Transcript: Sen. Kirsten Gillibrand’s Q&A w/ DOD & VA officials on the handling of military sexual assault, PTSD & suicides

Partial transcript of Sen. Kirsten Gillibrand’s (D-New York) Q&A on the Department of Defense and Department of Veterans Affairs 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:

Sen. Kirsten Gillibrand (D-New York):
…I’ve heard from survivors and others that some are stopping therapy because they’re afraid that their mental health records will be used against them during the court martial. For example, the alleged victim in the Navy Academy case stopped going to therapy once she learned her records could be reviewed by a military judge and possibly provided to the accused and his attorneys. I understand that this comes under the constitutional exception to the psychotherapist-patient privilege, but I’m concerned about the negative impact on survivors’ mental health if they feel like there’s no confidentiality for their treatment. As practitioners, what might be the impact on the survivors if they choose not to seek care because they’re worried about therapy being made public? Are you seeing this happening? What do you the risks…related when a victim and a survivor doesn’t report a case they might not have access to those mental health services because they have not been willing to come forward, so again the risk of PTSD or suicide may be higher than they should? I’d love your thoughts on that.

Dr. Nathan W. Galbreath, Senior Executive Advisor of Department of Defense Sexual Assault Prevention and Response Office [SAPRO]:
Thank you, ma’am. Just to start out, as a psychologist I am required to inform all of patients seeking care with me that there are limitations to privacy and confidentiality in the military. That’s part of the informed consent that document that everybody who wants to see me as a provider has to understand. Not only do I work through them through those limitations to privacy and one of those issues is if administrative or court proceedings, there might be a situation where those records might become available. I also give them a verbal counseling as well to document that.

That is a concern, I think, that all therapy providers in the Department of Defense have. I haven’t seen it happen very often but it does happen. And I am concerned.

I’ve never had anyone quit treatment with me because of that concern, but I have seen other situation where that occurs.

So one of the things that I do, given my law enforcement background, is I’m very careful about how I document care, and I also teach others at the Center for Deployment Psychology at the Uniformed Services University. I see about every two months, I treat anywhere from 60 to 70 different providers and we talk about these issues and how to best protect our patient’s care. So that’s something that we’re very concerned.

You asked about what the chances are of a person’s condition worsening if they don’t get care, and that is definitely a possibility. Most people do tend to get better. And I think what our research shows is that what we can do for most people is help them get better sooner with our therapy and our care. However, for some people, they don’t get better and they do without care, and we do want to have a number of different ways to provide them treatment.

So, given those concerns, the DOD has looked at a number of different ways to help people sample what’s right for them.

As you know, any victim of sexual assault has had a number of different things taken away – their health, their privacy, their sense of being.

We want them to sample it at the rate that they’d like to.

The most anonymous way of doing that is through our DOD Safe Help Line. That’s run for us by the Rape Abuse Incest National Network – RAINN. It’s completely anonymous. Victims can call in from any area and they can get care and services they need through there.

Sen. Kirsten Gillibrand (D-New York):
Thank you. Thank you, Dr. Galbreath.

We have some information. I think this is for Dr. Guice. So SAPRO gave us some new numbers, and we have raw numbers about restricted and unrestricted reports that have been made, and we have a number of about 5,400 reports. Do we have the number of incidents so we can assess whether reporting has gone up or not? Because when we compared the earlier reports when we had the benefit of looking at 2012 and 2011, the number of reported rapes went up but the incidents rate went up higher, so there was a decrease in reporting from 13% to 9%. Do we know if there’s a higher incident rate or if we really have a higher reporting rate?

Dr. Nathan W. Galbreath, Senior Executive Advisor of Department of Defense Sexual Assault Prevention and Response Office [SAPRO]:
Ma’am, we don’t have a survey this year for that. But what I would offer to you is we know that even in 2006 when we had the highest rate of unwanted sexual contact reported, we only got about 2,900 military service members coming forward to make a report. This year with the 5,400 we really do assess that this is due to increased victim confidence and more people hearing our message and understanding that we’re going to take care of them.

One piece of that that I would offer you to consider is there are a portion of reports that come to us every year that occurred prior to military service, and this year that percentage increased from 4% in 2012 to 11.5% in 2013. Those – all the offenders in those cases are outside the military justice system. So the only real reason for our survivors to come forward in that situation is to get care and services that we offer through the Sexual Assault Prevention Response Program. We feel that that’s a real good sign.

