Transcript: Dr. Karen Guice’s testimony on the DOD’s handling of military sexual assault, PTSD & suicides

Partial transcript of testimony of Dr. Karen S. Guice, Principal Deputy Assistant Secretary of Defense for Health Affairs, on the DOD’s handling of post traumatic stress disorders and suicides of service members who suffered military sexual assault. The hearing before the Senate Armed Services Subcommittee on Personnel was held on Feb. 26, 2014:

Madam Chairman, members of the committee, thank you for the opportunity to assess the Department of Defense’s support for sexual assault survivors and the relationship between sexual assault, the subsequent development of PTSD and suicide.

Sexual assault survivors are at an increased risk for developing sexually transmitted infections, depression, anxiety, and PTSD – conditions that can have a long-lasting effect on well-being and future functioning, and can precipitate suicidal thought.

To address these and other potential risks – and regardless of whether survivor is male or female, whether the sexual assault occurred prior to joining the military or during service, or whether the manifestations are physical or emotional – the Department of Defense has policies, guidelines, and procedures in place to provide access to a structured competent and coordinated continuum of care and support for survivors of sexual trauma.

This continuum begins when the individual seeks care and extends through their transition from military service to the VA or care in their communities.

DOD has issued comprehensive guidance on medical management for survivors of sexual assault for all military treatment facilities and service personnel who provide or coordinate medical care for sexual assault survivors. Included in this guidance is the requirement that the care is gender-responsive, culturally-competent, and recovery-oriented.

Any sexual assault survivor who presents to one of our military treatment facilities is treated as a medical emergency. Treatment of any and all life-threatening conditions takes priority. Survivors are offered testing and prophylactic treatment options for sexually transmitted illnesses. Women are advised of the risk for pregnancy and counseled with regards to emergency contraception. Prior to release from the emergency department, survivors are provided with referrals for additional medical services, behavioral health evaluation and counseling in keeping with the patients’ preferences for care.

In locations where DOD does not have the needed specialized care, including emergency care within a given military treatment facility, patients are referred to providers in the local community.

Last Spring, the Assistant Secretary of Defense for Health Affairs issued a memorandum to the services regarding reporting compliance with these standards. The services returned detailed implementation plans and the first of the yearly reporting requirement is due this summer from each of them.

The long-term needs of the survivors of sexual assault often extend beyond the period which a service member remains on active duty. To support individuals with mental health care needs, DOD provides the in-transition program. This program assigns service members to a support coach to bridge between health care system and providers.

You asked about the relationship between suicide, PTSD, and sexual abuse. We know from civilian population research that sexual assault is associated with an increased risk of suicidal ideation, attempts, and completions. Furthermore, this association appears to be independent of gender.

Sexual assault is also associated with mental health conditions, such as depression, anxiety, and PTSD. Likewise, these mental health conditions are associated with suicidal ideation, attempts, and completions.

For military populations, the evidence associating sexual assault and subsequent suicidal ideation, attempt or completion is less well-defined than that of civilian population. Between 2008 and 2011, the number of individuals who attempted and completed suicide and reported either sexual abuse or harassment in DOD ranged from six to 14 per year or 45 in total. Only nine of those individuals also had a diagnosis of PTSD.

These data show an association that is similar with clinical experience and prior studies in civilians. The data do not, however, describe causation, the nature of its association, its directionality, or potential influence of additional co-morbidity factors.

The Department has a variety of research initiatives directed to understand a variety of issues associated with suicide, including risk factors, the impact of deployment and possible precursors.

Madam Chairman, members of the committee, thank you for the opportunity to discuss these very important issues.

Our policies within DOD are designed to ensure that trauma survivors and particularly those subjected to sexual assault have access to a full-range of medical and behavioral health programs to optimize recovery and that their transition from military service back to civilian life is supported.

I also would like to add my thanks to the witnesses today. It’s compelling testimonies that make us see ourselves in a better light.

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