VVA Testimony VVA Testimony
VVA Testimony





Submitted By

Thomas J. Berger, Ph.D.
Chairman, VVA National PTSD & Substance Abuse Committee
Before the
Subcommittee on Health
Committee on Veterans’ Affairs
U. S. House of Representatives


Mental Health Treatment for Families:
Supporting Those Who Support Our Troops

February 28, 2008

Mr. Chairman, Ranking Member Buyer, and other distinguished members of this Subcommittee, Vietnam Veterans of America (VVA) appreciates the opportunity to present our views on the need for the Department of Veterans Affairs (VA) to provide mental health assistance and treatment within VA medical centers for family members of veterans.  VVA thanks you for your concern and leadership about the mental health care of our veterans’ families, and in seeking out the views of veterans’ service organizations on this very important, timely, and relevant issue. 

As you are well aware, one of the recommendations of the Dole-Shalala Commission was to “significantly strengthen support for families.”  This will not be an easy task, but VVA believes this hearing can serve as the opening dialogue on a very serious concern.

As more and more troops return home damaged emotionally and mentally as well as physically, their families must contend not only with the shock of seeing the physical desolation of their loved ones, but come to grips with the new reality of their lives, which have changed dramatically, and not for the better.  Take for example a 35-year-old soldier or Marine with two children who returns home with what is diagnosed as Traumatic Brain Injury (TBI).  His impairment affects the future of the entire family.  His, or her, spouse and children have to deal with his/her inability to concentrate, the mood swings, depression, anxiety, even the loss of employment.  As you can imagine, the economic and emotional instability of a family can be as terrifying and as real as any difficulty focusing or simply waking and crying in the middle of the night.  In cases of severely brain-damaged casualties, spouses, parents, and siblings may be forced to give up careers, forsake wages, and reconstruct homes to care for their wounded relatives rather than consign them to the anonymous care at a nursing home or assisted living facility. 

VVA believes that the mental health stresses of war may be even greater for the families of those serving in the National Guard or Reserves in that deployment of these individuals often results in dramatic losses of income along with numerous legal and family complications affecting the children.  These can include domestic violence and substance abuse.  In addition, unlike family members of active-duty military who often have an established support system available to them on base, family members of Guard and Reserve troops must often struggle to create their own systems of support.

There will be cries that the VA medical facilities (with the notable exception of the VA VET CENTERS operated by the Readjustment Counseling Service) are not authorized to provide mental health treatment for the families of veterans. You will also hear that neither the military nor the VA (including the Vet Centers) has the organizational capacity or personnel resources to provide such.  In addition, you will hear that there are issues about the intensity and drains of vitally needed family support that will be hard to sustain, as well as significant issues regarding the complexity of other medical and specialized needs that have to be addressed simultaneously with the mental health needs. All of this was true last year. However in calendar year 2007, thanks largely to the leadership of this committee, Chairman Spratt, and Chairman Obey as well as the Speaker of the House more than $11 Billion was infused into the VA system, mostly for health care. Unfortunately this is only a start, albeit a very good start, toward restoring/building the organizational capacity needed to properly take care of veterans of every generation who have earned the right to health care by virtue of their service to country in uniform.

Frankly, much in the way of proper diagnosis of mental health in the veteran does not transpire on the primary care teams because those teams at many facilities are seeing too many veterans per clinician to be able to do the kind of thorough job of which they are capable. We need a funding level for the Veterans Health Administration that is significantly above the Administration’s request, by at least $3 Billion (and that is just for health care).

VVA believes that many of these logistical and organizational challenges can be overcome through legislation that authorizes partnerships between the VA and professional mental health organizations (such as the National Council for Community Behavioral Healthcare, which represents 1,400 community-based mental health programs), as is already suggested in H.R. 2874, the Veterans’ Health Care Improvement Act of 2007, and its companion bill S. 38, the Veterans’ Mental Health Outreach and Access Act of 2007.  A model of such a collaborative partnership involving the VA, the Maine National Guard, and the Community Counseling Center, a local behavioral healthcare provider, has been in operation since 2006 in Portland, Maine, and has achieved positive results. The example of what is happening in Connecticut is another model of the type of creative partnerships and very effective and useful work that can be done when VA does not insist on having total bureaucratic control over all of the activities and care delivery in which they may play some role.

Vet Centers

Certainly, the experience at the Vet Centers, where families of veterans are in fact part of the therapeutic milieu, illustrates the importance and efficacy of providing counseling for family members.  This can and ought to be extended, considering the current reality of too many of our troops returning to our shores discombobulated mentally, and too many family members frustrated and seemingly impotent about what to do to help them. Last year there was $20 million added to the VA budget for additional Vet Center staff in the Emergency War Supplemental Appropriation that was never spent to hire an additional 250 fulltime qualified clinicians in the existing Vet Centers, as directed in that legislation. Since the Readjustment Counseling Service did not receive the $20 million from OMB and the business office at VA Central office in time to hire any staff, what they did with the money was to purchase vehicles to do much more rural outreach, and do some long overdue computer enhancements.

