Improvements In Mental Health Care Sought For Returning Troops

Team Infidel

Forum Spin Doctor
May 1, 2008 CNN Newsroom, 2:00 PM
MELISSA LONG, CNN ANCHOR: Of course, the scars of war are not all visible. Acknowledging this and recognizing this, the Pentagon announcing today a new policy that considers the impact on troops' minds and their spirits.
To get more on this, let's bring in Senior Pentagon Correspondent Jamie McIntyre -- Jamie.
JAMIE MCINTYRE, CNN SR. PENTAGON CORRESPONDENT: Well, Melissa, the Pentagon is moving to ease the fears of thousands of U.S. troops returning from Iraq and Afghanistan with war-related anxiety, depression, Post-Traumatic Stress Disorder, who fear that seeking psychiatric help or mental help will harm their careers and possibly cost them their security clearances.
Defense Secretary Robert Gates, touring a facility down in Fort Bliss, Texas, today designed to help soldiers with Post-Traumatic Stress Syndrome, announced that the Pentagon will change what he called the infamous question 21. This is a question that soldiers have to answer to get a security clearance, and the old question, simply said, "In the last seven years, have you consulted a mental health professional or another mental health care provider about a mental health-related condition?"
And that's the question that people were afraid to answer. They thought it might hurt their careers.
So they've changed the question. It's now essentially the same question, but it has a second part to it -- advice to the soldiers to "answer no if the counseling is for marital, family grief, not related to violence by you, or adjustments from service in combat." In other words, they'll no longer have to reveal their previous mental health treatment unless it was court ordered or involved violence. And it says right in the question, "Mental health counseling in and of itself is not a reason to revoke or deny a clearance."
The Pentagon today, the Joint Chiefs chairman, Admiral Mike Mullen, said he thinks this will make a big difference in the way troops view the problem of mental health and getting help for it.
(BEGIN VIDEO CLIP) ADM. MIKE MULLEN, JOINT CHIEFS CHAIRMAN: Psychological health and fitness is no different than physical health and fitness. Both are readiness issues. Both are leadership issues.
Getting this question changed is a terrific step to achieving better readiness for the individual and for the service. I hope it's also a great first step in changing our culture. (END VIDEO CLIP)
MCINTYRE: Now, the Pentagon says the problem isn't as bad as some soldiers think. They say the reality is that less than one percent of security clearances are denied because of some mental health issues. But a survey by the American Psychiatric Association showed that three out of five service members believed it would hurt their career. And that's what this question is aimed at reassuring them, that they can have the kind of routine care that they need when they come back from a stressful situation without feeling that it's going to stop them from getting security clearances or advance in their career -- Melissa.
LONG: And so important to get that care because of what they've experienced, what they've seen. You know, that infamous question 21, is that being changed at this moment?
MCINTYRE: Yes. From now on -- it's actually a little bit longer than what we showed you on the air there. It has more explanation for why they can answer the question if they have to, how to explain it. And it tells them very specific times when they don't have to reveal any counseling that they've had. So, for instance, routine therapy, just to deal with the stress and the adjustment of war, that's not something they have to reveal.
LONG: Hopefully that will reassure them that they can get the care that they certainly need and often very, very much deserve after their care serving overseas.
Senior Pentagon Correspondent, Jamie McIntyre.
Jim Lehrer Newshour (PBS), 7:00 PM
JUDY WOODRUFF: Defense Secretary Robert Gates today encouraged U.S. troops to get treatment for post-combat mental problems. To make that easier, he announced changes to Pentagon policy. Troops and civilian defense employees will in most instances no longer have to reveal previous mental health treatment when applying for sensitive government jobs. At Ft. Bliss in Texas, Gates said he hoped to persuade troops they need the help.
DEFENSE SECRETARY GATES: I suspect that the first thing is to get them to admit they’re human. Part of the issue of removing the stigma is making it clear that you can be tough and seek help for dealing with these problems. After all, you’re tough and you go into the hospital when you receive a physical wound. That doesn’t mean you’re weak in some way. And so why wouldn’t you when you’ve received a psychological wound? It’s the same difference, they’re all wounded.
