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Military Mental Health: An Outsider Takes a Peek Inside

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The Inside Battle

Marjorie Morrison is a San Diego psychologist who took time out of her busy private practice to provide “pro-active” mental-health counseling to more than 500 Marines at the recruit depot there. Such counseling removes stigma – because everyone gets it, no one feels “different.” It’s designed to prevent mental-health ailments before they begin, instead of trying to fix them after they’ve taken root and disrupted lives. She details her fight and frustrations with  the military’s mental-health bureaucracy in a new book, The Inside Battle: Our Military Mental Health Crisis.

Morrison believes today’s war-strapped U.S. military needs to make such counseling as much a part of its everyday life as PT and field exercises. But that requires scaling up the military’s mental-health culture into a bigger commitment than it is now. She recently conducted this email chat with Battleland about her new book, which is being published Tuesday, September 11:

 Why did you write “The Inside Battle: Our Military Mental Health Crisis”?

In 2008, I had the unique opportunity to work as a mental health counselor at the Marine Corps Recruit Depot in San Diego. I decided to take a short leave from my busy private practice at hopes of doing some meaningful work and to give back to my community.

When I first arrived at the Depot, I was placed in the on-base counseling center where I was given administrative tasks and rarely used my clinical skills. I didn’t want to be another example of taxpayers waste and was determined to bring quality services to the Marines.

Through perseverance, some amazing forward thinking Marine leaders, and a little bit of luck, I ultimately created a thriving proactive counseling program. I routinely met with over 500 Drill Instructors in both individual and group sessions.

It was a tremendous experience and I learned so much having had access to that many Marines. After a year of working closely with them, I gained a deep understanding about what was really going on inside their heads, especially those that have returned from multiple deployments.

Through this exposure, I became convinced that making counseling an ongoing requirement is the only way to effectively help this population.

Tate

Unfortunately, even though the Marines were benefiting and publically supporting the program, I met peripheral roadblocks every step of the way. Between the on-base counseling centers and the for-profit insurance company I was contracted with, I became disheartened at the gross negligence that echoed throughout the broken system.

When I initially left the Depot, I wasn’t sure there was anything I could do with my newfound knowledge. It was a problem much bigger than what I could influence.

Nevertheless, not a week went by without some military member contacting me to ask for help for either himself or a buddy. I’d often hear the familiar sad story where someone that needed help didn’t get it, couldn’t find it, or got turned away. Marines would frequently ask me the hard questions, “Why aren’t you doing anything? Why haven’t you told your story?”

I felt guilty that I hadn’t spoken up, but was also afraid of the repercussions. After two and a half years of researching and writing, I’m finally ready to share what I observed and how I came to the conclusion of the necessity of proactive counseling.

Is it really a crisis? If so, why?

Absolutely! When you have more service members dying from suicide than from war, I’d say we have a crisis. The Army suicide rate this year so far in 2012 is surpassing last year’s numbers, particularly among active-duty soldiers.

Suicides are now the most common form of death in the Army, claiming more lives than combat or motor vehicle accidents. For every soldier killed in war this year, about 25 veterans now take their own lives.

It is a very difficult problem to solve because non-deployed service members are taking their lives the same as those having multiple deployments.

There are many different theories for the higher rate of suicides. One reason could be with the draw down of troops from combat, soldiers are spending more time at home struggling with the emotional adjustments. Another is the fear of getting help and that they may feel they have no options. To top that, service members and veterans who have sought help often can’t get it.

It’s also important to note that the crisis goes far beyond suicidal and homicidal acts. It has been estimated that the majority of those suffering from emotional wounds would never harm themselves, but nonetheless are still profoundly disabled. Close to half of those who served in Iraq or Afghanistan are now seeking compensation for injuries, in many cases psychological ones.

In addition to the human component of this crisis, the financial cost to care for the magnitude of service members requiring assistance is huge and we are just beginning to see the impact.

What are some important things the nation needs to do to ease this problem?

We need to stop waiting for service members to seek help on their own. A population of people, who are molded from the very beginning of their careers into being strong and reliant on their commanders for orders, will rarely seek help on their own, and if they do, it’s often too late. The military has such a large emphasis on being physically fit, but I don’t feel they spend nearly the time needed on being emotionally fit.

We need to change our culture and attitudes toward mental health from reactive to proactive. If everyone routinely goes in and sees a mental health professional there is no stigma.

Everyone has a certain propensity towards stress: some people become isolated and depressed, other display angry outbursts, and some turn to alcohol. Often we don’t slow down enough to wonder why we are implementing these coping mechanisms, but they usually develop as a response to fear.

When you learn what your triggers are, you can put strategies in place that will alleviate the symptoms. Catching things before they spiral out of control is the key to successfully managing your mental health.

It’s no different than getting a yearly physical from your doctor or developing a healthy lifestyle. You are investing in your long-term healthy future. I think that this process is especially important for our service members as they are exposed to more stress than the average civilian.

