In order for VA and DoD to properly manage the human and financial cost of providing medical care for our casualties, more robust data must be collected and analyzed immediately by the Administration, Congress, academics, and advocates.
* VA must be able to answer simple, tiffany sale questions. For example, what is the total number of unique deployed Iraq and Afghanistan war veterans who have received any VA benefit (healthcare, disability, etc.) since returning home? In another example, is VA able to accurately and consistently provide the expenditures for all of these VA programs? VCS remains alarmed VA is incapable and unwilling to answer these two easy questions.
* DoD and VA cheap tiffany bangle an official accounting of the financial costs for medical care, disability benefits, education benefits, life insurance, home loan guaranty, and all other DoD and VA benefits for servicemembers, veterans, and families. For the past several years, VCS has requested this information from VA using the Freedom of Information Act. VA has not provided any cost data. Starting in 2001, VA employees urged VA leaders to begin tracking war-related benefit use and costs, and nearly all requests were refused.
* DoD must provide an accounting of all discharges by type and branch of service, sorted by year, to monitor trends for both deployed and non-deployed servicemembers since 1990. Two prior cheap tiffany bracelet by this Committee documented tens of thousands of improper discharges, often for veterans at high risk of readjustment challenges due to TBI and PTSD. As the number of less than fully honorable discharges increases, additional highly vulnerable veterans flood into society. Many of these veterans either don't seek VA assistance or are refused VA help, instead turning to private, state, local, or university campus programs for assistance that should have been provided by the Federal government.
* VA should monitor negative post-deployment outcomes, such as homelessness, suicides, divorce, and crime, as well as state, local, and private expenditures on veterans. The most important oversight remains the Administration's inability to provide complete and accurate active duty, Reserve, National Guard, and veteran cheap tiffany cufflink data. Every year DoD has set new, and highly disturbing, records of active duty suicides. Most of the initial monitoring began with FOIA requests from advocacy organizations or journalists investigating patterns of disturbing developments such as suicides, homicides, unemployment, and homelessness. VA and DoD only began limited monitoring and research after repeated advocacy organization, media, and Congressional inquiries.
* The Department of Labor should monitor unemployment and underemployment, both for veterans and families. Veterans often move from the military installation to their home town shortly after cheap tiffany earring. Often, these cross-country moves uproot spouses from their jobs. The use of the Post-9/11 GI Bill, legislation introduced by Senator Jim Webb of Virginia, by hundreds of thousands of Iraq and Afghanistan war veterans may be masking already alarming reports of high unemployment among returning veterans.
Testimony by Paul Sullivan, Executive Director, Veterans for Common Sense
Veterans for Common Sense (tiffany key ring on sale) thanks Committee Chairman Filner, Ranking Member Buyer, and Members of the House Veterans' Affairs Committee for inviting us to testify about "The True Cost of War," and the consequences of the Iraq and Afghanistan conflicts. We are honored to be in the company of experts, advocates, and fellow veterans to discuss this important long-term issue.
VCS begins by presenting the Committee with the most salient official tiffany money clip on sale statistics about the human and social costs of the current conflicts. Our top priority for this hearing is to inform Congress, the press, and the American public about the human cost of the Iraq and Afghanistan wars because everyone in our country is impacted by high taxes, spending, and lost opportunity costs caused by war.
As of March 2010, government statistics show 565,000 new veteran patients were treated at Department of Veterans Affairs (VA) hospitals and clinics since 2001. As of today, based on an average of 9,000 new patients each month, VCS estimates the current count of VA patients is approximately 619,000.
The significant post-tiffany necklace on sale statistics about our veterans must be contrasted with events during 2002, when the Administration had no casualty estimate, no plan to monitor or estimate fatal or non-fatal casualties, no plan for caring for non-fatal casualties, and no dedicated long-term funding for non-fatal casualties.
The consequences of the war are high, especially for non-fatal casualties. There is a general lack of awareness about the hundreds of thousands of post-deployment casualties. And there appears to be a lack of urgency tiffany necklace on sale adequately and promptly meet our veterans' growing needs. Therefore, VCS urges Congress to pass a new law mandating that the Administration must estimate, monitor, plan, and fund healthcare and disability benefits for our casualties before starting or entering into a war.
VCS broadly defines casualty. This includes battlefield deaths, and caring for our grieving families. Casualty includes our servicemembers who become wounded, injured, or ill on the battlefield as well as during training. This includes post-war medical conditions among our veterans not immediately tiffany ring on sale while in the military, such as toxic exposures, traumatic brain injury, and mental health conditions.
Part One: Official Statistics
Government statistics paint a disturbing picture of enormous human suffering among our servicemembers and veterans. VCS obtained the following facts from the Department of Defen
won: "We're so pleased to support Youth Net, which is helping to fill the huge service gap for young people with mental health problems," says Today's Parent editor-in-tiffany jewellery on sale Caroline Connell.
