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Letter to President Barack Obama,

This letter eventually led to the Executive Order of August 31, 2012 establishing the Interagency Task Force on Military and Veterans Mental Health (Task Force), and The National Research Action Plan.

January 24, 2012

Dear President Obama:

Honor for ALL, a 501(c)3 non-profit organization, is dedicated to establishing visible recognition of the invisible wounds of Post-traumatic Stress Disorder (PTSD), Mild Traumatic Brain Injury (mTBI), depression, and survivor’s guilt. Our mission is to end the associated stigma, restore equity in the employment domain, preserve the dignity of families, and, most importantly, stop the tragic loss from suicide of veterans and family members suffering these wounds.

The adoption of Senate Resolutions #541 in 2010 and #202 in 2011 designating June 27 as National Post-Traumatic Stress Disorder Awareness Day, your decision to reverse the policy on condolence letters for service members lost to suicide in a war zone, and authoritative statements such as yours to the American Legion last August that the days of depression and PTSD being stigmatized must end, are important steps toward universal recognition for invisible wounds. Still, much is left to be done before all citizens understand the realities of these wounds. Much is left to be reconciled before our current veterans can comfortably re-enter their communities.

Please consider the following:

As our troops conclude their mission in Iraq and make the transition home, the impact of nearly ten years of combat will continue with mounting cases of veterans struggling to overcome the effects of PTSD, TBI, depression and survivor’s guilt. Tragically coupled with this, our veterans face discrimination in the workforce, alienation from friends and family, homelessness, and, most grievous of all, persistent thoughts of suicide. This terrible progression of despair is predominately the result of misunderstanding and misinformation – the stigma of these invisible wounds. Bringing an end to this culture of silence and avoidance is the reason for this letter.

Our military and VA have both taken a proactive position on this issue with increasingly positive results. However, as soon as a veteran steps off post or out of the clinic, that progress and support rapidly dissipate. This is more than just a military matter. We are all involved. Not until society at large understands the realities of invisible wounds can this stigma be defeated.

In recent years, we have seen another stigma – that surrounding breast cancer – successfully removed from our culture. Much of this achievement was accomplished through the efforts the American Cancer Society and the Susan G. Komen for the Cure organization, but it was not without the help of many high-ranking public officials, including presidents. Several Federal Advisory Committees were formed by the Executive Branch and twice included Nancy Brinker, founder of Komen for the Cure. These presidential panels were instrumental in channeling public concern into action. A wellspring of affiliation, they brought about effective collaboration and lasting impact on public opinion. Today, the complicated and pressing affliction of invisible wounds deserves the same official overview.

Across our nation numerous public and private organizations are anxious to help, but collectively they lack coordination, and individually they lack the clout, to act effectively.  Clearly, as a fundamental step toward consolidating this potential, the establishment of a Federal Advisory Committee should again be taken under consideration. 

I, along with the co-signers listed below, ask that you establish, under the authority of the Federal Advisory Committee Act, Title 5 U.S.C., as did President Clinton in 1995 to study Gulf War veterans’ illnesses, a committee comprised of qualified professionals and distinguished laymen to advise on the present exigency facing our veterans and nation. We ask that you put the establishment of this committee on a fast track, that it report directly to you, and that you personally lead us to end the stigma that has been attached to the psychological consequences of service on the field of battle.

The guiding principle for the work of the Committee should be to improve the individual health and family welfare of all service members, past, present, and future, having, or perceived as having, the invisible wounds of Post-traumatic Stress Disorder (PTSD), Mild Traumatic Brain Injury (mTBI), depression, or survivor’s guilt.

With conviction, dedication and collaboration we can conquer the stigma, save and improve the lives of the wounded, restore dignity to their families, and bring understanding to all.

