The document discusses mental health issues among US veterans. It notes that mental health problems are the main driver of high suicide rates among veterans and cause other social issues. The US government allocates a large portion of its budget (24%) to defense and veterans affairs, including spending $7 billion on veterans' mental healthcare annually. However, the current system is overwhelmed and unable to meet demand. The document calls for reforms to better support the millions of veterans struggling with "invisible wounds" like PTSD, depression, and substance abuse issues.
How many Americans Die everyday from an Opioid Overdose?Soroush Namini
The CDC research shows that an estimated 68,557 people died in 2018, down from 72,224 people in 2017. Deaths from natural and semi-synthetic opioids - painkillers like morphine, codeine and oxycodone - fell by 14.5%, the sharpest drop for any drug category.
How many Americans Die everyday from an Opioid Overdose?Soroush Namini
The CDC research shows that an estimated 68,557 people died in 2018, down from 72,224 people in 2017. Deaths from natural and semi-synthetic opioids - painkillers like morphine, codeine and oxycodone - fell by 14.5%, the sharpest drop for any drug category.
Health Economics and Policy 5th Edition Henderson Solutions Manualragivusog
Full download : http://alibabadownload.com/product/health-economics-and-policy-5th-edition-henderson-solutions-manual/
Health Economics and Policy 5th Edition Henderson Solutions Manual
Gun violence in the united states by statejuandemariana
Enrique Vargas analizará la función de las armas en una sociedad, desde la antigüedad hasta los tiempos modernos. Apoyándose en estadísticas y casos concretos, examinará cómo influye el acceso a las armas en el índice de criminalidad de los países. También comparará la diferente regulación de las armas en Europa y en los Estados Unidos y la distinta relación entre Estado e individuo que de ella se desprende.
Enrique Vargas Molina es musicólogo y músico. Ha sido entrenador de tiro de arma corta certificado por la National Rifle Association de los Estados Unidos durante más de 20 años, a lo largo de los cuales ha entrenado a cientos de alumnos.
Heart disease describes a variety of conditions that affect the coronary heart. Diseases underneath the coronary heart sickness umbrella consist of blood vessel diseases, together with coronary artery disorder, heart rhythm problems arrhythmias and heart defects, human beings are born with congenital heart defects , among others. If the heart disorder isnt recognized at an early stage, the patient's situation might get worsened and for that reason endanger his life. Therefore, this software program is evolved in order to research the patient check details and give an evaluation as to whether or not the affected person is healthful or requires remedy for heart disorder by giving the intensity of patient's heart situation because the result. Prof. Vikrant Chole | Karishma V. Bagde "Heart Disease Analysis System" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-4 , June 2020, URL: https://www.ijtsrd.com/papers/ijtsrd31070.pdf Paper Url :https://www.ijtsrd.com/engineering/other/31070/heart-disease-analysis-system/prof-vikrant-chole
Firearm suicide among the elderly poses a serious challenge to public health. One of the greatest barriers to finding a solution to this problem is the highly politicized and bipartisan nature of the gun control debate. This paper studies the underlying risk factors contributing to suicide and existing legislation to develop recommendations for reducing firearm suicide among the elderly. Various databases were searched for evidence of successful interventions including PscyhInfo, PubMed and Scopus. The search criteria were limited to studies published within the U.S. between 2008 and 2018. Based on available evidence, the social ecological model provides the best intervention for reducing firearm suicide and firearm mortality among the target population through small interventions at the intrapersonal, interpersonal, community and societal levels.
MEDICAL ETHICS AND CONFLICT OF INTEREST IN SCIENTIFIC MEDICINEhome
SUMMARY
The Office of Technology Assessment (OTA) was perhaps the US government's last honest agency that critically reviewed the state of the nation's health care system. The purpose of the OTA was to provide Congress with objective and authoritative analysis of complex scientific and technical issues. In its final critical report, the OTA concluded: “There are no mechanisms in place to limit dissemination of technologies, regardless of their clinical value.”
Shortly after the OTA released a report that exposed how entrenched financial interests manipulate health care practice in the United States, Congress disbanded the OTA.
Business magazine-style report on World Suicide Rate Analysis.
Andy Kirk's The Three Principles of Good Visualization Design was followed to create the report.
Tools used: RStudio, Tableau and Canva
Graphs plotted:
1) Map Chart is used to show the amount of suicide in each country
2) A horizontal bar graph is used to further compare the differences in suicide
counts in each country
3) A single line graph is used to show the amount of suicides committed each year
during the period 1985-2016
4) Stacked 100% Area graph is used to compare the suicide counts among
different age groups, namely 5-14 years,15-24 years, 25-34 years, 35-54 years,
55-74 years
5) Side by side bar chart is used to compare the number of suicide counts
among different age groups, sex-wise
6) A pie chart is used to see the composition of causes of deaths in the US in the year
2017
7) Bubble Chart is used to check out the methods by which people commit
suicide and to check which one causes the maximum death
8) A line graph is used to compare the Suicide count and happiness index for the years 2006 to 2015
9) The correlation matrix is used to find the correlation between different elements.
10) Side by side line graph is used to compare gender wise suicide
percentage in the US
11) Treemaps are used to see the composition of the number of suicides
among the states of US
12) Side by side area graph is used to see the availability of different drugs in the US
over time
Health Economics and Policy 5th Edition Henderson Solutions Manualragivusog
Full download : http://alibabadownload.com/product/health-economics-and-policy-5th-edition-henderson-solutions-manual/
Health Economics and Policy 5th Edition Henderson Solutions Manual
Gun violence in the united states by statejuandemariana
Enrique Vargas analizará la función de las armas en una sociedad, desde la antigüedad hasta los tiempos modernos. Apoyándose en estadísticas y casos concretos, examinará cómo influye el acceso a las armas en el índice de criminalidad de los países. También comparará la diferente regulación de las armas en Europa y en los Estados Unidos y la distinta relación entre Estado e individuo que de ella se desprende.
Enrique Vargas Molina es musicólogo y músico. Ha sido entrenador de tiro de arma corta certificado por la National Rifle Association de los Estados Unidos durante más de 20 años, a lo largo de los cuales ha entrenado a cientos de alumnos.
