The Road Home for Rural The Road Home for Rural Veterans … Veterans …

Cases in Southern Cases in Southern MarylandMaryland

Veterans Health Education & Veterans Health Education & Wellness Wellness

Conference Conference

The VETS GroupThe VETS GroupWashington, D.C., June 10, 2008Washington, D.C., June 10, 2008

Constance A. Walker, MS, Ed.; CAPT, USN (Ret)Constance A. Walker, MS, Ed.; CAPT, USN (Ret)President, National Alliance on Mental Illness, Southern Maryland President, National Alliance on Mental Illness, Southern Maryland 301.997.1655 / walkerca@md.metrocast.net 301.997.1655 / walkerca@md.metrocast.net

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The reality of rural caregivers

“It is impossible to overstate the stressors that rural family caregivers are bearing on a daily basis as they search for limited treatment and rehabilitative services, and attempt to navigate bureaucratic and unresponsive systems in support of a loved one whose cognitive abilities have been severely, sometimes permanently damaged by the invisible wounds of PTSD, other mental illness, or Traumatic Brain Injury.”

CAPT C. A. Walker, Testimony to Senate Committee on Veterans’ Affairs, Oct 24, 2007

an overview an overview

• Mental health care in rural areasMental health care in rural areas

• Mental disorders in Vets returning from the Global Mental disorders in Vets returning from the Global War on Terrorism War on Terrorism

• VA presence in a rural area of MarylandVA presence in a rural area of Maryland

• Case Studies of OIF / OEF Vets in SMC: Jamie … Case Studies of OIF / OEF Vets in SMC: Jamie … David … Mike … Danny … “Rob”David … Mike … Danny … “Rob”

• Issues, outreach, gaps in servicesIssues, outreach, gaps in services

• The cast of collaboratorsThe cast of collaborators

• RecommendationsRecommendations

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mental health care in rural areas …mental health care in rural areas …

• More than 60% of rural Americans live in More than 60% of rural Americans live in mental health professional shortage areasmental health professional shortage areas

• More than 90% of all psychologists and More than 90% of all psychologists and psychiatrists, and 80% of MSWs, work in psychiatrists, and 80% of MSWs, work in metropolitan areasmetropolitan areas

• More than 65% of rural Americans get their More than 65% of rural Americans get their mental health care from their primary care mental health care from their primary care providerprovider

• For most rural residents, the mental health For most rural residents, the mental health crisis responder is a law enforcement officercrisis responder is a law enforcement officer

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mental disorders in returning mental disorders in returning veteransveterans

Mental disorders account for more than 530,000 service Mental disorders account for more than 530,000 service connectedconnected

disabilities and are in the top six of rated disabilitiesdisabilities and are in the top six of rated disabilities

Common disabilitiesCommon disabilities # of # of

DiagnosesDiagnoses Post Traumatic Stress Disorder 256,271Post Traumatic Stress Disorder 256,271 Generalized Anxiety Disorder 61,357Generalized Anxiety Disorder 61,357 Major Depression 41,419Major Depression 41,419 Schizophrenia 31,027Schizophrenia 31,027

Date of Info: April 1, 2006 (VHA)Date of Info: April 1, 2006 (VHA)

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Dispelling the Myth

CW: The VA and some State agencies provide the necessary outreach and coordination to ensure Veterans receive timely and regular access to the mental health and substance abuse treatment and rehabilitative services they need.

The conventional wisdom is WRONG.