Sincerely,

Thomas Mahany

President, Honor for ALL

/Cosigned by:

The Honorable Thomas E. White, BG (Ret), US Army, USMA 1967, former Secretary of the US Army 

The Honorable Malcolm R. O’Neil, former Assistant Secretary of the Army

LTC (Ret) Ronald Eric Ray, US Army, Medal of Honor Recipient, Vietnam Veteran

SSgt Jeremiah Workman, US Marine Corps, Recipient of the Navy Cross, OIF Veteran

VADM (Ret) Norb Ryan, USN, President, Military Officers Association of America

LTG (Ret) Harry E. Soyster, USA, Purple Heart Recipient

MG (Ret) Leo M Childs, USA, former Chief of Signal

MG (Ret) Alan Salisbury, USA, USMA 1958, Founder and Chairman, Code of Support Foundation

MG (Ret) O.B. Sewall, USA

RADM (Ret) William W. Cobb Jr., USN, USNA 1968, Vice President, General Dynamics,

RADM (Ret) Edward Masso, USN, Chairman of the Board, Not Alone

BG (Ret) Edward F. Rodriguez Jr., USAF

BG (Ret) James R. Ralph, Jr., USA

BG (Ret) Clarke M Brintall, USA, Wounded Warrior Mentor Program 

Gregg Keesling, contributor to Presidential policy on Letters of Condolence for victims of suicide within    a war zone, father of suicide victim Spc Chancellor Keesling, US Army

Kim Ruocco, MSW, Manager for Suicide Outreach and Education Programs, Tragedy Assistance           Programs for Survivors (TAPS), wife of suicide victim Major John Ruocco, USMC

Matthew Leaf, OEF/OIF Veteran, witness to suicide of combat comrade SSgt Joseph Biel, US Army,             June 27, SSgt Biel’s birthday, has been designated as National PTSD Awareness Day

Dr. Frank Ochberg, former Associate Director of the National Institute of Mental Health

Dr. William P. Nash, former Navy psychiatrist, combat stress researcher and author

Bonnie Carroll, Founder and President, Tragedy Assistance Program for Survivors (TAPS)

Susan H. Connors, President/CEO, Brain Injury Association of America

Mike Jones, former Cpt, US Army, OIF Veteran, Executive Director, Not Alone

Kristina Kaufmann, Executive Director, Code of Support

Paul Rieckhoff, Founder and Executive Director, Iraq and Afghanistan Veterans of America

Mark Robbins, Executive Director, Yellow Ribbon Fund  

Pam Derrow, Executive Director, Comfort for America’s Uniformed Service (CAUSE)

Tara E. Crooks, Co-Founder, Army Wife Network, Author, 1001 Things to Love About Military Life

Dr. Christal Presley, Author and Founder of United Children of Veterans

Linda Kelly, President, John Kinzinger, VP, John Lockwood, WW Consultant, Operation Never Forgotten

James Gandolfini, Jon Alpert, Tom Richardson, and Matthew O’Neil, HBO’s Wartorn

Jay Ungar and Molly Mason, Musicians

Gwen Weiner, Director, EOS Foundation

Allan Horlick, President and General Manager, WUSA9 TV, Washington, DC

Mike Walter, Documentary Filmmaker, creator of Breaking News, Breaking Down

Dr. Jeffrey Rosenberg, Michael Humphries, RN, and Eugene Pyatenko, Prizm Pain Management

Senior Vice-Commander Gilbert Grylls, VFW Post 2216, Staunton, VA

Anthony Asher, CEO, Sullivan, Ward, Asher & Patton, P.C

Mary and Patrick E. Lynch, Former President National Funeral Directors Association

Mai Fernandez, Executive Director of the National Center for Victims of Crime

Michael J. Asher, Attorney, Sullivan, Ward, Asher & Patton, P.C

Maj (Ret) Rick Briggs, US Air Force, Veterans Program Manager, Brain Injury Association of Michigan

Vito A Pampalona, Yellow Ribbon Fund – National Chairman Ambassador Program

Janet and Dr. Ellsworth Levine, Former Captain, US Air Force

Judith Broder MD, Founder/Director, The Soldiers Project, 2011 Presidential Citizens Award Medal

R. Drew Fezzey, Music Producer and Filmmaker

Carrie Fox, President, C. Fox Communications

Catherine Wallace, Small Business Owner

Judy Weiner, Small Business Owner

Paul Loes, Small Business Owner

John F. Linehan, Jr., 101st Airborne, US Army, Vietnam Veteran

Steve Robinson, Retired Army Ranger, Veteran and Advocate

Thomas Phillips, Wounded Warrior/Navy, Desert Storm Veteran, SDVOSB

Lennie A. Fine, USMC, Vietnam Veteran

LTC (Ret) Ron Capps, Founder and Director, Veterans Writing Project

LTC (Ret) Edward R. Lynch, AROTC, 1983

LTC (Ret) Kathleen L. Lynch, AROTC, 1983

LTC (Ret) Thomas J. Lynch, USMA, 1982

1LT (Ret) John Harry Jorgenson, USMA 1967, former Counsel to Inspector General, Federal Reserve

