Politics

04.05.14

Fixing Military Mental Healthcare

To fix the military’s mental healthcare system we need to give service members regular, individualized care so they can get help for problems before they get out of hand.

No one yet knows exactly what led to the shooting rampage at the Fort Hood Army base, where a soldier, Ivan Lopez, killed 3 people and wounded 16 before taking his own life. We do know, that Lopez had reported himself for mental health problems and saw an army psychiatrist a month before his crime.

Stigmatizing soldiers by depicting them all as mentally unstable is a damaging fallacy but we have to face up to the serious shortcomings in the way the military treats the psychological and emotional problems of those in its ranks.

There are serious, systemic problems with the military’s mental healthcare system. I should know, I’ve been working inside the military for over a decade trying to improve mental health treatment and encountering serious resistance along the way.

Despite the billions of dollars spent, about 1,000 veterans of the Iraq and Afghanistan war era are diagnosed each week with post-traumatic stress disorder and more than 800 with depression, according to VA statistics. Suicide rates among veterans ages 18-24 who are enrolled in a VA health program killed themselves at a rate of 80 per 100,000 in 2011, the latest year for which data is available. Non-veterans of the same age had a rate of 20 per 100,000 for 2009 and 2010, according to the latest available data from the Centers for Disease Control and Prevention.

Our current military mental health solutions are primarily reactive. Most service members don’t get regular mental health screenings, except in the period after they have returned from a deployment overseas. For an average soldier there is no regular check up, it’s only after they have a problem that they might seek help. Compare this with how we monitor physical health, using one-on-one check ups with doctors to learn early on about potential problems.

 If you are an emotionally healthy person the current system isn’t necessarily so bad. Most people figure out what their personal stress overload feels like and they put remedies in place to deescalate, like going for a run or reading a book to relax.  But if you take someone in a high stress job like the military, who may not have had the time or skills to identify early warning signs, it’s essential that there is a individualized routine counseling process to catch problems early and treat them before they blow up into a crisis.

The way the military’s current mental health model operates would be like having a cancer patient only seek help when they are in their final stages of the disease. Intuitively we know that paradigm makes no sense, but if you think about it, that is how much of American society views mental health. We seek help once in a crisis state. At that point things are typically so bad that we need the quick fix, which often means that a litany of psychiatric medications get doled out. Side effects from these medications can sometimes outweigh the benefits of treating the initial problem, but when we are focused on symptom reduction instead of prevention, we lose sight of the root issues.

My military work has been focused on developing pro-active counseling programs that respond to the psychological and emotional needs of military members but that’s not how the majority of mental health programs are designed.

We need to carefully examine who is actually in charge of creating the current military mental health programs. It is not uncommon for external organizations or insurance companies who are not part of the military, to design a treatment program and then sell it to the Department of Defense.  Military installations then get pushed into mental health assistance services that often times don’t fit their needs

I say this from first hand experience. I moved on to Camp Pendleton, a Marine base in California, to develop and implement a proactive counseling program. My idea was to let the Marines help shape their own treatment by using a grass-roots initiative to design a program based on the needs of the people it would serve.

Despite the high level of involvement at the base, it was nearly impossible to get the program up and running. After interviewing hundreds of Marines and shaping the pilot program based on my team’s research, we learned that we didn’t have a credential that was required to begin implementation. Though the military has already invested tremendous time in my treatment model, it’s sixteen months later and we have still have not been able to obtain the credential to start the program.

We’ve had a congress member write a letter to Secretary of Defense Chuck Hagel pleading for assistance. Secretary of the Navy Ray Mabus has written two separate letters to us stating that he would lead an investigation, into getting the needed credential so we could begin treatment. A Navy Captain psychiatrist presented our program to Headquarters Marine Corps. And still nothing. Our efforts for a new approach have landed on deaf ears while the same expensive and, often ineffective, programs continue to provide inadequate care.  

Solving this problem is possible and could save our country tremendous amounts of money if done right. For example, we spend hundreds of millions of dollars on suicide prevention but still use a one size fits all model. In some cases, the only response to a military member at risk for suicide is to put them on 24 hour watch. Does anyone think that people at risk of killing themselves can be better after one day?

We should think about mental health more like how we tailor physical training routines. People have different fitness regiments from weight lifting to running. We do what resonates with our bodies.  We should train people individually on how stress effects them, teach them warning signs and help them design a personalized intervention plan before there problems escalate.

The answers are available; the problem is how to implement the change. It begins at the top, where an ineffective congress holds most of the power, but has been ineffective in producing positive change. Congress creates the laws the military has to follow but when our congressional members are campaigning for re-election every two years, it doesn’t leave much room for legislating. The campaigns are also expensive to run making congress reliant on donations. Sadly, the company’s donating money repeatedly get awarded military contracts which often contribute to substandard, ineffective programs.

The Department of Defense and civilians holding key positions inside the military are also part of the problem. They’ve been known to wait out service members that don’t agree with their policies, aware that every two to three year’s military personnel rotate out into new positions. Military officers shoulder some of the responsibility as well. Leaders within the military have not focused enough on making cultural changes to mental health care, too often they have been satisfied with the appearance of change.

It’s time to remove the stigma and make individualized mental health training mandatory for all active duty military and reservists. These mental health check-ups should cover a variety of issues from financial, health, and relationships to basic stress management. Alternative treatment modalities like mindfulness, mediation and yoga, should be introduced early on before things get out of control and instead of using prescription drugs as the answer to every problem.

We know the same behaviors yield the same results.  It’s time for real cultural change to occur.