Rep. Patrick J. Kennedy (D-RI)

Remarks of Rep. Patrick J. Kennedy (D-RI), excerpted from transcribed video of the briefing

All those families that have loved ones who have served our country, all serve our country because all of them are sacrificing a great deal. When one of some person's family goes over there, the whole family goes over there in their minds and are wondering when they are going to come home. [They] probably qualify for as much help as the service person themselves because they are so traumatized by the images and the news and they are never certain because of the uncertainty of their loved one.

And of course, this last week, with the remembrance of 9-11, there was a great deal of talk about the images of 9-11 and that even those who were not at ground zero were traumatized by 9-11 just by watching TV. You can only image now, those who have family members of loved ones who are serving over in the war on terror, are reacting to these very same images in the context of the war. I think that when we talk about helping our service men and women in returning, we've got to talk about it also in terms of their families because clearly their families need to be best prepared.

It would be fantastic if more families were aware and had the tools and didn't feel out of sorts in terms of how to deal with the reactions that their loved one is having, having just returned from Iraq, for example. Our country needs to do more to prepare military families with the tools, resources, and support systems, because ultimately the family is the main source of resilience for that person returning. Psychologists or mental health professionals are terrific, but ultimately that person is coming back into the family.

And if the family is better prepared to absorb the psychological trauma that has befallen their loved one, then they can help that person get back on their feet as well as any mental health professional. I make this point because when we see kids all over this country traumatized in their homes because of domestic violence, you have to realize that they don't even have the tools that an adult has. At least an adult has some of the coping mechanisms. A child that has witnessed their parents beat each other or has witnessed violence in the home of some kind has no tools whatsoever. All of the counseling and support for early intervention is terrific, but it won't match up to helping the parent get the support that they need so that they don't continue to re-traumatize their child. All of our efforts often go to the "victim" in the narrow sense - and that is the child - but forgetting about the person who is going to be spending the most time with the child from this point out is their parents; our programs target the child, but don't target the parents who are inflicting the trauma on the child.

I've worked hard to put through legislation that actually got attached to the "Leave No Child Behind Act" called the Foundations for Learning Act and that essentially targets the parents of the children. If you want to help the children, help the parents. It's kind of counterintuitive, because why would you want to help the people that are victimizing the child? But frankly, if the parents get better the child stands the greatest chance of getting better and this approach should hold true for those returning from Iraq as well.

I want to thank all the panelists for their activism - their personal sacrifice and their activism help spearhead a greater awareness of trauma in our country and how to respond to it. Frankly, we talk a lot about Homeland Security and this past week I was among many colleagues who were saying that we haven't fully implemented the 9-11 Commission Report. One of the things that concerns me about the 9-11 Commission Report is that there weren't any recommendations to have more in the way of consequence management. That should be a top priority because terror is a psychological weapon and yet we keep buying fire trucks and stockpiles of vaccinations and first responder gear. And boy, we need all of that - no question - we need inter-operable systems of communication and cargo holds to be inspected and we need shipping containers to be inspected. But frankly what we really need is a way to prepare a resilient America so that when we do eventually have another attack, we will respond in a way that will minimize the adverse impact of the maladaptive behavior that a public will invariably exhibit in the wake of what is essentially an effort to throw the American people off. It's not so much the attack itself, but it's the consequences that are really intended in any terrorist attack. Yet, we worked very hard to try to get money set aside in the Homeland Security dollars, so that every state in the country that was receiving Homeland Security dollars would have to come up with a resilience preparedness plan.

It is important that we help build the public's input and involvement in potential responses to a terrorist attack so that they feel empowered. If the American people felt empowered, they would be better prepared to take a proactive role in knowing what to do if an event came along. I look forward to working with you to get in the President's budget money for trauma awareness - but one of the best ways to get that money is through Homeland Security because that should be an essential part of any Homeland Security preparedness plan: to know how we are going to communicate in the event of a terrorist attack so that we don't compound people's fear. Who is going to communicate? What words and language are they going to use so that they don't compound it?

Rudy Giuliani is celebrated to this day as a mayor because the way that he responded to 9-11 really helped mitigate fear and reinforce a positive sense of security amongst the people of New York. He didn't do so in a vacuum. He was smart enough to know that there were people he needed to talk to that could advise him as to the language to use so as to not re-traumatize people and the image to project. Now, if we as a country don't have it together in terms of who to look to for information, if the information that they are giving us is not true, and if the American people don't have a sense that we know, as a country, how to prepare them to respond, then we are leaving ourselves open to re-traumatizing the American public in some ways. And in thinking about 9-11, we also have heard a great deal about those responders who thought they were doing a good job, helping to debrief families or victims, were actually compounding the trauma because they weren't properly trained in the area of trauma response. And so, it's not enough to have your parish priest down there talking about the events - they might mean well, but frankly, they might be bringing these memories back up to the victim and, in a sense, re-traumatizing them.

