Reduction of stigma to seeking help has begun, says Chiarelli
January 19, 2012
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WASHINGTON (Army News Service, Jan. 19, 2012) -- The Army released a study today on behavioral health and reported that the number of suicides decreased this past year and more Soldiers are seeking treatment for their problems.
The report "Generating Health and Discipline in the Force, Ahead of the Strategic Reset," was discussed at a Pentagon press conference by Gen. Peter Chiarelli, Army vice chief of staff. The three-year study outlined the problem of suicide in the Army and related issues of substance abuse, spouse abuse and child abuse.
Nearly two years ago, only 210,000 Soldiers sought behavioral health practitioners for their problems, Chiarelli said, adding he remembers the public reaction to this number. 'My gosh, you've got that many in the Army? That's not good, is it?'"
"I told them we'd like to see that number go up. And in fact, it has gone up. It's gone up to 280,000. I think we have begun the process in the Army of de-stigmatizing behavior health issues. That to me is absolutely critical. People who need help, get the help that they need. I think we've (been able to do this with the help of) commanders and leaders at all levels," Chiarelli said.
Three years ago, then Secretary of the Army Pete Geren and Chief of Staff Gen. George Casey appointed Chiarelli to look at driving down the number of suicides seen occurring in the Army.
He found that drug abuse, suicide attempts, alcohol abuse, prescription drug abuse and anger management issues are all high-risk behavior that Soldiers might enter into. In fact, most Soldiers who end up committing suicide demonstrate these high-risk behaviors, he said.
"For the calendar year 2011," he said, "if you take a look at all the categories, the overall suicide numbers decrease by 10 percent, from 350 to 315. The only category where we had an increase of five suicides was in the active duty category," Chiarelli said.
Most important, he said, is the increased numbers of Soldiers who have received early intervention and treatment.
"This shows why I think we have arrested this problem and hopefully will start to push it down, because we have leader involvement. They're not walking past the problem and are getting Soldiers the help that they need. And that to me is a very positive sign," Chiarelli said.
TRAUMATIC BRAIN INJURY
"One of the huge advances that we've made downrange today are the protocols that are in place that have caused us, just last year, to diagnose 9,000 Soldiers who were in concussive events downrange, to give them an initial screening, and hold them off the battlefield, off the battlefield for another 24 hours for a second screening. If they fail any of those two screenings, they are sent to one of our concussion recovery centers. Some of them stayed up to 21 days until their brain looked normal, after healing from the concussive event," he said.
Traumatic brain injury and the cognitive issues involved, he said, occur when concussions are not treated.
"I think this is a huge step forward that we made. We have diagnosed so far into this war 126,000 cases of TBI throughout the 10-plus years of this war. But I've got to tell you, if they're treated properly, most Soldiers will have a full recovery from traumatic brain injury. The problem is if they return and get a second concussion before the brain has healed," he explained.
"PTS is one of the key ones," Chiarelli said. "It represents a prevalent psychological injury with over 70,000 Soldiers diagnosed by the Army since calendar year 2003. That's not 70,000 out of 1.1 million. That's 70,000 out of a much greater number because we have Soldiers entering and leaving all the time."
The problem with PTS, he said, it shares many of the same symptoms as TBI. But doctors cannot, with any kind of guarantee, conduct a diagnosis for PTS in every single instance.
This is because, he said, in some of the most difficult cases, the symptoms don't appear for weeks, months, or even years after the event.
"I don't think we've done a good job in explaining the immaturity in the science of the brain," he said. "I was quoted a figure that basically said that from the time an initiating event for PTS takes place to the time that somebody gets into treatment is 12 years. Twelve years nationally -- that's not with Soldiers, that's nationally."
"And the horrible thing about that is all the bad things that happen in between. The abuse of alcohol, the abuse of drugs, prescription drugs, the anger management issues -- all those things that happen in between," Chiarelli said.
"We continue to close the gap in drug surveillance and drug rehabilitation programs. Although we had an increase in fiscal year 2011, we think due to an increase in surveillance, illicit drug use declined by 19 percent from earlier highs in 2006 and 2008.
"Last year, we saw over 24,000 Soldiers in our Army substance abuse program. I know, because of the connection of alcohol abuse to post-traumatic stress, many people who go untreated for PTS self-medicate with alcohol. I know that after 10 years of war, those numbers have gone up, so seeing an increase in the number who are in the program is a positive step," he said.
LITTLE BIT OF BAD NEWS IN REPORT
"What concerns me the most is an increase in violent sex crime offenders by 64 percent from 2006 to 2011. This is unacceptable. We have zero tolerance for this. Army leaders take sexual assault seriously. We're expanding our surveillance and response against these crimes. We've identified numerous sex crime factors, such as alcohol and the newly designed barracks that offer privacy, coupled with a lack of leadership.
This impacts the youngest and most junior female Soldiers and the perpetrators mirror that age, he said.
"We also had an increase in 2006 to 2011 in domestic violence. It increased by 33 percent, from 293 to 383. And our child-abuse cases increased by 43 percent in that time period from 201 to 287.
Alcohol, associated with domestic violence, increased by 54 percent, and with child abuse by 40 percent, he said.
"And research informs us that PTS is a factor in partner aggression. A person diagnosed with PTS is three times more likely to participate in some kind of partner aggression.
"That is why it is so critical to eliminate the stigma associated with PTS and get people in for treatment for their alcohol problem, their drug-abuse problem, prescription drug-abuse problem, or anger-management problems, spouse abuse and child abuse. That to me is critical. And the National Institute of Mental Health lays this out as not just an Army problem, this is a national problem.
LOOKING AHEAD TO RESET
Similar to any post-war period, reset and recovery must remain focused on the health and discipline of the volunteer force, Chiarelli said.
"We have an opportunity to avoid mistakes of prior post-war environments by applying science and the many lessons learned to mitigate health, discipline and readiness challenges," he said. "I often tell folks if you were to ask somebody what good comes out of war, they would point to military medicine and the advances that are made that benefit us all. And I think if you were to ask somebody today what is the greatest advancement in military medicine in this war, they would probably point to the advancements we've made in prosthetics."
"But I honestly believe 10 years from now with some of the things that I'm seeing and the advancements we've made in brain science, that 10 years from now if you were to ask that question people are going to look back and say, 'you know the greatest advancements that were made in these particular conflicts was our understanding of the brain,'" Chiarelli said.