Heart disease describes a variety of conditions that affect the coronary heart. Diseases underneath the coronary heart sickness umbrella consist of blood vessel diseases, together with coronary artery disorder, heart rhythm problems arrhythmias and heart defects, human beings are born with congenital heart defects , among others. If the heart disorder isnt recognized at an early stage, the patient's situation might get worsened and for that reason endanger his life. Therefore, this software program is evolved in order to research the patient check details and give an evaluation as to whether or not the affected person is healthful or requires remedy for heart disorder by giving the intensity of patient's heart situation because the result. Prof. Vikrant Chole | Karishma V. Bagde "Heart Disease Analysis System" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-4 , June 2020, URL: https://www.ijtsrd.com/papers/ijtsrd31070.pdf Paper Url :https://www.ijtsrd.com/engineering/other/31070/heart-disease-analysis-system/prof-vikrant-chole
Firearm suicide among the elderly poses a serious challenge to public health. One of the greatest barriers to finding a solution to this problem is the highly politicized and bipartisan nature of the gun control debate. This paper studies the underlying risk factors contributing to suicide and existing legislation to develop recommendations for reducing firearm suicide among the elderly. Various databases were searched for evidence of successful interventions including PscyhInfo, PubMed and Scopus. The search criteria were limited to studies published within the U.S. between 2008 and 2018. Based on available evidence, the social ecological model provides the best intervention for reducing firearm suicide and firearm mortality among the target population through small interventions at the intrapersonal, interpersonal, community and societal levels.
MEDICAL ETHICS AND CONFLICT OF INTEREST IN SCIENTIFIC MEDICINEhome
SUMMARY
The Office of Technology Assessment (OTA) was perhaps the US government's last honest agency that critically reviewed the state of the nation's health care system. The purpose of the OTA was to provide Congress with objective and authoritative analysis of complex scientific and technical issues. In its final critical report, the OTA concluded: “There are no mechanisms in place to limit dissemination of technologies, regardless of their clinical value.”
Shortly after the OTA released a report that exposed how entrenched financial interests manipulate health care practice in the United States, Congress disbanded the OTA.
Business magazine-style report on World Suicide Rate Analysis.
Andy Kirk's The Three Principles of Good Visualization Design was followed to create the report.
Tools used: RStudio, Tableau and Canva
Graphs plotted:
1) Map Chart is used to show the amount of suicide in each country
2) A horizontal bar graph is used to further compare the differences in suicide
counts in each country
3) A single line graph is used to show the amount of suicides committed each year
during the period 1985-2016
4) Stacked 100% Area graph is used to compare the suicide counts among
different age groups, namely 5-14 years,15-24 years, 25-34 years, 35-54 years,
55-74 years
5) Side by side bar chart is used to compare the number of suicide counts
among different age groups, sex-wise
6) A pie chart is used to see the composition of causes of deaths in the US in the year
2017
7) Bubble Chart is used to check out the methods by which people commit
suicide and to check which one causes the maximum death
8) A line graph is used to compare the Suicide count and happiness index for the years 2006 to 2015
9) The correlation matrix is used to find the correlation between different elements.
10) Side by side line graph is used to compare gender wise suicide
percentage in the US
11) Treemaps are used to see the composition of the number of suicides
among the states of US
12) Side by side area graph is used to see the availability of different drugs in the US
over time
GSOM SPbU is the first Russian school to be included in the significant International Financial Times ranking (2013, 2014) along with the leading international schools of business and management
GSOM SPbU is #1 business school in Russia and in Eastern Europe according to EDUNIVERSAL International Ranking (2012, 2013, 2014)
Strong networks of academic and corporate partners: global network of 58 top business schools; over 190 companies provide internships for our students. Many Russian and international business leaders are guest speakers at GSOM.
GSOM provides three master programs: Master in Management, Master in Corporate Finance, Master in Public Management.
Dr. William Allan Kritsonis, Editor-in-Chief, NATIONAL FORUM JOURNALS (Founded 1982). Dr. Kritsonis has served as an elementary school teacher, elementary and middle school principal, superintendent of schools, director of student teaching and field experiences, professor, author, consultant, and journal editor. Dr. Kritsonis has considerable experience in chairing PhD dissertations and master thesis and has supervised practicums for teacher candidates, curriculum supervisors, central office personnel, principals, and superintendents. He also has experience in teaching in doctoral and masters programs in elementary and secondary education as well as educational leadership and supervision. He has earned the rank as professor at three universities in two states, including successful post-tenure reviews.
Lesson 13 Policy Considerations for Special Populations Reading.docxSHIVA101531
Lesson 13: Policy Considerations for Special Populations
Readings
NOTE: The Cochran et al. (2003) article in the syllabus has been replaced with the Mustanski, Garofalo & Emerson (2010) article below.
McGuire, T., & Miranda, J. (2008). New evidence regarding racial and ethnic disparities in mental health: Policy implications. Health Affairs 27(2): 393-403.
http://content.healthaffairs.org/content/27/2/393.abstract.
Mustanski, B., Garofalo, R. & Emerson, E. (2010). Mental health disorders, psychological distress, and suicidality in a diverse sample of lesbian, gay, bisexual, and transgender youths. American Journal of Public Health, 100(12), 2426-2432. Http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2978194/
Vogt, D. (2011). Mental health-related beliefs as a barrier to service use for military personnel and veterans: A review. Psychiatric Services, 62(2), 135-142.http://ps.psychiatryonline.org/article.aspx?articleid=102171
Summary This week’s lesson below focuses on the particular challenges facing certain groups who have specific challenges in accessing mental health services. These groups include, but are not limited to older adults, people living in rural areas and the homeless. Our readings address three other groups with significant challenges: the LGBTQ community, military personnel and veterans Much of the lesson focuses on the needs of Missourians but the issues are applicable to the rest of the nation as well. Older Adults
Approximately 20% of all adults aged 65 and older have been classified as having a mental disorder, including dementia (Karel, Gatz & Smyer, 2012). Issues related to aging can exacerbate mental health disorders when factors such as chronic illness, institutionalization, isolation, and grief are more likely to be present. Some mental problems, such as depression, also are associated with an increased risk for suicide. Data presented in Lesson 12 demonstrated that older adult white males have the highest suicide rate of any age/gender group in the state.
