Policy Brief by Kris Metzger
School of Social Work, Boston University
Abstract
The purpose of this policy brief is to first examine the alarming mental health statistics of Veterans in America and further scrutinize how this population is being underserved when it comes to mental health care. This brief recommends for the passing of House Bill 3684, the Douglas Mike Day Psychedelic Therapy to Save Lives Act of 2023, as well as advocates for the use of psychedelic therapy for Veterans in general, in order to expedite the healing process for Veterans and better serve the mental health care of the Veteran community. This bill also points out the cons of House Bill 3684 and the concerns this brings force. In turn, a few modifications are proposed in order for this bill to be most effective.
Context
America has long been a two-party system, but in the last several years the partisan polarization has become palpable. Democrats and Republicans views of one another have increasingly become more negative, with each party seeing not only the other party, but the people who identify with that party, as more immoral, dishonest, and more close-minded than the other (Pew Research Center). Currently, 72% of Republicans view Democrats as immoral, and 63% of Democrats say the same about Republicans (Pew Research Center).
In a survey conducted among 6,174 Americans between June 27 and July 4, 2022, the American Trends Panel revealed the belief that the opposing party’s policies are harmful to the country remains a major factor in why Republicans and Democrats choose to affiliate with their party (Pew Research Center). And while Republicans and Democrats continue to express negative views of those in the other party, they simultaneously have become more positive about the people in their party (Pew Research Center).
Overall, the antipathy expressed by both parties is higher than it has been in decades (Pew Research Center). When viewing any media source, bipartisan or dead center, the divide can be felt like a tidal wave with culture wars at the undercurrent.
Current culture wars, seemingly rooted in the idea of extinction, are plentiful when it comes to issues such as the LGBTQIA+ community, gender ideology and religion in schools,
gun control, abortion, critical race theory, and race and class issues in general (Pew Research Center). However, Veterans seem to be a neutral entity within this particular war (Jordan, 2023).
And while culture wars could be seen as a political battle over certain kinds of cultural issues, the truth is that such cultural issues underwrite our politics and the ways in which our politics become reflections of deeper cultural dispositions—not just attitudes and values—and it is these politics which then become policy (Politico). And it is these policies which bleed into the everyday lives of Americans whether we realize it or not.
The Problem
When it comes to mental health and mental health policy within the United States (U.S), to say there is a long way to go is an understatement. Mental Health America stated in its 2023 key findings that the vast majority of individuals with a substance use disorder in the U.S. are not receiving treatment, millions of adults in the U.S. experience thoughts of suicide with the highest rate among multiracial individuals, almost a third of all adults with a mental illness reported they were not able to receive the treatment they needed, and in the U.S. there are an estimated three hundred and fifty individuals for every one mental health provider (Mental Health America).
With PTSD rampant in the Veteran community, these mental health issues appear to be even more dire in the Veteran community. Veterans are one point five times more likely to commit suicide than nonveterans, with an average of 22 Veterans dying by suicide every day, with the recent discovery that it could be as high as 44 Veterans per day (Jordan, 2023 & Leonard). The National Center for PTSD found that eleven to twenty percent of Operation Iraqi Freedom (OIF) and Enduring Freedom (OEF)
Veterans are diagnosed annually with PTSD (VETS). And with PTSD leaving out no generation, twelve percent of Gulf War Veterans and 30% percent of Vietnam War Veterans are affected by PTSD (VETS). Additionally, Special Operations Forces (SOF) have been diagnosed with PTSD at a rate almost double NON-SOF units (VETS). One out of every five female Veterans report having experienced military sexual trauma while serving in the military (MST) (Leonard).
Furthermore, men and women who have experienced MST have the highest lifetime rates of PTSD with sixty fiver percent of male Veterans and forty-nine point five percent of
female Veterans experiencing such (VETS). Other prominent issues within the Veteran community which are adversely impacting the lives of Veterans include Traumatic Brain Injuries (TBIs) with nearly 414,000 U.S. service members having experienced a TBI between 2000 and late 2019, substance abuse with two out of every ten Veterans experiencing a substance use disorder, anxiety and depression with one in three Veterans having depressive symptoms, chronic pain with one in five Veterans experiencing chronic pain, social anxiety, obsessive compulsive disorder (OCD), the LGBTQIA+ community and their place within the Veteran community, suicidal ideation, and moral injury (VETS & VA).
Current treatments for such disorders which are approved and used by the VA include trauma-focused therapies such as Cognitive Processing Therapy (CPT), Eye Movement
Desensitization and Reprocessing (EMDR), Prolonged Exposure (PE), Motivational Interviewing (MI), Cognitive Behavioral Therapy (CBT), and medication to name a few (VETS & VA).
