thedrifter
12-26-06, 07:32 PM
January 01, 2007
Unseen scars
Survey shows mental health care problems may be rising; treatment concerns remain
By Gayle S. Putrich and Michelle Tan
Staff writers
New data collected by the military in the Iraq war zone show suicides and stress symptoms continue to rise, and officials are expressing concern about higher rates of potential mental health problems among troops who have made repeated deployments to the theater.
The data comes as a Pentagon task force continues to crisscross the country assessing the state of military mental health care and as the Pentagon revamps mental health deployment policies to get war fighters the help they need and avoid sending troubled troops back into combat.
But access to mental health care remains an issue, according to members of the Defense Health Board’s Mental Health Task Force, who say they hear the same refrains at nearly every stop on their nationwide tour of mental health facilities.
The recent data on troops who have deployed to Iraq, released in a Dec. 19 report, paints a stark picture. For example, the suicide rate among soldiers supporting Operation Iraqi Freedom almost doubled in 2005, going up to 19.9 per 100,000 troops from 10.5 per 100,000 the year before.
Yet the data from 2003 show the rate that year to be 18.8 per 100,000 troops, which makes officials cautious about drawing conclusions.
“We haven’t made a connection between the stress on the force with a significant increase in suicides,” said Lt. Gen. Kevin Kiley, Army surgeon general, who discussed the data Dec. 20 at the Pentagon. “That isn’t to say there aren’t any. [But] I don’t have any evidence that there is a correlation between [post-traumatic stress disorder] and suicides.”
The report also found that troops who have deployed to Iraq more than once reported higher levels of acute stress symptoms as well as higher levels of anxiety and depression than those serving their first tours.
Almost 19 percent of troops with at least one prior tour in Iraq reported acute stress symptoms, compared with 12.5 percent on their first tour.
On the plus side, troops say getting help in theater is now easier and the stigma of seeking that help is decreasing.
The study was compiled by the Mental Health Advisory Team III, established at the request of Multi-National Force-Iraq, using data collected in October and November 2005 in theater. Similar assessments were made in late 2003 and 2004.
The study “reflects a snapshot of the morale and mental health” of deployed troops last fall in Iraq, Kiley said. It also was the first time the team was able to compare data on troops with multiple deployments with those on their first tour.
A total of 1,461 soldiers, 172 behavioral health providers, 172 primary care providers and 94 unit ministry team members participated in the assessment.
Nationwide assessment rolls on
Kiley was in the Washington area for the fourth in a series of public meetings of the Pentagon’s Mental Health Task Force. The panel, established in June at the request of Congress, has held previous field hearings in Texas, San Diego and San Francisco.
The 14-member panel — seven Defense Department members and seven civilian health professionals — is due to submit a report and recommendations on the military’s mental health system in May. The task force will travel next to the Tacoma, Wash., area in January.
The data on Army suicides contained in the recent report from Iraq did not include troops who might have PTSD — the troops were surveyed in theater, and PTSD develops only after an individual leaves the combat zone.
“Are we concerned that soldiers on their second or third deployments are at increased risk for PTSD? We sure are,” Kiley said. “Are we encouraged because the stigma is dropping and soldiers are seeking more help? Yes, it’s encouraging.”
But when troops do seek help for combat stress or PTSD once they get home, will it be there? Mental health task force members said that from what they’ve seen so far, the answer seems to be: “Maybe.”
Task force members said they have heard of war fighters waiting up to eight weeks to get into a military treatment facility or to see a Tricare-approved mental health practitioner.
Air Force Col. (Dr.) Robert Ireland, program director for mental health policy in the Pentagon’s Office of Health Affairs, who also spoke to the task force, acknowledged that eight weeks is too long to wait to get mental health help.
But, he said, there is a lot of pressure to book appointments with a limited number of approved care providers.
“Should people be waiting eight weeks? Absolutely not,” Ireland said. “My sense is that we’re competing for mental health providers. There are major cities where you can’t get an appointment in eight weeks under any circumstances. We’re in that competitive market.”
That pressure could be alleviated if Tricare would pay for mental health care given by licensed counselors, veterans’ and family groups say. Tricare approves professional counselors for mental health care only if they have a particular master’s degree, have logged 3,000 supervised clinic hours and are supervised by the referring physician. They cannot independently contract with the Pentagon without meeting those criteria, no matter how many years of experience they have.
Just before adjourning in December, Congress passed a bill allowing the Department of Veterans Affairs to contract with independently licensed professional counselors. But similar provisions that would allow the Pentagon to have Tricare do the same have been removed from the annual defense authorization bill in each of the past several years.
Tighter redeployment policy
On another front, the Pentagon is making efforts to keep troops from being further traumatized by redeployments.
Defense officials recently revamped their policy on the deployability of service members with diagnosed mental illnesses.
Under the new policy, service members must be diagnosed, must have begun treatment and must have “demonstrated a pattern of stability without significant symptoms” for at least three months to be considered fit to deploy.
If psychiatric conditions crop up while service members are deployed and they do not respond to treatment within two weeks, they’ll be sent to their home duty station for treatment.