The majority of older adults receiving mental health care are treated by their primary care physicians (Administration on Aging (AA), 2001). While many primary care physicians provide excellent care, there are also many who confuse mental health problems with the debilities caused by chronic physical disease or may consider late onset mental illnesses to simply be a part of normal aging. When mental health treatment is attempted by these physicians, older adults commonly receive inappropriate prescription of psychotropic medications (AA, 2001). Despite these problems, both substance abuse and mental health problems in older adults are treatable and can often be prevented (Choi, N. G., & DiNitto, D., 2013). In addition to mental health treatment, activities geared toward preventing depression and suicide have proven to be effective. Specifically, both support groups and peer counseling have been shown to be effective for older adults at risk for depres ...
Running Head THE NEED FOR APPROACHES TO IMPROVE CAUSE ADMINISTRA.docxaryan532920
Running Head: THE NEED FOR APPROACHES TO IMPROVE CAUSE ADMINISTRATION AND REPAYMENT IN THE HEALTHCARE SYSTEM
1
THE NEED FOR APPROACHES TO IMPROVE CAUSE ADMINISTRATION AND REPAYMENT IN THE HEALTHCARE SYSTEM
10
Title: The Need for Approaches to Improve Case Administration and Repayment in the Healthcare System
Abstract
The medical care system of the United States of America for the past years has been considered to be the most expensive in the world. The government of the United States has to spend huge amounts of money for medical care in relation to the gross domestic product and these sums are systematically increasing. Now many scholars came to the conclusion that it is the government programs, which held the responsibility for the growth of uncontrolled spending on medical care, with which such growth is a threat to the financial stability of the United States. The issue is worth-discussing, thus, the given work is devoted to the overview of the structure and the main issues of the US healthcare system to find the effective solution.
Unlike other developed countries the medical care system in the United States of America demands more and more funds while its quality remains the same. 1/3 of the US citizens are still uninsured and there is no future hope for improving the situation. People suffer from rapidly growing prices of medical services and slow growth of salaries inclement. Furthermore, the department of insurance loses its integrity and honesty; since they use such an opportunity to fraud money as well as not paying the workers. The risk of becoming bankrupt is very high in medical care system because of unplanned budget. The insurance programs, financed by the state, are also becoming more expensive, and the government is forced to pay more and more money, which later brings about increase in state financial expenditure that immensely contribute to the poor economy. Employees do not have the free will to change their job due to the high cost of insurance and the monopolization (Stone, et al., 2008,p.2-57). This paper will provide evidences by giving the most effective solution to control this problem and also encouraging people make decisive market decisions by finding new approaches.
There are many ways of handling this subject issue of “The Need for Approaches to Improve Case Administration and Repayment in the Healthcare System,” but this research paper primarily will focus on the five articles that represent scholarly articles concerning the subject issue on this topic. The five scholarly articles are: Nolin, (2015) in his study about “Jail overcrowding a perennial issue for many counties; (Stone, P., Hughes, R., & Dailey, M. 2008)about “Creating a safe and high-quality health care environment: Agency for Healthcare Research and Quality (US); U.S. Department of Health & Human Services (2014). New HHS Data Shows Major Strides Made in Patient Safety, Leading to Improved Care and Savings; Unit ...
CHAPTER 1History of the U.S. Healthcare SystemLEARNING OBJECTI.docxmccormicknadine86
CHAPTER 1
History of the U.S. Healthcare System
LEARNING OBJECTIVES
The student will be able to:
■ Describe five milestones of medicine and medical education and their importance to health care.
■ Discuss five milestones of the hospital system and their importance to health care.
■ Identify five milestones of public health and their importance to health care.
■ Describe five milestones of health insurance and their importance to health care.
■ Explain the difference between primary, secondary, and tertiary prevention.
■ Explain the concept of the iron triangle as it applies to health care.
DID YOU KNOW THAT?
■ When the practice of medicine first began, tradesmen such as barbers practiced medicine. They often used the same razor to cut hair as to perform surgery.
■ In 2014, the United States spent 17.5% of the gross domestic product on healthcare spending, which is the highest in the world.
■ As a result of the Affordable Care Act, the number of uninsured is projected to decline to 23 million by 2023.
■ The Centers for Medicare and Medicaid Services predicts national health expenditures will account for over 19% of the U.S. gross domestic product.
■ The United States is the only major country that does not have universal healthcare coverage.
■ In 2002, the Joint Commission issued hospital standards requiring them to inform their patients if their results were not consistent with typical care results.
▶ Introduction
It is important as a healthcare consumer to understand the history of the U.S. healthcare delivery system, how it operates today, who participates in the system, what legal and ethical issues arise as a result of the system, and what problems continue to plague the healthcare system. We are all consumers of health care. Yet, in many instances, we are ignorant of what we are actually purchasing. If we were going to spend $1,000 on an appliance or a flat-screen television, many of us would research the product to determine if what we are purchasing is the best product for us. This same concept should be applied to purchasing healthcare services.
Increasing healthcare consumer awareness will protect you in both the personal and professional aspects of your life. You may decide to pursue a career in health care either as a provider or as an administrator. You may also decide to manage a business where you will have the responsibility of providing health care to your employees. And last, from a personal standpoint, you should have the knowledge from a consumer point of view so you can make informed decisions about what matters most—your health. The federal government agrees with this philosophy.
As the U.S. population’s life expectancy continues to lengthen—increasing the “graying” of the population—the United States will be confronted with more chronic health issues because, as we age, more chronic health conditions develop. The U.S. healthcare system is one of the most expensive systems in the world. According to 2014 statistics, the ...
