By Amy Hinton and Lamar Davis
On November 5 a shooting spree at the Fort Hood Soldier Processing Center in Killeen, Texas left 13 soldiers dead and another 29 wounded. Subsequently, the shocking revelation that the alleged perpetrator was an active duty Army psychiatrist seemed to defy belief.
The recent actions attributed to Major Nidal Hasan have been subject to intense media coverage. Few, however, have questioned how such a deeply troubled individual could avoid detection while working in the very mental health system that was intended to be the safety net for our returning troops.
A 2008 RAND Center for Military Health Policy research study reported two significant challenges that face the military mental health system. First, the mental health system has difficulty responding to the treatment needs of soldiers in a timely manner. This is likely due to the intense and pervasive stigma about mental illness that often prevents people from seeking mental health treatment, particularly in the military. Second, the limited availability of mental health resources – services, providers and dedicated funding -- essentially determines access to and quality of treatment. Arguably, the most serious deficiency driving these challenges is the grossly inadequate number of qualified, credentialed mental health professionals available to meet the current demand.
A recent New York Times article noted the U.S. Army currently employs just 408 military, civilian and contract psychiatrists to provide critical mental health treatment to the approximately 553,000 active-duty troops stationed around the world. The astonishing patient caseloads – some providers routinely see as many as 10 seriously mentally ill soldiers in an eight-hour workday – should give serious pause to every American. In a recent CNN interview, Army Chief of Staff General George W. Casey Jr. noted the Army, like most other military and civilian mental health service providers, has ongoing difficulties hiring sufficient numbers of treatment professionals from such a limited labor pool.
The shortage has far reaching implications. To date, approximately 34,000 soldiers have already been diagnosed with post-traumatic stress disorder (PTSD), a serious anxiety disorder requiring early identification and immediate treatment. RAND reports that 18.5 percent of active duty troops returning from Iraq and Afghanistan have PTSD and that the estimated 50 percent of active duty service members who report seeking treatment for PTSD receive “less than adequate” care. These numbers represent only active duty military personnel. More than 255,000 National Guard troops and approximately 202,000 Reservists have been deployed to Iraq and Afghanistan since 2001, but are not included in these estimates.
Upon their return, many will suffer debilitating physical injuries or traumatic brain injury, as well as a host of related disorders that often result in profound, protracted psychological distress. These will need timely diagnosis, intensive treatment and access to the most appropriate medications. Presumably, they also will need ongoing mental health treatment.
But who will serve such a large population? And, perhaps more importantly, what is the potential impact on the existing military mental health system from such a large influx of troops? Who bears responsibility for ensuring the mental health of the mental health treatment providers? Who counsels the counselors and provides therapy to the therapists? Are we comfortable assuming military mental health providers will seek their own needed treatment as the demands of their work escalate? How can such an understaffed and overwhelmed system ensure an appropriate and coordinated response to mental health crises among their own treatment providers?
As the Fort Hood investigations continue, alleviating the critical shortage of qualified, credentialed mental health professionals in both military and civilian settings – must be elevated to the top of President Obama’s domestic health policy agenda. We need deliberative, proactive solutions to address shortages of qualified mental health personnel. We must also ensure widespread availability of mental health resources for treatment providers and determine the extent to which traditional military values and culture may stigmatize mental illness and discourage troops from seeking needed treatment.
These issues have yet to be fully explored with the intensity they deserve. If the extreme nature of the Fort Hood tragedy fails to generate the necessary political will to direct the time and attention to military mental health policy that is clearly needed, the entire nation must be willing to accept collective responsibility for the consequences.
Thursday, November 19, 2009