WOODRUFF: Gates insisted that seeking mental health care should not jeopardize security clearances or careers. We’ll have more on this story later in the program.
WOODRUFF: Now, new efforts to provide mental health care for returning troops. Betty Ann Bowser of our Health Unit begins with some background on today's developments. The unit is a partnership with the Robert Wood Johnson Foundation.
MILITARY SERVICEMEMBER: Point out to us who the insurgency are.
BETTY ANN BOWSER: About 1.5 million American men and women have served in Afghanistan and Iraq. And the Pentagon says an estimated 20 percent of them are suffering from mental health problems; other estimates are even higher.
Two recent reports have found that military personnel are not seeking help when they need it. The American Psychiatric Association said yesterday that it found three in five members of the military think that seeking treatment for mental health concerns would have some negative impact on their career.
A larger study by the Rand Corporation last month found nearly one out of three service members reported a mental health problem or symptoms of traumatic brain injury. And only half of them sought help.
That study also found that many of the returning troops thought seeking treatment would have a negative impact on their security clearance and their careers.
During a visit today to a Ft. Bliss, Texas, treatment center designed to help troops with post-traumatic stress disorder, Secretary of Defense Robert Gates announced a policy change aimed at fixing that.
GATES: The most important thing for us now is to get the word out, as far as we can, to every man and woman in uniform to let them know about this change, to let them know the efforts that are underway to remove the stigma, and to encourage them to seek help when they are in the theater or when they return from the theater.
DOCTOR: I'm glad that you actually were able to verbalize –
BOWSER: Gates said, under the new policy, troops and civilian employees applying for a security clearance will no longer have to admit they've had mental health treatment unless it was court-ordered or violence-related.
He referred to the infamous question 21 on the form which asks applicants whether they have consulted a mental health professional in the past seven years.
GATES: It now is clear to people who answer that question that they can answer "no" if they have sought help to deal with their combat stress.
BOWSER: Later at the Pentagon, the chairman of the Joint Chiefs of Staff, Navy Admiral Michael Mullen, said he wants to send a message to everyone in the military.
ADM. MIKE MULLEN [Chairman, Joint Chiefs of Staff]: Psychological health and fitness is no different than physical health and fitness. Both are readiness issues; both are leadership issues.
Getting this question changed is a terrific step to achieving better readiness for the individual and for the service. I hope it's also a great first step in changing our culture.
BOWSER: The new policy is effective immediately.
WOODRUFF: Jeffrey Brown has more on this story.
JEFFREY BROWN: To what extent is stigma a barrier to treatment? And are servicemembers getting the mental health care they need?
We explore those questions with Colonel Loree Sutton, the director of the Department of Defense's Center of Excellence for Psychological Health and Traumatic Brain Injury; Terri Tanielian, a researcher at the Rand Center, who co-directed the recent study on mental health care needs for veterans; and Jason Forrester, director of policy for the advocacy group Veterans for America.
Colonel Sutton, starting with you. Define the stigma problem that you're trying to address today.
COL. LOREE SUTTON [Defense Center of Excellence for Psychological Health and Traumatic Brain Injury]: Well, let me start out by saying that today is such an important day, it's such a historic day for our troops, whether they be soldiers, sailors, airmen, Marines, coastees, whether they be in the Guard, the Reserve, whether they be veterans and their family members, because this marks a huge milestone in our journey to really eliminate stigma, that barrier that keeps troops and their family members from getting the help that they need.
And so, as Secretary Gates said earlier, we are so excited to be able to put the word out and get the word out at all levels so that we can move forward together and make sure that our troops, their family members, get the help they need.
BROWN: But how ingrained, how big a problem is the stigma?
SUTTON: You know, I've been a psychiatrist in the Army for over 20 years now, and I will tell you this is an issue for our troops, for our families, for our communities. It's an issue across America.
We've made tremendous progress, but we've still got a ways to go, and today's milestone is another step in that journey.
BROWN: Terri Tanielian, what does your work show about the gap between those who need care, but are unwilling to come because of stigma?