Sen. Kirsten Gillibrand (D-New York):
So we’ve seen an uptick in reporting before or prior to service?

Dr. Nathan W. Galbreath, Senior Executive Advisor of Department of Defense Sexual Assault Prevention and Response Office [SAPRO]:
Yes, ma’am.

Sen. Kirsten Gillibrand (D-New York):
And is that the difference between the two numbers?

Dr. Nathan W. Galbreath, Senior Executive Advisor of Department of Defense Sexual Assault Prevention and Response Office [SAPRO]:
It’s not the entire difference. It’s – last year, we had a total of about 132 reports that were for incidents that occurred prior to service. This year, the number is 621.

Sen. Kirsten Gillibrand (D-New York):
So that’s a huge increase for people who were assaulted before they joined the military.

Dr. Nathan W. Galbreath, Senior Executive Advisor of Department of Defense Sexual Assault Prevention and Response Office [SAPRO]:
Yes, ma’am.

Sen. Kirsten Gillibrand (D-New York):
And they are eligible for –

Dr. Nathan W. Galbreath, Senior Executive Advisor of Department of Defense Sexual Assault Prevention and Response Office [SAPRO]:
Care and services.

Sen. Kirsten Gillibrand (D-New York):
A related question. We’ve heard from survivors that after they report the assault and they attempt to seek mental health treatment, they were diagnosed with a personality disorder and are medically-discharged. So this diagnosis is labeled as a pre-existing condition and therefore effectively cuts off services for the survivor. Many of these same survivors have said that after the assault, they still wanted to stay in the military and were planning on doing so but because of the diagnosis of personality disorder, they were kicked out. What was your experience with that issue and what is the best way to address it? And I don’t know if VA wants to address or Dr. Galbreath.

Dr. Karen S. Guice, Principal Deputy Assistant Secretary of Defense for Health Affairs:
So what we have done is that no one can leave the military, be separated for a personality disorder without a complete medical review so that we make sure that there’s no underlying TBI that’s causing the action or behavior or psychological health issue that needs to be addressed. So I think we’ve actually put a mechanism in place to make sure that we’ve safeguarded and that people are not leaving without a second look by medical professionals.

Dr. Nathan W. Galbreath, Senior Executive Advisor of Department of Defense Sexual Assault Prevention and Response Office [SAPRO]:
If I could add to that, ma’am. Section 578 of the FY’13 NDAA, you all helped us out with that. And we took your advice and we kind of expanded on it a little bit. You asked us to – for any separation due to retaliation within a year of a report, it had to be reviewed by a general officer. That was the nature of the law. I checked in our military instructions and that has been incorporated into the administrative separation instruction, but we’ve expanded it just a little. So instead of just a year from the date of report, we took it from a year from the date that the case disposition was made so it’s a much longer period. And instead of just retaliation admin separation, any separation administratively can be heard in this process and be reviewed. And in addition to that, instead of the first general officer and flag officer in the chain, we took it to the first general officer, flag officer in the chain of that administrative separation authority’s chain of command. So it goes beyond that one person. So we took your good idea and put it into our instructions.

Sen. Kirsten Gillibrand (D-New York):
Thank you.

Sen. Kirsten Gillibrand (D-New York):
Dr. McCutcheon, I just want to follow up on Sen. Graham’s question. When did the military sexual trauma coordinators get placed in every VA in the country? Is that in the last year, last six months?

Dr. Susan J. McCutcheon, National Mental Health Director, Family Services, Women’s Mental Health and Military Sexual Trauma, Department of Veterans Affairs:
2000, ma’am.

Sen. Kirsten Gillibrand (D-New York):
So there’s been a military sexual trauma coordinator in every VA in the United States since then?

Dr. Susan J. McCutcheon, National Mental Health Director, Family Services, Women’s Mental Health and Military Sexual Trauma, Department of Veterans Affairs:
Yes.

Sen. Kirsten Gillibrand (D-New York):
Is that person busy?

Dr. Susan J. McCutcheon, National Mental Health Director, Family Services, Women’s Mental Health and Military Sexual Trauma, Department of Veterans Affairs:
[Laughs] Yes, ma’am. It’s a position where there’s a great focus on looking at our screening data, our treatment data, educating staff.

Sen. Kirsten Gillibrand (D-New York):
Do they meet with trauma survivors?