What military background did you have prior to working with the Marines?

None. I knew very little about the military. I wasn’t raised in a military community and none of my family members or friends ever served. Everything I knew about the military was either something I had read in a book or seen on TV. Only 1% of the American population is currently serving in our military and only 7% of the population is veterans.

That leaves over 90% of Americans like me, an outsider. I had the unique advantage of being let inside. This gave me the opportunity to see things with a fresh set of eyes.

I quickly understood at a very deep level why the majority of us knows very little about what really goes on in the military world. I hope my book will help the average civilian gain a better understanding of military life, and get a closer look at what the critical issues our men and women in uniform are faced with.

What surprised you the most about the state of mental-health care in the Marine Corps today?

There are a multitude of programs that exist, many which are under utilized and not frequently used.

At the same time, there is a profound need for mental health services. I was employed by a for-profit insurance company to provide anonymous, confidential counseling.

I was initially placed at the Family Advocacy Center, which was the on-base counseling center and the same place that Marines are mandated to go to for charges or accusations placed upon them including domestic violence, anger management, etc.

Needless to say, service members might not consider it a place where they would feel comfortable voluntarily walking into for help.

Additionally, my contractor gave me almost no training and I had practically no oversight. I quickly realized that they cared more about not making waves then they did providing quality services.

I am now convinced that an inherent conflict presents itself any time you have a for-profit insurance company, whose primary function is to report earnings to share holders, be the same people that are responsible for providing mental health services to our military. I think it’s a systemic issue that definitely needs to be looked at more closely.

How applicable are your lessons to the other services?

I have to think they are very applicable.

I implemented this program with Marine Corps Drill Instructors, often considered the “best of the best.” In order to receive the assignment of Drill Instructor, you must be a high achiever in your military career. Only 1% of Marines are accepted for this billet and the majority of them have had multiple deployments.

If the program worked with them, I am confident it will work with all branches of the military. I think it’s symbolic of how American culture as a whole is much more reactive than proactive. Change in our country happens very slowly and sadly, we don’t always look at models that are working before we ‘reinvent the wheel’.

In Israel, military psychologists play a key role in a soldiers’ life the entire time they are enlisted. Their involvement includes mental preparation prior to any and all activities performed, counseling throughout the operation, and participation in tackling any mental disorders after the mission ends. The role of ongoing psychologist is pinpointed as one of the key factors in why the Israeli Defense Force is so efficient. It’s sad to say, but in the U.S., seeking mental health services is still often considered a sign of weakness.

How big is the issue of stigma in the corps in terms of keeping Marines from seeking help?

It’s a very complicated issue with multiple layers contributing to the problem.

In an attempt to simplify things, the military prepares its members to be strong, tough and rely on authority to make decisions for them. I saw this first hand, watching recruits get molded from young men into Marines while training at MCRD “boot camp.”

They are required at the earliest stages to follow “instantaneous obedience to orders.” You are trained to think about the military unit first, and as an individual second. If you have any personal issues, they get pushed to the back burner. Even if the overt message is “seek help,” the covert message is “you should be strong and man up.”

I was very surprised at what I learned at MCRD.

I anticipated Marines to be reluctant to talk with me, based on the belief that talking would indicate signs of weakness. I observed the contrary: the Marines were extremely open and welcomed the opportunity to share about themselves and the challenges they were experiencing.

Once they opened up, they were motivated to take changes in their life. Over time, it became overwhelmingly evident that this was not a population that would seek out services on their own. Not because they don’t want to talk, but because they are afraid it will hurt their career.

Part of the problem with their fear is that it is somewhat rational. Although the government has tried to remove the stigma, there can be real ramifications for seeking counseling.

If military members receive a diagnosis that indicates impairment in their daily functioning, they may be able to receive the help they need, but may not be able to advance their careers.

The stigma is still there and is deeply embedded in the military mindset.

What is the best way to reduce that stigma?

In my opinion, the only way to mitigate this is to make mental-health counseling a routine event that everyone partakes in from the top of the chain of command to the bottom. I’m not going to claim to have all the answers but with the individual and group sessions I implemented there was no stigma.

Receiving help was an expected part of training. The group sessions provided the opportunity for members to share their personal experiences and feelings, which created a shift from struggling as separate individual to participating in a collective group experience.

The process was so powerful to watch because it immediately normalized the challenges the Marines were facing and created avenues for people to offer help to their peers. The groups not only helped strengthen the individual, but also created a greater sense of camaraderie within the unit.

The individual sessions were equally as important for helping build emotional intelligence and giving people the opportunity to share feelings and concerns in a private setting.

14 comments
Diane Carlson
Diane Carlson

In San Diego they have Fleet and Family support. The clients got 10 to 12 sessions.

Diane Carlson, Psy.D., MFT, private practice.