TERRI TANIELIAN [Rand Public Policy Expert]: Sure. Based on our research, we were able to identify that, among the top five barriers to getting care, when we asked folks, "What gets in your way of getting the help you need?"
Three of those top five were about concerns for their career, that it could harm their career, that they could be denied a security clearance, or that their co-workers and fellow unit members may have less confidence in them doing their job.
BROWN: And those are directly tied to the sense that there's a stigma because they've come forward?
TANIELIAN: They're really institutional or cultural kind of barriers to getting help. There's a concern and a perception among servicemembers and veterans that, by getting help, that it could be somehow used against them in their career.
BROWN: Mr. Forrester, do you think that these steps today go far enough? Are they helpful? What?
JASON FORRESTER [Director of Policy, Veterans for America]: They're helpful, but they're late. To Secretary Gates' credit, on June 21st of last year, he announced that he had hoped to remove question 21 from the security clearance forms.
I'm glad that it's being removed now. I feel for those soldiers and Marines and others who've had to live with the hope of seeing the question removed for the past at least around a year and before that.
Veterans for America's Wounded Warrior Outreach Program works across the country with servicemembers who are coming back from multiple tours, often with inadequate time at home, and, yes, they find considerable stigma when they return to their bases.
The stigma is growing a little bit smaller, but, unfortunately, they still find considerable stigma, and they often find very long wait times to be able to see a mental health care professional on-base.
For instance, Ft. Drum, New York, home of the 10th Mountain Division, the 2nd Brigade Combat Team, 3,500 soldiers, recently completed its fourth deployment since 9/11. When those soldiers came home, it was taking some of them up to two months to get an appointment with a mental health care professional.
This is late. It's laudable what's being done, but, unfortunately, we're just realizing the magnitude and the great variety of steps that need to be taken to rectify these certain problems.
BROWN: Colonel Sutton, how do you answer that? An accessibility question is, even if the soldiers come forward, is there a place to treat them? Is there adequate care available?
SUTTON: That is a major concern for us, and it's one that we've taken great steps towards addressing the shortages. There's a national shortage of mental health professionals, which makes it difficult, although I will tell you, we've made a lot of progress.
The V.A., for example, has been able to add on nearly 4,000 mental health professionals over the last two years. Our TRICARE contract support partners – that would be Health Net, Humana, and TriWest – over the last year, they've been able to add on an additional 3,000 mental health professionals.
Currently, within the Department of Defense, we're working to fill about 1,000 additional billets for mental health professionals. We also have some public health service professionals who will be coming on to join the team.
And I will tell you, everywhere I go, I put the word out to really help challenge folks, whether it be the American Psychiatric or American Psychological Association. The response has been tremendous.
Because if you want a job, whether you're a social worker, a nurse, a psychiatrist, a psychologist, if you want to do something where, at the end of the day, you never have to guess whether you're making a difference in the lives of those who need your help, this is the place to come.
BROWN: What steps does your research suggest are needed to deal especially the stigma problem?
TANIELIAN: Sure. Well, first, we need to close the access gap, getting to the care.
So we need to address the capacity issue that we've been discussing, making sure that that there's enough mental health professionals and other health professionals who are trained in delivering the types of care that we know will be effective for those who are suffering from PTSD and depression.
BROWN: And stop there for a minute. Why do you think there's a gap?
TANIELIAN: Well, we know there's a shortage in U.S. health care of mental health professionals. We know that there's a shortage of individuals who are trained in these types of therapies and these approaches.
This is really a systemic issue across U.S. health care. We need to think about the pipeline of individuals coming into this profession so we can make sure they get the right training, they're in the systems where the veterans are going to seek care, and that we don't have this just moving providers from one place to another, but that we really have a strong pipeline of individuals who are coming into this career field.
BROWN: And what other steps, what other kinds of steps do you think are needed?
TANIELIAN: Well, once we can address the concerns about the capacity and the supply of providers, we also need to address the concerns and remove the barriers that inhibit servicemembers and veterans that have problems from getting care, like concerns about their career.
We need to make sure that there are options and opportunities available for them to get help early before these problems accrue to a level where they are no longer able to do their job.