Terry Atkinson, Former Capt US Army, USMA 1967, Vietnam Veteran

Thomas Beierschmitt, Former Capt US Army, USMA 1968, Vietnam Veteran

LTC (Ret) John M. Greathouse, USMA 1969, Vietnam Veteran, Director, Monticello Capital

LTC (Ret) James T. Fouché Jr, USMA 1969, Vietnam Veteran

Michael D. Healy, Former Captain US Army, USMA 1969

Pete Dencker, Former Major US Army, USMA 1969, Vietnam Veteran, Purple Heart Recipient

Robert W. Haines, former Major US Army, USMA 1969

LTC (Ret) F. Chris Sautter, USMA 1969, Vietnam Veteran

LTC (Ret) John R. Hamilton III, USMA 1969, Vietnam Veteran, Double Purple Heart Recipient

IMPROVING ACCESS TO MENTAL HEALTH SERVICES FOR VETERANS, SERVICE MEMBERS, AND MILITARY FAMILIES

The last clause, (c)iii, was included in response to the efforts of Honor for ALL and the letter to President Barak Obama requesting the formation of a Federal Advisory Committee to direct and advise on the emotional health of Veterans and their families.

Sec. 6. Military and Veterans Mental Health Interagency Task Force. There is established an Interagency Task Force on Military and Veterans Mental Health (Task Force), to be co chaired by the Secretaries of Defense, Veterans Affairs, and Health and Human Services, or their designated representatives.

(a) Membership. In addition to the Co-Chairs, the Task Force shall consist of representatives from:

               (i) the Department of Education;

               (ii) the Office of Management and Budget;

               iii) the Domestic Policy Council;

               (iv) the National Security Staff;

               (v) the Office of Science and Technology Policy;

               (vi) the Office of National Drug Control Policy; and

               (vii) such other executive departments, agencies, or offices as the Co-Chairs may designate.

A member agency of the Task Force shall designate a full time officer or employee of the Federal Government to perform the Task Force functions.

(b) Mission. Member agencies shall review relevant statutes, policies, and agency training and guidance to identify reforms and take actions that facilitate implementation of the strategies outlined in this order. Member agencies shall work collaboratively on these strategies and also create an inventory of mental health and substance abuse programs and activities to inform this work.

(c) Functions.

               i) Not later than 180 days after the date of this order, the Task Force shall submit recommendations to the President on strategies to improve mental health and substance abuse treatment services for veterans, service members, and their families. Every year thereafter, the Task Force shall provide to the President a review of agency actions to enhance mental health and substance abuse treatment services for veterans, service members, and their families consistent with this order, as well as provide additional recommendations for action as appropriate. The Task Force shall define specific goals and metrics that will aid in measuring progress in improving mental health strategies. The Task Force will include cost analysis in the development of all recommendations, and will ensure any new requirements are supported within existing resources.

               ii) In addition to coordinating and reviewing agency efforts to enhance veteran and military mental health services pursuant to this order, the Task Force shall evaluate:

1) agency efforts to improve care quality and ensure that the Departments of Defense and Veterans Affairs and community based mental health providers are trained in the most most current evidence-based methodologies for treating PTSD, TBI, depression, related mental healthconditions, and substance abuse;

2) agency efforts to improve awareness and reduce stigma for those needing to seek care; and

 3) agency research efforts to improve the prevention, diagnosis, and treatment of TBI, PTSD, and related injuries, and explore the need for an external research portfolio review.

               iii) In performing its functions, the Task Force shall consult with relevant nongovernmental experts and organizations as necessary.

47 States and both Houses of Congress drop the “D”

  

 A WOUND NOT A WEAKNESS         

The diagnostic term Post-traumatic Stress Disorder (PTSD) was crafted in 1980 by the American Psychiatric Association (APA) to commonly describe and categorize the psychological aftermath of experiencing traumatic events. Since, as the result of intensive electromagnetic imaging research, it has been shown that severe post-traumatic stress, combat-induced or otherwise, causes physical changes within the brain which more accurately describe an injury than a disorder – a treatable wound calling for definitive and timely treatment.

The stigma advanced by the term “Post-traumatic Stress Disorder” presents a needless liability to the health and welfare of those already overwhelmed by this basic natural response to an extraordinary event. To label them “disordered” only serves to add to their struggle, discouraging some of the afflicted from seeking care while keeping others, particularly those who do not know them, from truly caring.

