Children in military families are often subject to stressful conditions stemming from difficult transitions. The various stressors increase childrens' risks emotional distress, substance abuse, and other risky behaviors. Working with the NJ National Guard Family Program and its eight Family Assistance Centers based at armories around the state, the New Jersey Prevention Network provides programs to serve returning military personnel and their families through two evidence-based programs, Coping with Work and Family Stress and the Strengthening Families Program. Both programs are designed to enhance protective factors to support military members and their families in making responsible parenting and individual choices in regards to drug and alcohol use.

By 2010, nearly 40% of U.S. Veterans will be at least 65 years old, emphasizing the need to understand and address the long-term impact of both positive and negative effects of military service on the mental and physical health of aging (U.S. Department of Veteran’s Affairs, 2009). Rates of mental illness and substance abuse among aging veterans continue to increase. Older veterans, particularly those over 85, are especially likely to have multiple, complex chronic diseases requiring comprehensive health care including long-term care services (U.S. Department of Veteran’s Affairs, 2004). If these trends continue, medical settings will serve more aging veterans impacted by mental illness and substance abuse (SAMHSA, 2008). The need to allocate resources for the prevention and treatment of these issues among older adults is clear and increasingly salient.

Re: Leading Change: A Plan for SAMHSA’s Roles and Actions 2011-2014
Strategic Initiative #4: Military Families

Therapeutic Communities of America (TCA) is pleased to have the opportunity to submit comments to SAMHSA on the “Leading Change: A Plan for SAMHSA’s Roles and Actions 2011-2014” document. It is our hope that our comments will inform the discussion at SAMHSA and across agencies at the Department of Health and Human Services, as well as at other federal departments and agencies, and result in positive outcomes for people in and/or seeking recovery.

Therapeutic Communities of America (TCA) was founded in 1975 as a non-profit membership association for therapeutic communities across the United States and Canada. Since then TCA has grown to a consortium of over 650 substance abuse and mental health treatment programs run by 51 non- profit agencies located in 32 states, Washington DC, Puerto Rico, Guam, Virgin Islands, and Canada. The therapeutic methodology of treatment was established in the 1950’s addressing the entire social, psychological, cognitive, and behavioral factors in combating drug and alcohol abuse. TCA member agencies provide services to clients with a diversity of special needs as well as a continuum of care including such services as assessment, detoxification, ER triage, community residential care, in-prison programs, case management, outpatient, family therapy, transitional housing, education, vocational, primary medical services and continuing care. Therapeutic Communities have been leaders, creating innovations in addiction treatment including but not limited to services to addicted women and their children, individuals with co-occurring disorders and clients of the criminal justice system.

TCA commends SAMHSA for conducting this strategic planning process which will guide it as it seeks to fulfill its mission of reducing the impact that substance abuse and mental illness have on America’s communities. As you proceed with this endeavor, TCA respectfully requests that you consider our specific comments and recommendations on Strategic Initiative #3, Military Families.

TCA believes that SAMHSA has accurately identified key challenges that face policymakers who wish to address the significant unfulfilled needs of military servicemen and servicewomen as well as veterans who should be receiving substance abuse and mental health treatment services. As discussed on p.43 of “Leading Change,” TCA agrees that there are many barriers, including stigma, which deter servicemen and servicewomen and veterans for seeking the services for which they are eligible. Instead, these populations often seek care in communities across this country, particularly from local and/or private behavioral health care systems when they are able to access such services at all.

Therapeutic communities traditionally have provided mental health and addiction treatment to disadvantaged Americans with multiple barriers to recovery, including veterans. Our returning veterans from Iraq and Afghanistan who have or are at-risk for substance use and co-occurring mental disease disorders constitute a special population that will need treatment that has been modified from traditional modalities of care. Traditional methods of confrontation for addiction do not always work, especially with women who may have other trauma issues including sexual abuse. Our returning discharged military will need a continuum of care, including co-occurring treatment for Post Traumatic Stress Disorder and will need to be welcomed to a nurturing and safe environment. The buddy camaraderie of a military unit needs to be translated into services located in their home community.

As per SAMHSA, among the fundamental expectations that underlie the work plan for the Military Families Strategic Initiative is that, when appropriate, military families should have access to well-prepared civilian service systems. In light of this, TCA believes that SAMHSA must lead efforts coordinate with the Secretary of the Veterans Administration, the Secretary of HHS, and the Secretary of Defense to develop model programs that coordinate military, Veteran Affairs, and public health systems of care for substance abuse and/or co-occurring mental health disorders for returning veterans and their families. Ideally, this could be implemented through demonstration grants that would support the following:

1. Regional and State case management systems that broker and coordinate private, public, and non-profit resources for substance abuse prevention and treatment for returning veterans and their families.
2. Coordinated programs for women veterans and/or for children of returning veterans specific to substance abuse and co-occurring illness.
3. Coordinated programs for the purposes of developing early intervention, outreach and treatment to veterans at risk in their communities for substance abuse for veterans that do not use or not eligible VA services.
4. Research and evaluation of demonstration grants for both coordination of resources and clinical outcomes.