What the money means: "This award will fund our Pens & Paint program, a 10-week activity run by youth with a background in creative expression and mental health," says Jessica Ripley, program coordinator at Youth Net. "Through this wonderful program, kids learn to cope with stress constructively - through social interaction, visual arts and creative writing."
To investigate the prevalence and correlates of missed opportunities for addressing reproductive and mental health needs during patients' visits to primary healthcare facilities. We tiffany bangle on sale a random sample of participants from 14 of the 49 clinics in Cape Town's public health sector using stratified, cluster random sampling ( n = 2618). Participants were screened to identify those at risk for unsafe sexual behavior and a mental disorder (specifically substance use, depression, anxiety, and suicide). Information pertaining to whether or not respondents were asked about these issues during clinic visits during the previous year was elicited. The rates and correlates of missed opportunities for providing reproductive and mental health interventions were calculated. The criteria of a strict definition of a missed opportunity for reproductive or mental health care information were fulfilled by 25% of the sample, while 46% met criteria for a looser definition. tiffany bracelet on sale adjusting for the effects of other variables in the model, men and Colored respondents were more likely to have satisfied the definition of a missed opportunity for an intervention, while having completed high school and having children increased the likelihood of receiving an intervention. Consultations with primary healthcare providers in which these issues are not discussed may represent missed opportunities. Persons presenting for routine care can be counseled, screened and, if required, treated. tiffany cufflink on sale are needed at the patient, provider, and community levels to increase the opportunities to provide reproductive and mental health care to patients during routine visits.
There is a general lack of awareness about the hundreds of thousands of post-deployment casualties. [...] there appears to be a lack of urgency to adequately and promptly meet tiffany earring on sale veterans' growing needs. [...] VCS urges Congress to pass a new law mandating that the Administration must estimate, monitor, plan, and fund healthcare and disability benefits for our casualties before starting or entering into a war. According to DoD: * At the end of August 2010, a total of 5,670 U.S. servicemembers died in the Iraq War and Afghanistan War combat zones. * At the end of August 2010, a total of 91,384 U.S. servicemembers in the two war zones were wounded or were medically evacuated due to injuries or illnesses that could not be treated in the war zones. * The grand total of U.S. battlefield casualties is more than 97,000.
Typically, it's a parent who first recognizes that his child might have a mental health problem. But teachers are the ones sounding the alarm in about 16 percent of cases. And yet, only nine percent of frank gehry jewellery said that school personnel were their most helpful source of support. Teachers may be on the front line with kids, but they lack the training and resources needed to support kids and families affected by mental illness. Anderson adds that without better bridging between home and school, extra training and programs will not be effective. Many parents she speaks with report having negative experiences with their children's schools, and say their kids feel most discriminated against at school. "You can't just work with the child," she says. "If we're going to do something with schools, let's try and engage families."
Sadly, the stigma lives on
Parents whose kids have mental paloma picasso jewellery often feel judged; more than threequarters believe that most people see their children's difficulties as the result of the family environment (44 percent) or a "negative personality" (32 percent). Despite increasing public awareness about children's mental health, families do not feel that their kids' struggles are understood as real illnesses that need and deserve to be treated. Which is why paediatrician and parent Carlson-Reid believes that we need to keep talking about the issue. "Nobody's immune from the possibility of mental illness," she says.
At Youth Net, people between the ages of 18 and 30 talk to kids return to tiffany jewellery mental illness and connect them with professionals. They also snowboard, hike and practise yoga with them. "Kids are surprised to learn that up to 25 percent of people have mental illness, and it can be as common as test anxiety or social phobia at school," [LAURA ARMSTRONG] says. "They don't realize that other young people can relate to what they feel and can help them through the darkness."
When Laura Armstrong was 10 years old, a friend in her Ottawa neighbourhood grabbed a knife and threatened suicide. "She had lost her mom and was distraught," recalls tiffany 1837 jewellery. A few years later, another pal confided in Armstrong about her plan to jump off a bridge. Armstrong gave her friend two options: Call Kids Help Phone or meet with her high school guidance counsellor.
Today Armstrong is a doctoral student in clinical psychology at the University of Ottawa, and mom to one-year-old Keriana. As part of her studies, she did a clinical placement at Youth Net, a peer support organization for youth with mental health problems. "Only one in six youth who need mental health services ever gets them in Canada, and this organization is working to boost that statistic," Armstrong says.
At Youth Net, people between the ages of 18 and 30 talk to kids about mental illness and connect them with professionals. They also snowboard, hike and practise yoga with them. "Kids are surprised to learn tiffany somerset jewellery up to 25 percent of people have mental illness, and it can be as common as test anxiety or social phobia at school," Armstrong says. "They don't realize that other young people can relate to what they feel and can help them through the darkness."