In the 21st Century, SOLUTIONS will come from

WORKING PARTNERSHIPS between

-- VA, DoD, HHS -- State and County Governments -- Local Communities -- EDUCATED employers and Health

Depts -- Private / Non Profit Sectors -- Education Institutions -- Faith Communities

VA presence in St. Mary’s CountyVA presence in St. Mary’s County(federally designated as a mental health services shortage (federally designated as a mental health services shortage

area in 2005)area in 2005)

VA facilities (round trip) from Leonardtown, MDVA facilities (round trip) from Leonardtown, MD

--- CBOC, Charlotte Hall (60:00)--- CBOC, Charlotte Hall (60:00)

--- VA Medical Center, Baltimore, MD (3.5 - 4 hours)--- VA Medical Center, Baltimore, MD (3.5 - 4 hours)

--- VA Medical Center, Washington DC (3.5 - 4 hours)--- VA Medical Center, Washington DC (3.5 - 4 hours)

--- VA Medical Center, Perry Point, MD (6 – 7 hours)--- VA Medical Center, Perry Point, MD (6 – 7 hours)

--- Vet Centers: Five in MD (3 to 6 hours)--- Vet Centers: Five in MD (3 to 6 hours)

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JAMIE DEAN, OEF Vet (Leonardtown)JAMIE DEAN, OEF Vet (Leonardtown) Army reservist with 18 months service in Army reservist with 18 months service in

Afghanistan returned home to St. Mary’s CountyAfghanistan returned home to St. Mary’s County

After receiving orders to Iraq, barricaded himself After receiving orders to Iraq, barricaded himself alone inside his father’s home in St. Mary’s alone inside his father’s home in St. Mary’s County on Dec 26, 2006 threatening to County on Dec 26, 2006 threatening to commit suicidecommit suicide

A member of Jamie’s family asked local police to A member of Jamie’s family asked local police to do a health and safety check do a health and safety check

Shot by State Police after a 14 hour stand-offShot by State Police after a 14 hour stand-off

Outcome: Death Outcome: Death CAW/ SMC_HD_1007CAW/ SMC_HD_1007

DAVID B., OEF Veteran (Leonardtown)DAVID B., OEF Veteran (Leonardtown)

• incarcerated in St. Mary’s County, incarcerated in St. Mary’s County, diagnosed with PTSD while in Afghanistan diagnosed with PTSD while in Afghanistan (in the medical record)(in the medical record)

• Jail psychiatrist: 300 mg seroquel, 100 mg Jail psychiatrist: 300 mg seroquel, 100 mg zoloft daily zoloft daily

• Vet requested help from Commissioner Vet requested help from Commissioner Mattingly, who contacted NAMI SoMD Mattingly, who contacted NAMI SoMD

• NAMI SoMD asked VAMC Baltimore to NAMI SoMD asked VAMC Baltimore to conduct a VA PTSD assessment and conduct a VA PTSD assessment and provide recommendations for public provide recommendations for public defender’s use. Request supported by defender’s use. Request supported by Sheriff Cameron and BOCC. Sheriff Cameron and BOCC.

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DAVID … continuedDAVID … continuedInitial VA Maryland Health Care System Initial VA Maryland Health Care System

(VAHMCS) response (VAHMCS) response

“ “38 CFR 17.38©(5)states that ‘the VA medical benefits package does not include 38 CFR 17.38©(5)states that ‘the VA medical benefits package does not include hospital and outpatient care for a veteran who is either a patient or inmate in an hospital and outpatient care for a veteran who is either a patient or inmate in an institution of another government agency if that agency has a duty to give the institution of another government agency if that agency has a duty to give the care or services.’ This means that VA does not provide medical treatment to an care or services.’ This means that VA does not provide medical treatment to an inmate in a prison or jail when the prison or jail is obligated to provide medical inmate in a prison or jail when the prison or jail is obligated to provide medical care. In this case, the veteran is an inmate in an institution of a St. Mary’s care. In this case, the veteran is an inmate in an institution of a St. Mary’s County government agency which has a duty to provide medical care. In fact, County government agency which has a duty to provide medical care. In fact,

the veteran has been receiving services …”the veteran has been receiving services …”

Second answer (verbal):Second answer (verbal): the State of MD must officially request the State of MD must officially request the VA to administer a PTSD assessment and treatment / therapy the VA to administer a PTSD assessment and treatment / therapy recommendations for an incarcerated veteran. A request from a Board of recommendations for an incarcerated veteran. A request from a Board of County Commissioners, Sheriff’s Dept, or designated advocacy organization is County Commissioners, Sheriff’s Dept, or designated advocacy organization is insufficient. insufficient.