Please call Dr. Sushma Taylor, President of TCA at the TCA National Office at 202-296-3503, if you need additional information or comments. Thank you again for the opportunity to provide feedback. TCA looks forward to working with SAMHSA to fulfill all the needs of our servicemen, servicewomen, and veterans who have served our country with such distinction.

Sincerely,

Dr. Sushma Taylor
President
Therapeutic Communities of America

Under Goal 3.1 and Objective 3.1.1, SAMHSA states that it will sponsor TRICARE/Behavioral Health Care Provider Organization Forums, but we believe that the sub-agency should also consider providing resources to help service providers obtain TRICARE certification.

Under Goal 3.1 and Objective 3.1.2, SAMHSA should define criteria as to which service providers would be eligible for receiving TRICARE Technical Assistance. Will this opportunity be made through a competitive bid process?

Under Goal 3.1 and Objective 3.1.3, SAMHSA should help service providers who do not have TRICARE certification to be included in the user-friendly resource package for veterans which will be developed by DoD, VA, and HRSA.

As a military wife, I would love to see the changed made for out military families. We have been though one deployment with out any support or follow up after my husband came home (one year ago). TRICARE was not helpful for us, as the paperwork was so difficult and time consuming. I was told doctors would be approved and TRICARE would not approve the paper work that I submitted leaving me in much medical debt. The behavioral health treatment was none for our family. I was very disappointed and hope that other military families do not have to go through what we have. I would support what has been outlined fully.

Key mental health consumer and psychiatric survivor leaders supported the following statement at a SAMHSA summit.

Bastille Day 2010 Statement – Rockville, MD

14 July 2010

The Urgent Necessity for More Non-Drug Alternatives in Mental Health Care

We are alarmed about the over-reliance on psychiatric medication in mental health care because of the undue influence of the pharmaceutical industry. We see an urgent need for a far greater range of non-pharmaceutical mental health care.

We are participants in the USA Substance Abuse and Mental Health Services Administration (SAMHSA) meeting, “Past, Present, and Future: SAMHSA Efforts to Promote Consumer/Survivor Inclusion.” We are speaking today only for ourselves as individuals, and not for SAMHSA. We applaud SAMHSA's endorsement of the values of peer support, social justice, self-determination, trauma-informed care, and a dignified life in the community for everyone.

As leaders in the mental health consumer and psychiatric survivor movement, we affirm the principle of choice in mental health care, and continue to work towards the elimination of coercion in all mental health treatment. We support the right of those who willingly choose to take prescribed psychiatric medications.

However, the inappropriate prescriptions of psychiatric medication are harming a wide range of the USA population, including infants, vets, people of color and seniors. Severe side effects are contributing to heartbreaking suffering and approximately 25 years of premature mortality for people in the public mental health system. Advertisements, the media and far too many mental health organizations are disseminating misleading information about psychiatric medication. Some individuals are even involuntarily administered psychiatric drugs over their expressed wishes, including on an outpatient basis.

Our constituency's right to choice, empowerment and self-determination in mental health care is threatened as never before, in the USA and internationally. We call upon SAMHSA to work with their federal partners and consumer/survivors to:

• Address the conflict of interest in the current relationship between the federal government and the pharmaceutical industry.

• End direct-to-consumer advertising for psychiatric medications.

• Complete the President's New Freedom Commission recommendation to investigate the long-term effects of psychiatric medication.

• Independently research on the efficacy, safety and successful ways of reducing psychiatric medications.

• Research and fund non-drug alternatives such as mental health peer-run respite centers and recovery-oriented education.

We encourage all those concerned to speak out about this crisis.

Signed:

Ellen K. Awai
Randall Bosin
Jean Campbell, Ph.D.
Gladys DeVonne Christian
Mary Ellen Copeland, Ph.D.
Jonathan David, Ph.D.
Daniel Fisher, M.D., Ph.D.
David Fuller, CPRP
Patrick Hendry
J. Rock Johnson, J.D.
Jacki McKinney, M.S.W.
James McNulty
David W. Oaks
Pat Risser
Stephen Robinson
Gilberto Romero
Lauren Spiro
Sharon P. Yokote, HCPS

What if Combat Operational Stress First Aid were marketed and trained the same way CPR is...normal "first aid" that anyone can learn. Knowing what to do, what can be done, what not to do, would give military families tools to succeed. Start providing the information on day one of boot camp...or even better, hand out "First Aid" info at the recruiting stations. Don't wait until PreDeployment or even worse, until they come home from deployment. Military families understand that their service members are at war. There is no need to limit this training to only Chaplains, Medical staff or Command leadership. Spouses and Parents are the front lines of support for America's service members. We know we are at war, we are patriots too...please help us obtain the training and tools we need to do our job.