Military ‘Borrows’ Civilian Mental Health Workers for Troops

WASHINGTON, June 4, 2008 – The Defense Department has partnered with the Department of Health and Human Services to offer more mental health professionals on military bases, officials announced at a Pentagon news conference today. Under the agreement with HHS’s Public Health Service, some 50 mental health practitioners will be detailed in the coming weeks to military bases throughout the United States to provide additional resources for military members and their families to seek treatment, Dr. S. Ward Casscells, assistant secretary of defense for health affairs, said.

Pentagon officials expect to detail to bases as many as 200 doctors, nurses, psychologists and social workers, as those professionals are identified, Casscells told reporters.

The agreement was months in the works, as the military became increasingly “overwhelmed” by the need for mental health professionals due to operations in Iraq and Afghanistan, Casscells said. “We’ve been in ‘beg, borrow and steal’ mode, but it’s no crime to borrow from the Public Health Service, and we will give them back,” he said. “During a time of war, there is enormous need. Today, the cavalry riding to the rescue is the Public Health Service.”

Casscells noted a longstanding shortage of mental health workers, not just in the military, but also among civilian facilities nationwide. Such a shortage is particularly problematic in mental health, he explained, as successful treatment is built around a trusted and understanding relationship between the provider and the patient. With mental health services, “a person may legitimately say they only want a woman” counselor or make some other personal request, he said.

“This is the most sensitive and most personal form of health care,” said Casscells, a cardiologist. “The right counselor is worth his or her weight in gold. It’s hard to find that hand-in-glove fit. So, people need choices [in mental health professionals], and you need a lot of people to provide those choices.”

Casscells recently returned from an eight-day trip to Afghanistan, where he traveled the country talking to U.S. servicemembers about health care. Troops from one unit were particularly nervous about losing a popular military psychologist who soon would be redeployed, he said. “You could fill the billet and it still may not be the right person” for servicemembers to receive effective counseling, he said.

The mental health professionals will not all be doctors, but they must be skilled listeners with advanced training who understand the military, Casscells said. Some will be former military members, he said.

“I love the fact that we’ll have counselors who have not been over there and who have not been in uniform, because that gives a second opinion,” Casscells said. “These people are going to be good for the military. They’re going to come in and ask questions and chafe at the bureaucracy.”

The practitioners will provide medical services in psychiatry and neurology, including speech and behavioral therapy, and a host of psychological services including individual, family and group counseling, said Dr. Joxel Garcia, assistant secretary for health at HHS, who holds an admiral’s commission in the Public Health Service.

The agreement with the Defense Department is one of seven such partnerships in which the Public Health Service is reaching out to raise public awareness and services for mental health treatment, he said.

“This is not only to help veterans returning from conflict, but will also become a model for our nation,” Garcia said. “We learned a lot after 9/11. This is a science that is developing.”

Because servicemembers historically are reluctant to disclose mental health problems, it is hard to quantify the demand for services. In one post-deployment survey, 20 percent of combat troops reported having some mental health problems, said Ellen P. Embrey, DoD’s deputy assistant secretary for force health protection and readiness.

The agreement coincides with a Defense Department effort to decrease the stigma associated with mental health treatment, an effort Casscells said is working.

“Everyone in this building — and not just doctors, even hard-line leaders — are talking a lot about who is really ready” to go to combat and how they are doing while they’re there, he said. “There’s clearly been a change in the minds of the combatant leaders on this issue.”

The program will mark the first major effort at trying to prevent mental health problems among U.S. military members, Embrey said. “We are focused on education. We would like to prevent [mental health problems] from happening in the first place.”