4.1 INTRODUCTION
The United States of America (USA) covers 3,717,727 square miles and is made up of 50 states
(Infoplease, 2010). The USA’s population in 2004 was 293,027,571 (U.S. Census, 2004). In 2010
the population reached over 307 million. The proportion of the population that is under 15 years
old in the United States (U.S.) is 21%, and the over-60 population proportion is 16% (UNO,
2004). Slightly more than 12.4% of the population were 65 years and older of which 1,557,800
(4.5%) were living in nursing homes (U.S. Census, 2010). The primary languages spoken in the
United States are English and Spanish. The largest ethnic groups are European American (75%).
African American and Latino groups each constitute approximately one-eighth of the population.
The largest religious groups are Protestant (over 50%) and Roman Catholic (25%).
The United States is the largest, most powerful nation in the industrialized (developed) world, and
it has a high literacy rate. However, in 2006, while it led the world in healthcare spending per
capita, it ranked 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male
mortality, and 36th in life expectancy, earning an overall ranking of 37th in the industrialized world
in healthcare performance (Murray & Frenk, 2010, p. 1). Life expectancy in the United States is 80
years of age for European American women, 75.9 for African American women, 75.3 for
European American men, and 68.9 for African American men. The life expectancy rate for the
United States is among the lowest for the industrialized world, and infant mortality is among the
highest. Americans consider quality, affordable health care a birthright, an expectation. Yet, unlike
other world powers, the U.S. government plays a small role in ensuring that everyone has equal
access to quality health care and services.
Although the United States is envied for its wealth, high technological capabilities, and research
savvy, historically it has not kept pace with other industrialized nations in the area of healthcare
delivery. This is reflected by its poor outcomes in infant mortality and life expectancy. The
healthcare system is also overwhelmed by disparities and inequities in care and lack of access
(except for the most aff ...
Running head: ROUGH DRAFT 1
2
Running header: ROUGH DRAFT
Rough Draft
Rodney Buentello
GEN 499 General Education
Instructor John Thorburn
May 29th, 2015
Over the years, it has been well-documented that there have been a lot of problems concerning substance abuse, suicide and mental disorders in the military and its ranks. A pentagon report released during the summer time showed that close to 18percent suicide increase cases were experienced in a period of one year. During the first half of the year 2012, the rate of suicide experienced among the active-duty of the nation greatly outpaced the number of military officials that died in the battle. Despite the failure of the department to fully understand the fact that a lot of military officials encounter problems with emotions and drug abuse, experts from psychological fields say that there is a very close connection of such habits when the officials are deployed to countries like Afghanistan and Iraq. Officials from the defense department have come to the mutual conclusion that American army has never engaged themselves in wars with such problems becoming frequent among its officials. A lot of money has been spent by the top brass trying to formulate prevention and treatment programs for the officials making it clear that any person that has uniform need not be stigmatized when seeking medical treatment.
Introduction
The military is defined as the forces that have been authorized to use weapons and deadly force to try and support the interests of the citizens and their state. They are usually assigned with the task of defending their people by protecting them against wars from other countries. Additionally, they may have both the non-sanctioned and sanctioned functions in the society that include promoting agendas of politics, controlling the internal population, economic interests and society functions. Despite being reliable and efficient to their citizens, the military has faced problems regarding drugs, suicide and huge rates of depressions among their officials. Such problems are growing at rates that are alarming and sensitive to the nation due to the many number of deaths that are reported on a yearly basis. A lot of efforts have been made by organizations but more needs to be done as the army officials are encountering a lot of hardships in trying to deal with such problems. The study examines the problems in detailed form and explains what needs to be done.
To begin with, IOM came up with the conclusion that prevention and treatment programs are inconsistent as they frequently use evidence based drugs that the providers of the healthcare departments have not gotten adequate training on them at all their levels contribut.
Running head UNIVERSAL DISEASE AND MEDICAL CONDITIONS1UNIVE.docxtoltonkendal
Running head: UNIVERSAL DISEASE AND MEDICAL CONDITIONS
1
UNIVERSAL DISEASE AND MEDICAL CONDITIONS
4
Universal Disease and Medical Conditions
Name
Institution
Course
Date
Introduction
In the recent past, concern and attention has been directed towards climate change, politics and the war on terrorism. The federal and state governments have shifted their focus and attention in trying to eradicate these national issues that have been affecting the world at large. The issue of climate change has brought about a lot of unwarranted effects on the climatic conditions experienced in the US and other countries (Brownson et al., 2018). Issues such as heat waves and floods arising from Hurricanes have been reported rapidly in the country. Thus, its justified for the authorities to concern themselves in trying to balance the climate from the effects brought about by human activities and practices.
This justification can also be extended to other emotive issues such as the war on terrorism and politics, which also affect the welfare of the people as well as the performance of their economy. Without a healthy population, the government will not be able to combat the war on terrorism successfully and neither will it be able to mitigate the environment against the ill effects of climate change. All in all, there is greater need for the federal and local governments to shift their focus on matters to do with public health and come up with scientific evidences necessary to reduce the already discovered medical conditions in the US (Brownson et al., 2018).
Thesis Statement
In this paper, I am going to highlight some study cases that have been conducted by researchers in different fields of medicine and show how the Federal and state governments have ignored the issue of public health. The paper will be discussing the medical conditions in the US that have been researched and documented, but the government is not giving them the attention it deserves. My point in the paper is that the US government has focused its attention and resources on national issues such as climate change and the war on terrorism and forgot to fund research on public health medical conditions that also area a national concern. I will be using scholarly articles to discuss the discovered medical conditions.
My argument is that public health is strategically centered in the achievement of developmental and sustainable goals by the national government. There are several studies that have been conducted to document some public health concerns that are affecting the human populations, animals and the environment. I sought to discuss some of the medical conditions through an overview of articles published to highlight the effects of these conditions on humans and the environment and what the authorities need to do in order to reduce or eliminate such public health concerns
The Health Effects of a World Without Darkness
This article was composed by Rebecca Boyle. According the artic ...
Clients Presentation Your client can make up whatever they want.WilheminaRossi174
Clients Presentation: Your client can make up whatever they want. They can be as dramatic as they want to be. Have fun with it!
Subjective Data (4 points): (Review History questions in power point and on page 534-535 of text.)
Objective Data (4 points):
Inspection: What is the shape and size of the abdomen? Any masses or pulsations upon inspection? Skin smooth? Striae, scars, lesions?
