Army's medical staff works to overcome mental health stigma
September 8, 2006
FORT RICHARDSON, Alaska (Army News Service, Sept. 6, 2006) - The Army's top doctor wants to help put aside the stigma preventing Soldiers and family members from seeking or receiving the mental health care they need and deserve.
Army Surgeon General Lt. Gen. (Dr.) Kevin C. Kiley toured medical facilities Monday and Tuesday at forts Richardson and Wainwright, and spoke about healthcare initiatives in Alaska and Army-wide.
"We really need to do for our Soldiers and families what we do for our helicopters and Strykers," Kiley said. "We bring those things back and we strip down every nut and bolt, we pull the power train and we go through that thing and we reset it.
"We ought to be doing that with every Soldier starting with the brigade and battalion commanders and sergeant majors all the way down."
He refered to a recent reset mission at Madigan Army Hospital, Fort Lewis, Wash., as a good example.
"The staff down there did a reset where if you came in and had a backache you went and saw the orthopedic surgeon, and then you went and saw the psychologist," he explained. "If you came in and said, 'I'm having nightmares and anger control problems,' you went and saw the psychologist.
"If you came in and answered your questionnaires and said you had no problems at all, you went to see the psychologist. Everybody went to see the psychologist," he continued.
"So then either the whole unit is weak because everybody had to go see the psychologist (which is not true), or hey, maybe this is just a part of a normal reset," he said. "In cases where the Soldiers needed to be referred for more counseling or discussion, or maybe medical therapy, that just flowed naturally and without the stigma that used to be attached."
Kiley said the nature of war means no Soldier will return unchanged.
"If you take a brigade and you put them through combat operations you get a bell-shaped curve of response," he explained.
"We get some Soldiers at one end who, even though they've seen a lot of combat, they don't appear to be terribly affected by it.
"You have a small number on the opposite end who are severely affected, who are severely depressed and have terrible problems with Post Traumatic Stress Disorder."
He said the vast majority of the troops will fall into the middle area. They will be changed by the experience, but not suffer severe symptoms.
"We know the more Soldiers are engaged in combat - with IEDs, with small arms fire, with RPGs, with mortars and rockets - the more they see their own buddies injured or killed, the more they see civilians killed or even the enemy killed, the more they are at risk to have PTSD or PTSD symptoms," Kiley said.
"What we've done is expand and improve the sophistication of the system that we use to give Soldiers - and we hope families - an opportunity to ask for help, to identify that they have problems, to query them and then to get them into systems that will help them."
He said few cases call for psychiatric intervention, with most being referred to psychologists or social workers.
"We're also integrating a new plan, which we're propagating across MEDCOM, called Respect.mil, where we're going to ask family practitioners and PAs in our TMCs and our primary care base to do a little extra training, and as they talk to Soldiers - because we know 90 percent of our force will seek primary care - ask the questions about PTSD," Kiley explained.
"Questions like: 'Are you having nightmares, hyper vigilance, anger control, spouse or child abuse concerns, alcohol use and abuse and is it affecting your work and your life and your family''
"When you get yes answers to those questions, instead of saying, 'Now you need to go to behavioral health or mental health,' we're going to ask primary care to take care of that, to say, 'Well, why don't we talk about this. Why don't you come back tomorrow and see me and let's talk about what our options are for therapy.'"
He said the program is headed by Lt. Col. (Dr.) Chuck Engel of the Walter Reed Army Medical Center Deployment Health Clinical Center in conjunction with Duke University.
"He ran a pilot program at Fort Bragg that went very well, so I've resourced him to start this program across our other installations," Kiley said.
"That's one thing," he said. "The other thing is to do the PDHA, the post deployment health assessment, and then the PDHRA (Post Deployment Health Reassessment).
"So when the Stryker Brigade comes back in the December time frame, three to six months later we're going to come back to those Soldiers and ask, 'So, how are you doing now' You got your block leave, you got home and reunited with your family; now are you still waking up in the middle of the night' Are you still having nightmares' Are you still having trouble getting to sleep' Do you find yourself drinking too much' Have you had episodes of road rage' Are you getting into trouble' Do loud noises still startle you''
"And if the answers to those questions are yes, we want them to come in and talk to somebody," he said.
He explained the goal is to help the Soldiers and their families come to terms with the experiences they've been through.
"We're not trying to make victims or patients out of them," he said. "There's an opportunity to grow and be better from the experiences they went through in OIF and OEF. It's about growth and recovery, and improved capability and self confidence."
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