ShareThisIn the aftermath of the Fort Hood shootings last week, the spotlight is suddenly on the military's overstressed mental health care system.
Questions are emerging about how a few hundred military mental health counselors are treating thousands and thousands of men and women in the armed forces in Afghanistan and Iraq.
According to official Army figures, 308 military psychiatrists serve 1.4 million active-duty members. On average, 200 behavioral-health personnel - including psychiatrists and other mental-health counselors - are deployed in Iraq and about 30 in Afghanistan.
Dr. Nancy Sherman, a military ethicist at Georgetown University, said the military and mental health care systems in general are "very stressed."
"We are a military fighting two wars at once with a non-drafted army," she said.
Sherman said there has been a shortage of military doctors throughout the wars in Iraq and Afghanistan and likely a scarcity of military psychiatrists and therapists.
A 2008 study by the Rand Corporation found that nearly 20 percent of service members who have returned from Iraq and Afghanistan, or 300,000 people, suffer symptoms of PTSD or major depression.
The shooting at Fort Hood that left 13 dead, raising questions about how military psychiatrists and therapists deal with the daily stresses and emotional issues of their jobs as they counsel others about the horrors of war. The alleged gunman, Maj. Nidal Hasan, was a military psychiatrist who was reportedly distraught about an imminent deployment and other possible issues.
"I think a lot of times you want to make sure that people have a level of self-awareness of what impact their work has on their psychological well-being," said Dr. Mary Helen Davis, a psychiatrist at the Kentucky Physicians Health Foundation. She has treated post traumatic stress disorder and other behavioral disorders.
Active-duty service members are often deployed for several tours in Iraq and Afghanistan, sometimes with a quick turnover, Davis said.
From 2001 to 2007, some service members were redeployed less than a year after their previous tours, according to an Army spokesman. In 2007, the Department of Defense enacted a policy that prohibited redeployments after less than a year without authorization.
Another stress factor for service members is that many of them are young and have significant others, marriages or young families.
"There's a lot of stress and trauma that soldiers carry with their families," Sherman said.
Sherman said military psychiatrists also act as family counselors as well as treating soldiers who have lost limbs, been disfigured, have trouble sleeping at night or feel stigmatized by their mental or behavioral problems.
Even though military psychiatrists are trained to counsel people with these issues, Davis said that doesn't mean they're immune to emotional, mental or behavioral problems themselves.
"They are still vulnerable to the same types of stresses that the general population is," she said.
Davis and Sherman said military therapists may develop secondary trauma because of the volume of patients they treat.
Training for military psychiatrists and therapists varies, Sherman said, and some may not undergo psychoanalysis before becoming military psychiatrists.
"As is the case for all soldiers returning from deployment, military psychiatrists undergo several iterations of screening," said Maria L. Tolleson, spokeswoman for the U.S. Army Medical Command and Office of the Surgeon General, in a statement.
All members of the military, including military psychiatrists, go through a health assessment at the time of deployment and another assessment three to six months after they return, when stress symptoms may surface.
"Like all other health-care providers, shortly after return from deployment military psychiatrists should sit down with their supervisors and discuss their experiences while deployed, indicate any challenges they are having," Tolleson said.
Tolleson said the Army's Provider Resiliency Training program teaches health-care providers how to recover emotionally from stress related to their duties and home station environments. According to a fact sheet on behavioral health care released by the Army, several other programs are available for soldiers who have mental and behavioral health problems.
"There's probably room for improvement in both recognizing these disorders and providing treatment for them as well as improving access to that treatment," Davis said.
She said the military has been better about developing programs in the past few years to help service members deal with behavioral problems but said many soldiers may go untreated or seek help from community or private mental health facilities outside the military.
Some service members fear having mental-health treatment in their records could hurt their careers. But civilian therapists may not be trained to treat the types of issues that arise from combat deployments.
(Distributed by Scripps Howard News Service, www.scrippsnews.com.)
The reason military
The reason military Behavioral (Mental) Health doesn't work is because it is military – designed and administered by military psychiatrists and psychologists who are unable to drop their military orientation while developing programs and counseling Soldiers. These dedicated providers who are now in leadership positions serve in an Army at war for the past 7 years. Most of these health care providers personally served a great deal of time in a combat zone where their only job is to "conserve the fighting strength".(The motto of the Medical Corps) by assisting Soldiers to continue on with their responsibilities of killing others, watching atrocities and continuing to function even when their closest friend is killed in front of them.
As noted by Lieutenant Commander Heidi Kraft's in Rule Number Two these psychiatrists. psychologists, social workers and nurses work only minimal personal support for the stress they are experiencing and return to non-combat counseling responsibilities lacking an empathic response for people who seem to have inconsequent problems compared to Soldiers in a Combat Zone. This coupled with their desure to remain on Active Duty force them to deny their own reactions to traumatic experiences or the vicarious trauma from counseling soldiers and continue to perform as competent and capable military officers in leadership positions were they are answering to other senior officers who also have either survived combat tours without developing PTSD or are “holding it together” until they are able to retire and admit that they are part of the 20% of the fighting force that develops PTSD despite all of the “preventive” activities designed to prevent PTSD, suicides and military family problems..
Even when returning to non-combat positions they continue to see their job as helping Soldiers deal with the stress and "drive on" so that the military mission is accomplished. Unfortunately these are fine men and women who started off with the desire to serve humanity as psychiatrists or psychologists but those that remain to assume the leadership positions have compromised their dedication to their patients by making sure they are seen as competent military officers who function well in an extremely rigid system that has no tolerance for flexibility and independent thinking. These values are essential for sending men into dangerous situations and doing everything possible to protect them, but are not useful in assisting young men and women who are having problems dealing with the stress associated with their military occupation. These stresses are frequently unrelated to their military stresses as they must deal with spouses who are suffering from lack of support in their marital relationship because the needs for the Army take priority over all other relationships and responsibilities.
As a psychiatrist who served many years on Active Duty and now works with Soldiers I am distressed that the leadership of the Army Psychiatry and Psychology have been under a great deal of stress and have no way to break out of their military roles and see that they must design a behavioral health system for men and women who wanted to serve their country but for either biological or psychological vulnerabilities have problems fulfilling that commitment. They are NOT JUST service members who need a few techniques so that they can remain functional as Soldiers but need someone who really cares about them as a whole person.
Maybe it would be helpful to remember that we have something to learn from Viktor E. Frankl in Man’s Search for Meaning concerning his Logo therapy that assists people suffering from stress related distress with therapy that allows people to strengthen their coping with stress by finding meaning and purpose for themselves. Even more useful might be the writings of Carl Rogers in 1944 when he used his then new Person-Centered Therapy to assist servicemen at the Chicago USO.