Other PTSD treatments which are beginning to be explored through the VA include Stellate Ganglion Block (SGB) which requires an injection of anesthesia into the sympathetic nerves of the neck, impacting the bodies flight or fight system, as well as mindfulness and present-centered therapy (VETS & VA). However, half of Veterans do not complete the full course of therapy or medication due to unwanted side effects and/or increased symptoms, long VA wait times, and the stigma around mental health treatment (VETS).
And with the VA receiving the third-lowest rating among ten agencies and departments in a recent Pew Research Center survey, this makes sense (Stanton, 2021). Veterans continue to be dismissed and underserved, as they are passed through the VA like hot potatoes (their description), with no real resolution to complex mental health issues which are inhibiting Veterans from integrating back into the civilian world and leading a whole, full life (Bedford, 2016). In other words, statistics show there is a clear discrepancy between the care which exists for Veterans and the desired outcome. It is clear that organizations, such as the VA, want to provide care for Veterans, but the outcome is far from what Veterans need or desire. It is unclear why Veteran care is not a priority, especially when there is more than one possible solution to the problem(s) that Veterans are and have been facing.
Evidence
Strong evidence indicates that the therapeutic use of psychedelics could be the answer in solving this discrepancy. While psychedelics have been around for many, many years, research on plant medicine is just in the emerging stages. However, thus far, the research is promising, especially when it comes to serving and healing the Veteran population. For the purposes of narrowing down evidence, focus will be given to U.S. Special Operations Forces Veterans (SOF) not only because they are at an increased risk for a variety of mental health problems and cognitive impairment associated with their specific military service (Davis et al., 2020 & Frueh et al., 2020).
SOF Veterans include the most elite and well-trained military members across all branches (VETS). These elite service members are constantly at the ready, have significantly more deployments than non-SOF members, experience high rates of direct-contact during missions, experience combat and training injuries, higher rates of death/injury (especially impact injuries leading to TBIs), and psychological distress and long-term disability (VETS & Frueh et al., 2020). Due to the specific and complex mental, physical, and emotional issues that SOF Veterans face, a new term “Operator Syndrome,” was given to the community (Davis et al., 2020).
Operator syndrome may be understood and defined as the natural consequence of an extraordinarily high allostatic load, the accumulation of physiological, neural, and neuroendocrine responses resulting from the prolonged, chronic stress; and physical demands of a career with the military special forces (Davis et al., 2020). In other words, SOF Veterans experience overlapping medical, physiological, and quality of life impairments which differ from other Veteran sectors and require more accurate treatment and care (VETS).
Current available treatments, such as EBIs and pharmacotherapies, demonstrate limited efficacy in addressing the unique and complex spectrum of psychiatric symptoms in SOF
Veterans, which is why we must support policies which advocate for potentially curative treatment approaches such as psychedelic therapies, as research shows they may be able to address the underlying etiology and complex spectrum of symptoms the SOF Veteran population experiences (Davis et al., 2020). Specifically, psilocybin, lysergic acid diethylamide (LSD), and 3,4-methylenodloxymethamphetanine (MDMA) are the most widely researched psychedelicassisted therapies which exhibit potential transdiagnostic treatment approaches for psychiatric conditions including depression, anxiety, treatment-resistant depression, substance use disorders, and Veterans with PTSD (Davis et al., 2020).
It is hypothesized that through pharmacological action on serotonergic functioning, stimulation of neurotrophic growth factors and neuroplastic changes, and through psychological mechanisms of reprocessing such as traumatic content, emotional breakthroughs, mystical-type experiences, and fostering adaptive changes in personality the efficacy of these plant medicines takes place (Davis et al., 2020). Promising
results from preliminary studies show that Ibogaine, 5-MeO-DMT, and MDMA may offer Veterans rapid, robust, and well-tolerated treatment options when it comes to psychological and cognitive impairment (Davis et al., 2020).
Policy Option
Recently, House lawmakers have introduced a bill that would create a psychedelic research grant for active-duty troops, the Douglas Mike Day Psychedelic Therapy to Save Lives Act of 2023 (Congress.gov). The bill requires the Department of Defense to award grants to eligible entities to research the treatment of certain members of the armed forces using specific psychedelic substances (Congress.gov). Research must focus on members of the armed forces who are serving on active duty and have been diagnosed with PTSD, TBI, or chronic traumatic encephalopathy (Congress.gov). Eligible entities under the bill include federal/state government entities, academic institutions, and nonprofit entities (Congress.gov). While we should support this bill, we must not forget the Veterans who have already served and are in dire need of
treatment.