Auscultation: Bowel Sounds Present in all 4 quadrants? Hypoactive, Normoactive, etc. Any bruits upon auscultation?
Percussion: Tympany in all 4 quadrants?
Palpation: Abdomen soft, firm? Any enlarged organs? Masses? Tenderness?
Any other objective data you found important to document?
Describe 2 Actual/Potential Risk Factors (2 points):
CHAPTER 15
15.1 INTRODUCTION
Although in some cases behavioral and psychiatric/mental are grouped under the same broad
category, behavioral health problems are generally effectively treated on an outpatient basis with
combination psychotherapy and pharmacotherapy (medications). Behavioral health professionals
are licensed by the state in which they reside to practice, and they collaborate on the management
of clients’ behavioral problems. These professionals include psychiatrists, psychologists,
psychiatric nurse practitioners, social workers, family counselors, and drug/alcohol and mental
health counselors (Parker, 2002). Such chronic problems as dementia and mental retardation are
considered psychiatric/mental problems rather than behavioral.
There is a distinct interconnectedness between mental health and health in general. The WHO
defines health as, “a state of complete physical, mental, and social well-being, and not merely the
absence of disease and infirmity” (WHO, 2001b, p. 1). Mental health on the other hand is defined
as, “a state of well-being in which the individual realizes his or her own abilities, can cope with the
normal stress of life, can work productively and fruitfully, and is able to make a contribution to his
or her community … it is determined by socioeconomic and environmental factors and it is linked
to behavior” (WHO, 2001a, p. 1; WHO 2010, p. 1). For example, people are generally resilient
enough ...
Similar to The Invisible Wounds - VA Policy Report - Gaspare Mura (18)
2. 2
fbh
he purpose of this paper is to analyse the VA (the US Department of Veteran Affairs) mental
health policy in the USA in a context of conflicts and economic crisis. Mental problems are the
main cause of suicide among veteran communities and the origin of associated social issues such
as problems with the law or unemployment. Two main aspects have been analysed; the financial
aspect (considering 23% of the entire US budget is allocated to defence) and the social aspect. It
has been argued that the social side is the key to improving the financial aspect through moves
such as improving the efficiency of treatment, seeking a more efficient use of existing facilities
and increasing the VA system capabilities by establishing partnerships with healthcare providers.
Moreover, there is the need to develop IT management in order to cut waiting times and share all
the information to allow a 360-degree access to veterans who seek care in the private sector, and
create new categories of healthcare professionals able to deal with the particular needs of the
veterans. To conclude, a change is required to try to honour and support the million of service
members who fought not for them but for their people, for their country.
T
Executive Summary
3. 3
In America, on any given
day 22 veterans put an
end to their own lives.
(Carter, 2013)
1
Introduction
The World is changing and the nature of War is changing, and
as a matter of fact we are living in a period of constant
conflicts. A new world has evolved since the 9/11 episodes
and with it, new wars. These are exhausting and endless wars
wherein tactics have changed, and young men and women
are sent into combat situations even before they figure out
their future. As a result, both causes and effects are
changing. However, these developments are different for
every country and are tailored to the culture of that nation. In
this paper, we will analyse and evaluate the mental health
policy of veterans in the USA; one of the countries most
affected by this problem.
For instance, in the UK, the Department of Health (2009)
affirms that there is no prevalence of mental disorders among
people who served in the army and furthermore the number
of suicides of soldiers and veterans are not greater than those
figures found in the civilian population. On the other hand,
overseas in the USA the VADM (Vice Admiral) Regina
Benjamin (U.S. Surgeon General and of the National Action
Alliance for Suicide Prevention, 2012, p.3) stated that
“Suicide among those who serve in our Armed Forces and
among our veterans has been a matter of national concern”.
In the USA, on any given day, 22 veterans put an end to their
own lives (Carter, 2013) and more than 69% are 50 years of
age or older (Kemp & Bossarte, 2012). They are Vietnam and
Gulf War veterans who are facing life transitions such as
retirement, becoming grandparents or aging. The other 31%
are young soldiers coming back and finding trouble dealing
with the reality of an economic crisis. Young women are also
affected, and never before has the presence of women been
so considerable in the army. They are returning from a
combat environment and coping with the consequences of
separation from children (Make the Connection, 2012) and
other parenting related challenges.
Defining the “real” problem
However, the high suicide rate is only the tip of the iceberg.
Underlying this are the `real´ problems. Mental disorders are
the main cause of suicides. In the literature, they are called
“invisible wounds” because they alter the psychological
sphere instead of the physical, and most of the time they are
not understood by the family or are unknown by healthcare
professionals (Tanielian et al., 2008). Mental problems are
PTSD (Post Traumatic Stress Disorder), depression and
anxiety. These are the principal cause of homelessness,
domestic violence, divorce or separation, child issues and
problems with the law (Mental Health Foundation, 2010).
According to Elspeth (2012) 10% of all those imprisoned in
In America, on any given
day, 22 veterans put an
end to their own lives.
(Carter, 2013)
4. 4
2
the USA are Veterans.
Other disorders include; military sexual trauma, substance
abuse, bipolar disorder and schizophrenia (U.S. Department
of Veteran Affairs, 2013).
This current national concern is explained by Carter (2013)
who claims there is a peak in veterans’ mental healthcare
needs 10 – 20 years after the end of a war. We saw this
phenomenon after Vietnam, and it is going repeat itself after
the 9/11 and global terrorism war including OEF (Operation
Enduring Freedom) and OIF (Operation Iraqi Freedom). The
U.S. government has not been deaf to this call. In fact, on
31st August 2012 President Obama signed an executive order
directing the VA and other departments to improve mental
health care services for the veteran community (Cloud et al.,
2013). These are the reasons why current policy is examined
here, and recommendations are given for improving the
service, whilst acknowledging that a great deal has been
done, and the U.S. context is complicated and unique.