VVA understands that the 100 non-clinician peer counselors that work for the Vet Centers have been converted to permanent positions, and that the Vet Centers have finally hired an additional 62 clinicians for existing centers since last summer. However, that is not nearly enough when you are talking about more than 200 service delivery points. If the Vet Centers are going to be able to utilize those vehicles to do much needed rural outreach and satellite sessions for a day per week at remote sites without taking away from the veterans currently being served by an overworked staff, then they need to hire additional personnel in the Readjustment Counseling Service. Why has the VA continued to refuse to hire adequate staff in the Vet Center system to meet the continually growing demand?

VVA is frankly puzzled as well as frustrated by this inaction on the part of the most senor leadership of the Veterans Health Administration (VHA), as the Vet Centers are our forward aid stations in regard to suicide prevention, PTSD, and readjustment counseling needs of combat veterans of every generation, but particularly those returning home today from Iraq and Afghanistan.

The Vet Centers are also the most studied of any VA program, and have consistently proved to be the most cost efficient, cost effective medical program operated by VA. They by and large do great work, AND they can serve the families as well. However, they can’t do it unless VA will use some of the “new” additional funds to expand the size of the clinical staff of the Vet Centers.

Joint Hearings

It may be time to do a joint hearing with the authorizing and/or the appropriations committees that oversee the Federal dollars that go to local community mental health programs, in order to see if there can be incentive funds made available for those centers to better serve the families of those returnees (as well as the families of those families while the service member is deployed).

Frankly, these citizens are in need now, and there are significant Federal dollars that flow through the Governors to these local communities. Because these problems are due to Federal service of the service member, it is only right that the funds from Health and Human Services (HHS) be increased specifically for this purpose. VVA stresses that these should be “fenced” funds that can only be used for this specific purpose of acquiring proper PTSD clinicians and family counselors, and training/re-training of existing staff of community mental health centers. VA must be mandated to fully cooperate and to provide training where possible to community leaders/clinicians.

This distinguished panel can make a difference by promoting the process of healing – of veteran and family member in a way that has never been done before if there is cooperation across the jurisdictions of the Congress.

I thank you for affording VVA the opportunity to present our views, and thank you for what you are doing to assist veterans and their families. I will be pleased to answer any questions you may have.



Funding Statement
February 28, 2008


The national organization Vietnam Veterans of America (VVA) is a non-profit veterans' membership organization registered as a 501(c) (19) with the Internal Revenue Service.  VVA is also appropriately registered with the Secretary of the Senate and the Clerk of the House of Representatives in compliance with the Lobbying Disclosure Act of 1995.
VVA is not currently in receipt of any federal grant or contract, other than the routine allocation of office space and associated resources in VA Regional Offices for outreach and direct services through its Veterans Benefits Program (Service Representatives).  This is also true of the previous two fiscal years.

For Further Information, Contact:
Executive Director of Policy and Government Affairs
Vietnam Veterans of America.
(301) 585-4000, extension 127


Dr. Thomas J. Berger


Dr. Tom Berger is a Life Member of Vietnam Veterans of America and currently serves as national chair of VVA’s PTSD and Substance Abuse Committee.  As such, he is a member of the Veterans’ Healthcare Administration (VHA) Consumer Liaison Council and the Mental Health Quality Enhancement Research Initiative for the Committee on Care of Veterans with Serious Mental Illness.  In addition, Dr. Berger holds the distinction of being the first representative of a national veterans’ service organization to hold membership on the Executive Committee of the Veterans’ Administration Substance Use Disorder Quality Enhancement Research Initiative.  He is also a member of VVA’s national Health Care, Government Affairs, Women Veterans, and Project 112/SHAD committees.  At the local level he serves as Secretary of the Missouri Vietnam Veterans Foundation and as both Board President and Secretary for Welcome Home, Inc., a non-profit domiciliary for veterans suffering from PTSD and substance abuse problems.

Upon completion of his military service as a Navy corpsman with the 3rd Marine Division in Vietnam and then subsequently after earning his doctoral degree, he has held faculty and administrative appointments at the University of Kansas in Lawrence, the State University System of Florida in Tallahassee and the University of Missouri-Columbia, as well as program administrator positions with the Illinois Easter Seal Society and United Cerebral Palsy of Northwest Missouri.  His professional publications include books and research articles in the biological sciences, wildlife regulatory law, adolescent risk behaviors, and post-traumatic stress disorder.

Dr. Berger now devotes his efforts full-time to veterans’ advocacy at the local, state and national levels on behalf of Vietnam Veterans of America. 

He presently resides in Columbia, Missouri and his hobbies are cycling, music, cooking, and reading. 

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