We need to make sure that we have a certification of those people who are delivering trauma counseling because one of the areas of mental health that we really need to work on the most is professionalization of the workforce - across the board. One of the real pitfalls of the mental health field is that we have so many forms of professions in mental health - family therapists, grief counselors, psychologists, psychiatrists, social workers - but we need to make sure that we professionalize in the sense that… what are the areas that this person is going to be focused on so that they are best prepared to deliver the best kind of assistance?

I am working on a number of these proposals. The most important of which, however, is parity. Because frankly, everyone talks about how we're going to deal with trauma here or there … we are taking an approach where the bigger picture is missing. We need mental health integrated into our whole health system because there isn't an event in any of our lives that doesn't require mental health counseling and support or trauma preparedness. For one person, it may not be traumatic - they might be resilient enough to respond. But for someone else that very same event might be paralyzing. In a sense, we need to be prepared to build resilience in a mental health system where any time someone goes to a doctor - whether it's their primary care doctor or a gynecologist or whomever - that the provider has awareness of mental health and is not treating that person in isolation - in a vacuum. But to this day in this country, mental health still is not incorporated into the overall treatment of a human being. We, as a country, spend all this money picking up the pieces in the emergency room of people who have never been put together mentally and end up falling apart physically. And as a result we respond through the back rather than up front.

On the military side I introduced a bill called the Psychological Kevlar Act, which is intended to make sure that we incorporate mental health awareness and strength into our soldiers before they go into conflict so that it's not just a matter of debriefing them after they get back. We know that we make a major emphasis when we train our military to get physically fit - to be able to do one hundred pull-ups, to run with the 50 pound backpack, to be able to do all kinds of incredible things physically. That ought to incorporate part of their understanding that part of their ability to be strong soldiers needs to be aware - themselves - of the psychological stressors that will befall them within the field of combat. That way, they will be less stigmatized when they do suffer from this trauma because they will know that it is part and parcel of being in the theater of conflict. Any human being who is exposed to the kind of violence that they are-that is, the fear of being killed that day-would respond like they are. It is natural for them to feel that trauma.

This concept became real to me when I first got elected to Congress. I was asked by the John F. Kennedy Special Warfare Center at Fort Bragg to come down for the 30th Anniversary dedication in honor of my uncle. When I went down there I was really shocked because I was taught all about how the strength of our Green Berets was more than just physical, it was mental. In fact, mental was an essential part of the overall training. In fact, they had mental health counselors available to each member of those Green Beret teams, 24 hours, seven days a week. Why? Not because these are "weak" people - to the contrary, these are the strongest most resilient people that we could ever imagine. Imagine going through what they go through in Special Forces training.

The emphasis was, we want them stronger. We want them, when they go out and do their jobs, to be able to have nothing else on their mind than to do the job they were trained to do. And as a result, we are going to have psychiatrists available to them 24/7. Now the military was thinking purely about performance - purely about the bottom line. And I only wish the rest of the country would adopt that military understanding, because if business in this country understood that the bottom line was important, than they would pass parity because their workforce would be more productive and we wouldn't lose $180 million dollars in lost productivity due to "present-eeism" (which is, when they are at the job and can't focus) or absenteeism (when they can't even show up to begin with). If only the healthcare system would focus, in advance, on mental health preparedness, we wouldn't have to pick up all the pieces … We wouldn't have to have a corrections system where two-thirds of the people in our jail system are there for drugs and alcohol. And I guarantee you, if you asked any one of their teachers - if you went backwards - you would find out that they were exposed to trauma in their lives as children. What are we doing to break that cycle of trauma? You want to find a direct correlations between a child and their likelihood of going to jail, just find a child whose parent is in jail and you have the correlation nearly one-to-one. And yet, we just cut the money to help and intervene with those children.

Trauma is everywhere in peoples lives. The key here is - how do we prepare for it and how do we respond to it? Unfortunately, without mental health parity in this country, we're never going to fully do the job. We need to pass initiatives like the one you are advocating for today. But we need to do so in the context of a comprehensive approach to having mental health incorporated into all facets of our lives. And that will require an attitude adjustment because, quite frankly, we still treat mental illness as if it is something wrong with the person. They can't pull themselves up by their bootstraps … They can't get on with life. I don't know the last time someone was able to think their way out of diabetes or think their way out of coronary disease, and that essentially is the logic that people are using when they say "pull yourself up by your bootstraps." They are saying "well, you ought to think your way out of a chemical imbalance in your brain that has been caused by toxic stress"-it just doesn't make any sense. We need to get that message out there.

We have another bill called the Ready Willing and Able Act, which is about helping to prepare local response to terrorism that involves the community. You can't have this from the top down; it's got to involve the people if they are going to feel empowered. That was the result of a lot of studies - they weren't my studies - I'm just building this legislation around work that people like you do every day and tell me, as a public policymaker, what I ought to do as an elected official on your behalf. Thank you for the good work that each of you do.