Dr. Susan J. McCutcheon, National Mental Health Director, Family Services, Women’s Mental Health and Military Sexual Trauma, Department of Veterans Affairs:
As part of their clinical work, yes. The majority of them do also provide treatment. The MST coordinators are predominately either a psychologist or a social worker and so as part of their clinical workload, they would be MST therapy as well as looking and monitoring their screening, treatment rates, other rates.

Sen. Kirsten Gillibrand (D-New York):
Okay. I’m going to make a formal request afterwards to get data on all of the military sexual trauma coordinators in every VA, how many patients they see a year, what their workload is. Because maybe they’re just not even known that they exist. So I’d like to know actually what is their, what do they actually do. So we can work on that later.

Dr. Susan J. McCutcheon, National Mental Health Director, Family Services, Women’s Mental Health and Military Sexual Trauma, Department of Veterans Affairs:
Thank you, ma’am.

Sen. Kirsten Gillibrand (D-New York):
Dr. Galbreath, I just want to go back a little bit over your testimony. I agree that we have to set a climate of dignity and be more involved and not less involved for commanders. I agree that the commanders actually need to actually be taking responsibility for setting command climate, making sure there’s no retaliation, making sure the victims feel safe to come forward and report the crime, making sure he or she gets the mental health services and the support they need. So no one is suggesting that they become less involved, and in fact, when they do so, they actually distort the debate. Because the only commanders today who have the authority to be the convening authority, to make the decision about whether to go to trial are very senior level commanders. It’s less than 3% of commanders.

So, the 97% of commanders are as involved as they’ve ever been involved. And what we’ve been trying to do in the underlying bill is to make them more responsible by actually reviewing their record on creating a command climate that’s consistent with no rape, no assault, that’s conducive for victims to come forward. Those commanders will never have the right to make legal decisions.

So whether or not we take that right away from that 3% of top level commanders, the purpose is to instill confidence by the victims. If you listen to our victims’ panel and you listen to what they’ve said, one of our victims was retaliated against by all these junior level commanders. And so, her hope that a senior commander would have her back doesn’t exist because her perception is that all the other in the chain of command are going to retaliate against me so they will believe those commanders over me every time.

So I really want you to focus on that. Because when you say “I don’t think they should be less involved. I don’t think they should be less responsible, no one is arguing them to be less involved, to be less responsible. In fact, everything we’ve done in NDAA is making them more responsible and more involved. I just wanted to remove that appearance.

And the VA’s website specifically says that the current system is undermining recovery. It’s actually creating greater PTSD and undermining the patients, and I read it when I did my opening statement. I don’t know if you heard it, if you were all here…It says here, “Many victims are reluctant to report sexual trauma, and many victims say that there were no available methods for reporting their experiences to those in authority. Many indicate – ” and that’s a perfect example of what our first witness, Ms. Kenyon said. She didn’t feel like she could tell anybody because everyone in her chain was retaliating against her. “Many victims are reluctant to report sexual trauma and many victims say there were no available methods for reporting their experiences to authority. Many indicate that if they did report the harassment, they were not believed” – perfect example with Ms. Kenyon – “they were not believed or encouraged to keep silent about the experience. They may have had their reports ignored or even worse have been themselves blamed for the experience. Having this type of invalidating experience following a sexual trauma is likely to have a significant negative impact on the victims’ post-trauma adjustment.”

How do you view that VA website’s analysis?

Dr. Nathan W. Galbreath, Senior Executive Advisor of Department of Defense Sexual Assault Prevention and Response Office [SAPRO]:
…I would offer to you that the system that we have in place today is not the system that we had in place even a few years ago. When Mr. Panetta took the stand in January of 2012 and he said “We have a problem” and he cited numbers associated with that, he put a chain of events in motion that I would offer to you have really substantively changed the landscape of the current military system.

What you see in our numbers this year – this is the system that we have now, this is the system that we have today. I believe that the increase in the number of reports have come from people that believe what our commanders are doing is correct and supporting them, that the –

Sen. Kirsten Gillibrand (D-New York):
Dr. Galbreath, two out of 10 rape victims are reporting today. I would not pat yourself on the back for two out of 10.

Granted, according to your number, we know that there’s more reports but we don’t have the base number. So we don’t know if it’s the same thing that happened between 2011 and 2012 where total reports were up but the incident rate skyrocketed so in fact reporting by a percentage went down.

