Progressive Voices

We have heard a lot about the plight of returning veterans with acquired disabilities - post traumatic stress disorder (PTSD), traumatic brain injury (TBI), loss of limbs, spinal cord injuries, etc. The Veteran Administration (VA) will, of course, provide everything these soldiers deserve and need to return to their pre-injury lives. Right? Wrong, especially for Veterans of US Military Operations in Iraq and Afghanistan who experience a TBI. For those veterans, their care will likely come from the state of North Carolina and local communities.

The rate of TBI diagnosis is 8.2 percent among all wounded troops (through December 2006). The disabilities which result from a TBI depend upon the severity of the injury, the location of the injury, and the age and general health of the individual. Some common disabilities include problems with cognition (thinking, memory, and reasoning), sensory processing (sight, hearing, touch, taste, and smell), communication (expression and comprehension), and mental or behavior disorders (depression, anxiety, personality changes, aggression, acting out, and social inappropriateness).  

TBI, especially closed head injuries, is difficult to diagnose and may go unrecognized unless specific screening is performed after a soldier returns from deployment. The danger for veterans with undiagnosed TBI is dishonorable discharge. One of the symptoms of closed head injury is poor impulse control - usually resulting in behavior not tolerated by the military. Soldiers who are discharged dishonorably for their behavior no longer have access to medical and rehabilitative services from the VA. 

So what happens? The communities these discharged vets call home will be responsible for their care. In North Carolina, community-based systems are ill-equipped to provide veterans with TBI the services they desperately need. 

According to one national study, about 40% of those hospitalized with a TBI had at least one unmet need for services one year after their injury. The most frequent unmet needs were:

• Improving memory and problem solving;
• Managing stress and emotional upsets;
• Controlling temper; and
• Improving job skills

In North Carolina, it will be even harder to get appropriate treatment. In recent months, we've read a lot about the state's failed mental health reform and the frayed safety net of services for people with mental illness. It's not just people with mental illness who have been failed by this service system - its all people with disabilities, including those with TBI. The failing mental health reform structure is the same one that serves individuals struggling with substance abuse and people with developmental disabilities (DD) including people with TBI. This is because North Carolina, for some reason, has included TBI in the state's definition of DD. (The federal definition of DD, in contrast, includes the stipulation that the disability occur before the age of 22, significantly limits the ability in three of seven functions, and is lifelong.) 

In addition to poor community-based services for people with TBI, our state has only one facility specializing in helping people with TBI. This was inadequate before the large numbers of vets returned home. The one-million dollars earmarked this summer by the General Assembly to increase community capacity specific to TBI is just a drop in a bucket of need. And it doesn't begin to address the mistaken assumption that the same community-based services available for people with DD will be appropriate for people with TBI. Unfortunately, services for adults with DD are built on a philosophy of habilitation - helping those individuals acquire skills not yet learned and then to maintain them. Adults with DD will need life-long services at a sustained level. 

This type of service philosophy doesn't work for adult who experience TBI. What they need is to re-learn skills lost due to the injury. They and their families remember lives that are now fundamentally different. They want to restore skills. Our services are not designed to do that; in fact the traditional DD service structure may be a barrier to meeting the needs of people with TBI.

Too bad it has taken a war to highlight a need that North Carolinians with TBI have always experienced. North Carolina has inadequate services for people with TBI. Maybe this war will reap ‘collateral benefit'; maybe as services are developed for our vets with TBI, an array of services will be developed for all people with TBI.

Vicki Smith is the Executive Director of Disability Rights NC

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This entry was posted on Tuesday, August 19th, 2008 at 10:57 am and is filed under Progressive Voices. You can follow any responses to this entry through the RSS 2.0 feed.