TARGET 8 Treatment of military sexual trauma below average in Columbia

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COLUMBIA - "I went into the military prepared to fight the enemy; it turned out the enemy was right beside me," said Ben Ortiz, a Vietnam veteran.

The story of Ben Ortiz

Forty-four years ago, Ortiz served in the Vietnam war. But he said six months in, things took a turn for the worst. Ortiz said he is a victim of military sexual assault and was raped by a number of his fellow service members. 

"They surrounded me to go to the back of the NCL club, and that's when it happened," Ortiz said. 

When it was over, he fled.

"I was walking so hastily. I didn't want to get caught without my pants."

Ortiz said he never imagined he'd live in fear of a fellow soldier.

"It seemed like they wanted to kill me," he said.

The result of such an assault is what's called military sexual trauma, a term that's defined by the Department of Veteran Affairs as the "sexual assault or repeated, threatening sexual harassment that occurred while the veteran was in the military."

Data shows it happens to tens of thousands of military service men and women around the country.

The Treatment Problem

Despite the increased number of reports of sexual assaults in the military, the cases are said to be both prevalent and under-treated,  according to the American Psychological Association (APA).

VA data shows the rate of screening and treatment at Columbia's facility is the lowest in Missouri and lags behind the national average:

The data showed that in 2014, the Columbia facility had 453 women screen positive for military sexual trauma, but only 231 received treatment. In addition, 367 men screened positive, while only 111 received treatment.

That means just 51 percent of women were treated, but only 30 percent of men were.

Grant O'Neal, PTSD clinical team leader and MST coordinator for the Columbia VA, said he realizes Columbia's numbers are not "ideal."

"Yes, we're concerned about the veterans, male or female, who aren't receiving treatment, but that need the treatment," O'Neal said.   

He said part of the reason is either people have already received treatment or haven't developed symptoms or impairment related to suggest that treatment is necessary. He also said other outliers could be: access to care, stigma, or perceptions of treatment.

KOMU 8 News talked with the acting team leader at the San Francisco Vet Center, Elizabeth Flemming, who felt differently about why treatment rates can be low.

"If veterans already received treatment, then it should have been recorded," Flemming said. "As far as, 'not yet developing symptoms related to MST', if the veteran had experienced military sexual assault they would have symptoms from day one." 

Ortiz said he knew he had to talk about his assault or it was only going to get worse.

"All these years I've been lying to myself trying to bury it," he said.

Columbia VA's Proposed Solution

O'Neal said his team plans to use more social media, and post more signs in the hospital as ways to bring those treatment rates up. In addition, the Columbia VA plans to encourage health care providers to identify victims of military sexual trauma.

O'Neal said he doesn't think it will be enough. 

"There isn't a silver bullet on how to treat every individual that come's along," he said.

Flemming said she doesn't think social media will work with this type of trauma. 

"There is so many feedback pieces to it," Flemming said. "If somebody was to ask a question and if someone answers the question in a very negative way, that's really hard. It's sensitive, dignity, respect, shame."

O'Neal said there are people that his team has difficulty meeting the needs of.

"It's not a perfect system," he said.

Columbia's VA Compared on a State and National Level

According to the Department of Veteran's Affair's annual MST Related Outpatient data, Columbia's facility has the lowest treatment rates in the state. In addition, every Missouri VA facility's treatment rates are below the national average. The national average for what's called a "mental health encounter" is 60 percent for women and 47 percent for men. 

A mental health encounter refers to when a clinician has seen a patient and properly documents it.

Below are rates from across Missouri:



What constitutes a "positive screen" for military sexual trauma?

According to O'Neal, a positive MST screen indicates that the individual being screened has responded in the affirmative to at least one of the two broad screening questions.

The questions reflect forms of sexual assault and sexual harassment. As a screen, it casts a wide net. Individuals may have a positive result on the screen, meaning that they responded in the affirmative to one or both questions, and may or may not have mental or physical health problems associated with the experience.

Columbia's Current Staff Requirements and Qualifications

According to O'Neal, the Columbia VA has 27 psychologists currently on staff and 23 of them provide direct patient care. All have their doctorate in psychology (clinical or counseling psychology).

However, only six of the 27 psychologists are certified to treat veterans who have experienced military sexual trauma. The certification is called cognitive processing training. The certification process for CPT requires clinicians to treat two individuals with various types of post traumatic stress disorder (PTSD).

To put Columbia's facility in perspective:

  • Kansas City's VA has 19 psychologists.
  • St. Louis's VA (John Cochran Division and Jefferson Barracks Division) has 30 psychologists.

Flemming questioned whether CPT training is enough for a caretaker to provide treatment specific to veterans who have experienced military sexual trauma. 

"The sexual trauma piece is so mixed with emotions and you have pull it all apart just to get an idea how to deal with it," Flemming said. "No matter how much training you have, just CPT alone isn't enough, it's only one piece of the puzzle."

Flemming's requirements include five patient cases in addition to 50 training hours with each various diagnosis's of PTSD. 

From a Veteran's perspective: What could be done differently?

Ortiz said, "It has to be dealt with when you first get out of the military."

It took Ortiz 42 years to come forward. He said one of his biggest regrets was not seeking treatment earlier.

"If someone approached me back then, I probably would have gone, but I spent most of my time trying to run away and trying to hide," Ortiz said.

Flemming said VA facilities need to do more outreach.

Ortiz said, "If I was welcomed at the VA, maybe I would have talked about it."

The Defense Department reported there were more than 20,000 men and women who were victims of military sexual assault in 2014.

"It's time to come forward so the VA realizes it's time for this secret to go. It's got to stop. It's got to stop now," Flemming said.