So please, before we have the evidence and data, we should not be patting ourselves on the back on any level. And having two out of 10 report is insufficient and is still a significant failure. So please do not say we’re succeeding because eight out of 10 victims stay mum because they don’t believe justice is possible or because they fear retaliation. We are failing eight out of 10.

Dr. Nathan W. Galbreath, Senior Executive Advisor of Department of Defense Sexual Assault Prevention and Response Office [SAPRO]:
We have a long way to go. You’re absolutely correct. But I would offer to you is that this is evidence of changing the system.

Sen. Kirsten Gillibrand (D-New York):
We don’t know that. If we don’t have the raw numbers, we don’t know. We know that if you’ve been raped before you get into the military, there’s been an increase in reporting. We don’t know what the raw numbers of total rapes within the military were this year; we just know the number of rape individuals who came forward and actually signed their names to a real report. But if the number of actual rapes went up, we’re not doing any better. If it’s still one out of 10 cases, we’re still where we were last year.

Dr. Nathan W. Galbreath, Senior Executive Advisor of Department of Defense Sexual Assault Prevention and Response Office [SAPRO]:
I don’t see the data that way, ma’am.

Sen. Kirsten Gillibrand (D-New York):
We don’t know the raw numbers, you can’t see the data anyway.

Dr. Nathan W. Galbreath, Senior Executive Advisor of Department of Defense Sexual Assault Prevention and Response Office [SAPRO]:
We’ve had very consistent reporting of unwanted sexual contact from since 2006. It’s somewhere between 4% for women and 7%, and for men, it’s between 1% and 2%. In that historical context, I judge that this increase in reporting is progress.

Sen. Kirsten Gillibrand (D-New York):
Unless there’s an increase in rape like what we saw between ’11 and ’12.

Dr. Nathan W. Galbreath, Senior Executive Advisor of Department of Defense Sexual Assault Prevention and Response Office [SAPRO]:
But even so, ma’am, that was just in two instances in two services. That wasn’t across the board.

Sen. Kirsten Gillibrand (D-New York):
That’s the DOD’s report.

Dr. Nathan W. Galbreath, Senior Executive Advisor of Department of Defense Sexual Assault Prevention and Response Office [SAPRO]:
Yes, ma’am. I was involved in that. What I would offer to you ma’am is that you’re exactly right. Next year when we have prevalent survey when we’re able to judge in better context what this increase in reporting means, we’ll have a better picture. But given historical data and confirmation from other independent surveys that we have that have been conducted in the last five years, that this increase in reporting is a positive sign. We’re not done by any means. We’re very cognizant that we have a lot more work to go, to do, and it’s not a pat on the back by any means. But I just want to make you understand that we do take this very seriously, and we’re doing everything we can to bring more victims forward so they can get the help and care that they need so that they can restore their lives.

Sen. Kirsten Gillibrand (D-New York):
So can we go back to the issue of the VA’s website? What’s your impression of that?

Dr. Nathan W. Galbreath, Senior Executive Advisor of Department of Defense Sexual Assault Prevention and Response Office [SAPRO]:
Ma’am, I would offer to you that that was probably a snapshot of things in the past history. I don’t know this article. I don’t know what they’re talking about as far as the time aspect goes. But like I said, that since 2012, we’ve had a number of reforms helped by you and members of this body as well as a number of other things that we’ve done to bring more victims forward.

Sen. Kirsten Gillibrand (D-New York):
Dr. Bell?

Dr. Margret E. Bell, Director for Education & Training, National Military Sexual Trauma Support Team, Department of Veterans Affairs:
Well, this is – I’m really best position to speak to research. But it looks like it’s coming from a National Center for PTSD’s website, which is of course a VA entity. I mean, what I would turn to thinking research-wise is we certainly know that the types of support, the types of reaction that people get after experience of sexual assault are really pivotal in their recovery. In fact, we know that it’s the biggest and strongest predictor of their recovery afterwards and the biggest and strongest predictor of developing PTSD. So, I think the systemic responses, I think the support from family and friends, I think the societal response more generally is really going to strongly shape the course of someone’s recovery after an experience like this.

Sen. Kirsten Gillibrand (D-New York):
Well, thank you all for testifying. I am extremely grateful for the hard work you are doing. I am extremely grateful that you have taken it upon yourself with both the DOD and the VA to meet the needs of these survivors. I know that this is a very, very hard, hard and difficult road ahead of us. But I trust your commitment and I’m grateful for that commitment because you are the difference between men and women receiving the care they need and not. Thank you so much for your service and thank you for being here today.

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