Current Picture – Policy Context
Since September 2011, 20% of all the 2.6 million soldiers
deployed in OIF and OEF, may have experienced symptoms
of PTSD or mental problems. Now, on any given day in the
USA, 7-8 million people have PTSD episodes, and in 2010
38,000 veterans lost their lives by committing suicide (Cloud
et al., 2013). Until now, more than half of the 900,000 Iraq
and Afghanistan VA patients have been diagnosed with PTSD
(Carter, 2013). During operation OIF and OEF more than
15,000 service members reported an injury in combat and
60% of all the soldiers wounded by explosive devices
reported TBI (Traumatic Brain Injury). TBI may cause mental
issues such as anger problems, sight difficulties and lack of
judgment and control (GAO, 2005). What is most worthy of
note is that in 2012, VA cared for approximately 6 million
patients, which represents almost one quarter of the entire
veteran community, including 83.6 million out-patient visits
and 703,500 in-patient admissions, and most of them have
been treated for mental health problems (Carter, 2013).
These are the figures the VA has to deal with, and despite
more than 150 trusts in the territory, 800 community clinics
and thousands of clinicians they are not sufficient to satisfy
the demand for mental health care (Carter, 2013).
Until now, more than
half of the 900,000
Iraq and Afghanistan
VA patients have been
diagnosed with PTSD.
(Carter, 2013)
5. 5
Frauds Issue
We are living in an economic
crisis, the benefits from the
state could be seen as a life
saver. However, cases of
fraud have not been rare and
from 1999 to 2004, the
number of veterans receiving
benefits for PTSD increased
by 79,5% (Frueh et al.,
2007). In their study, Frueh
et al (2007) found that it
could be a potential fraud
cost to the U.S. government
of $19.8 billion. From 1999
to 2004, the claims for PTSD
payments increased by 148%
and 94% of service members
applying for VA benefits
related to mental problems
were for PTSD. In reality,
only half of them are really
seeking psychiatric care
during the applications. Many
veterans’ clinicians do not
believe their patients
anymore; indeed they
suspect they are pretending
to be suffering from the
disease only to obtain
disability payment. This led
to suggestions to exclude
compensation for Veterans in
clinical research, and change
policies that are encouraging
chronically ill patient roles
(Frueh et al., 2007).
3
Costs and Savings
This is an extract from the Executive order signed by the
President of the United States of America, Barack Obama:
“Since September 11, 2011, more than two million service
members have been deployed to Iraq or Afghanistan. Long
deployments and intense combat conditions require optimal
support for the emotional and mental health needs of our
service members and their families. The need for mental
health services will only increase in the coming years as the
Nation deals with the effects of more than a decade of
conflict” (Cloud et al., 2013, p.47). The Veterans community
amounts today to 22 million (Carter, 2013); they could be an
independent state when we consider that the population of
the Netherlands is roughly 16 million (CBS.nl, 2014).
Furthermore, the number of veterans with mental illness or
substance disorder is expected to increase as the military
operations in the Middle East come to an end and soldiers are
returning to civilian life. We have already witnessed this trend
between 2004 and 2008 and as a matter of fact the numbers
of ill veterans soared by 38.5% (Watkins et al., 2011).
Accordingly, to ensure the best care for veterans, the
government this year will spend $7 billion (Carter, 2013),
defence itself including VA healthcare represents 24%(see
Figure 1) of the entire US federal budget spending
(Christopher, 2013); and in particular one third of the entire
VA medical costs is allocated to VA mental health care
(Watkins et al., 2011). Lastly, there are hidden costs of
frauds (see the box) that do not directly affect the defence
budget, but affect the U.S. Government`s spending, and on
the other hand prevent the full process of recovery of the
service members.
Figure 1: U.S. Federal Budget. (Christopher, 2013)
Social outcome becomes Income
Most of the analyses and research conducted have simply
focused on direct medical costs and the short-term costs such
as cost of delivery, structures, benefits and HR
remunerations. They do not focus on the more long-term
costs such as loss of productivity, homelessness, jurisdictional
problems, and suicides (see Figure 2). In research (Tanielian
et al., 2008), it has been assessed that the cost of PTSD and
other mental problems for two years for a veteran, ranges
from between $5,900 and $25,760 per person, that applied to
6. 6
Figure 2: Distribution of costs including
Suicide mortality (Tanielian et al., 2008)
The cost of PTSD and other
mental problems for two
years for a veteran, ranges
from between $5,900 and
$25,760 per person, that
applied to all people suffering
from these illnesses results in
an amount between $4 billion
and $6.2 billion.
(Tanielian et al., 2008)
4
all people suffering from these illnesses results in an amount
between $4 billion and $6.2 billion.
On the other hand, with the implementation of evidence-
based treatments in all cases it would be possible to save up
to $1.7 billion, and in two years this system could allow the
therapies to pay for themselves (Tanielian et al., 2008). In
reality this may be considered to be a visionary plan, because
a self-financed system is seen as a daydream; something
unachievable. Nonetheless, there is no immediate answer. A
solution would be changing the culture, starting to plan in the
longer term, lowering targets to achieve a better patient care
outcome which will result in a saving for VA.
VA Services and Organizations
In this paper it has been decided to focus on the support that
VA and organizations offer to service members with PTSD or
associated mental problems outside trusts. As one of the
main obstacles to veterans seeking care is the fear of being
stigmatized as ill, it is vitally important to establish a means
of approach outside the hospital that allows them to realise
the problem. Moreover, this approach allows them to retain
their anonymity and at the same time take the first step
towards recovery by admitting the problem. The support is
based on digital platforms as there are web-based
psychological healthcare tools, smartphone apps as well as
telephonic support. This is an important step for the whole
healthcare world, the beginning of a new era. The digital
services available to veterans has to be seen as setting an
example to all other fields. The use of low-cost devices such
as smartphones has two main advantages. Firstly, it ensures
that everyone has access to support both before and during
the therapy. Secondly, it overcomes the problems associated
with distance.
The first organization operating on the web is “Make the
Connection” and it has been proved through research
literature (Cloud et al., 2013) that the best way to help
Veterans is through sharing the experience with other service
members that have already overcome the problem. Through
different media, on the site, veterans can find support,
testimonies and advice from a fellow in the same situations or
others that have successfully dealt with mental challenges.
