Battleland

Military Mental Health’s Wins and Losses Since the Iraq Invasion

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Looking back, 10 years after we pushed into Iraq, how have we done?

Let us start out by reviewing some of the improvements:

— Better screening for Post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI), including screening on the Post Deployment Health Re-Assessment (PDHRA, fielded in 2005)and the Periodic Health Assessment (PHA, fielded in 2009).

— More education and screening about PTSD, TBI and suicide, with numerous efforts really beginning in 2007; there is a plethora of products available for service members, families and clinicians.

— The Mental Health Advisory Teams in Iraq and Afghanistan, the first ever surveys in the theater of war to measure psychological symptoms, and barriers to care, including stigma.

— More emphasis on resiliency: in the Army, evolving from Battlemind to Comprehensive Soldier Fitness; the Marines have the OSCAR program.

— An marked increase in the number of behavioral health providers in all the Services.

Changes in policy to ensure that PTSD gets diagnosed correctly.

— A marked decrease in the number in administrative separations for personality disorders.

— More collaboration between the military and the Veterans Administration.

— A comprehensive data bank of all active duty suicides, and increased information on reservist suicides.

— A willingness to experiment with many new and innovative therapies.

But stubborn problems remain, highlighted again by last summer’s Institute of Medicine report and last week’s Task Force on Army Behavioral Health study.

— Service members only admit to PTSD when they are already looking to leave the service, in general.

— The persistently and stubbornly elevated suicide rate, currently prominent in those who have never deployed and in reserve forces.

— Stigma relatively unchanged, from when the Army first started measuring it, despite all the educational efforts.

— Problems with access to behavioral health care and evidence based treatments.

— Vast inequities as to which service members receive state of the art therapy versus clearly substandard care.

— An inability to measure any of the outcomes of the numerous resiliency programs.

— The electronic health record of the military (ALTHA) and the VA (VISTA) still do not talk to each other in a clinically meaningful way.

— In a real pendulum shift, the Task Force on Army Behavioral Health thinks too many Soldiers are getting medical boards as opposed to administrative separations.

— The innovative new therapies still do not have robust scientific basis, including my favorite therapy — dogs; virtual reality therapy, however, is developing a scientific literature.

So, in my assessment and those of many others, after 10 years, a mixed report, like so many other legacies of the Iraq war. But, I will opine, it is not for lack of trying, by many dedicated Army professionals, psychiatrists and generals.

The resounding take-home lesson for me, is that a decade of war leads to persistent mental health problems. These will last for decades, and need to be addressed by the nation.