Third response (action)Third response (action): : coordination with VISN-8 after veteran’s coordination with VISN-8 after veteran’s extradition to FL to obtain VA PTSD assessment and recommendations for public extradition to FL to obtain VA PTSD assessment and recommendations for public defender and receiving jail (defender and receiving jail (VISN-8 took this case immediately)VISN-8 took this case immediately)

Outcome: Jail diversion and treatment Outcome: Jail diversion and treatment CAW/ SMC_HD_1007CAW/ SMC_HD_1007

MIKE S., OIF Veteran MIKE S., OIF Veteran (Leonardtown) (Leonardtown)

TimelineTimeline Event Event Jan - Jul 03 Operation Iraqi Freedom deploymentJan - Jul 03 Operation Iraqi Freedom deployment Jan - Sep 04 Hospitalization, diagnosis, medical board, retirementJan - Sep 04 Hospitalization, diagnosis, medical board, retirement Oct 04 Home (St. Mary’s County, Leonardtown, MD)Oct 04 Home (St. Mary’s County, Leonardtown, MD) Nov 04 – May 05 Community-based residential services and treatment (Pathways)Nov 04 – May 05 Community-based residential services and treatment (Pathways) May 05 Social Security Administration SSI / SSDI decision receivedMay 05 Social Security Administration SSI / SSDI decision received July 05 Disability rating decision by VA receivedJuly 05 Disability rating decision by VA received May 05 – Sep 05 National Institute of Mental Health: voluntary admission May 05 – Sep 05 National Institute of Mental Health: voluntary admission Sep 05 – Sep 07 Community-based treatment and services (Affiliated Sante Group, Sep 05 – Sep 07 Community-based treatment and services (Affiliated Sante Group,

TRICO, PCM and Specialist care) TRICO, PCM and Specialist care) Dec 05 – Sep 07 DORS Case Management (career assessment, conduit for Assistive Dec 05 – Sep 07 DORS Case Management (career assessment, conduit for Assistive

TechTech from VA VR&E, SERVSAFE (partial), CLST (partial)from VA VR&E, SERVSAFE (partial), CLST (partial) July 07 Small apartment in Leonardtown, monitoring 3-4 days / wk by FM (no July 07 Small apartment in Leonardtown, monitoring 3-4 days / wk by FM (no

external source external source for ‘assisted living’ visits available)for ‘assisted living’ visits available) Interviewed for PT employment (McKays, accompanied by DORS CM)Interviewed for PT employment (McKays, accompanied by DORS CM) Aug 22 – Sep 6 07 Employed at McKays – Vet discontinues meds on Sep 2 “affecting Aug 22 – Sep 6 07 Employed at McKays – Vet discontinues meds on Sep 2 “affecting

work performance”work performance” (no DORS / McKay’s store mgmt dx of DORS client or disabled (no DORS / McKay’s store mgmt dx of DORS client or disabled

OIF Vet status) Sep 13 - 15 Emergency Room admission into SMH OIF Vet status) Sep 13 - 15 Emergency Room admission into SMH Sep 17 – present Now in local PHP, lives at home, no longer drives Sep 17 – present Now in local PHP, lives at home, no longer drives Sep 28 VAMC Baltimore recommends voluntary hospital admission in Sep 28 VAMC Baltimore recommends voluntary hospital admission in

Baltimore (vet declines)Baltimore (vet declines) Oct 5 Refusing all meds, including hypertension med. Decompensation Oct 5 Refusing all meds, including hypertension med. Decompensation

continues. continues.