In 2012, the American Psychiatric Association held an open hearing to debate the name change of post-traumatic stress disorder (PTSD) to include post-traumatic stress injury (PTSI). Regrettably, the APA’s decision was not to change or add to the name in DSM 5.

Beyond this obvious obstruction to the healing process, the use of the word “disorder” here negates the sense of honor owed the brave men and women who have received these wounds while risking their lives to protect ours, be it on the field of battle, the emergency rooms of our hospitals, or the streets of our communities. On a personal level, it disparages the character of victims of crime and abuse, as well as survivors of life-threatening accidents, natural disasters, and more. 

In 2013, Honor for ALL began a grassroots campaign to rebrand the term as Post-traumatic Stress Injury on a cultural level by petitioning federal, state, and local officials to declare June 27 as Post-traumatic Stress Injury Day Awareness Day (the date June 27 was first chosen by the United States Senate as National PTSD Awareness Day in 2010). Our objective was, and remains, to gather enough support among governing bodies, the press, and the electorate to positively influence succeeding actions of the APA’s DSM Scientific Review Committee in favor of name change.

Our first state resolution for Post-traumatic Stress Injury Awareness Day came from our home state of Michigan in 2014. As of the Spring of 2022, 47 states have participated by way of bill, resolution, and/or proclamation designating June 27 as PTS Awareness Day. The US House of Representatives signed on in 2017, and the Senate designated June 27 as PTS Awareness Day beginning in 2016.

HFA Medical Advisor, Dr. Frank Ochberg, former Associate Director of the National Institute of Mental Health (NIMH) and member and chair of APA councils, committees, and task forces in the late 1970s and early 1980s materially responsible for advancing the creation and modification of the original diagnosis known as PTSD agrees, “As far as I am concerned, the name PTSD, was never important.  The concept was important.  We knew before 1980 that research would help us adjust the diagnostic criteria over time.  We knew that later versions would reflect evolving scientific knowledge.  And now, evolving knowledge leads us to a modification in the name as well as modifications in criteria.  The basic concept remains. Some details have changed.  The fact that profound trauma creates injuries to brain function, brain physiology, and brain anatomy is well established.  Removing the “D” can reduce the stigma, and that is good. Adding the “I” for injury introduces honor, and that is better.”

Although our original intent was to advocate for service members and veterans, we have come to realize that the impact of this trauma, whether it stems from personal tragedy, societal upheaval, or the horrors of war, is a pervasive and insidious threat to the well-being of all our fellow citizens.

Without pressure from the public sector, the APA will most certainly continue to use this harmful term, which acts as a barrier to getting adequate and timely care. The first critical decision that a victim of severe post-traumatic stress is forced to deal with is the one of ownership. The stigma created by the word ‘disorder’ interferes with that ownership, which in turn interferes with access to treatment, which in turn, too often leads to depression, despair, and ultimately self-destruction.

Identifying Post-traumatic Stress as an Injury by officially and publicly declaring a Day of Awareness cannot unwring the bell sounded by the APA in DSM III some forty years ago when they coined their original descriptor, but it can serve to redirect public sentiment. Officially and publicly declaring a Day for Post-traumatic Stress Injury Awareness says we are committed to excluding shame, adding honor, and in the end – saving lives.

Honor for ALL specifically encourages the use of the full term “Post-traumatic Stress Injury” rather than simply “Post-traumatic Stress” in resolutions and bills. The primary reason is as follows: for medical and or legal reference, PTS only has to comply with Criteria A; PTSI (née PTSD) must comply with Criteria A through H of Section 309.81. Both of these diagnoses come under the umbrella of Traumatic Stress, for which the DSM does not provide a specific definition but is clearly an increasingly common mental health issue in present-day life. A lot of the pushback from the existing opposition stems from the belief that changing the name will present confusion and complexity in obtaining compensation and healthcare qualifications. For this reason, we encourage all bills and resolutions to include a clause stating, “any injury exhibiting compliance with criteria A through H, §309.81 in the Diagnostic Statistical Manual deserves consideration and compensation strictly matching legal entitlements provided for disabilities that have been or are currently, classified as post-traumatic stress disorder”. 

For individual Bills, Resolutions and Proclamations to date go to *Supporters*.