NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL YEAR 2010--Continued -- (Senate - July 21, 2009)
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AMENDMENT NO. 1475
Mr. CARDIN. Mr. President, I am going to talk about an amendment we
have not yet cleared unanimous consent for it to be brought up. I am hopeful that will come. But in order to advance the issue, I intend to talk about my amendment, No. 1475, without offering it at this time. I think it is an appropriate amendment to talk about at this point following Senator Lieberman's amendment because his amendment deals with increasing our forces.
One of the reasons it is important to do that is the stress that the restricted numbers provide on our military personnel. Senator Lieberman mentioned, and I will repeat, the number of suicides and attempted suicides by our young men and women serving in the military has increased and one of the reasons, frankly, is that the repeated deployments and the length of the deployments have added to the stress of our servicemen.
Health experts agree that there is most likely a combination of factors leading to this increase in suicides. Many of these factors are simply the results of the prolonged conflict that our Nation finds itself in, including multiple deployments, extended separations from family and loved ones, and the overwhelming stress of combat experiences; each placing a unique and tremendous strain on the men and women of our all-volunteer force.
But while Congress has recognized these strains, and acted to help provide relief by increasing the size of our forces and thereby reducing the number and frequency of deployments, we cannot as easily remedy the stress or mental trauma created by combat experience.
For those who have had to witness the ugliness and devastation of war first-hand, they have encountered something very unnatural for the human mind to comprehend or accept. For these service members, recovering from these experiences involves a long and arduous journey in learning to identify, control and cope with a wide array of emotions. And this learning process is often only accomplished with the guidance and management of highly trained mental or behavioral health specialists.
In this light, we in Congress have acted to increase funding for more mental health providers and improved access for our troops and their families, and we have sharpened the focus of the military on addressing these care needs. That is very positive and has had a very positive effect.
What we must now focus on, and direct the military's attention to, is the potentially harmful practice of administering antidepressants to a population that frequently moves throughout a theatre of war and is therefore susceptible to gaps in mental health management. We are not certain they are getting the follow-up care they need.
A 2007 report by the Army's fifth Mental Health Advisory Team indicated that, according to an anonymous survey of U.S. troops, about 12 percent of combat troops in Iraq, and 17 percent of combat troops in Afghanistan, are taking prescription antidepressants or sleeping pills to help them cope with this stress. This equates to roughly 20,000 troops on such medications in theatre right now.
What I find particularly troubling, when reviewing these figures, is that the Pentagon has yet to establish an official clearinghouse that accurately tracks this kind of data. In fact, the Army's best reported estimate can only tell us that the authorized or prescribed drug use by troops in Iraq and Afghanistan is believed to be evenly split between antidepressants--mainly selective serotonin reuptake inhibitors, or SSRIs--and prescription sleeping pills. My amendment would provide us with the information so we know what is happening with the use of these drugs.
Providing that this best estimate contains some degree of accuracy, it is important for us to also recognize that many of these same antidepressants, after strong urging by the FDA, recently expanded their warning labels to state that young adults--ages 18-24 years old--may be at an elevated risk of suicidal thoughts and behavior while using the medication. This same age group--18-24 years old--represents 41 percent of our military forces serving on the front lines in Iraq and Afghanistan.
While keeping this warning label in mind, it is imperative that my colleagues understand that nearly 40 percent of Army suicide victims in 2006 and 2007 are believed to have taken some type of antidepressant drugs--and overwhelmingly these SSRIs. And as I mentioned at the beginning of this statement, the number of Army suicides reported each month are outpacing each preceding month.
This class of antidepressants--these SSRIs--are unlike most earlier classes of psychiatric medications in that they were, from their inception, specifically designed for use as an antidepressant --that is, they were engineered to target a particular process in the brain that plays a significant role in depression and other anxiety disorders. More significantly, however, these SSRIs are unlike most other antidepressant medications because they are still allowed by Department of Defense policy to be prescribed to service members while they are deployed and directly engaged in overseas operations.