The second group is “Wounded Warrior Project”. In their
website their mission is written as, “to honour and empower
wounded warriors”, they serve veterans and wounded or
injured or ill following 9/11. Veterans seeking help can find
programs focused on Mind, Body, Economic Empowerment
and Engagement (Wounded Warrior Project, 2014). The last
association is “Military Kids Connect”. It is worthy of
consideration because it is the first application offering
support at all levels of the family of veterans in parenting
7. 7
5
problems (Cloud et al., 2013).
Then, in the event of experiencing suicidal feelings, a former
soldier or family can text, chat or call the VCL “Veteran Crisis
Line” and he or she will be put in contact immediately and
directly with a VA healthcare professional, the service is
active 24/7 and 365 days a year (Cloud et al., 2013). This
service has been improved recently with an executive order
directed at the Departments of Veteran Affairs, Defence, and
Health and Human Services. Reinforcing the capacity of VCL
in a program of suicide prevention by 50%(Cloud et al.,
2013)
Apps are the latest kind of help from the VA and, as today
mobile devices are part of daily life, software has been
developed to support treatment programs. These apps are
Breathe2relax, which advocate a diaphragmatic technique to
calm down in conditions of stress. PE coach and PTSD coach
have been developed jointly by the DoD and VA, and they
respectively offer treatment and help to self-assess in case of
PTSD episode, and put users in direct contact with support
resources (Cloud et al., 2013). However, apps and web tools
are only meant to be a complement to the therapy and they
cannot replace a professional mental health cure (Cloud et
al., 2013).
Today Issues, Tomorrow Solutions
Veterans own their destiny
Veterans are the main actors and influencers in the first
category of issues. First of all, the “average delay by a person
with PTSD in seeking care is 12 years” (Cloud et al.,2013,
p.8). Many of them do not seek help at all and only 40% of
veterans whose results prove positive in screening for mental
disorders visit a healthcare professional (Mental Health
Advisory Team IV, 2007 cited by American Psychological
Association, 2012); the number is even smaller, 30%, if we
talk in particular of PTSD cases (Tanielian et al., 2008).
Figure 3: 1-17 th Infantry
helps clear 120 kilomweters
to Shorabak (Mackie, B.,
2012)
8. 8
6
Veterans perceive mental illness as a stigma, they feel it is
embarrassing and dishonourable to be sick (SAMHSA, 2007
cited by American Psychological Association, 2012).
Furthermore, researchers have found an exclusive
characteristic of the military context to be a barrier to seeking
help. In the army, soldiers are bound under a secret law to
look out for their “buddies”, and this and the good of the unit
become the priority. Following this belief, veterans think that
they do not deserve the help. They believe there is a fellow
soldier who needs the support more than they do because he
or she has been in a combat environment or they have been
exposed to harder conditions. In respect of that, inside the
service, members felt a sense of shame for using resources
(Make the Connection, 2012).
To address this problem, the veterans’ awareness
must be increased. It is essential to communicate the
message that illness is not a shame. They must be aware that
therapies with proven effects exist and that there is support
preventing them from feeling alone. In this case, the media
plays an essential role. Already in the USA there are
campaigns like “Veterans Voices”, “Stand By them” or “Side
by Side” launched by PSA (Public Service Announcement).
Also, within the world of sport, the NFL for example supports
the cause, and Hollywood is helping to transmit the
information with shows like Homeland, Bones (Cloud et al.,
2013) or Army Wives.
Another obstacle is the struggle of service members to
collaborate with civilian healthcare professionals. Veterans
believe that they cannot understand their feelings, and they
do not comprehend the army culture (Mental Health
Foundation, 2010). “Military services involve entry and
participation in a unique culture, one with a particular value
set and cultural identity distinct from the civilian population”
(Cook et al., 2013, p.29). Although, it is true that mental and
health providers in communities have different backgrounds,
and many of them are inexperienced with army culture or war
related trauma and disorders (Burnam et al., 2009).
Overall, there is a lack of specified training on the mental
health specialty workforce (Cook et al., 2013). To make up
for this deficiency it is necessary to create new professionals,
clinical and social workers and psychologists with skills in
military and social work. It might be necessary to create a
new human capital pipeline from the base, following the
example of collaboration with the universities of Southern
California and South California (Carter, 2013).
Last, is the warrior mentality whereby a soldier feels himself
to be a killer machine. He feels proud to serve the country
and protect all his brothers, so when there are signs of
weakness they try to minimize them. Moreover, if and when
“Military services involve
entry and participation in a
unique culture, one with a
particular value set and
cultural identity distinct from
the civilian population”
(Cook et al., 2013, p.29)
9. 9
7
they accept the treatment, working in a group puts them in
an uncomfortable position, delaying the recovery and
contrasting the change (Cook et al., 2013).
VA - time to change
VA and clinicians have the power to change the second
category of issues: facilities, communications, prescription
drug misuse and efficiency of the treatment.
VA capacity has proven insufficient in satisfying the demand,
in spite of the efforts made by the DoD (Department of
Defence) and VA to improve the service by hiring 1058
mental health clinical providers, 1600 mental health
professionals and 100 peer specialists in January 2013 (Cloud
et al., 2013). After all, still “there is a large gap between the
need for mental health services and the use of those
services” (Tanielian et al., 2008, p.2).
The current model of VHA (Veteran Health Administration)
relies mostly on VA employees to deliver care and this makes
it the largest government workforce outside the DoD. There
are three alternative ways of addressing the problem of the
capacity of the VA healthcare system. First, hire more
clinicians. Second, expand the use of the existing facilities
(more hours, new types of care) or create new facilities
(Carter, 2013). In order for there to be a solution that can
satisfy all these needs, contracted work would be necessary.
Government bureaucracy involved in hiring process could be
avoided if the VA were empowered to hire contractors
directly, then it would provide the scalability that VA Human
resources needs, and in the long term costs would be lower.
Pilot projects, like that of CBOCs (Community-based
Outpatient Clinics), showed that this option produces a
similar or better patient satisfaction (Carter, 2013).
