delays (12 months in one case) in scheduling appointments and with long wait times between appointments. The providers who spoke stated that they do not have sufficient time for long-term treatment or to ensure necessary followup visits for their patients. The mental health providers also stated difficulties in recruiting and retaining qualified mental health professionals because of overwhelming caseloads (one speaker referred to a high rate of “burnout”) and noncompetitive compensation; those difficulties were exacerbated by the need to attract skilled providers to remote rural locations. One of the nurses who attended the meeting noted that there was only one neuropsychologist for the combined Temple, Austin, and Waco area.

Several attendees expressed frustration with the lack of couples and family counseling services, especially relationship and anger-management counseling. Although both veterans and care providers expressed frustration with barriers to accessing mental health care, they seemed pleased with the quality of the care. For example, one veteran stated that the Department of Veterans Affairs’ 7-week posttraumatic stress disorder (PTSD) treatment program was “wonderful” and provided the skills to “to deal with my everyday PTSD.”

Other issues centered on the burden of traveling long distances to receive needed care, which was described as a disincentive to many who could not take time from work or be away from children or who found the ride too painful (for those with injuries) to make long trips. For example, one woman veteran of OIF who suffered multiple illnesses and injuries described how for a year she had had to drive 2 hours from Ft. Hood to Brooke Army Medical Center in San Antonio twice a week for treatment that was not available in Killeen. During that time, her children, both young teenagers, had to become caretakers for their mother. Their father, her ex-husband, is serving his third tour of duty in Iraq.

The committee heard from reservists (in Killeen and elsewhere) who had trouble in getting medical care when accidents occurred while they were in transit to or from reporting to duty. In one case, a reservist was caught between the Department of Defense (DOD) TRICARE health-care system and private health insurance, noting that neither would pay for his care and each stated that it was the responsibility of the other because he was injured on his trip home from service. He stated that he was paying for his medical care “out-of-pocket” and had already lost his car because he could not continue to make payments on it. He and other reservists noted that they felt that the reserve and National Guard members were treated like second-class citizens compared with active-duty service members with regard to obtaining care.

Austin, Texas (Camp Mabry): Texas National Guard

On April 28, 2009, the committee met with community leaders and representatives of groups that provided services to the reserve component at Camp Mabry, in Austin, Texas, the headquarters of the Texas National Guard (both Army and Air National Guard). The attendees stated that the community, reservists, and employers face substantial employment-related issues. For example, a representative from the Employer Support of the Guard and Reserve reported that employers are initially supportive of reservists during their first deployment, but their willingness to bear the cost of keeping jobs open for activated reservists declines sharply during subsequent deployments, especially in the current economic recession. He noted that many businesses cannot sustain the rehiring of people over multiple deployments, because their positions have been filled by permanent employees.

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