Military Doctors Withholding Treatment from Soldiers with Mental Health Problems
By Maggie Mahar, Health Beat
Posted on February 27, 2008, Printed on February 28, 2008
Since 9/11, one Army division has spent more time in Iraq than any other group of soldiers: the 10th Mountain Division, based at Fort Drum, New York.
Over the past 6 years and and six months, their 2nd Brigade Combat Team (BCT) has been the most deployed brigade in the army. As of this month, the brigade had completed its fourth tour of Iraq. All in all, the soldiers of BCT have spent 40 months in Iraq.
At what cost? According to a February 13 report issued by the Veterans for America's (VFA) Wounded Warrior Outreach Program, which is dedicated to strengthening the military mental health system, it is not just their bodies that have been maimed and, in some cases, destroyed. Many of these soldiers are suffering from severe mental health problems that have led to suicide attempts as well as spousal abuse and alcoholism.
Meanwhile, the soldiers of the 2nd BCT have been given too little time off in between deployments: In one case they had only six months to mentally "re-set"; following an eight-month tour in Afghanistan -- before beginning a 12-month tour in Iraq.
Then, in April 2007, Secretary of Defense Robert Gates decided to extend Army tours in Iraq from 12 to 15 months -- shortly after the BCT had passed what it assumed was its halfway mark in Iraq.
As the VFA report points out, "Mental health experts have explained that 'shifting the goalposts' on a soldier's deployment period greatly contributes to an increase in mental health problems."
Perhaps it should not come as a surprise that, during its most recent deployment, the 2nd BCT suffered heavy casualties. "Fifty-two members of the 2nd BCT were killed in action (KIA)," the VFA reports and "270 others were listed as non-fatality casualties, while two members of the unit remain missing in action (MIA)."
This level of losses is unusual. "On their most recent deployment," the VFA report notes, "members of the 2nd BCT were more than five times as likely to be killed as others who have been deployed to OEF and OIF and more than four times likely to be wounded." One can only wonder to what degree depression and other mental health problems made them more vulnerable to attack.
When they finally returned to Fort Drum, these soldiers faced winter conditions that the report describes as "dreary, with snow piled high and spring still months away. More than a dozen soldiers reported low morale, frequent DUI arrests, and rising AWOL, spousal abuse, and rates of attempted suicide. Soldiers also reported that given the financial realities of the Army, some of their fellow soldiers had to resort to taking second jobs such as delivering pizzas to supplement their family income."
What has the army done to help the soldiers at Fort Drum? Too little.
In recent months, VFA reports, it has been contacted by a number of soldiers based at Fort Drum who are concerned about their own mental health and the health of other members of their units. In response, VFA launched an investigation of conditions at Fort Drum, and what it found was shocking.
Soldiers told the VFA that "the leader of the mental health treatment clinic at Fort Drum asked soldiers not to discuss their mental health problems with people outside the base. Attempts to keep matters 'in house' foster an atmosphere of secrecy and shame," the report observed "that is not conducive to proper treatment for combat-related mental health injuries."
The investigators also discovered that "some military mental health providers have argued that a number of soldiers fake mental health injuries to increase the likelihood that they will be deemed unfit for combat and/or for further military service."
The report notes that a "conversation with a leading expert in treating combat psychological wounds" confirmed "that some military commanders at Fort Drum doubt the validity of mental health wounds in some soldiers, thereby undermining treatment prescribed by civilian psychiatrists" at the nearby Samaritan Medical Center in Watertown, NY.
"In the estimation of this expert, military commanders have undue influence in the treatment of soldiers with psychological wounds," the report noted. "Another point of general concern for VFA is that Samaritan also has a strong financial incentive to maintain business ties with Fort Drum -- a dynamic [that] deserves greater scrutiny."
Because some soldiers do not trust Samaritan, the report reveals that a number of "soldiers have sought treatment after normal base business hours at a hospital in Syracuse, more than an hour's drive from Watertown ... because they feared that Samaritan would side with base leadership, which had, in some cases, cast doubt on the legitimacy of combat-related mental health wounds.
