More soldiers and military families are reaching out for mental health care at Joint Base Lewis-McChord, raising hopes that the Army is breaking down the stigma that keeps them from getting help for distress triggered by repeated combat deployments.
Diagnoses for post-traumatic stress are on the rise at Madigan Army Medical Center. So are prescriptions for common antidepressants.
Meanwhile, a mental health clinic at Madigan is handling some 30 daily drop-in appointments, up from about 20 a day before 18,000 soldiers returned from combat tours last year – the largest wave of homecomings of the last decade.
Madigan and Lewis-McChord also established a process that gives soldiers several “touches” with behavioral health resources in the months after a homecoming.
Other mental health services targeted at military families also are getting heavy use, as counselors connect with thousands of people each month, according to data from Madigan.
“I think we’re actually starting to win this battle on stigma. People are way more willing to seek behavioral health than they used to be,” said Madigan commander Col. Dallas Homas.
Still, no one’s declaring victory in the Army’s efforts to curb a rise in suicides that peaked two years ago, when 162 active-duty soldiers killed themselves. Nine Lewis-McChord soldiers committed suicide in each of the past two years, up from seven in 2008.
Officers also track signs of distress, such as drunken driving arrests and domestic violence reports. They’ve increased recently, too, but not in a dramatic spike that would signal a “meltdown” among soldiers.
At Lewis-McChord, officials cautiously say they think they’re on the right path. They added 55 behavioral health specialists, such as psychologists and social workers, between January 2010 and January 2011.
Madigan now has 189.5 employees in that field, giving it one of the most robust networks of mental health support in the Army. Fort Hood, a base in Texas with 8,000 more service members than Lewis-McChord, has 141 such specialists.
“I don’t care how long it takes; we’ll see every soldier who comes in,” said Col. Jerome Penner, who led Madigan for the past two years before handing over his command to Homas in April.
“Do we get it right every time? I’m not going to say that,” Penner said. “But we are making progress.”
MORE SEEK HELP
At Lewis-McChord, doctors say they’re busier than ever counseling recent war veterans since they came home in the thousands. What’s not clear is how much of that increased pace is the result of distress caused by combat and long separations, and how much is the result of sheer numbers. More than half of the base’s 40,000 service members were gone from mid-2009 to mid-2010.
• Diagnoses for post-traumatic stress, acute stress disorder or an anxiety disorder increased 24 percent. Madigan in 2010 diagnosed 1,418 service members with the three common reactions to combat that are associated with depression. In 2009, the hospital diagnosed 1,140 service members with those disorders.
• Prescriptions for common antidepressants went up 15 percent. The Army hospital filled 6,185 prescriptions in 2010, up from 5,401 in 2009. The number includes refills, meaning some service members are counted more than once.
• Visits to the drop-in mental health clinic grew by 37 percent. Active-duty service members recorded 932 new visits and follow-up appointments in January, up from 679 last July. Soldiers admitted for inpatient psychiatric care at Madigan declined slightly from 2009 to 2010, falling from 542 to 519. Those numbers held relatively steady because Madigan’s psychiatric ward accepts patients from 20 Western states, not exclusively from Lewis-McChord.
Army leaders want soldiers to become “resilient” in coping with the stress of repeated deployments. In part, that means persuading them to seek psychiatric help when they need it, just as they would ask to see a doctor for a physical injury.
This can be a tough sell for soldiers who fear repercussions to their careers if word gets out they’ve been diagnosed with PTSD.
Multiple attempts were made through Madigan doctors and Army I Corps officers over six months to find a service member willing to talk about mental health services they had used. None was willing to be interviewed for this story.
The Army insists soldiers won’t be held back, but perceptions remain that a diagnosis for an anxiety disorder can lead to a forced medical retirement.
“If you come out with a diagnosis, that changes the situation,” said Randi Jensen, a civilian therapist who volunteers to work with service members through the Soldiers Project Northwest. “You’re fit for duty or you’re not fit for duty. Who decides?”
Jensen said her organization sees about 15 former service members a month, triple what it saw a year ago. She said clients generally are people who waited to seek help until after leaving the military. She’s looking for more volunteers to meet the growing demand for counseling among veterans.
Former service members also are eligible to access counseling through the Department of Veterans Affairs, though some prefer civilian settings.
THE ARMY’S PROCESS
Col. Penner led Madigan as it established programs to make sure that every soldier returning from combat has six “touches” with behavioral health specialists and other resources in the six months after a homecoming. (That doesn’t include a screening every soldier goes through before deploying.)
Soldiers who served in Iraq or Afghanistan six years ago remembered having no mandatory mental health visits.
“When I came home from Afghanistan, I don’t recall there being much of anything,” said Homas, who served there in 2005 as a surgeon.
Homas served in Iraq in 2009-10 as the top surgeon for Lewis-McChord’s I Corps. He noticed that new standards compelled him to answer questions about his emotional health when he came home from Iraq, even though he felt he was doing well.
In the past, soldiers filled out a survey on a computer and didn’t have a face-to-face talk with a behavioral health specialist.
“I wouldn’t have spilled my guts,” Homas said about the new steps. “It opens that door, though, and at least you realize there are people there.”
That six-step process rolled out a year ago for the first time as Lewis-McChord’s infantry brigades started coming home from the Middle East. It’s up to the soldiers whether they want to follow up on their “touches,” but the base ensures that they know how to find help if they want it.
“We just try to open the door and let them make the choice,” said clinical psychologist Daniel Christensen, who manages the drop-in mental health clinic.
The Army spreads the contacts over several months because signs of post-traumatic stress commonly show up long after an incident. When soldiers first come home, they usually feel too excited about seeing friends and family to dwell on difficult times they had overseas, Madigan leaders said.
Across the various mental health encounters, service members are reminded that it’s normal to have trouble readjusting to stateside life after spending a year or more away from family.
“The whole process is one of destigmatization,” said Joe Etherage, Madigan’s chief of programs and research in its Department of Psychology.