San Diego Union Tribune

June 16, 2007

Panel urges military mental health services overhaul

Pentagon gets 6 months to come up with a plan


WASHINGTON – The military's mental health system falls far short of meeting the needs of troops and their families, especially at a time when the nation is engaged in the most sustained combat since the Vietnam War, a Pentagon task force reported yesterday.

The 14-member panel, made up of military and civilian professionals with expertise in military mental health, said more funding and staff are necessary to improvement the system.



“We concentrate a great deal on physical health; that is how fast can you run a mile, how many sit-ups and push-ups can you do,” Vice Adm. Donald Arthur, who co-chaired the task force, said at a news conference yesterday. “But we don't often concentrate on the psychological health of the service member.”

The report listed 95 recommendations to bolster psychological services, though it did not identify overall levels of staffing or funding needed. That will be left to the Pentagon, which has six months to develop a corrective plan under a mandate from Congress.

“Clearly, we have a deficit in our availability of mental health providers,” Arthur said.

The ongoing “surge” of more than 30,000 additional U.S. troops in Iraq and Afghanistan will exacerbate this gap, as will the rapid growth in the number of soldiers, Marines and other troops who have served more than one combat tour, heightening the risk of mental illnesses, the report said.

The task force, which began work last June, based its report on visits to 38 U.S. military care facilities – including several in San Diego – in the United States, Europe and Asia; interviews with care providers, military personnel and their families and commanders; as well as expert testimony and research.

It found that 38 percent of soldiers, 31 percent of Marines, 49 percent of Army National Guard members and 43 percent of Marine Reservists reported symptoms of PTSD, anxiety, depression or other problems, according to military surveys completed this year by service members 90 and 120 days after returning from deployments.

Traumatic brain injury and post-traumatic stress disorder are two “signature injuries” that have emerged from the current conflicts, according to the report.

While Congress recently approved $900 million for PTSD and traumatic brain injury as part of the emergency war funds bill, this is only a start, said Ward Casscells, the assistant secretary of defense for health affairs.

Casscells also said the Army's plan to hire 200 mental health professionals involved a “good round number” but may not be enough. The Army says it employs 600 to 800 such professionals, including civilians and contractors.

The task force stressed the need to remove the “pervasive” stigma associated with seeking help for battle-induced stress or PTSD. Surveys of troops serving in Iraq and Afghanistan show that more than half believe their careers would suffer if they sought counseling, even though mental health experts say stress is a normal reaction to combat.

Arthur acknowledged the challenge in convincing troops that seeking help will not undermine their advancement or harm their reputation.

He said the key to convincing them lies with leadership.

“We are all different as human beings and I think that these differences need to be recognized,” Arthur said. “We have some people who are very hardy in their response to stress and others who are not. They are equally valuable as service members.”

Proposals by the task force to reduce stigma include programs to give military leaders greater understanding of psychological health, a broader public education campaign, embedding health-care providers with units and offering treatment at primary medical care facilities, where service members can seek psychological help without singling themselves out.

Improved access to mental health services and closing gaps in the continuum of care also are identified as priorities. The report urges the Pentagon to establish a seven-day standard for getting mental health treatment, the same as required for primary care services.

In the course of its research, the congressionally commissioned task force visited military installations including Camp Pendleton, the San Diego Naval Base and Marine Corps Air Station Miramar. It also held nine hearings across the nation, including one in San Diego last October.

Shelley M. MacDermid, a Purdue University professor and co-chair of the task force, credited the military health system with “many examples of excellence.”

But she added, “There are urgent matters that need attention.”

The 99-page report said the “global war on terrorism” has created unforeseen demands on the mental health system, which has lacked a “wartime focus.”

“As such, the system of care for psychological health that has evolved over recent decades is insufficient to meet the needs of today's forces and their beneficiaries, and will not be sufficient to meet their needs in the future,” the report said.

The Washington Post and Reuters contributed to this report.

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