Certain medications also disqualify troops from deployment, such as lithium or anti-convulsants prescribed for manic depression or bipolar disorder and anti-psychotics prescribed for bipolar disorder or chronic insomnia.
Any condition that requires long-term monitoring or treatment would render a service member unfit for duty; under the new rules, he would be processed out of the military.
“This new guidance will improve mental health screening by assisting our physicians to make the best possible decisions regarding the deployment of service members who experience mental conditions,” said Dr. William Winkenwerder Jr., the Pentagon’s top health official.
The policy was set in part as a response to provisions in the fiscal 2007 Defense Authorization Act requiring the Pentagon to lay out specific mental health conditions and treatments that would prevent a combat deployment, Winkenwerder said.
Also in the works are new annual health assessments, implementation of a new mental health self-assessment across the services and a new Post Deployment Health Re-assessment, Air Force Col. (Dr.) Kenneth Cox, director of force health readiness, told the mental health task force Dec. 20.
The new PDHRA, to be given at the unit level 90 to 180 days after service members return home, is designed to extend the window of outreach and referral for those who develop PTSD or other mental health issues after being home for a few months.
An October study published in The American Journal of Psychiatry showed that the number of troops reporting symptoms of PTSD or depression was relatively low when they were first surveyed but increased by 200 percent after they were home for four months.
The current post-deployment surveys were never intended as diagnostic tools for detecting PTSD or depression, Cox said.
Over time, he said, the new tools will help track those at risk and in need of care.
Mental health resources
• Military OneSource, a free, 24-hour-a-day information and referral service for a variety of questions and access to free counseling, www.militaryonesource.com; toll-free (800) 342-9647; overseas, (800) 3429-6477.
• www.battlemind.org, which features materials developed by the Walter Reed Army Institute of Research — Psychiatry and Neuroscience. A training video “For Soldiers and Families” shows examples of scenarios troops and their families face in readjusting, and how to deal with them.
• Tricare. For example, Triwest beneficiaries can order a free DVD, “Getting Home: All the Way Home,” from www.triwest.com.
• Department of Veterans Affairs National Center for Post Traumatic Stress Disorder, www.ncptsd.va.gov.
• Center for the Study of Traumatic Stress of the Uniformed Services University of the Health Sciences, www.usuhs.mil/psy/ PTSDbrochure.pdf.
• The Department of Health and Human Services, which offers help finding affordable care outside the military, ask.hrsa.gov/pc.
• American Psychological Association, www.apa.org.
• American Counseling Association, www.counseling.org.
• Mental Health America, ww.nmha.org; click on Operation Healthy Reunions on the left side of the page.
—Karen Jowers
Ellie
Unseen scars
Survey shows mental health care problems may be rising; treatment concerns remain
By Gayle S. Putrich and Michelle Tan
Staff writers
New data collected by the military in the Iraq war zone show suicides and stress symptoms continue to rise, and officials are expressing concern about higher rates of potential mental health problems among troops who have made repeated deployments to the theater.
The data comes as a Pentagon task force continues to crisscross the country assessing the state of military mental health care and as the Pentagon revamps mental health deployment policies to get war fighters the help they need and avoid sending troubled troops back into combat.
But access to mental health care remains an issue, according to members of the Defense Health Board’s Mental Health Task Force, who say they hear the same refrains at nearly every stop on their nationwide tour of mental health facilities.
The recent data on troops who have deployed to Iraq, released in a Dec. 19 report, paints a stark picture. For example, the suicide rate among soldiers supporting Operation Iraqi Freedom almost doubled in 2005, going up to 19.9 per 100,000 troops from 10.5 per 100,000 the year before.
Yet the data from 2003 show the rate that year to be 18.8 per 100,000 troops, which makes officials cautious about drawing conclusions.
“We haven’t made a connection between the stress on the force with a significant increase in suicides,” said Lt. Gen. Kevin Kiley, Army surgeon general, who discussed the data Dec. 20 at the Pentagon. “That isn’t to say there aren’t any. [But] I don’t have any evidence that there is a correlation between [post-traumatic stress disorder] and suicides.”
The report also found that troops who have deployed to Iraq more than once reported higher levels of acute stress symptoms as well as higher levels of anxiety and depression than those serving their first tours.
Almost 19 percent of troops with at least one prior tour in Iraq reported acute stress symptoms, compared with 12.5 percent on their first tour.
On the plus side, troops say getting help in theater is now easier and the stigma of seeking that help is decreasing.
The study was compiled by the Mental Health Advisory Team III, established at the request of Multi-National Force-Iraq, using data collected in October and November 2005 in theater. Similar assessments were made in late 2003 and 2004.
The study “reflects a snapshot of the morale and mental health” of deployed troops last fall in Iraq, Kiley said. It also was the first time the team was able to compare data on troops with multiple deployments with those on their first tour.
A total of 1,461 soldiers, 172 behavioral health providers, 172 primary care providers and 94 unit ministry team members participated in the assessment.
Nationwide assessment rolls on
Kiley was in the Washington area for the fourth in a series of public meetings of the Pentagon’s Mental Health Task Force. The panel, established in June at the request of Congress, has held previous field hearings in Texas, San Diego and San Francisco.
