The wars in Iraq and Afghanistan are resulting in injuries that are currently disabling for many, and potentially disabling for still more. They are also putting unprecedented strain on families and relationships, strain that can contribute to the severity of the service member's disability over the course of time. NCD concurs with the recommendations of previous Commissions, Task Forces and national organizations that:

1. A comprehensive continuum of care for mental disorders, including PTSD, and for TBI should be readily accessible by all service members and veterans. This requires adequate staffing and adequate funding of VA and DoD health systems.
2. Mechanisms for screening service members for PTSD and TBI should be continuously improved.
3. The current array of mental health and substance abuse services covered by TRICARE should be expanded and brought in line with other similar health plans

It is particularly critical that prevention and early intervention services be robust. Effective early intervention can limit the degree of long term disability and is to the benefit of the service member or veteran, his or her family and society. Therefore NCD recommends:

1. Early intervention services such as marital relationship counseling and short term interventions for early hazardous use of alcohol and other substances should be strengthened and universally accessible in VA and TRICARE.

Consumers play a critical role in improving the rehabilitation process. There are many opportunities for consumers to enhance the services offered to service members and veterans and their families. NCD recommends:

1. DoD and VA should maximize the use of OIF/OEF veterans in rehabilitative roles for which they are qualified including as outreach workers, peer counselors and as members of the professional staff.
2. Consumers should be integrally involved in the development and dissemination of training materials for professionals working with OIF/OEF veterans and service members.
3. Current and potential users of VA, TRICARE and other DoD mental health and TBI services should be periodically surveyed by a competent independent body to assess their perceptions of: a) the barriers to receiving care, including distance, cost, stigma, and availability of information about services offered; and b) the quality, appropriateness to their presenting problems and user-friendliness of the services offered.
4. VA should mandate that an active mental health consumer council be established at every VA medical center, rather than have this be a local option as is currently the case.
5. Congress should mandate a Secretarial level VA Mental Health Advisory Committee and a Secretarial level TBI Advisory Committee with strong representation form consumers and veterans organizations, with a mandate to evaluate and critique VA's efforts to upgrade mental health and TBI services and report their findings to both the Secretary of Veterans Affairs and Congress.

DoD and VA have initiated a number of improvements but as noted by earlier Commissions and Task Forces, gaps continue to exist.

It is imperative that these gaps be filled in a timely manner. Early intervention and treatment is critical to the long-term adjustment and recovery of service members and veterans with PTSD and TBI. NCD recommends: 

1. Congress and the agencies responsible for the care of OEF/OIF veterans must redouble the sense of urgency to develop and deploy a complete array of prevention, early intervention and rehabilitation services to meet their needs now.

As this report indicates, the medical and scientific knowledge needed to comprehensively address PTSD and TBI is incomplete. However, many evidence-based practices do exist. Unfortunately, service members and veterans face a number of barriers in accessing these practices including stigma; inadequate information; insufficient services to support families; limited access to available services, and a shortage of services in some areas. Many studies and commissions have presented detailed recommendations to address these needs. There is an urgent need to implement these recommendations.