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MIKE S. continued …MIKE S. continued … Levels of government and agencies involved in this caseLevels of government and agencies involved in this case

Federal:Federal: DoD (Army, Navy, WRAMC for Physical Evaluation Board)DoD (Army, Navy, WRAMC for Physical Evaluation Board)VA Central Office (investigation into VR&E Services supplied by Baltimore Regional Offices)VA Central Office (investigation into VR&E Services supplied by Baltimore Regional Offices)VA Regional Offices (Roanoke, Baltimore, Washington DC)VA Regional Offices (Roanoke, Baltimore, Washington DC)VA Maryland Health Care System: VA Maryland Health Care System: VA Medical Centers in DC and Baltimore, Charlotte Hall Community Based Out Patient VA Medical Centers in DC and Baltimore, Charlotte Hall Community Based Out Patient

ClinicClinic

State:State:DOE (Division of Rehabilitative Services)DOE (Division of Rehabilitative Services)VA VR&E (Waldorf Office, reports to Baltimore)VA VR&E (Waldorf Office, reports to Baltimore)Dept of Labor, Maryland Job ServiceDept of Labor, Maryland Job ServiceSSA (to correct for the record a local provider’s misquote of Axis 1 diagnoses)SSA (to correct for the record a local provider’s misquote of Axis 1 diagnoses)

Local:Local:MHASM – DORS -- DOL Maryland Job Service -- SSA (in SMC twice a month) – Care providersMHASM – DORS -- DOL Maryland Job Service -- SSA (in SMC twice a month) – Care providers (Pathways, Affiliated Sante Group, TRICO, St Mary’s Hospital, local PCM, specialty provider) (Pathways, Affiliated Sante Group, TRICO, St Mary’s Hospital, local PCM, specialty provider)

Outcome: Relapse Outcome: Relapse CAW/ SMC_HD_1007CAW/ SMC_HD_1007

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issues, outreach, gaps in issues, outreach, gaps in services in SMC services in SMC

• Services are limited, fragmented, access is confusing & complex, and by Services are limited, fragmented, access is confusing & complex, and by COMAR regulations: vets are shut out COMAR regulations: vets are shut out

• General population is ill-informed about mental illness General population is ill-informed about mental illness

• Not many providers … and they’re not being trained Not many providers … and they’re not being trained (mild TBI – CDC package / PTSD 101 training – Natl Center for PTSD(mild TBI – CDC package / PTSD 101 training – Natl Center for PTSD

• No Vet Centers are accessible and no one is asking for one, for the region. No Vet Centers are accessible and no one is asking for one, for the region. • Putting a disabled veteran into a traditional Day Program is inappropriate. Putting a disabled veteran into a traditional Day Program is inappropriate. • When is the last time you visited a Community Mental Health Center Day When is the last time you visited a Community Mental Health Center Day

Program? Program?

• What are SoMD veteran demographics What are SoMD veteran demographics

• Co-occurring disorders among vets who are not being treated for PTSD Co-occurring disorders among vets who are not being treated for PTSD

• What is the full time psychiatric, mental health, and substance abuse support What is the full time psychiatric, mental health, and substance abuse support staffing at CBOC, Charlotte Hall? staffing at CBOC, Charlotte Hall?

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for Vets in rural areas, “seamless transition” for Vets in rural areas, “seamless transition” is not is not

VHA Directive on Mental Health Intensive Case Management (MHICM)VHA Directive on Mental Health Intensive Case Management (MHICM) “ “At sites where there are insufficient patients to justify a full team, At sites where there are insufficient patients to justify a full team,

consideration is to be given to partnering with the community, e.g., consideration is to be given to partnering with the community, e.g., existing Assertive Community Treatment (ACT) teams. A model for existing Assertive Community Treatment (ACT) teams. A model for rural MHICM teams where there is not a sufficient patient base for a rural MHICM teams where there is not a sufficient patient base for a full MHICM model is being developed.”full MHICM model is being developed.”

