PTSD report: Challenge for N.H. lies in education
New Hampshire’s civilian health system is capable of caring for veterans with post-traumatic stress disorder and traumatic brain injury, but the challenge lies in educating both veterans and providers, members of a state commission said yesterday.
The commission, which was created by the Legislature two years ago, released a report yesterday with one broad recommendation – make the panel permanent so it can accomplish more than half a dozen more detailed goals. If approved, the new commission would be divided into several committees focused on reducing the stigma associated with PTSD and traumatic brain injury, training civilian health care providers to understand military culture and streamlining care between the Veterans Administration system and civilian providers.
The commission found that while veterans do seek health care from nonveteran providers with general success, the greater challenge comes when veterans struggle with invisible injuries. In a survey of nearly 1,200 veterans, 30 percent said they were not getting the help they needed because they were embarrassed or ashamed. Another 16 percent said they did not feel understood by the providers who served them.
Commission member Nicholas Tolentino, a Navy veteran of the wars in Iraq and Afghanistan, said he never thought during his deployments about how his combat experience would affect the rest of his life.
“You’re told to be strong: You’re the strongest person out there,” he said. “You’re 10 feet tall and bulletproof. You’re never weak.”
At home, he had nightmares, was overcome by anxiety in crowded places and hid under a table during fireworks displays. After he was diagnosed with PTSD and traumatic brain injury, the stigma of being treated as if he were damaged and unstable became “the new enemy,” but he said he is hopeful that the commission’s work will change that for others.
“New Hampshire veterans deserve the care and to be able to seek that care openly without disgrace, without dishonor,” he said.
New Hampshire has the fifth-highest veteran population per capita in the United States, with 115,000 veterans making up nearly 11 percent of the state’s population. The state does not have an active duty military installation where veterans can easily find support and services, however, and New Hampshire is the only state that doesn’t have a full-service VA medical facility.
An obvious and simple first step would be asking all patients, “Have you served?” the commission said, but many providers do not ask, and the question doesn’t appear on most health history forms. Lt. Col. Stephanie Riley of the New Hampshire Army National Guard described a soldier who went to the emergency room complaining of headaches and being unable to sleep. He wasn’t asked about his military service and was treated for migraines.
“When I saw him as a military case manager, I did set him up with the VA, but unfortunately he had been suffering for some time, and decided to end that suffering on his own terms by killing himself,” she said. “Tragically, this is a scenario that plays itself out entirely too often.”
Tammy Krueger, acting director of the Manchester VA Medical Center, said the facility recently hired a new mental health services manager, has been conducting military culture training for its nonmilitary staff and has started embedding its mental health staff into the primary care setting so patients can receive short-term therapy there. It also has extended its hours for mental health treatment and, by next fall, plans to complete construction on 30 new exam rooms, 18 of which will be used for mental health treatment.