Advancements in PTSD/TBI Soldier Care
August 8, 2007
Army leadership is taking aggressive, far-reaching steps to ensure an array of behavioral health services are available to Soldiers and their Families to help those dealing with PTSD and TBI. Soldiers and their Families are telling senior leaders that their behavioral health care is a top concern, and Army leaders are in turn making it their number one priority.
The following list of continually evolving programs and initiatives are examples of the integrated and synchronized web of behavioral health services in place to help Soldiers and their Families heal from the effects of multiple deployments and high operational stress.
Aca,!Ac The Post Deployment Health Assessment, originally developed in 1998, was revised and updated in 2003.
Aca,!Ac In the fall of 2003 the first Mental Health Assessment Team (MHAT) deployed into theater. Never before had the mental health of combatants been studied in a systematic manner during conflict. Three subsequent MHATs in 2004, 2005, and 2006 continue to build upon the success of the original and further influence our policies and procedures not only in theater but before and after deployment as well. Based on MHAT recommendations, the Army has improved the distribution of behavioral health providers and expertise throughout the theater. Access to care and quality of care have improved as a result.
Aca,!Ac In 2004, researchers at the Walter Reed Army Institute of Research published initial results of the groundbreaking "Land Combat Study" which has provided insights related to care and treatment of Soldiers upon return from combat experiences and led to development of the Post Deployment Health Reassessment (PDHRA).
Aca,!Ac In 2005, the Army rolled out the PDHRA. The PDHRA provides Soldiers the opportunity to identify any new physical or behavioral health concerns they may be experiencing that may not have been present immediately after their redeployment. This assessment includes an interview with a healthcare provider and has been a very effective new program for identifying Soldiers who are experiencing some of the symptoms of stress-related disorders and getting them the care they need before their symptoms manifest into more serious problems. We continue to review the effectiveness of the PDHRA and will add or edit questions as needed.
Aca,!Ac In 2006 the Army Medical Command piloted a program at Fort Bragg, intended to reduce the stigma associated with seeking mental health care. The Respect-Mil pilot program integrates behavioral healthcare into the primary care setting, providing education, screening tools, and treatment guidelines to primary care providers. It has been so successful that medical personnel are in the process of implementing this program at 15 other sites across the Army.
Aca,!Ac Also in 2006, the Army incorporated into the Deployment Cycle Support program a new training program developed at WRAIR called "BATTLEMIND" training. Prior to this war, there were no empirically-validated training strategies to mitigate combat-related mental health problems. MEDCOM personnel are evaluating this post-deployment training using scientifically rigorous methods with good initial results. It is a strengths-based approach highlighting the skills that helped Soldiers survive in combat instead of focusing on the negative effects of combat.
Aca,!Ac The Army Medical Command's pursuit for improvement continued in 2007 with BATTLEMIND training program for Soldiers and spouses prior to deployments; a behavioral health web site http://www.behavioralhealth.army.mil; creation of a Behavioral Health Proponency Office and AMEDD Suicide Prevention Office; and a new PTSD training course starts in June.
Aca,!Ac A suite of Family re-integration materials are in production. Coming this summer are very important initiatives: the Family Re-Integration DVD/Videos and Brochure.
Aca,!Ac A suite of Family reintegration materials are available at http://www.behavioralhealth.army.mil under the children icon. Two DVD/CDs that deal with Family deployment issues are available: an animated video program for 6 to 11 year olds, called "Mr. Poe and Friends," and a teen interview for 12 to 19 year olds, "Military Youth Coping with Separation: When Family Members Deploy." Viewing the interactive video programs with children can help decrease some of the negative outcomes of Family separation. Parents, guardians and community support providers will learn right along with the children by viewing the video and discussing the questions and issues provided in the facilitator's guides with the children during and/or after the program. This reintegration Family tool kit provides a simple, direct way to help communities reduce tension and anxiety, and use mental health resources more appropriately, and promote healthy coping mechanisms for the entire deployment cycle that will help Families readjust more quickly on redeployment.
Aca,!Ac The chain teaching program will include commanders using a standardized script and supporting audio-visual products describing signs and symptoms of these conditions and reinforcing what Soldiers know about taking care of each other. There also will be a companion video oriented towards family members.
A litany of programs and medical systems are also in place to care for Soldiers and their Families who need health care because of Traumatic Brain Injury.
