WASHINGTON • Forty-two years ago, Missouri Sen. Thomas Eagleton was dropped from George McGovern’s presidential ticket over mental health concerns.
This month, a current Missouri senator, Roy Blunt, will tour civilian and military mental health facilities in the state to highlight a push to equate mental health treatment with physical care and to destigmatize the disease.
But Blunt, a Republican, does not wax much about progress these two images may represent.
“We haven’t come nearly as far in 42 years as we should have, and I intend to continue to work to see that we view mental health issues like any physical issue,” he said.
Prodded by problems of post-traumatic stress and traumatic brain injury in returning veterans from Iraq and Afghanistan and shocked by mass shootings involving attackers with mental health problems, Congress is tackling mental health more than any time in at least a generation, according to those involved.
Blunt and Sen. Debbie Stabenow, D-Mich., are among the leaders, in a bipartisan pairing rare in the current Congress.
Their efforts come amid allegations of poor service in Veterans Administration hospitals, including St. Louis, and concerns that the nation may not be ready for the post-traumatic stresses of its war veterans.
Spending on mental health in the armed services has doubled since 2007, and the Pentagon says it has made progress in treating soldiers and their families who are facing mental health issues. But some experts have also raised doubts about whether any of the programs are working.
Blunt said he sees an opportunity to confront a problem that he says has too long festered among civilians and soldiers.
“This is an area that, as a society and as a government, we have just not been willing to deal with in a way that we need to deal with,” Blunt said in an interview in his office. “And now appears to be a good opportunity to move forward on a couple different things on mental health.”
One of those is a Blunt-Stabenow law, signed this year by President Barack Obama, establishing pilot programs in eight states by 2017 expanding access to community mental health services. Blunt said he hopes Missouri is one of those states, but there is no guarantee.
The second bill, introduced by Blunt and a bipartisan group of senators, would bring mental health treatment for military service men and women and their families into line with the way physical ailments are treated, taking away limits on hospital stays, for instance, that exist for mental but not physical health.
It “really is the first legislation that addresses mental health in a comprehensive way from a federal perspective in many years,” said Brent McGinty, president and CEO of the Missouri Coalition of Mental Health Centers.
The act, he said, adds new requirements for community-based mental health centers, including 24-hour care, home-health care programs that integrate physical and mental health treatment and partnerships with substance-abuse treatment providers. The requirements, which will begin testing in the eight states 2017, will come with additional federal aid, set at $25 million for the test program.
Currently, clinics and doctors dispensing medicine and treatment for mental health often don’t also ask about blood pressure, diabetes, or other physical maladies that may be connected, McGinty said The new law sets standards that allow for more integrated, “holistic” treatment, he said.
Getting beyond the stigma of mental illness remains a challenge, both among civilians and members of the military, according to experts. Some think the push to equate and integrate mental and physical treatment can be a barrier breaker.
“It is a critical change because, I think, we have traditionally as a society conceptualized mental and physical health as two separate types of injuries, even though we have known for decades that this artificial line we have drawn between these two classes is just kind of made up,” said Craig Bryan, executive director of the National Center for Veterans Studies at the University of Utah.
An Air Force veteran with a doctorate in psychology, Bryan was chief of primary care psychology and director of the Pentagon’s traumatic brain injury clinic in Iraq while deployed there in 2009.
Bryan said that a host of federal studies on mental health aimed at dealing with the aftermath of the wars are about to be finished. One that he is co-authoring concluded that a treatment, called “brief cognitive behavioral therapy,” has proved in early results to reduce suicide attempts among military personnel.
In it, trauma victims are taught to re-experience and re-imagine the traumatizing event over and over to habituate the patient with the fear and emotions associated with the event.
“In essence, you are training them how to manage their negative emotions,” Bryan said.
Mental health experts say the recession put pressure on states and the federal government to cut spending. The result, McGinty said, is that many people who might have gotten better with mental health treatment end up in jail, at far higher costs to taxpayers and more suffering for mentally ill patients and their families.
One area where research and treatment has been growing exponentially, however, has been in the military, which has over the past 12-plus years confronted PTSD, traumatic brain injuries, alcoholism and drug abuse normally associated with the aftermath of war.
The Congressional Research Service last year said the Pentagon spent more than $4.5 billion on mental health treatment from 2007 to 2012, rising to just under $1 billion annually, roughly double that of 2007.
The CRS said that mental health diagnoses among active duty service members increased by 65 percent between 2001 and 2011; more than 936,000 service members were diagnosed with mental health disorders over that decade. Diagnoses of post traumatic stress were up six-fold, while those of alcohol abuse, schizophrenia and personality disorders were actually down, the CRS report said.
The Army’s spending on mental health treatment rose by more than 10 percent this year over last year, to just under $360 million. The service branch is making progress, Army Surgeon General Patricia Horoho told Congress last month.
Embedding health-care professionals with troops has lowered the incidence of “acute crises,” and required fewer hospitalizations in 2013 as compared with 2012, she said.
But, she added, “I worry about the long-term repercussions of these wars on our veterans.”
Blunt said stories like the ones alleging lax mental health service at a Veterans Administration facility in St. Louis shake taxpayer confidence in the programs. Allegations were made by a former official there that backlogs of cases had piled up because psychiatrists were seeing too few patients. “If what he says is happening is happening, it is not acceptable,” Blunt said.
He and Sen. Claire McCaskill, D-Mo., sent a letter to embattled VA Secretary Eric Shinseki asking for more information, and claiming that if the allegations were true that it “is putting the health and safety of veterans at risk.”
A hospital spokeswoman said the VA was taking the allegations seriously and looking into them.
For active-duty soldiers, the Army says it has seen positive results from its high-profile Comprehensive Soldier and Family Fitness Program. Instituted in 2009, it’s designed to bolster soldiers’ psychological resilience against battlefield and everyday stress. Pentagon reports have attested to its effectiveness.
The program has proved effective by taking a holistic approach — incorporating mental with physical and spiritual fitness — to help soldiers and their families handle stress, said Lt. Col. Sharon McBride, executive officer of the Comprehensive Soldier and Family Fitness Program, who is a research psychologist.
But not all mental health professionals and analysts agree.
Carrie Farmer, who has co-authored Rand Corporation reports on Pentagon programs addressing psychological health and traumatic brain injury, said that “interventions aimed at improving resilience or preventing mental health problems” have so far had “a weak effect, at best.”
McBride said it may take 10 years to see the full effects of the Comprehensive Soldier and Family Fitness Program. “We really didn’t start training soldiers until 2010” and only now are instituting the program Army wide, she said. “To criticize it when it is just being launched” is unfair, she said.
Blunt said there are problems with a lack of consistency in screening and treatment of mental health issues in both the active services and the VA. An Institute of Medicine report said those problems threaten “delivery of high-quality care and hampers. He said he’s unsure whether the doubling of mental health spending at the Pentagon has been enough.
“Don’t know yet,” Blunt said. “Are we spending enough, and are we spending it the right way?”
One thing is clear, he said. The mental health aftermath of two long wars will be with the country for decades.