Lack of Research and Treatment Programs Burdens Survivors of Military Sexual Trauma

• Categorized in: 2010 Issues, July 2010

WASHINGTON, DC—For a civilian victim of sexual assault, the after-effects are devastating. There’s the physical, emotional, and psychological trauma to contend with, as well as having to navigate a world that seems more dangerous than it did before.
For a military servicemember dealing with sexual trauma, these after-effects are compounded by the fact that the perpetrators are almost always their peers—the people they live with and work with—and are sometimes their supervisors. For a victim of military sexual trauma (MST), it can be seemingly impossible to find a place to feel safe, and even seeking treatment can unintentionally force them to relive the initial trauma.
“Perpetrators are frequently peers or supervisors responsible for the decisions on work-related evaluations and promotions,” explained Rep John Hall, D-NY, chair of the VA subcommittee on disability assistance, at a hearing on benefits and treatment options for MST last month. “This means that victims must choose between continuing their military careers at the expense of frequent contact with their perpetrators, or ending their careers in order to protect themselves.  Many victims share that when they do report the incident, they are not believed or are encouraged to keep silent because of the need to preserve organizational cohesion.
“There also has been frustration with the lack of appropriate healthcare providers to treat veterans who have experience working with MST. VA and DoD need to ensure that proper treatment is available.”
Both VA and DoD have made significant progress in recent years in training healthcare providers in recognizing and treating the effects of MST. However, as legislators learned last month, there is still a long way to go before victims of MST can get proper care in a nonthreatening environment.
VA Screening, Treatment
“It is important to remember that MST is an experience, not a diagnosis or a mental health condition in and of itself,” declared Susan McCutcheon, RN, EdD, VA’s director of military sexual trauma, at last month’s hearing. “There is no one way that everyone will respond. For some veterans, MST will continue to affect their mental and physical health many years later. Fortunately, people can recover, and VA has services to do that.”
Since 1992, VA has been developing programs to monitor MST screening and treatment, providing staff with training on most MST issues. Most recently, VA established a national-level MST Support Team to help further all MST-related objectives.
All veterans seeking care at VA are asked two questions: one to assess sexual harassment, and one to assess sexual assault. “Any that answer yes to either question are asked if they are interested in treatment,” McCutcheon said. “VA data indicates that approximately 1 in 5 women and 1 in 100 men seen at VA respond yes when asked about MST.”
McCutcheon noted that, because of the high proportion of men to women in the military, there are actually only slightly fewer men than women seen in VA who have experienced MST.
Every VA facility has a designated MST coordinator who serves as a contact point for patients, helping them find and access VA services. Many facilities have outpatient mental health services focusing on sexual trauma, and some have inpatient programs. There are also single-gender programs to accommodate veterans who do not feel comfortable in mixed-gender treatment.
VA Programs—Few and Hidden
While these initiatives by VA show the agency has the right idea, they are few and far between, veterans’ advocates say. According to GAO, only 9 of 153 medical centers nationally have residential treatment programs for women suffering from mental health injuries. When GAO investigators began researching VA programs, they had trouble discovering which VA facilities had what programs.
“VA’s website did not provide a complete list of facilities that provided MST programs,” according to Jennifer Hunt, project coordinator for the Iraq and Afghanistan Veterans of America (IAVA).
One of IAVA’s top recommendations is for VA to do a better job of advertising its MST programs. “According to one IAVA member, she did not know until three years after returning from a deployment that VA provided sexual trauma counseling,” Hunt said. “In her words, ‘It’s well-hidden and not talked about at VA.’”
Another concern is that inpatient mental health services and gender-specific programs are just too sparse. “VA must expand availability of its specialized sexual trauma treatment in the inpatient setting. Less than 10% of VA medical centers offer inpatient treatment for MST. IAVA recommends that every VISN offer at least one inpatient setting specializing in care for MST victims,” Hunt said. “And victims should not have to settle for mixed-gender options because there are no [VA] treatment programs in their area.”
Mixed-gender treatment programs can be an unacceptable solution for an MST patient, who does not want to discuss or relive the trauma among members of the opposite gender.
“VA medical centers ought to have separate facilities for women patients, and easy, safe, and direct access to MST treatment areas for both male and female MST survivors,” said Anuradha Bhagwati, executive director of the Service Women’s Action Network (SWAN). “Another disturbing trend is VA’s integration of residential programs with other mixed-gender veterans’ programs, in which MST patients are not guaranteed privacy or safety from other patients of the opposite sex. VA needs to invest in separate facilities for MST programs, and guarantee the safety and welfare of all participants.”
Gender-Specific Research
Not enough is known about the physical and mental health consequences of MST, or how those consequences differ between men and women. According to Phyllis Greenberger, president of the Society for Women’s Health Research, studies in the area of MST and sexual assault have revealed interesting sex-based differences that need to be explored further to help improve treatment methods.
“First, women are more likely than men to contract a sexually transmitted infection, or STI. STIs are often more difficult to treat in women and can have emotional and mental impacts over a woman’s lifespan,” Greenberger noted. “The impacts of MST are not limited to reproduction.  Infection with HPV after a sexual assault can result in cancer decades later.”
Also, sexual assault can be a common trigger for post-traumatic stress disorder, which researchers—many of whom are based in VA facilities—are finding presents differently in women than in men. “Women do not respond the same to some of the common medications prescribed for PTSD, often fairing worse than men taking the same medication for the same diagnosis,” Greenberger explained. “[Also] multiple traumas can increase the likelihood of developing PTSD, and the combined impacts of working in a war zone, multiple deployments, MST, and for a disproportionate share of female military members, exposure to early life trauma, all raise the risk for an eventual PTSD diagnosis.  Females in the military have twice the levels of PTSD and depression as their male counterparts.”
Research also suggests that the ultimate impact of a traumatic event on a woman may depend on hormone levels. “The role of cyclical hormonal variations, as well as studies finding that during pregnancy PTSD symptoms decrease, may offer insight into which women develop PTSD after MST, and may further help discover more effective PTSD therapies for women—therapies that are responsive to sex-based hormonal differences,” Greenberger explained. “There is clearly a need for more sex-based research at VA.”
At the very least, a better understanding by VA physicians of MST and its effects could help veterans suffering from it to feel more comfortable seeking VA treatment. “Many veterans are ignored, isolated, or misunderstood at VA facilities because their PTSD is not combat-related. The veterans’ community still primarily considers PTSD to be a combat-related condition, to the great detriment of MST survivors,” Bhagwati noted. “Survivors who have used the VA routinely say they are fed up with being given endless prescription medication—one Iraq veteran described the experience of her VA MST treatment as nothing but ‘pills and pep talks.’”
She recommended that VA allow MST survivors to seek fee-based care where they feel most comfortable, if such care is not provided by their local VA facility, including giving them access to alternative treatments, such as yoga, massage therapy, and acupuncture.