The 14-member panel — seven Defense Department members and seven civilian health professionals — is due to submit a report and recommendations on the military’s mental health system in May. The task force will travel next to the Tacoma, Wash., area in January.
The data on Army suicides contained in the recent report from Iraq did not include troops who might have PTSD — the troops were surveyed in theater, and PTSD develops only after an individual leaves the combat zone.
“Are we concerned that soldiers on their second or third deployments are at increased risk for PTSD? We sure are,” Kiley said. “Are we encouraged because the stigma is dropping and soldiers are seeking more help? Yes, it’s encouraging.”
But when troops do seek help for combat stress or PTSD once they get home, will it be there? Mental health task force members said that from what they’ve seen so far, the answer seems to be: “Maybe.”
Task force members said they have heard of war fighters waiting up to eight weeks to get into a military treatment facility or to see a Tricare-approved mental health practitioner.
Air Force Col. (Dr.) Robert Ireland, program director for mental health policy in the Pentagon’s Office of Health Affairs, who also spoke to the task force, acknowledged that eight weeks is too long to wait to get mental health help.
But, he said, there is a lot of pressure to book appointments with a limited number of approved care providers.
“Should people be waiting eight weeks? Absolutely not,” Ireland said. “My sense is that we’re competing for mental health providers. There are major cities where you can’t get an appointment in eight weeks under any circumstances. We’re in that competitive market.”
That pressure could be alleviated if Tricare would pay for mental health care given by licensed counselors, veterans’ and family groups say. Tricare approves professional counselors for mental health care only if they have a particular master’s degree, have logged 3,000 supervised clinic hours and are supervised by the referring physician. They cannot independently contract with the Pentagon without meeting those criteria, no matter how many years of experience they have.
Just before adjourning in December, Congress passed a bill allowing the Department of Veterans Affairs to contract with independently licensed professional counselors. But similar provisions that would allow the Pentagon to have Tricare do the same have been removed from the annual defense authorization bill in each of the past several years.
Tighter redeployment policy
On another front, the Pentagon is making efforts to keep troops from being further traumatized by redeployments.
Defense officials recently revamped their policy on the deployability of service members with diagnosed mental illnesses.
Under the new policy, service members must be diagnosed, must have begun treatment and must have “demonstrated a pattern of stability without significant symptoms” for at least three months to be considered fit to deploy.
If psychiatric conditions crop up while service members are deployed and they do not respond to treatment within two weeks, they’ll be sent to their home duty station for treatment.
Certain medications also disqualify troops from deployment, such as lithium or anti-convulsants prescribed for manic depression or bipolar disorder and anti-psychotics prescribed for bipolar disorder or chronic insomnia.
Any condition that requires long-term monitoring or treatment would render a service member unfit for duty; under the new rules, he would be processed out of the military.
“This new guidance will improve mental health screening by assisting our physicians to make the best possible decisions regarding the deployment of service members who experience mental conditions,” said Dr. William Winkenwerder Jr., the Pentagon’s top health official.
The policy was set in part as a response to provisions in the fiscal 2007 Defense Authorization Act requiring the Pentagon to lay out specific mental health conditions and treatments that would prevent a combat deployment, Winkenwerder said.
Also in the works are new annual health assessments, implementation of a new mental health self-assessment across the services and a new Post Deployment Health Re-assessment, Air Force Col. (Dr.) Kenneth Cox, director of force health readiness, told the mental health task force Dec. 20.
The new PDHRA, to be given at the unit level 90 to 180 days after service members return home, is designed to extend the window of outreach and referral for those who develop PTSD or other mental health issues after being home for a few months.
An October study published in The American Journal of Psychiatry showed that the number of troops reporting symptoms of PTSD or depression was relatively low when they were first surveyed but increased by 200 percent after they were home for four months.
The current post-deployment surveys were never intended as diagnostic tools for detecting PTSD or depression, Cox said.
Over time, he said, the new tools will help track those at risk and in need of care.
Mental health resources
• Military OneSource, a free, 24-hour-a-day information and referral service for a variety of questions and access to free counseling, www.militaryonesource.com; toll-free (800) 342-9647; overseas, (800) 3429-6477.
• www.battlemind.org, which features materials developed by the Walter Reed Army Institute of Research — Psychiatry and Neuroscience. A training video “For Soldiers and Families” shows examples of scenarios troops and their families face in readjusting, and how to deal with them.
• Tricare. For example, Triwest beneficiaries can order a free DVD, “Getting Home: All the Way Home,” from www.triwest.com.
• Department of Veterans Affairs National Center for Post Traumatic Stress Disorder, www.ncptsd.va.gov.
• Center for the Study of Traumatic Stress of the Uniformed Services University of the Health Sciences, www.usuhs.mil/psy/ PTSDbrochure.pdf.
• The Department of Health and Human Services, which offers help finding affordable care outside the military, ask.hrsa.gov/pc.
• American Psychological Association, www.apa.org.
• American Counseling Association, www.counseling.org.
• Mental Health America, ww.nmha.org; click on Operation Healthy Reunions on the left side of the page.
—Karen Jowers
Ellie