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Army's mental health programs swamped, understaffed

| Monday, Feb. 7, 2011

WASHINGTON -- Thousands of sick and wounded soldiers within the Army's Warrior Transition program aren't receiving psychological care they need and are being discharged into communities ill-prepared to help them.

A nine-month investigation by the Tribune-Review, buttressed by documents passed to the newspaper by soldiers and the Pentagon's Office of Wounded Warrior Care & Transition Policy in Alexandria, Va., reveal an Army reeling from an epidemic of mental and behavioral health problems after nearly a decade of constant combat overseas.

At Joint Base Lewis-McChord in Washington state, officials in April told investigators mental health cases skyrocketed 400 percent in recent years, according to files provided to the Trib.

A late 2009 report from New York's Fort Drum, home to the 10th Mountain Division, found "backed up" mental health clinics on and off base for soldiers suffering from depression and Post-Traumatic Stress Disorder (PTSD).

Nationwide, more than one out of every five of the 9,300 Warrior Transition patients suffers from diagnosed PTSD, according to the files.

At Hawaii's Tripler Army Medical Center, officials in an early 2010 report estimated three out of every five Warrior Transition soldiers brought there suffered from "behavioral health issues." The hospital treated them for depression, anxiety and suicidal thoughts, but the files claimed the program "is not designed to be PTSD-specific."

The Pentagon documents reveal a chronic shortage of trained social workers, psychologists and other mental health professionals to diagnose and treat the suffering at bases nationwide. At the 25th Infantry Division's Schofield Barracks in Hawaii, for example, investigators determined there was only one Army mental health officer for every 265 cases. The military standard is one to 50, according to the report.

While Pentagon investigators visited the bases, the Army was coping with a series of tragedies linked to the service's mental health workers. A Nov. 5, 2009, rampage at the Army's Fort Hood in Texas left 13 soldiers dead and 30 wounded.

Army psychiatrist Maj. Nidal Hasan is charged with the murders. Nine of the victims were Army therapists.

The massacre followed the May slayings of five soldiers at Baghdad's Camp Liberty by a soldier seeking psychological counseling there.

On Jan. 31, federal prosecutors in Kansas charged an Army-contracted therapist -- who was treating a Fort Riley sergeant grappling with PTSD and marital issues -- with stalking and sexually assaulting the patient before leading police on a high-speed chase after she strayed onto base.

The therapist, Rachelle Santiago, 43, worked at Irwin Army Community Hospital, base officials told the Trib.

Breaking point

None of these incidents comes as a shock to Dr. Stephen M. Stahl, a University of California-San Diego professor of psychiatry who led a team of clinicians teaching Army mental health workers at Fort Hood.

A study he authored in the December 2009 neuroscience journal "CNS Spectrums" pointed to an Army mental health system that's "understaffed, under tremendous pressure, and near the breaking point."

"But it's not something we can't fix," Stahl told the Trib. "It might take two years, but with the proper training and retraining, we can get a group of dedicated professionals who are already there, the nurses, to tackle the Army's mental health challenges."

Stahl's research indicated Fort Hood commanders and nurses had little confidence in Army mental health care. Staffers told him patients were overmedicated, especially with too many opiate-based pills. These drugs, when mixed with other substances, often triggered the suicide attempts plaguing Army bases nationwide.

Stahl understood exactly what he was witnessing. He's the author of the most widely read textbook in the field of pharmaceutical and psychiatric research.

Like the Pentagon investigators, Stahl concluded Fort Hood suffered from chronic lack of mental health practitioners. He said only about 400 psychiatrists are in uniform or hired under contract to treat the more than 1.2 million active duty Army Reserve and National Guard soldiers. Although the Army has pledged to fill more than 1,000 vacancies for mental health workers, Stahl said "they're not getting the number of volunteers that they need."

Stahl learned soldiers were leaving base to seek the help of civilian doctors -- who often didn't know the medication already prescribed. He found an Army culture that continued to stigmatize mental illness despite nine years of combat and an active-duty force that has 17 percent of its personnel on anti-depressant medication.

Although Fort Hood's nurses believed PTSD to be a real disorder, Stahl's study concluded most cadre staffers overseeing wounded soldiers in the barracks thought patients were faking it.

Army officials declined to comment.

'No clear answer'

Similar concerns were voiced in reports from the Office of Wounded Warrior Care & Transition Policy. The Pentagon team agreed with commanders that some soldiers in the Warrior Transition units game the system to garner financial rewards by faking PTSD, but uncovered other serious problems nationwide.

Without naming bases, Pentagon reports revealed the Army located three Warrior Transition units near firing ranges. Patients "complained about having flashbacks or negative reactions when training occurs."

A 2009 report on the Warrior Transition unit at North Carolina's Fort Bragg found "no clear answer" for how it helped those diagnosed with Traumatic Brain Injury or related severe mental health problems "other than to say a Personal Digital Assistant (PDA) is provided" to help the memory-impaired get to appointments.

The Army reported problems at Fort Bragg were corrected, but declined further comment.

The report on New York's Fort Drum revealed combat soldiers often hurt their own mental health: "Some soldiers have started memorizing answers" on parts of the Military Acute Concussion Evaluation in order "to stay in theatre" and fight, even though they realized they were defeating their chances of getting help later, according to the files.

That concerns Barbara Van Dahlen, a Washington clinical psychologist and founder of the "Give an Hour" nonprofit that so far recruited more than 5,000 mental health providers to donate treatment to America's military veterans.

"Local communities will bear the brunt of caring for these people long-term, not the military," said Van Dahlen.

Researchers estimate more than 400,000 active and former service members might suffer from PTSD, traumatic brain injuries and other illnesses tied to nearly a decade of war. Van Dahlen fears soldiers who aren't getting proper treatment in the Army will be thrust upon local caregivers, often in small communities, and many of them aren't trained specifically to aid combat vets.

That's why she's linking mental health workers to veterans before it gets worse.

"There's a public health crisis that's brewing," she said. "It's an entire generation of combat veterans, and we don't want to lose them."

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