We need to be able to offer services that are confidential, off the record, so that they do know that, by getting help, they're increasing their fitness and the readiness of the force and it won't be held against them in their career.
But we also need to raise the gap in quality. We need to make sure that the care that is delivered throughout the sectors, the DOD, the V.A., and the U.S. health care system, is providing a level of care that we know will have the most promise in facilitating recovery.
BROWN: Mr. Forrester, you raised earlier one of the issues that's become a continuing issue in this war, is the multiple deployments, soldiers being sent back several times. To what extent is that exacerbating the kinds of problems we're talking about here?
FORRESTER: It is a considerable factor exacerbating the problems. Once again, to the credit of the Department of Defense, there have been studies afoot for years looking at the affect of multiple deployments on servicemembers.
In particular, the Mental Health Advisory Team, MHAT, has now produced five reports in the course of the Iraq war and also now is covering Afghanistan.
In the MHAT-IV report, the Army doctors, among others, found that the likelihood of a servicemember having a severe mental health problem, post-combat mental health problem, a wound, not an illness, a wound, it rose by about 60 percent from one deployment to another.
The most recent report from the Mental Health Advisory Team V found, when they look specifically at non-commissioned officers – these are sergeants and others who lead troops into battle day in, day out – they found that, if you compared an NCO on their first deployment to one on their third or fourth deployment, that the likelihood of a person on their third or fourth deployment having a mental health problem rose by about 129 percent.
So this is the kind of problem – these problems are being generated day in, day out, as we have multiple deployments. This is why it deserves a national conversation on, what do we owe to these servicemembers, for instance, the members of the Army brigade combat teams, the members of the Marine Corps battalions who have been deployed again and again and again?
So we need to look at the cost that this is having on them, as well as what needs to be done. For instance, they need more time at home. Once again, the Department of Defense, through the Mental Health Advisory Team itself, says that more time at home – also known as dwell time – is a key variable in ensuring that these problems are dramatically reduced.
BROWN: Do you accept that evaluation of the situation, especially about multiple deployments, and what does the military do to deal with that problem?
SUTTON: We are very concerned about that. We appreciate the advocacy and the shared concern around the country, because it is a national conversation. To understand that never in the history of our republic that I'm aware of has so much been borne on the shoulders of so few on behalf of so many for such a long time.
And so there are things that we must do to support the families, just some of the most heroic folks you will ever meet, the military family. We had a chance, of course, earlier this week to introduce the "Sesame Workshop" DVD that helps children talk with their parents about the changes related to deployments.
But we also know that it's so important to get after that stigma, get after the culture. You know, stigma, as the Canadian armed forces are viewing it now – and I subscribe to this – they talk about it as being a toxic occupational work-related hazard, one that prevents servicemembers, their families, veterans, their loved ones from getting the help that they need.
So, again, we are just really very excited about today's – a major milestone in that journey.
BROWN: But is it not part of the warrior tradition and culture that you have to deal with here, that people would sense that that's why they feel they're perceived as weak, if they seek mental health? I mean, is it as serious as that, to try to somehow wedge a way into what is a traditional military culture?
SUTTON: Well, and it's exactly the culture that we are working to transform, to help our servicemembers, to help their families, our communities understand that seeking help, it is a sign of strength. It's a leadership issue; it's a readiness issue.
But, you know, it's important also to understand that there's a whole continuum of stress. And so we work at this end to build a resilience in our families and servicemembers from the day they come into military service.
And, you know, there may be in the course of their duties, certainly what our troops are experiencing abroad in harm's way right now, where they come under tremendous stress. And they may react to some of that stress, in which case the leaders work with them and the medical community to mitigate those risks.
Now, sometimes the stress becomes even more difficult, in which case someone may become injured. You heard Secretary Gates talk about the importance of psychological injuries, as well as physical injuries. They're on an equal footing.
We can intervene at every point along that continuum to prevent that servicemember from getting ill and requiring medical care. Of course, if and when a servicemember or their family does require that care, we want to have it there for them, and we want them to know it's a sign of strength to seek it.
BROWN: All right, Colonel Loree Sutton, Terri Tanielian, and Jason Forrester, thank you all very much.
SUTTON: Thank you so much.