VA Model: Rural Access Network Growth Enhancement (RANGE) MHICMVA Model: Rural Access Network Growth Enhancement (RANGE) MHICM Rural MHICM Model sent to VA Central Office for review in Feb ’06. Rural MHICM Model sent to VA Central Office for review in Feb ’06.

First training meeting is scheduled for Aug ’07 in Denver. Addendum: First training meeting is scheduled for Aug ’07 in Denver. Addendum: GAO report released Sep ’06 cites VA misdirection of and failure to GAO report released Sep ’06 cites VA misdirection of and failure to spend funding allocated for mental health services for Veterans spend funding allocated for mental health services for Veterans returning from Iraq and Afghanistan. returning from Iraq and Afghanistan.

VA Contracting with LOCAL ACT Program has been done – in Nebraska.VA Contracting with LOCAL ACT Program has been done – in Nebraska. VISN-23 Chief, Mental Health Behavior Sciences Dept (Dr. Bhatia)VISN-23 Chief, Mental Health Behavior Sciences Dept (Dr. Bhatia) PACT Program in Omaha, Nebraska: Dr. Susan BoustPACT Program in Omaha, Nebraska: Dr. Susan Boust

Note: More Vet Centers being built (not in MD) … approx 20 sites Note: More Vet Centers being built (not in MD) … approx 20 sites identified for MHICM RANGE (none in VISN-5) …CBOCs being identified for MHICM RANGE (none in VISN-5) …CBOCs being augmented for psych services (plan goes thru FY-09) … VA will augmented for psych services (plan goes thru FY-09) … VA will collaborate with SAMHSA (MOU)collaborate with SAMHSA (MOU)

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MHICM Rural Access Network for Growth Enhancement MHICM Rural Access Network for Growth Enhancement (RANGE) (RANGE)

““The Comprehensive VHA Strategic Plan for Mental Health Services (July The Comprehensive VHA Strategic Plan for Mental Health Services (July 9, 2004 Revised) mandated development of a strategy to “ensure that 9, 2004 Revised) mandated development of a strategy to “ensure that veterans in rural areas have access to mental health care”… MHICM veterans in rural areas have access to mental health care”… MHICM

RANGE Model 10/20/06 1RANGE Model 10/20/06 1• White River Junction, VTWhite River Junction, VT• Bath, NYBath, NY• Wilkes-Barre, PAWilkes-Barre, PA• Butler, PAButler, PA• Wilmington, DEWilmington, DE

• Clarksburg, WVClarksburg, WV This is the listThis is the list • Huntington, WVHuntington, WV• Asheville, NCAsheville, NC

• Dublin, GADublin, GA ofof• Saginaw, MISaginaw, MI• King/Appleton, WIKing/Appleton, WI• Wichita, KSWichita, KS

• Ft. Meade, SDFt. Meade, SD MHICM RANGE MHICM RANGE SitesSites

• Alexandria, LAAlexandria, LA• Dallas, TXDallas, TX

• Prescott, AZPrescott, AZ in FY07in FY07• Sheridan, WYSheridan, WY• Cheyenne, WYCheyenne, WY• Roseburg, ORRoseburg, OR• Fresno, CA Fresno, CA

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for combat vets returning to rural for combat vets returning to rural areas, areas,

more questions than answers continue more questions than answers continue … …

Every rural area has unique characteristics … what’s in the inventory? Every rural area has unique characteristics … what’s in the inventory?

• What is the size of the rural population need (how many returning Vets are What is the size of the rural population need (how many returning Vets are there in a specified rural areas?) there in a specified rural areas?)

• What is the homeless Vet population? What is the incarcerated Vet What is the homeless Vet population? What is the incarcerated Vet population? What is the family caregiver info? Were it not for family population? What is the family caregiver info? Were it not for family support … how many Vets would be homeless? support … how many Vets would be homeless?