"In one case," the report continued, "after a suicidal soldier was taken to a Syracuse hospital, he was treated there for a week, indicating that his mental health concerns were legitimate. Unfortunately, mental health officials at Fort Drum had stated that they did not believe this soldier's problems were bona fide."
According to the VFA, the problem of military doctors refusing to back soldiers with mental health problems is widespread: "VFA's work across the country has confirmed that soldiers often need their doctors to be stronger advocates for improved treatment by their commanders and comrades. For instance, soldiers need doctors who are willing to push back against commanders who doubt the legitimacy of combat-related mental health injuries."
While talking to soldiers at Fort Drum, VFA also discovered "considerable stigma against mental health treatment within the military and pressure within some units to deny mental health problems as a result of combat.
Some soldiers who had been in the military for more than a decade stated that they lied on mental health questionnaires for fear that if they disclosed problems, it would reduce their likelihood of being promoted."
Soldiers at Fort Drum are not alone. In an earlier report titled "Trends in Treatment of America's Wounded Warriors" VFA disclosed that leaders of the military mental health treatment system have been warning Department of Defense leadership of the magnitude of the mental health crisis that is brewing.
A report by the Army's Mental Health Advisory Team (MHAT) that was released last May found that the percentage of soldiers suffering "severe stress, emotional, alcohol or family problem[s]" had risen more than 85 percent since the beginning of Operation Iraqi Freedom. MHAT also found that 28 percent of soldiers who had experienced high-intensity combat were screening positive for acute stress (i.e., Post-Traumatic Stress Disorder, PTSD).
Finally, MHAT disclosed that soldiers who had been deployed more than once were 60 percent more likely to screen positive for acute stress (i.e., PTSD) when compared to soldiers on their first deployment.
VFA's most recent report notes points out that, despite these warnings, soldiers at Fort Drum do not have access to the care they need: "More than six years after large-scale military operations began in Afghanistan and, later, in Iraq, a casual observer might assume that programs would have been implemented to ensure access for Soldiers from the 10th Mountain Division to mental health services on base. Unfortunately, an investigation by VFA has revealed that [soldiers] who recently returned from Iraq must wait for up to two months before a single appointment can be scheduled ...
"Given the great amount of public attention that has been focused on the psychological needs of returning service members, a casual observer might also assume that these needs would have been given a higher priority by Army leaders and the National Command Authority -- the two entities with the greatest responsibility for ensuring the strength of our Armed Forces. These needs have long been acknowledged but," the report concludes " there has been insufficient action."
Last month the army tried putting a band-aid on the problems at Fort Drum by sending three Army psychiatrists from Walter Reed Army Medical Center (WRAMC) to the Fort D on a temporary basis to treat the large influx of returning soldiers requiring mental health care. But, as the VFA points out, "this is only a temporary fix", as the Walter Reed-based psychiatrists will likely return to Washington, DC, within a few weeks.
Fort Drum will again be left with the task of treating thousands of soldiers with far too few mental health specialists. In addition, for those service members who were initially treated by psychiatrists from Walter Reed, their care will suffer from discontinuity, as their cases will be assigned a new mental health professional on subsequent visits."
And the war drags on. Earlier this month, the UK Times reported that "the conservative Washington think tank that devised the "surge" of US forces in Iraq [the American Enterprise Institute] now has come up with a plan to send 12,000 more American troops into southern Afghanistan.
A panel of more than 20 experts convened by the (AEI) has also urged the administration to get tough with Pakistan. "The US should threaten to attack Taliban and Al-Qaeda fighters in lawless areas on the border with Afghanistan if the Pakistan military did not deal with them itself, the panel concluded."
Where do conservatives expect to find those troops?
More soldiers are likely to suffer the fate of the soldiers at Fort Drum. They will be sent back to combat, again and again -- until finally, they break. Soldiers suffering from post-traumatic stress syndrome, depression or a host of other mental problems are not in a good position to protect themselves. Sending them back only guarantees that fatalities will rise.
Maggie Mahar is a fellow at The Century Foundation and the author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006).
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