Project the Outcomes
Veterans seem to be encouraging psychedelic bipartisanship due to their boots on the ground approach and moving personal accounts which continue to be accompanied by research (Jordan, 2023). A similar bill was introduced last year by Dan Crenshaw and while the bill passed in the House, it failed in the Senate. Research has since increased, more Veterans are coming forward, and the psychedelic movement has gained a lot of traction in the last year with various states beginning to implement bills regarding the decriminalization of psychedelic drugs for therapeutic use. Therefore, it seems that the chances of this bill passing are higher than last year.
Evaluative Criteria
Should this bill be passed Veterans which are actively serving and meet said criteria could benefit greatly. A good way to measure success of the bill would be to look at Veteran suicide rates. Should there be a five percent decrease in Veteran suicide in the first two years of Veterans being treated, the bill would seem to be successful.
Weigh the Outcomes
While the bill has many pros, as mentioned before, the seemingly biggest con is that the bill does not include those who are not active duty. At some point another similar bill including active duty members should be introduced and/or the current bill should be amended to include non-active duty members. Additionally, there is some concern around the eligible entities that the bill mentions. Those being a department or agency of the Federal of State government, an academic institution, and nonprofit entities. There is concern around how these eligible entities will implement psychedelic research among those serving.
Decision/Recommendation
While this policy would serve active members of the armed forces, besides the physical criteria listed (those active duty members who have been diagnosed with PTSD, TBI, or chronic traumatic encephalopathy), it is unclear what other criteria, if any, these active duty members would have to meet. This would and should certainly be specified as it is important to know how such criteria would or could affect various such as racial/ethnic minorities, LGBTQIA+ members, and so forth. Therefore, while this bill should be supported, as previously mentioned, there are some concerns which need to be looked out for and/or addressed in order to effectively serve all sectors of the Veteran population.
References
Bedford, S. (2016, August 8). Nine major veterans affairs failures. Washington Examiner.
https://www.washingtonexaminer.com/nine-major-veterans-affairs-failures Congress.gov. https://www.congress.gov/bill/118th-congress/house-bill/3684/
Davis, A., Averill, L., & Amoroso, T. (2020, July 8). Psychedelic treatment for trauma-related psychological and cognitive impairment among US special operations forces veterans. Sage Journals. https://doi.org/10.1177/2470547020939564
Frueh, B., Madan, A., Fowler, J., Stomberg, S., Bradshaw, M., Kelly, K., Weinstein, B., Luttrell, M., Danner, S., & Beidel, D. (2020). “Operator syndrome”: a unique constellation of
medical and behavioral health-care needs of military special operation forces. The International Journal of Psychiatry in Medicine, 0(0), 1-15. https://sealff.org/wpcontent/uploads/2021/07/Operator-Syndrome-International-Journal-of-Psychiatry-inMedicine.pdf
Hooyer, K., Applbaum, K., & Kasza, D. (2020). Altered states of combat: veteran trauma and the quest for novel therapeutics in psychedelic substances. Journal of humanistic psychology.
https://doi-org.ezproxy.bu.edu/10.1177/00221678209045
Jacobs, A. (2021). Veterans have become unlikely lobbyists in push to legalize psychedelic drugs. NY Times. https://www.house.mn.gov/comm/docs/N9u3nH44kKH4uLV0zKBCQ.pdf
Jordan, K. (2023, April 3). Vets encourage psychedelic bipartisanship. Lucid News.
https://www.lucid.news/vets-encourage-psychedelic-bipartisanship/
Leonard, N. The ongoing veteran healthcare crisis. National League of Cities.
https://www.nlc.org/article/2019/11/08/the-ongoing-veteran-healthcare-crisis/
Mangini, P., & Averill, L., & Davis, A. (2021). Psychedelic treatment for co-ocurring alcohol
misuse and post-traumatic stress symptoms among United States Special Operations Forces Veterans. Journal of psychedelic studies. 5(3), 149 155. https://doi.org/10.1556/2054.2021.00176
Mental Health America. (2023). The state of mental health in America.
https://www.mhanational.org/issues/state-mental-health-america
Pew Research Center. (2022, August 9). As partisan hostility grows, signs of frustration with the two-party system. Pew Research Center. https://www.pewresearch.org/politics/2022/08/09/as-partisan-hostility-grows-signs-offrustration-with-the-two-party-system/
Schaeffer, K. (2021, April 5). The changing face of America’s veteran population. Pew Research Center. https://www.pewresearch.org/short-reads/2021/04/05/the-changing-face-ofamericas-veteran-population/
Stanton, Z. (2021, June 20). How the ‘culture war’ could break democracy. Politico.
https://www.politico.com/news/magazine/2021/05/20/culture-war-politics-2021-
democracy-analysis-489900
Veterans Administration. https://www.va.gov
Veterans Seeking Treatment Solutions. https://vetsolutions.org
