Marsha Four is a Registered Nurse and the Chair of the Vietnam Veterans of America's Woman Veterans Committee. Wednesday, she testified to the US House Committee on Veterans Affairs. We're noting the following from her opening statement. US House Rep Bob Finer is the chair of the committee and C.I. covered the hearing in Wednesday's "Iraq snapshot." Here's Four:
WOMEN VETERANS
Women comprise a growing segment of the Armed Forces, and thousands have been deployed to Iraq and Afghanistan. This has particularly serious implications for the VA healthcare system because the VA itself projects that by 2010, over 14 percent of all veterans utilizing its services will be women.
The nature of the combat in Iraq and Afghanistan is putting service members at an increased risk for PTSD. In these wars without fronts, “combat support troops” are just as likely to be affected by the same traumas as infantry personnel. They are clearly in the midst of the “combat setting”. No matter how you look at it, Iraq is a chaotic war in which an unprecedented number of women have been exposed to high levels of violence and stress. Nearly 200,000 female soldiers have been deployed to Iraq and Afghanistan…this compared to the 7,500 who served in Vietnam and the 41,000 who were dispatched to the Gulf War in the early ‘90s. The death and casualty rates reflect this increased exposure.
There have been few large-scale studies done on the particular psychiatric effects of combat on female soldiers in the United States, mostly because the sample size has been small. More than one-quarter of female veterans of Vietnam developed PTSD at some point in their lives, according to the National Vietnam Veterans Readjustment Survey conducted in the mid-‘80s, which included 432 women, most of whom were nurses. (The PTSD rate for women was 4 percent below that of the men.) Two years after deployment to the Gulf War, where combat exposure was relatively low, Army data showed that 16 percent of a sample of female soldiers studied met diagnostic criteria for PTSD, as opposed to 8 percent of their male counterparts. The data reflect a larger finding, supported by other research that women are more likely to be given diagnoses of PTSD, in some cases at twice the rate of men.
Matthew Friedman, Executive Director of the National Center for PTSD, a research-and-education program financed by the Department of Veterans Affairs, points out that some traumatic experiences have been shown to be more psychologically “toxic” than others. Rape, in particular, is thought to be the most likely to lead to PTSD in women (and in men, where it occurs). Participation in combat, though, he says, is not far behind.
Much of what we know about trauma comes primarily from research on two distinct populations–civilian women who have been raped and male combat veterans. But taking into account the large number of women serving in dangerous conditions in Iraq and reports suggesting that women in the military bear a higher risk than civilian women of having been sexually assaulted either before or during their service, it’s conceivable that this war may well generate an unfortunate new group to study–women who have experienced sexual assault and combat, many of them before they turn 25.
Returning female OIF and OEF troops also face other crises. For example, studies conducted at the Durham, North Carolina Comprehensive Women’s Health Center by VA researchers have demonstrated higher rates of suicidal tendencies among women veterans suffering depression with co-morbid PTSD. And according to a Pentagon study released in March 2006, more female soldiers report mental health concerns than their male comrades: 24 percent compared to 19 percent.
VA data showed that 25,960 of the 69,861 women separated from the military during fiscal years 2002-06 sought VA services. Of those seeking VA services 35.8 percent requested assistance for “mental disorders” (i.e., based on VA ICD-9 categories). Of these, 21 percent was for post traumatic stress disorder or PTSD, with older female vets showing higher PTSD rates. Also, as of early May 2007, 14.5 percent of female OEF/OIF veterans reported having endured military sexual trauma (MST). Although all VA medical centers are required to have MST clinicians, very few clinicians within the VA are prepared to treat co-occurring combat-induced PTSD and MST. These issues singly are ones that need address, but concomitantly create a unique set of circumstances that demonstrates another of the challenges facing the VA. The VA will need to directly identify its ability and capacity to address these issues along with providing oversight and accountability to the delivery of services with qualified therapists and clinicians in this regard. All of these issues, traumas, stress, and crises have a direct effect on the women veterans who find themselves homeless.
HOMELESS WOMEN VETERANS
While the overall number of homeless veterans is decreasing, and rather significantly over the past few years, the number of women veterans in this population is rising. When it was reported that there were 250,000 homeless veterans, 2 percent were considered to be female, roughly 5,000. Of the current estimate of 131,000, approximately 4-5 percent are women veterans, which can be as high as 6,550. Striking, however, is the fact that the VA also reports that of the new homeless veterans (OEF/OIF), they are seeing this is as high as 11 percent for woman veterans.
It is believed that this dramatic increase is directly related to the increased number of women now in the military (15 percent - 18 percent). About half of all homeless veterans have a mental illness and more than three out of four suffer from alcohol or other substance abuse problems. Nearly forty percent have both psychiatric and substance abuse disorders. Homeless veterans utilize the entire VA the same as any other eligible group of veterans. Therefore all delivery systems and services offered by the VA have an impact on homeless veterans, as do they on it.
The VA must be prepared to provide services to these former service members in appropriate settings.
One of the confounding factors with homeless women veterans is the sexual trauma many of them suffered during their service to our nation. Few of us can know the dark places in which those who have suffered as the result of rape and physical abuse must live every day. It is a very long road to find the path that leads them to some semblance of “normalcy” and helps them escape from the secluded, lonely, fearful, angry corner in which they have been hiding.
Not all residential programs are designed to treat mental health problems of this very vulnerable population. In light of the high incidence of past sexual trauma, rape, and domestic violence, many of these women find it difficult, if not impossible, to share residential programs with their male counterparts. They openly discuss their concern for a safe treatment setting, especially where the treatment unit layout does not provide them with a physically segregated, secured area. They also discuss the need for gender-specific group sessions.
Reports also indicate that in mixed gender residential programs, women remain fearful, isolated, stifled, and unsafe. This rises from a number of fronts. Women have had very different experiences from male veterans not only in the military but after also. Some women live as victims of extremely violent pasts. They have been used, abused, and raped. They trust no one. They fear that any day it could happen again. They are suspicious and paranoid.
Some women have sold themselves for money, taking part in unimaginable activities in order to pay for food, a bed, or drugs. Some have reported being sold for sex at the age of three. They wake up everyday, remembering what they did, encased in total humiliation and guilt. They have given away very own children…this they also live with for the rest of their lives.
In order to survive on the streets or stay alive moving from house to house or bed to bed, they can become callused, aggressive, and develop attitude. This behavior can often be a means to remain safe, or to keep predators at bay. In light of the nature of some of their personal and trauma issues, and the humiliation and guilt they must endure, how can anyone expect these women veterans to open up to therapy and profit from mixed gendered group therapy. While some facilities have found innovative solutions to meet the unique needs of women veterans, others are still lagging behind. VVA requests that all residential treatment areas be evaluated for the ability to provide and facilitate these services, and that medical centers develop plans to ensure this accommodation.