Now, to be fair, there is widespread consensus in the community of professional mental health providers, and empirical evidence to support, that SSRIs do offer significant benefit for the treatment of posttraumatic stress and some forms of depression. And although there are some side effects, they are reportedly much milder and shorter in duration than other antidepressants. Additionally, SSRIs are also believed to potentially prevent, or at least some believe, lesson the more harmful long-term effects of posttraumatic stress disorder.
My concern, however, and hopefully that of my Senate colleagues, is not the long-term efficacy of these SSRIs, but more pointedly the volume and manner in which these drugs are being administered to our service men and women overseas.
You see, unlike medications that work on an as-needed basis, SSRIs only begin to work after having been taken every day--at a specific dosage--for a significant period of time. This frequently translates to a 3 to 6 week latency period before the therapeutic effect materializes and patients begin to feel improvement. In light of the population I have been discussing, there are two very readily apparent problems with this shortcoming--first, is that service members serving in forward operating areas, such as Afghanistan and Iraq, are quite frequently subject to moving between bases or into other areas--some so remote that there may be no trained mental health provider available to administer the treatment and to make sure it is effective.
Second, and more importantly, is that this initial period is when patients, particularly younger patients, often suffer an escalation in the severity of depression and/or anxiety.
In essence, DOD may be prescribing SSRIs to its service members, without the assurance that they will remain in a capacity to be observed by a highly trained mental health provider. Worse yet, these same patients may very likely find themselves ordered off to conduct combat operations during this same latency period.
Let's return our focus back to the alarming increase in the number of military and veteran suicides reported in 2008 and 2009.
At what point do we step forward to direct that action be taken by DOD to capture, track and report this data? And at what point do we ensure that DOD is properly prescribing, dispensing and administering these drugs to our troops without having in place the necessary controls and or patient management practices?
As a first step in this direction, the amendment I intend to introduce will accomplish a better understanding as to the potential magnitude of this issue. This amendment directs the Department of Defense to capture, at a macro level--at a macro level, not individual information, without divulging or violating any protected patient health information--the volume and types of antidepressants, psychotropics or antianxiety drugs being prescribed to our men and women serving in Iraq and Afghanistan. It will also require DOD, beginning in June of 2010 and then annually thereafter through 2015, to report to Congress an accurate percentage of those troops currently and previously deployed to Iraq and Afghanistan since 2005 who have been prescribed these types of drugs.
I wish to reiterate that this measure specifically directs the disclosure of
this information by DOD to be done in such a way as to not violate the individual patient privacy rights of our service men or women as defined by HIPAA.
This legislation further directs DOD to contact the National Institute of Mental Health and provide any and all data as determined necessary by the Institute to conduct a scientific peer reviewable study to determine whether these types of prescriptions, and/or the method in which they are being prescribed and administered by DOD, are in any way contributing to the rising number of suicides by servicemembers or Iraq or Afghanistan veterans.
I want to specifically address one issue I have heard from some who express concern about this amendment by saying it would stigmatize, in the eyes of our troops, those seeking mental health care. Nothing could be further from what this amendment does. This amendment would collect information in an anonymous manner, and it will be invisible to the servicemembers serving on the front line.
The men and women serving in our military, and equally so their families, deserve our utmost assurance that we are doing everything in our power to see that our Nation's warfighters are provided the best medical care available. An integral part of our commitment must also be to ensure that these service men and women volunteering to serve our Nation are not being exposed to what may potentially endanger them when they seek medical care and mental health service.
This amendment is very simple. It asks us to gather information so we can make a judgment in a macro sense, without violating the individual privacy of our service men and women. It allows us to gather the information, to have the best information. This Congress has a proud record of providing the necessary resources for the health care of our warriors and their families.
This amendment will complement that by making sure that we have the analytical tools to make sure we are providing the right type of mental health services to our service men and women who are in theater. It gets us the information in order to judge what is being done today.
I would hope my colleagues would agree that we would want to have this information, and I hope at a later time I will have the opportunity to actually offer the amendment.
I yield the floor.
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