Aca,!Ac Army medical professionals collaborate and partner with the Defense and Veteran's Brain Injury Center (DVBIC). The Center is the Defense Department's point on evaluation, treatment and clinical research on traumatic brain injury, and is working to increase our knowledge on TBI encountered after the first Gulf War. It has a participating network of military, VA and civilian sites, and has worldwide contact with TBI experts who participate in expert panels and research. More information is available at www.dvbic.org.
Aca,!Ac The DVBIC produced a suggested clinical practice guideline for evaluation and treatment of mild Traumatic Brain Injury in August 2006, and produced a more rigorous guideline in December 2006 with the assistance of a nationally recognized expert panel. The August guideline was adapted and adopted as a Joint Theater Trauma System clinical practice guideline: the December product is to become Department of Defense policy, in theater and in garrison, after staffing.
Aca,!Ac The DVBIC DVD "Survive, Thrive and Alive!" is available at http://www.behavioralheal.army.mil under the PTSD/TBI icon. Understanding Traumatic Brain Injury". It is an excellent resource and explains mild to severe TBI in understandable terms.
Aca,!Ac There are four Department of Veteran's Affairs (VA) Polytrauma Centers designed to meet the needs of Service Members and veterans who experienced severe injuries resulting in TBI. There have been 249 case of severe TBI, with 240 going to the VA Polytrauma Centers for treatment.
Aca,!Ac Mild TBI, commonly known as a concussion, may affect from 10 to 20 percent of Soldiers and Marines redeploying from combat in Iraq and Afghanistan. A screening tool for mild TBI, the Military Acute Concussion Evaluation, or MACE, is available in theater to assist in diagnosing mild TBI. About 70 percent of Soldiers with TBI have mild injuries and recover over time. Mild TBI may cause behavioral health symptoms such as sleep problems, memory problems, confusion and irritability. Many Soldiers experiencing these temporary symptoms may not know why they have them. Medical treatment involves reassurance and education for Soldiers and Family members as well as specific treatment for the symptoms. People usually recover from mild TBI spontaneously with supportive treatment.
Aca,!Ac At Fort Carson, Colo., for example, all redeploying Soldiers are surveyed by healthcare providers for indications of possible MTBI. Fort Carson doctors noted that survey responses indicated that approximately 17 percent of redeploying Soldiers could have MTBI. Leaders at Fort Carson, beginning with the Commanding General, have encouraged Soldiers to consider their mental health needs the same as any other medical need affecting their readiness and to seek any help needed without delay. The command explicitly addressed the need to remove any stigma associated with seeking mental healthcare for either MTBI or PTSD.
Aca,!Ac Mild Traumatic Brain Injuries (mTBI) may be commonly referred to as concussions or "getting your bell rung." Unlike severe TBI in which there may be a penetrating head injury with an obvious wound, a mild TBI or concussion may have no physical signs. It may result from a hard blow or jolt to the head, or a blast exposure that causes the brain to be shaken within the skull.
Aca,!Ac TBI may involve confusion, disorientation, or impaired consciousness, dysfunction of memory (amnesia), or loss of consciousness. Most people with mild TBI recover fully, but recovery can take time.
Aca,!Ac All Soldiers in combat suffer stress, but most recover quickly. Those whose symptoms persist may have Post Traumatic Stress Disorder. PTSD is a condition that often follows a terrifying physical or emotional event, causing the person who survived the event to have persistent, frightening thoughts and memories, or flashbacks, of the ordeal. People with PTSD often feel chronically, emotionally numb.
Aca,!Ac Soldiers with PTSD may have three kinds of symptoms for weeks or months after the event is over and the individual is in a safe environment. These symptoms are re-experiencing the event over and over again; avoiding people, places or feelings that remind them of the event; and feeling keyed up or on-edge all the time. These symptoms may interfere with the ability to live their normal lives or do their jobs.
Aca,!Ac PTSD is treatable, especially if treatment begins early. Treatment options include medication and talking therapy. Most Soldiers diagnosed with PTSD are treated successfully and remain on active duty.
Aca,!Ac The Army provides many resources to help Soldiers suffering from PTSD, TBI or other behavioral-health problems. These include chaplains, deployable stress-control teams, medical and behavioral-health clinics and the Military One-Source hotline (1-800-342-9647), through which up to six free, confidential counseling sessions per issue can be scheduled.