Discussion
The findings from our systematic review on the pathways to care of patients with FEP suggest that the type of contact differs depending on whether the first contact or the referral source is considered. These contact points represent different time-periods in the course of illness, and may suggest a failure to identify previously untreated patients with psychotic return to tiffany presenting to a general practitioner. This could be because the symptoms are subtle, the assessment contact is too brief, or the presentation of a psychotic disorder is an infrequent event in a general practice. The care pathways also differed by geographical region, probably because of differences in social, cultural, and health service contexts. These regional trends highlight the need for tiffany 1837 that is specific to the jurisdiction of interest.
Our findings support prior claims that involuntary and negative pathways to care, such as with police or emergency services, are frequent for patients with FEP (Garety & Rigg, 2001). This is of particular concern given that negative pathways to care may be associated with poor engagement in treatment (Compton, 2005) and greater dissatisfaction with services (Bhugra et al. 2004). Qualitative research on help-seeking in FEP also indicates that negative experiences with psychiatric tiffany somerset may have an impact on future delays in help-seeking (Monteiro et al. 2006). Taken together, these findings suggest that we need to pay greater attention to the potentially deleterious impact of the involvement of police, ambulance, and emergency services on the pathway to care.
Contacts with non-physicians tended to be infrequent relative to contacts with physicians and emergency services, except in some specific Asian jurisdictions. tiffanys et al. (1998) suggest that non-physician contacts may be involved as part of a 'parallel help-seeking strategy', which would not be captured by the indices used by the included studies. Qualitative research on help-seeking in early psychosis indicates that non-physician contacts play an important role in linking the families of patients with psychiatric services (Wong, 2007 a , b ) and families may use personal contacts as resources to expedite the help-seeking process (Bergner et al. 2008). There is also evidence that patients tend to under-report contact with non-physician services, possibly because of the perception that informal contacts do not warrant equal status on the help-seeking pathway (Lincoln & McGorry, 1995).
The studies that explored the sex, tiffany bangles uk-economic, or ethnic determinants of the pathways to care had conflicting findings, probably reflective of contextual differences across studies. In addition, the objective of the included studies was generally not to explore the sociodemographic determinants of the pathway to care, but rather to use these variables as covariates for other analyses. Of exception, several studies did focus on ethnic differences as the primary objective. The included studies were also limited in their power to explore these determinants, and future research may obtain a better understanding from studies that are designed and powered to examine the sociodemographic determinants of the pathway to care.
Twenty-four studies provided data on the DUP of participants, which varied substantially across studies (Tables 2 and 3), probably due in part to differences in definition and atlas jewelry (Compton et al. 2007). The median DUP ranged from 4 weeks for a study from New Zealand (Turner et al. 2006) to 68 weeks for a study from Germany (Fuchs & Steinert, 2004) (median across studies=21.6 weeks).
Of the 23 studies that measured DUP, 15 examined a putative association between the pathway to care and DUP (Table 1). Ten studies assessed the impact of the first contact, with two finding no significant association (O'Callaghan et al. 2009; Sharifi et al. 2009) and a third having an insufficient sample to allow cushion jewelry to be drawn (Temmingh & Oosthuizen, 2008). A Canadian study found evidence that patients whose first contact was with a non-physician had a significantly longer DUP (Bechard-Evans et al. 2007). Descriptive data from German studies also indicated a longer DUP for patients who made first contact with a non-physician or at a hospital for another complaint (Fuchs & Steinert, 2004), and a shorter DUP for patients who made first contact with emergency services (Kohn et al. 2004). By contrast, a U.S. study found longer treatment delays when first contact was with a general practitioner (elsa peretti jewelry et al. 2006). Data from France suggest longer delays when first contact is with a private psychiatrist, as compared with a general practitioner or public psychiatrist (Cougnard et al. 2004 b ). Similarly, a study from China also suggests that DUP is longest when the first care pathway contact is a psychiatrist or psychologist (Chiang et al. 2005). Finally, a study from Singapore found no difference between making first contact with a traditional or religious healer as compared with those who sought help from another type of care pathway contact (Chong et al. 2005).
Five studies assessed the impact of the referral source on the DUP, with two finding no significant association (Scholten et al. 2003; O'Callaghan et al. 2009). A study frank gehry jewelry Canada found that patients referred from in-patient units to early intervention services had a significantly shorter DUP, whereas patients referred by community agencies, psychologists, or psychiatrists had a significantly longer DUP (Addington & Addington, 2006). Similarly, a study from Switzerland found delays in time to referral when the referral source was a psychiatrist, psychologist, or non-physician service, as compared with referral by a general practitioner or psychiatric services (Platz et al. 2006). Data from the UK suggest that individuals referred by a home treatment team or the emergency department had the lowest DUP (Cratsley et al. 2008).
Lastly, a study from the UK reversed paloma picasso jewelry direction of the association and looked at the impact of DUP in predicting the type of care pathway contact. This study found that having a long DUP (>66 days) was not predictive of having a general practitioner or criminal justice source of referral (Morgan et al. 2005