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“The crisis is extremely significant at current levels of demand. Just try to imagine if more of the veterans who are eligible begin to use services,” Bellon said. “If a couple hundred thousand more show up on their doorstep they need to meet that demand.” As of June 30 this year, 211,819 veterans of the Iraq and Afghanistan conflicts have been diagnosed as potentially having PTSD, according to a quarterly report issued by the Department of Veterans Affairs. That includes 1,376 veterans who have been seen at the Veterans Administration Medical Center in Plains Township or its outpatient clinics. A study released in 2008 by the RAND Center for Military Health Policy Research entitled “Invisible Wounds of War” raised concerns regarding gaps in treatment for Iraq and Afghanistan veterans seeking care for PTSD and other mental health conditions. The study found that roughly half of the veterans who have symptoms of PTSD or major depression seek treatment. Of those who did seek treatment, only slightly more than half got “minimally adequate care.”
jail by enrolling in a strict probation program that requires them to undergo intensive counseling and other services. If the defendant successfully completes the program, their criminal record is expunged. Cosgrove said he became interested in establishing a veterans court based on his dealings with troubled veterans both as a judge and private attorney. “Those who have served in harm’s way have experienced circumstances that the average citizen can’t imagine,” Cosgrove said. “They were there because we asked them to go. We owe them something when they don’t come back whole and because of that find themselves in the criminal justice system.”
Severe consequences The consequences for veterans and their families are severe. Veterans suffering from untreated mental disorders are far more likely to have problems with substance abuse and are at higher risk to commit suicide. There were a total of 2,293 suicides of active duty members from 2001 to September 2011, with 298 of those occurring in a war zone, according to statistics compiled by Veterans for Common Sense. Former Marine Sgt. Stanley Laskowski of Carbondale is among those who returned from combat with the “invisible wounds” of war. The decorated Iraqi war vet suffers from severe PTSD brought on by his 5½ month tour of duty in Iraq in 2003. Laskowski, 33, maintains the VA’s failure to properly treat him when he first sought care in 2007 caused his condition to worsen to the point that he’s been declared 100 percent disabled and is unable to work. Dr. Antonette Zeiss, chief consultant for the VA’s Office of Mental Health in Washington, D.C., said she’s aware of the concerns that have been raised, but believes the VA – which saw more than1.28
NIKO KALLIANIOTIS/FOR THE TIMES LEADER
Former Marine Sgt. Stanley Laskowski and his wife, Marisol, talk about his tour of duty in Iraq. Laskowski suffers from post-traumatic stress disorder brought on by his experiences in combat.
million veterans for mental health issues in 2010 -- provides exceptional care. Zeiss said the VA, which operates the National Center for PostTraumatic Stress Disorder, is the leading organization conducting research on PTSD. That’s resulted in significant advances in the treatment of the disorder in the past five years. Those treatments focus on a combination of individual and group counseling, coupled with medications, said Zeiss and Dr. Matthew Dooley, a staff psychologist at the VA Medical Center in Plains Township. “It starts off by educating patients so they can learn to identify and understand their symptoms and learn coping skills so they can manage them better,” Dooley said. The VA is continually evaluating treatment options and modifies its approach as more information and data becomes available, Dooley said. There have been significant advances in treatments since 2006. “As treatments evolve and become more effective, you adapt your system so that you can help patients recover more effectively,” he said. Today the VA focuses treatment primarily on two evidence-based therapies, Cognitive Process Therapy and Prolonged Exposure Therapy. The therapies encourage veterans to talk about their trauma and teach them how to deal with anxiety and feelings of guilt they experience, Zeiss and Dooley said.
“Cognitive process therapy deals with self punishing distortions. Sometimes people can feel personally responsible for the death of a colleague in combat,” Zeiss said. “Cognitive process therapy deals with those distorted, self-critical thoughts.” “Prolonged exposure therapy puts more of an emphasis on learning how to live again in the world even though you have negative memories,” Zeiss said. Treatment issues Bellon agreed the VA has made advances in therapies, but there remains significant concern regarding the availability of mental health services, he said. An internal staff survey recently conducted by the Department of Veterans Affairs revealed that 70 percent of the 272 respondents don’t think the VA has the resources to handle the increasing demand for mental health services. According to the survey, 37 percent of the respondents said they cannot schedule an appointment for a new patient within the14-day standard the department mandates. Zeiss acknowledged the concerns raised by staff, but said those feelings conflict with other data the VA collects. “Our internal data shows that 95 percent of all patients new to mental health are seen within 14 days,” she said. “We track that carefully and think we are doing very well in that field.” The VA has also taken significant steps to improve services, in-
cluding the establishment of a suicide prevention program that includes a national hotline for veterans. The hotline received more than 460,000 calls as of July 31, 2011 that resulted in16,855 “rescues” of veterans who had attempted or were on the verge of attempting suicide, according to Veterans for Common Sense. The VA has also significantly increased mental health staff in recent years, Zeiss said. Since 2005, the VA has hired an additional 7,500 mental health professionals, giving it a total of 21,000. Bellon said those are positive steps, but he remains concerned that the efforts have come too late. “They are beginning to add people. The problem is it’s the tip of a problem that’s been allowed to accumulate. It’s going to take a substantial amount of time,” Bellon said. Zeiss said there are no immediate plans to hire more mental health professionals, but the department is continually monitoring the situation. “We are thinking about … what happens when all the service members come back from Iraq. We are looking at models to ensure we are appropriately prepared for what may be ahead.”
Many troubled vets Officials with veterans organizations and the criminal justice system have expressed concern regarding the growing number of veterans appearing in court who have serious mental health and substance abuse issues. An August 2008 report by the Substance Abuse and Mental Health Services Administration estimated that veterans make up 9 percent of the prison population in the United States. Statistics regarding the number of veterans who have appeared in Luzerne County Court were not available. But Cosgrove and Judge Lewis Wetzel, who oversees Luzerne County’s drug and mental health treatment courts, said the numbers are growing. The Department of Veterans Affairs established outreach programs at its medical facilities nationwide several years ago as part of its efforts to enhance mental health treatment, said Vince Riccardo, spokesman for the Veterans Administration Medical Center in Plains Township. Wetzel said Luzerne County has worked closely with the local VA to obtain assistance for veterans. Kim Sapolis-Lacey, a veterans outreach specialist with the hos-
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“Those who have served in harm’s way have experienced circumstances that the average citizen can’t imagine.”
pital, said she receives an average of five to seven referrals each month for veterans facing criminal charges, although not all of them qualify for the specialty treatment courts. “The prime thing we do is connect veterans to treatment at the VA. Many may not have access to Luzerne County health care any Judge Joseph other way,” SaCosgrove polis-Lacey said. “We make sure all their needs are met, including treatments that may not be available in the community, such as post-traumatic stress disorder and traumatic brain injuries and other issues related specifically to their military experience.” Expansion of efforts Cosgrove wants to expand on those efforts. A key component of veterans courts is establishing a mentoring program that pairs troubled veterans with other veterans. That type of program has been shown to be particularly helpful because veterans feel more comfortable speaking with other vets, who have a better understanding of what they’re going through, he said. Cosgrove, who was appointed in January 2010 to fill the unexpired term of former judge Mark Ciavarella, had hoped to have the court established by the time he leaves the bench at the end of December. That doesn’t appear likely as the plans for the court remain in the preliminary stage. He’s continuing to work with various organizations to get the structure in place so that it can hopefully come to fruition next year. “Our soldiers served with honor and integrity,” he said. “We need to address the things they may have suffered as a result of that service and restore themselves as productive citizens.”
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