• Where are the medical facilities? What are their capabilities? Psychiatric Where are the medical facilities? What are their capabilities? Psychiatric facilities? Detention Centers? Detention Centers offer psych services? facilities? Detention Centers? Detention Centers offer psych services? Vets screened for PTSD?Vets screened for PTSD?

• What community resources (CMHS, providers, DORS) are available? How What community resources (CMHS, providers, DORS) are available? How can they be leveraged to assist returning Vets?can they be leveraged to assist returning Vets?

• What training opportunities and obstacles exist (e.g., do local providers What training opportunities and obstacles exist (e.g., do local providers know to ask a new patient about Veteran status? Does local law know to ask a new patient about Veteran status? Does local law enforcement know about PTSD in returning combat vets? Is there Crisis enforcement know about PTSD in returning combat vets? Is there Crisis Intervention Training for dealing with individuals with mental health Intervention Training for dealing with individuals with mental health issues? Are there potential partnerships with local universities?)issues? Are there potential partnerships with local universities?)

HOW CAN WE BEGIN TO CLOSE GAPS IN SERVICES WITHOUT ANSWERS ?HOW CAN WE BEGIN TO CLOSE GAPS IN SERVICES WITHOUT ANSWERS ?

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how it should be in rural areas …. a how it should be in rural areas …. a collaboration collaboration

• Local health care providers who have received standardized Local health care providers who have received standardized VA training in mental and physical health issues of VA training in mental and physical health issues of returning veterans (or at least the CDC’s answer to mild TBIreturning veterans (or at least the CDC’s answer to mild TBI

• Convenient access to needed services – not a five hour round Convenient access to needed services – not a five hour round trip to the nearest VA Medical Center trip to the nearest VA Medical Center

• Comprehensive continuum of care that takes input from Comprehensive continuum of care that takes input from family caregivers into account and provides them with some family caregivers into account and provides them with some trainingtraining

• VA and HHS systems that work together, share resources, VA and HHS systems that work together, share resources, and focus on delivering what works within a reasonable and focus on delivering what works within a reasonable distance for veterans and their families who live in rural distance for veterans and their families who live in rural areas areas

• NO WRONG DOOR NO WRONG DOOR

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VA Creating Advisory Panel on Rural Health

VA News Release, Feb 20, 2008• Office of Rural Health, VACO, est Feb ’07

• First report to Congress on improving access to MH and long term health care in rural areas (Sep 07)

• Increased mileage reimbursement for patients from 11 cents to 28 cents per mile

• Projects under consideration: mobile health care vans, transportation grants, patient education through “pod-casts”, collaborating with non-VA facilities

• Expanding telehealth programs and investigating new applications (what is real utility for mental health?)

Women Veterans (VA statistics)

• Fastest growing segment of Veteran population, second only to elderly Veterans

• 255K women Veterans use VA health care services, 1.7 M women Veterans are 7 % of total Veteran population

• By 2020 women Veterans will comprise 10% of Vet population

Women Veterans’ Issues• Homeless Female Veterans – from 1983 to 2000,

percent of homeless female Vets increased from 4% to 12 %

• NY Times has reported a surge in homeless Vets from OIF, OEF and many are women

• A common risk factor: Military Sexual Trauma (MST)

• Husbands/partners leave or divorce them while they are deployed

• Many have children to care for

VA Reaches Out to Women VeteransVA News Release, March 27, 2008

2008 Initiatives include - enhancing skills of Primary Care Providers

to treat women Veterans

- examining womens’ health issues (cardiac care, breast cancer, colorectal cancer in women

- focusing on family issues / avoiding birth defects through enhanced pharmacy practices for women Veterans of child-bearing age

the numbersthe numbers1.4 million Servicemembers have been deployed in the Global 1.4 million Servicemembers have been deployed in the Global

War on Terror as of Jan ‘07War on Terror as of Jan ‘07

26,000 Servicemembers have been injured in OIF and OEF as of 26,000 Servicemembers have been injured in OIF and OEF as of Apr ’07, average of 16 wounded Servicemembers per fatality Apr ’07, average of 16 wounded Servicemembers per fatality

