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Finding Therapists Proves Hard for Troops •
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Study: Suicide Risk Double Among Male US Veterans
CNN News
Monday 11 June 2007
Study: Male US vets twice as likely as
non-vets to die by suicide. Researchers followed more than 300,000 men for 12
years. At biggest risk: white, college-educated and those with activity limitations.
The risk of suicide among male U.S. veterans is double that of the general
population, according to a study published Monday.
"We need to be more alert to the problem of suicide as a major public
health issue and we need to do better screening among individuals who have served
in the military, probe for their mental health risk as well as gun availability,"
said Dr. Mark S. Kaplan, professor of community health at Portland State University
in Oregon, lead author of the study in the Journal of Epidemiology and Community
Health.
For 12 years, Kaplan and his team of researchers followed more than 104,000
veterans who had served in the armed forces at some time between 1917 and 1994
and compared them with more than 216,000 non-veterans.
In all, between 1986 and 1997, 508 of them committed suicide - 197 veterans
and 311 non-veterans.
After adjusting for a host of potentially compounding factors, including age,
time of service and health status, the study showed that those who had been
in the military were 2.13 times more likely to die of suicide over time.
At biggest risk were veterans who were white, those who had gone to college
and those with activity limitations, according to the study, which was funded
by the National Institute of Mental Health.
"Life Is Too Complex"
Still, Kaplan would not say that the study proves that military service itself
results in an increased risk of suicide. "I never feel comfortable claiming
a causal relationship," he said. "Life is too complex."
No surprise was the finding that veterans were more likely to use guns to end
their lives than were their non-veteran counterparts.
One unanticipated finding was that being overweight appeared to confer protection
from suicide by more than 50 percent, the study found.
Kaplan cited a paucity of data on the subject, but said it might have to do
with the fact that people who are underweight are more likely to smoke, and
smokers are more likely to be depressed.
Though the study did not include veterans who served in Iraq and Afghanistan,
"We can say quite confidently that, regardless of the era when they served,
that veterans' status alone seems to be a risk factor for suicide," he
told CNN.
"With the projected rise in functional impairments and psychiatric morbidity
among veterans of the conflicts in Afghanistan and Iraq, clinical and community
interventions directed towards patients in both VA and non-VA health care facilities
are needed," the authors concluded.
Kaplan said officials in the Veterans Administration were surprised by the
findings, but welcomed them, "because it does point to a problem that they
need to be addressing."
The VA has recently begun expanding its mental health screening facilities,
but that may not solve the problem, said Kaplan, because three-fourths of veterans
do not receive their care from VA hospitals. "Our concern is that that
only touches a fraction of all veterans; that most of the veterans are not being
perhaps properly screened outside the VA facilities."
About 1.3 percent of deaths in the country are estimated to be suicides, Kaplan
said. But the true rate may be off by 25 percent, given that suicide has long
been shrouded in stigma.
"Health care facilities don't like to talk about suicide," he said.
"It's often viewed as a failure of the system.... Many physicians feel,
if you even mention suicide, that might prompt the behavior."
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Finding Therapists Proves Hard for Troops
By Kimberly Hefling
The Associated Press
Monday 11 June 2007
Tricare issues can prevent service members,
families for getting treatment.
Washington - Soldiers returning from war are finding it more difficult
to get mental health treatment because military insurance is cutting payments
to therapists, on top of already low reimbursement rates and a tangle of red
tape.
Wait lists now extend for months to see a military doctor and it can takes
weeks to find a private therapist willing to take on members of the military.
The challenge appears great in rural areas, where many National Guard and Reserve
troops and their families live.
To avoid the hassles of Tricare, the military health insurance program, one
frustrated therapist opted to provide an hour of therapy time a week to Iraq
and Afghanistan veterans for free. Barbara Romberg, a clinical psychologist
in the Washington, D.C., area, has started a group that encourages other therapists
to do the same.
"They're not going to pay me much in terms of my regular rate anyway,"
Romberg said. "So I'm actually feeling positive that I've given, rather
than feeling frustrated for what I'm going through to get payment."
Joyce Lindsey, 46, of Troutdale, Ore., sought grief counseling after her husband
died in Afghanistan last December. The therapist recommended by her physician
would not take Tricare. Lindsey eventually found one on a provider list, but
the process took two months.
"It was kind of frustrating," Lindsey said. "I thought, 'Am
I ever going to find someone to take this?"'
Roughly one-third of returning soldiers seek out mental health counseling in
their first year home. They are among the 9.1 million people covered by Tricare,
a number that grew by more than 1 million since 2001.
Tricare's psychological health benefit is "hindered by fragmented rules
and policies, inadequate oversight and insufficient reimbursement," the
Defense Department's mental health task force said last month after reviewing
the military's psychological care system.
The Tricare office that serves Fort Campbell, Ky., and Fort Bragg, N.C. -
Army posts with heavy war deployments - told task force members that it
routinely fields complaints about the difficulty in locating mental health specialists
who accept Tricare.
"Unfortunately, in some of our communities ... we are maxed out on the
available providers," said Lois Krysa, the office's quality manager. "In
other areas, the providers just are not willing to sign up to take Tricare assignment,
and that is a problem."
Tricare's reimbursement rate is tied to Medicare's, which pays less than civilian
employer insurance. The rate for mental health care services fell by 6.4 percent
this year as part of an adjustment in reimbursements to certain specialties.
Since 2004, Tricare has sped up payments to encourage more doctors to participate,
said Austin Camacho, a Tricare spokesman. In some locations, such as Idaho and
Alaska, the Defense Department has also raised rates to attract physicians,
he said.
"We are working hard to overcome those challenges," Camacho said.
Jack Wagoner is a retired military officer and psychologist and psychiatrist
in private practice who also works for a Tricare contractor. He told defense
mental health board members last December that in general, Tricare pays "considerably
lower" than private health insurance plans.
According to data from Tricare's Medical Benefits and Reimbursement System
office, Tricare pays mental health providers as much or more than a corporate
plan would pay a therapist for treating a patient - although in some cases
it is lower.
There are different coverage plans within Tricare, and the amount paid to providers
varies by plan, location, specialty and services performed.
Psychologists who treat active duty troops are paid 66 percent of what Tricare
views as the customary rate. So a psychologist eligible for a customary rate
of $120 per hour would be paid $79.20 for the hour by Tricare, even if the psychologist's
standard rate is $150 per hour.
Active duty troops use Tricare Prime, a managed-care option maintained by private
contractors. Their mental health care is free. Guard and Reserve troops and
their families frequently use Tricare Standard, a fee-for-service plan. They
pay an annual deductible and 20 percent of the amount Tricare pays the therapist.
John Class, a retired Navy health care administrator who now advocates on health
issues for the Military Officers Association of America, said Tricare Prime
contractors insist that the lower reimbursement rates has made it tougher to
maintain a network of providers.
"We are already starting to see the pinch," Class said.
In a limited study by Tricare released earlier this year, about two out of
three civilian psychiatrists in 20 states were willing to accept Tricare Standard
clients among their new patients, the lowest acceptance rate for any specialty.
Any additional cuts in Tricare payouts could mean that "some really good
psychologists who specialize in this treatment and are experienced will be seeing
less of [military families]," said clinical psychologist Marion Frank,
a widow who is president of the Philadelphia Chapter of the Gold Star Wives
of America, a support group for military widows.
In parts of Montana, some families drive two hours to see a physician of any
kind that will take Tricare, said Dorrie Hagan, state family program director
for the Montana National Guard.
"When you get away from a city of any size then you start struggling for
providers, and they'll tell you flat out it's because of the rate of pay,"
Hagan said.
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