Michele Gilliam
Michele Gilliam

For a nation that allows approximately 200,000 homeless veterans to

sleep on the streets, we need a lot more than what the President has

offered. Tending to their mental health is only a fraction of what is

needed for their situations to improve.

http://www.blackwiththeblues.c...

Harold Maio
Harold Maio

How big is the issue of stigma in the corps in terms of keeping Marines from seeking help?Such counseling removes stigma – because everyone gets it, no one feels “different.”The stigma is still there and is deeply embedded in the military mindset.Although the government has tried to remove the stigmaWhat is the best way to reduce that stigma?I’m not going to claim to have all the answers but with the individual and group sessions I implemented there was no stigma.

It is always interesting to me with what claims of "stigma" journalists will comply. Intended in each of the above is prejudice. Think the "stigma" of rape for apt example, it was our prejudice that placed that term in play, and when the Women's Movement made that clear, we stopped. Precipitously. I am sure Time remembers that.

There were other prejudices that existed in the armed forces, as they existed in society. The demeaning of African Americans was one, the demeaning of women was another. It was not only the attitude of individual soldiers, but of command.

How big is the issue of the term "stigma." It is of primary importance. As it is employed in journalism it is of considerable concern..

Harold A. Maio, retired mental health editor

Lindsey Morrison
Lindsey Morrison

Such a great article. Something that should have been done years ago. I hope this field get the help it needs.

Kathleen Trotter
Kathleen Trotter

They have since removed that question 

and changed the military rhetoric from a top-down approach. The problem is that the stigma is still there and is deeply embedded in the military mindset. http://WinforGoDaddy.webs.com

anonguest7619
anonguest7619

 Kathleen-you are wrong. Question 21 on the standard form 86 (security clearance questionnaire) still asks whether in the past 7 years you have sought mental health counseling. In 2008 it was amended to exclude combat related PTSD. But ORDINARY DEPRESSION COUNSELING STILL MUST BE REPORTED. If you don't believe me, google "security clearance questionnaire" and/or SF 86 yourself and look at Question 21.

anonguest7619
anonguest7619

Mark: this statement is absolutely incorrect: There have been some changes in the screening of service members. They

used to inquire whether or not the service member had sought mental

health counseling and, depending on how they answered, their security

clearance could be in jeopardy. They have since removed that question

and changed the military rhetoric from a top-down approach. The problem is that the stigma is still there and is deeply embedded in the military mindset.

See Dr. Ritchie's post regarding Question 21 on the standard form 86.  Q21 asks whether in the past 7 years you have sought mental health counseling. In 2008 the question was changed to exclude combat related PTSD (grief and family counseling are also exempt). BUT ALL OTHER FORMS OF COUNSELING MUST BE REPORTED (INCLUDING DEPRESSION). It never ceases to amaze me the level of ignorance amongst people working in this very field. Google "standard form 86." Pull it up. Read question 21. 

Marjorie Morrison
Marjorie Morrison

 Thank you for pointing out the correction. I really appreciate your response because I believe we are saying the same thing and your point further illustrates why the stigma still exists.  I'm attaching where I received my info., but going forward I will reword using your link--it a great help and something that definitely needs more spot light on.

http://www.defense.gov/news/ne...

anonguest7619
anonguest7619

 Majorie-I appreciate the work providers like yourself do. However, DoD *changed* the question to exclude combat related PTSD. If a Marine (or Soldier or Sailor or Airman) has ordinary depression, or has issues not related to combat, he is forced to report that counseling.

The reason I know about this is because I have PTSD from rape and was forced to report that counseling on my security clearance form last year. I was then asked in-depth questions about my assault by an OPM investigator. It was a deeply humiliating and traumatic experience. Though my provider believed, as you did, that I would not have to report that counseling, she was wrong. Again, I would encourage you to pull up the actual form (SF 86) and read question 21 yourself.

Marjorie Morrison
Marjorie Morrison

 What an amazing person you must be able to vocalize what you went through. I can't even imagine what that would have been like for you. I'm so sorry you experienced it and greatly appreciate your candidness. I now absolutely understand your sensitivity to the issue. It's WRONG that it needs to be reported on the security clearance. Every time you speak of what happened to you it helps others. You are also making it okay for others to come forward with tragedies that have happened to them. I hope you'll join our conversations on my Twitter (@askforhelp) and FB (https://www.facebook.com/TheIn.... I'd love to have your voice. Your words speak volume!

Mark Thompson
Mark Thompson

Thanks...you are correct and have tweaked that passage.

anonguest7619
anonguest7619

 thanks. Didn't mean to shout. But it bugs me that mental health professionals think this problem has been resolved when it has not been. It means they give bad advice to their clients, and when their clients discover the truth, they feel betrayed by that provider.

Marjorie Morrison
Marjorie Morrison

 No need to apologize and I most definitely do not think the problem has been resolved.  The contrary.  Thanks for your passion.  We all need to fight this together.

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