47% of returning Vets are National Guard and Reserve “Citizen 47% of returning Vets are National Guard and Reserve “Citizen Soldiers”Soldiers”

-- over 18K Active Duty, Reservists, and Guardsmen from MD -- over 18K Active Duty, Reservists, and Guardsmen from MD between Sep 01 and Aug ‘06between Sep 01 and Aug ‘06

““Signature Injuries” of GWOT are TBI and PTSD; “more than Signature Injuries” of GWOT are TBI and PTSD; “more than half of a sample of OIF and OEF vets returned from combat half of a sample of OIF and OEF vets returned from combat zones with MH issues, 1 in four had other health concerns” zones with MH issues, 1 in four had other health concerns” (American College of Occupational and Environmental (American College of Occupational and Environmental Medicine, June 07)Medicine, June 07)

177 days to process an initial VA claim, 657 days to process an appeal,177 days to process an initial VA claim, 657 days to process an appeal,US Court of Appeals for Veterans’ Claims is reviewing 300 / month US Court of Appeals for Veterans’ Claims is reviewing 300 / month CAW/ CAW/

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Don’t look now … but the Stakeholders are

US.

Our OIF and OEF Our OIF and OEF VeteransVeterans

are not coming home to the are not coming home to the VA.VA.

They’re coming home. They’re coming home.

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References and ResourcesReferences and ResourcesNew Freedom Commission on Mental HealthNew Freedom Commission on Mental Health Subcommittee Report on Rural Issues (DHHS Pub SMA-04-3890), 2004Subcommittee Report on Rural Issues (DHHS Pub SMA-04-3890), 2004 “ “Achieving the Promise: Transforming Mental Health Care in America” (DHHS Pub SMA-Achieving the Promise: Transforming Mental Health Care in America” (DHHS Pub SMA-

03-3832), 200303-3832), 2003 ““Rural Mental Health: Challenges and Opportunities Caring for the Country”Rural Mental Health: Challenges and Opportunities Caring for the Country” Dennis Mohatt, Western Interstate Commission for Higher Education (WICHE) MH Dennis Mohatt, Western Interstate Commission for Higher Education (WICHE) MH

ProgramProgram

““Grading the States: A Report on America’s Health Care System for Serious Grading the States: A Report on America’s Health Care System for Serious Mental Illness”Mental Illness”

National Alliance on Mental Illness, Washington, D.C., 2006 National Alliance on Mental Illness, Washington, D.C., 2006 www.nami.org

““Challenges Encountered by Injured Servicemembers During Their Recovery Challenges Encountered by Injured Servicemembers During Their Recovery Process”Process”

GAO Report of Testimony, GAO-07-606T, Mar ‘07GAO Report of Testimony, GAO-07-606T, Mar ‘07

““VA Health Care: Preliminary Information on Resources Allocated for Mental VA Health Care: Preliminary Information on Resources Allocated for Mental Health Strategic Plan Initiatives”Health Strategic Plan Initiatives”, GAO Report of Testimony, GAO-06-1119T, Sep , GAO Report of Testimony, GAO-06-1119T, Sep ’06’06

War Supplemental Bill Adds $100 Million for VA Mental Health Services, NAMI War Supplemental Bill Adds $100 Million for VA Mental Health Services, NAMI National Advisory, May 29, 2007 National Advisory, May 29, 2007 http://www.nami.org/template.cfm?template=/ContentManagement/ContentDisplay.cfm&ContentID=46926&lstid=275

Testimony on Maryland Senate Bill 873, Task Force to Study State Assistance to Testimony on Maryland Senate Bill 873, Task Force to Study State Assistance to Veterans, Apr ‘07Veterans, Apr ‘07

Constance A. Walker, CAPT, USN (Ret)Constance A. Walker, CAPT, USN (Ret)