.  Listed below are some of the findings and recommendations from the report which the Task Force determined impact the National Guard, as well as Reserve and Active Component combat veterans, in their successful reintegration into the mainstream, civilian environment.  I have borrowed liberally the verbiage contained in the report, especially as it pertains to veteran healthcare. 

A Significant finding found the Post-Deployment Process for returning veterans to be failing in many areas, noting that it has not been suitably effective nor conducted in an environment that facilitates attaining needed information from veterans who may have or are developing Post-Traumatic Stress Disorder (PTSD) or Traumatic Brain Injury (TBI) conditions.  The task force noted a number of deficiencies.  Demobilization station and home station processing is ineffective in identifying mental health issues, except for those who self-report, or have already been identified during military service.  Identification of a veteran's need for mental health services is ultimately based upon self-reporting.  Query and counseling processes supporting self-reporting are not mandatory, and existing query and health assessment processes are not effective in proactively identifying veterans who may need assistance.  The query and health assessment events are conducted only for a finite timeframe. When conducted, they are not done in an environment that provides sufficient confidentiality - while mitigating any stigmatizing impact.  Further, the personnel conducting the query or health assessment do not necessarily have the type of professional or technical training, education or experience needed to adequately recognize a Guardsman's emotional or mental health status.  Also at issue is the effectiveness and suitability of the query or health assessment instruments used.

The onset of emotional or mental health disability symptoms is variable and unpredictable.  Symptoms may manifest immediately or take years, which is problematic for Guardsmen (and other combat veterans) who have been discharged and are no longer a member of a military organization.  Veteran enrollment into the federal VA healthcare system is not automatic, with insufficient command emphasis to ensure this action takes place.

Another finding addresses the fact that veterans are reluctant to disclose mental health issues.   Several factors lead to this finding; to include concern about negative impacts on their employment and career (both in the military and civilian sectors), a perceived social stigma attached to emotional or mental health conditions or disorders, and a lack of knowledge about or sufficient confidence in available mental health services.  A veteran's reluctance to disclose mental health issues is further impacted by a lack of awareness by the general public, employers, and veterans' family members regarding the nature of mental health conditions; as well as access to and treatment of these type conditions. 

The report also noted a lack of statewide availability of counseling resources, particularly in rural areas.  Montana is the fourth largest state but with fewer than 1 million residents.  Many parts of the state are without a robust size community capable of sustaining medical or mental health professions.  The availability of these services may not be timely enough or available in needed frequency or proximity.  Additionally, a specific centralized coordination and referral capability does not exist.   Counseling services that are or may be available do not necessarily know about each other. These services include health services offered by the federal VA, Montana Department of Public Health and Human Services, and the communities.

The Task Force also found that National Guard commanders lack education on mental health issues, and the organization lacks an effective and well-publicized operational standard and policy that would support and maximally retain in military service a Guardsman who has a diagnosed emotional or mental health condition.   In addition, veterans service organizations (e.g., American Legion, Disabled American Veterans, Veterans of Foreign Wars, Vietnam Veterans of America) have posts/chapters located throughout the state and are not consistently utilized as a resource to assist in the post-deployment needs.  The number of federal VA Vet centers is limited and needs to be expanded to cover rural areas of Montana.

The Task Force developed sixteen recommendations that would markedly improve the post-deployment health of our returning veterans.  Expanding and enhancing the PDHRA process was viewed as a critical component; leading off with completion of an initial PDHRA for Guardsmen within 90 days after discharge from active-duty status or during the first scheduled National Guard drill period - whichever is earlier.  Subsequent PDHRAs need to be scheduled and conducted every six months after the initial query or assessment until a two-year time span has elapsed.  After the two-year period, the PDHRA process will accompany the required Periodic Health Assessment action.  This process needs to be accomplished for as long as the Soldier or Airman is in the military.  Expanding the PDHRA process is currently outside the scope and provided resources of the DoD program.  Providing additional resources to the existing program would ensure program enhancements such as the use of more comprehensive and effective mental health assessment instruments in the PDHRA process, e.g., VA screening templates, or other survey instruments such as the Mississippi Scale or the Beck Inventory.  Two additional enhancements needed are the inclusion of a "face to face" educational component in the PDHRA process during which issues related to mental illness stigma and self-reporting of mental health symptoms are discussed and a referral of Guardsmen who are identified as having mental health issues to appropriate mental health professions.  

Other recommendations included:  Mandate and monitor Guardsmen enrollment in the VA healthcare system through completion and submission of the VA Form 10-10EZ immediately after redeployment.  Develop and implement a comprehensive training program for command leadership and unit personnel that provides information on mental health issues such as combat stress, anxiety, depression and traumatic brain injury; leadership also needs to be educated on treatment methods for these conditions and educated as to available resources.  Develop, publish and distribute to all National Guard units and individual Guardsmen an information guide that contains - at a minimum - civilian and federal VA resources for medical and mental health services and care.  Provide information to the National Guard chain-of-command and all members regarding programs, resources and contact information to be used when a unit member self-reports or is identified as needing assistance for emotional or mental health conditions; which would also be posted in the Montana National Guard's website.  Actively participate in the newly authorized Suicide Prevention Program to be administered by the Montana Department of Public Health and Human Services.  Facilitate the development and implementation of increased "informal" support systems such as the "Vet to Vet" peer support program; and encourage - at both state and unit command levels - a more active and mutually supportive relationship with the state's veteran's service organizations. 

I have tasked my staff to immediately review the Task Force Report and develop a strategy which addresses the above outlined findings.  Some of the corrective actions necessary to better support our veterans and to satisfy the Task Force recommendations can be accomplished within my authority as Adjutant General.  However, some of the corrective measures need assistance from your level.  I have directed my staff to contact and work closely with Montana's Congressional Delegation to begin collaborating on effective solutions to better serve our Montana Soldiers and Airmen. 

Your continued support of the nation's veterans is truly appreciated.  Enclosed is a copy of the Task Force report and other attachments for your reference.  Please contact me if you have questions or concerns regarding the Post Deployment Health Reassessment report.

Sincerely,

RANDALL D. MOSLEY
Major General, Montana National Guard
The Adjutant General

Attachments:
1. Governor Schweitzer Letter
2. Montana PDHRA Task Force Report
3. Briefing Slides