This paper considers three main issues under the term
communications. First, there is the need to develop new
Figure 4: ‘America’s Battalion’
Marines, sailors run to honour
fellow wounded warrior (Reece,
L., 2012)
10. 10
8
software to schedule the visits. The GAO (Government
Accountability Office) claims that waiting time is a serious
problem, and 91.3% of VA doctors recognize that the
responsibility of the delay in care for VA patients is
attributable to the process of scheduling appointments, and
for this reason there is a need to integrate this system at a
National level (Carter, 2013). After the creation of a
management system for booking, the second step would be
the sharing of this information. The DoD, VA and HHS
(Department of Health and Human Services) must necessarily
increase communication and coordination between them
(Jackonis et al., 2008).
The VA, moreover, should try to create a unique patient
database, where private sector and VA health providers
supply information. More than 20% of veterans seek mental
health care outside the VA (American Psychological
Association, 2012); 75% have private insurance coverage,
and current research shows that the veterans prefer the
private sector in terms of its economic efficiency and
convenience (Carter, 2013). The VA has been accused of
lacking transparency and it is recommended that they should
make all the data available to focus on working towards
improving the services it provides (Carter, 2013).
Prescription drug misuse. There are many returning veterans
who suffer chronic pain problems, and through treating this
problem they are more at risk of developing an addiction to
painkillers (Cook et al., 2013). Chronic pain and mental
health problems are factors that increase the problem of
substance disorder such as alcohol (Cloud et al., 2013), and
this problem is usually is masked by the label of social drinker
especially for young veterans (Cook et al., 2013).
Prescription drug misuse is a real concern also because it is
an obstacle to seeking help. Many veterans are afraid of the
side effects of treatment and are concerned that it can
influence their job or their career (Burnam et al., 2009). It is
true that unemployment among veterans outpaces the civilian
rate (American Psychological Association, 2012).
“Raw” PTSD
The latest kind of issue has taken a new form. The most
recent veterans are different from the previous ones. Iraq
and Afghanistan soldiers display PTSD symptoms which are
more acute and with a higher level of anger. This more acute
form is known as “RAW PTSD”. Some explanation has been
found in the fact that the new veterans are freshly
“wounded”, bad memories are new, and they are younger
when they come back (Cook et al., 2013). As a consequence
of that, there is the need to change therapies and the means
of delivering care. It is necessary to update all the types of
care and to start to approach the study of the new disease in
a different way.
11. 11
9
Veterans’ Leverage
There is a strict connection between American politics and veterans, the connection
originated alongside the foundation of this country. In order of that, twenty-six of all forty-
four Presidents have served in the army, as it follows more than half of the Presidents were
veterans (U.S Department Veteran Affairs, 2011). The implementation of this policy is
mostly a matter of government, in fact, they would have the means to change the current
system and carry out the changes needed. In the first part of this brief paper it was
analysed that, through the development of care delivery, it would be possible to save up to
$1.7 billion a year, which would lead into creating general benefits for the US budget
spending. In addition to that, the policy can have implications on the political picture. In
the American society veterans inhabit respected positions earned due to their service in the
combat field. The citizens are eager to give their political preferences thinking of them as a
model of discipline, loyalty and honesty. According to that, 108 members of the 113th
congress were in the army or have served in the military (F.A.S. Federation American
Scientists, 2013). The significant numbers of veterans’ community can have an influence to
the entire political system shifting the equilibrium either to one or the other side. Simply
put, President Obama has won the last election with 62,611,250 popular votes (Politico
LLC, 2012), only the veterans’ society could represent one third of all voters for the
election of the future US President and change the destiny of the nation. Politicians cannot
afford to turn their back to veterans; the risk could be too high about lives, and more
importantly for them, about the power.
Conclusions
In conclusion, even if the American system is one of the best in the world (Make the
Connection, 2012), it is really difficult to cope with the needs of millions of Veterans. This
is one of the consequences of the GWOT (Global War of Terrorism); even if the combat
field is far away, in the USA the effects are being felt not only in the society. Furthermore,
the deployment in these years of crisis is seen as safe income, but too often young soldiers
consider just one side of this choice.
Clearly, through analysis it is possible to identify several efforts made by the VA and
Voluntary organizations to offer a vast range of services, but in respect of this point it
might be better to have a smaller quantity of services with more quality within them.
Moreover, the number of current facilities is not adequate, and most of the time these
facilities are located in urban centres excluding isolated suburban zones; a problem that
could be overcome through delegating services to contractors.
On the other hand, if the facilities are inadequate, the use of technology in healthcare for
veterans is worthy of note. Smartphone apps in healthcare could well be the future,
especially for patients like soldiers who are afraid of being recognized and judged. The
entire healthcare system could follow this example. The use of technology is the result of a
patient care centred system and many of these ideas have been suggested by non-profit
organizations that are around the VA. The efficiency of these organizations is well known,
and in a way Veterans are supporting and healing themselves following the order issued on
the combat field, “to look out for the fellow soldier”.
This paper has highlighted that there is the need to work on two sides of the current policy.
The conclusion to be drawn is that an effective means of improving the financial aspect
might well be best achieved by working on the social side. The aims are clearly to decrease
the suicide rate, improve the efficiency of therapy and adopt evidence-based treatments.
12. 12
0
As stated before, from the review it has emerged that VA departments offer a significant range
of services, but there is a lack of organization, coordination and development of evidence-
based treatments. There is the necessity to reduce waiting list times and there is the need to
share all data with the private sector for two reasons. First, in order to permit Veterans to seek
care in private trust. Secondly, in order to start focused research on the real results of the
current therapy. Furthermore, to improve the results of the therapy there is the need for
specialized healthcare professionals, starting partnerships with schools for the creation of MSc
studies or courses related to army subjects.
The final consideration here is that of Virtual Reality (VR) (Carter, 2013). Today it is possible
that service members could re-live certain situations and particular feelings through VR.
Studying therapies based on VR could be a successful strategy to adopt in order to fight these
veterans’ personal wars. In brief, VA mental health policy is a real concern that will affect the
USA for a long time. Acknowledging that today Vietnam Veterans are the most affected, this is
the main reason why it has to be a central theme both in the politics and within society in the
USA.
13. 1
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