http://www.stripes.com/article.asp?sectionfiltered=104&article=40219
YOKOSUKA NAVAL BASE, Japan - Gaps in care - combined with the stress of combat in Iraq and
Afghanistan - are creating a "perfect storm" within the U.S. military mental health system, according to a Navy commander
who spoke at Yokosuka Naval Base on Wednesday.
Quick to say that his opinions are unofficial - the product of his 24-year military career
and not the U.S. Navy or Department of Defense - Cmdr. Mark Russell gave a well-attended lecture called "Broken Promises:
The Unspoken Truth of Mental Health Care in the DOD" during the final day of the Multinational Medical Conference.
Russell, a child psychologist and director of Educational and Development Intervention Services
for bases across Japan, painted a picture of unmet needs and unrecognized opportunity stemming from the global war on terrorism.
"We are in a crisis situation," Russell said. "And it's going to get worse.
"We're making progress but are far from making good on our promise to provide the best mental
health care possible for the men and women we send to war," Russell told the gathering.
More than 56,000 troops, or 10 percent, have returned from Iraq and Afghanistan with a mental
health diagnosis, making up a third of those in Veterans Affairs care. The cost of mental health care is high, he said - the
VA spent $4.3 billion on post-traumatic stress disorder alone in 2004.
Also, of the 9,145 (out of a possible 178,644) veterans who showed signs of PTSD between
2001 and 2004, only 22 percent were referred on to mental health care. That creates a chasm between a need for care and actually
getting it, Russell said.
Another gap falls between DOD guidelines for mental health treatment and the training given
to mental health workers, he said.
"Out of 133 mental health providers I surveyed, 90 percent of them had no training in the
top four treatments the DOD recommends for PTSD," Russell said.
There also are problems with leadership, high burnout rates among caregivers and the tendency
to treat those suffering from hyper-arousal compared to those who disassociate, he said.
"The bottom line is that we have increased demand and fewer resources to meet that demand,"
Russell said.
But the DOD has made significant strides, especially in terms of front-line combat mental
health care, he added. The military's PIES system - basing combat mental health care on proximity, immediacy, expectancy and
simplicity - is working, he said.
"The numbers of mental health workers on the front lines is unprecedented," Russell said.
"This is an all-out effort."
More troops are using front-line mental health services, with 40 percent getting help in
2005 compared to 29 percent in 2004. And, most importantly, 90 percent of those who get front-line help return to duty, he
said.
The DOD also has improved screening programs, has established deployment centers with quality
information, is conducting more surveys and is getting more information out to veterans after they come home, Russell said.
But the DOD could be doing more for the troops, caregivers and for combat mental health
in terms of treating the "invisible wounds of warfare," he said.
"Right now, the DOD is in an historically unique position to lead the world in understanding,
assessment, prevention and treatment," Russell said. "Have we advanced science?"
The military has a "love/hate relationship" with mental health care, he added.
"We like it in war and know that increased mental health is a force multiplier," Russell
said. "But in peacetime, mental health falls to the low end of the totem pole."
It's up to the military health professionals today to "take up the sword," he said.
"I've already turned in my retirement paperwork," he said.
(c)
2006 Stars and Stripes. All Rights Reserved.
Friday, September 22, 2006
Expect more cuts in family support programs, Army warns
By Leo Shane III, Stars and Stripes
European edition, Friday, September 22, 2006
http://www.stripes.com/article.asp?sectionfiltered=104&article=40231
WASHINGTON - Army officials have told base commanders to prepare for even deeper cuts in
family support programs and other non-war-related expenses next fiscal year.
In June, the Army announced cuts in base discretionary spending and other non-war expenses
to offset unexpected costs associated with military operations in Iraq and Afghanistan. Even after Congress approved supplemental
military funding in response, service officials said they would continue to curb spending.
And although the fiscal 2007 defense budget is still being debated in Congress, Army officials
already have warned base commanders that they'll likely face more belt tightening under next year's budget because of the
ongoing combat operations.
"The time of having as much money as bases want for everything they want to do is gone,"
said Stephen Oertwig, spokesman for the Army Installation Management Agency. "We don't know what the exact budget will be,
but we know it will be a very austere budget."
On Thursday, military family advocates warned that further cuts in vital family support
programs could jeopardize military readiness by distracting soldiers.
"When families need these programs the most, they shouldn't be asked to do without," said
Joyce Raezer, director of government relations for the National Military Family Association. "Those soldiers need to know
that their families are being taken care of."
The House Armed Service Committee's ranking Democrat, Missouri's Rep. Ike Skelton, said
the Army received about $500 million less for base maintenance and programs this year because of the unexpected extra war
costs.
Raezer said she's already heard concerns from military spouses worldwide about the cuts.
At Fort Bragg in North Carolina, families have seen cuts in staff at the base child-care facilities. At Fort Campbell in Kentucky,
the hours and staff at the Family Readiness Assistance Center have been scaled back.
In Germany, several teen internship programs at Friedberg and Giessen Army facilities were
canceled, leaving more than 40 dependents without planned summer jobs.
Raezer said other problems, such as shorter dining hall hours and part-time military spouses
losing their on-base jobs, are widespread.
Oertwig said commanders have been open and honest with military families about the potential
program cuts, to help them prepare for the changes.
"Our local commanders know what their audience needs, and it's their job to balance the
issues on a tight budget," he said. "It's not something that's being ignored. All of our commanders are doing the best they
can to take care of these families."
House and Senate negotiators are currently finalizing the 2007 Defense budget and are expected
to complete their work in the next few days.
(c) 2006 Stars and Stripes. All Rights Reserved.
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