URGENT: Veterans in Crisis with Military Sexual Trauma Lack Safe Inpatient Crisis Care

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Being held prisoner and fighting off being raped in the military was a very terrifying experience for me. Receiving VA trauma related crisis care shouldn't be traumatizing. Unfortunately for veterans like myself, inpatient care can be re-traumatizing, even if it is well-intentioned by VA staff. Patients in locked inpatient units can be unpredictable as well as verbally, physically and/or sexually aggressive. This can cause a veteran with severe military sexual trauma (MST) and post traumatic stress disorder (PTSD) related triggers to go into fight-or-flight mode. A triggering or re-traumatizing inpatient care environment paired with a lack of trauma-informed care can also cause a veteran to experience an increase in panic attacks, flashbacks, nightmares, suicidal thoughts, hyper vigilance, fear, aggression, hopelessness and more. 

Even though I was a voluntary patient with no suicidal intent, I was denied the choice to leave the mixed-gender inpatient unit that severely exacerbated my PTSD symptoms. I did not come to the VA expecting or wanting inpatient care; still I was held for six days against my will in a mentally and physically unsafe environment, away from my husband, my children, my business, my VA PTSD counselor, and my service dog. I am still feeling the negative affects of this forced stay two years later. 

VA inpatient staff wrote this in my medical notes:

  • "Pt clearly has been triggered by hospitalization due to similar physical features of hospital with the place she was held captive by her attacker."
  • "Pt. curled up on floor in bathroom. Stated she felt trapped on the ward and was uncomfortable with the camera in her room." 

  • "Responded to pt, found hiding behind a sofa in the small dayroom. She reported feeling threatened by a male patient, who was yelling on the ward."
  • "Veteran is in an acute panic state for much of the morning, tearful, sweating and breathing rapidly. She states repeatedly that the unit is "dangerous" and she feels very unsafe, and the experience is re-traumatizing."
  • Patient "begged to be allowed to go home and be with her service dog. She described the unit and staff as terrorizing, traumatizing, and torturing."
  • "She is absolutely correct in her insistence that this environment has been triggering and exacerbating her symptoms, and that she has not been receiving expected treatment including medications (past medications include quetiapine, lorazepam, zolpidem per chart review) but also other stress-reduction tools including access to her service dog." 

My friend Christine moved to another city just so she would not have to come back to our VA, after her retraumatizing inpatient experience that involved a male patient exposing himself to her among other things. I've also met another MST/PTSD veteran online, since starting this petition, who wanted inpatient care but was subjected to inappropriate behavior by two elderly veterans with dementia at our VA. Because the environment was triggering, she was given a pill and sent home instead of receiving the safe trauma-informed crisis care she needed and deserved.

Veterans in crisis with severe trauma need trauma-informed care in a safe environment that is not triggering or re-traumatizing. Please join Christine and me in our fight for VA inpatient reform by signing this petition and urging the VHA, Department of Veterans Affairs, and/or congress to:

  1. Establish a standardized trackable MST/PTSD/suicide training program for all VA psychiatric inpatient staff and residents. Veterans Crisis Line VA employees get 40 hours of trackable training so they can talk to suicidal veterans in crisis on the phone, as well as 2-3 hours of annual job related training.[1] Why do the VA inpatient staff who physically take care of suicidal veterans with MST/PTSD in crisis get no trackable MST/PTSD/suicide training our VA? Please see FOIA request 17-02705-F. If all VA inpatient staff and residents were trained on topics such as MST, neurobiology of sexual assault, neurobiology of PTSD, suicide prevention and terms, how to respond to a MST patient being harassed by another patient, trauma-informed care, retraumatization prevention, how to perform grounding techniques, affects of traumatic brain injury, and what is happening in the brain during triggers and flashbacks - veterans with MST/PTSD/TBI histories would feel a lot safer and better taken care of while in VA inpatient crisis care.
  2. Amend the VHA Inpatient Mental Health Services Handbook 1160.06 to give veterans the #Right2Refuse inpatient care if it is not physically or mentally safe for them due to their trauma history. The VA/DoD Clinical Practice Guideline for Assessment and Management of Patients at Risk for Suicide states that no evidence exists to show that inpatient hospitalization is safer than any other care setting and that patients remain at risk for suicide during hospitalization (pg 60).[2] Since inpatient care is no safer, it is inhumane to keep a suicidal veteran in inpatient care if the environment itself is severely increasing their distress and suicidalness. The Veterans Health Administration (VHA) promises to provide Veterans "care in a safe environment free from excess noise" that is "personalized, patient-driven, compassionate, [and] state-of-the-art."[3]
  3. Start providing female only or MST specific crisis care inpatient options within every VA Medical Center. According to a VA national screening program, 1 in 4 women and 1 in 100 males responded "yes" to having experienced MST [4]. MST patients in crisis require patient centric trauma-informed care in a safe environment to reduce their risk of suicide. Patients who have dementia, sexual impulsivity issues, or aggression issues should not locked in the same treatment space as patients with severe MST/PTSD. VHA Handbook 1160.06 states "that women Veterans utilize inpatient mental health services at a higher rate than do male Veterans. Current utilization is at 6 percent and this number is projected to double within 5 years. Each facility must ensure adequate access to meet the demand as it increases." [5]

Thank you so much for your support, comments, and stories! Please share this petition with your friends and family so that Veterans with sexual trauma histories are ensured quality evidence-based care in a trauma-informed, safe environment. Please use the hashtags #ReformMSTcare #DontRetraumatizeVeterans #TraumaInformedCrisisCare and #Right2Refuse to let others know why this petition is important to you. Please tweet any statements of support, comments or questions to Twitter @LP_Right2Refuse.

     - Lindsay and Christine

 

Definitions:

Trigger: "For people with PTSD, it is very common for their memories to be triggered by sights, sounds, smells or even feelings that they experience. These triggers can bring back memories of the trauma and cause intense emotional and physical reactions, such as raised heart rate, sweating and muscle tension."[6]
 
Retraumatization: According to the National Center on Domestic Violence, Trauma & Mental Health, "Retraumatization occurs when any situation, interaction, or environmental factor replicates events or dynamics of prior traumas and evokes feelings and reactions associated with the original traumatic experiences. Retraumatization may compound the impact of the original experience."[7]
 
Trauma-Informed Care: "Providing “trauma-informed” care involves using what we know about trauma and its impact to respond differently. Maxine Harris (2004) describes a trauma informed service system as “a human services or health care system whose primary mission is altered by virtue of knowledge about trauma and the impact it has on the lives of consumers receiving services.” This means looking at all aspects of programming through a trauma lens, constantly keeping in mind how traumatic experiences impact consumers. Organizations that are informed by an understanding of trauma respond best to consumer needs and avoid engaging in practices that may cause additional harm. This type of change requires providers at all levels and in all roles and organizations as a whole to modify what they do based on an understanding of the impact of trauma and the specific needs of trauma survivors."[8]

Resources:

  1. Department of Veterans Affairs Office of Inspector General Healthcare Inspection. Veterans Crisis Line Caller Response and Quality Assurance Concerns. https://www.va.gov/oig/pubs/VAOIG-14-03540-123.pdf
  2. VA/DoD Clinical Practice Guideline for Assessment and Management of Patients at Risk for Suicide https://www.healthquality.va.gov/guidelines/MH/srb/VADODCP_SuicideRisk_Full.pdf
  3. Veterans Health Administration Rights and Responsibilities of VA Patients and Residents of Community Living Centers https://www.va.gov/health/rights/patientrights.asp
  4. Military Sexual Trauma https://www.mentalhealth.va.gov/docs/mst_general_factsheet.pdf
  5. VHA Handbook 1160.06 Inpatient Mental Health Services
  6. Mental Health America Post Traumatic Stress Disorder http://www.mentalhealthamerica.net/conditions/post-traumatic-stress-disorder
  7. Defining Triggering, Retraumatization & Revictimization https://ruralhealth.und.edu/dakota-conference/handouts/2015/session-4-triggering-retraumatization-and-revictimization.pdf
  8. Trauma-Informed Care for women veterans experiencing homelessness. A guide for service providers. https://www.dol.gov/wb/trauma/WBTraumaGuide2011.pdf


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