Routine clinic visits that begin with six simple questions about your mental health.
These are just some of the ways the U.S. military is trying to recognize and treat Post-Traumatic Stress Disorder and depression.
And for each new approach, the U.S. Army is leading the way in program implementation.
Even with a history that dates back to the U.S. Civil War – when the condition of PTSD was referred to as Soldier’s Heart or Shell Shock – the stigma for the behavioral health disorder is a concern for Soldiers.
In 2004, 80 percent of U.S. combat troops returning from Iraq who participated in a mental health study acknowledged they had problems. But fewer than half were interested in receiving help.
According to the authors of a new Army-wide mental health assessment program RESPECT-Mil, “the gap between need for treatment and receiving (treatment) deserves urgent attention.”
Don’t worry. I’m not writing this down
“A lot of Soldiers have that stigma of if they go to a behavioral counselor then it goes on their permanent records,” said Annamaria Doby, family advocacy specialist for U.S. Army Garrison Wiesbaden.
“But with military and family life consultants, there’s no record of counseling. They don’t write anything down,” she said. “It definitely attracts Soldiers to that option. It doesn’t go in medical records or go back to his or her unit.”
Funded by the Office of the Secretary of Defense, the Military & Family Life Consultant Program began as a pilot program for the U.S. Army’s 1st Armored Division in Europe.
In April 2004, 1st AD was given notice that its tour in Iraq would be extended by 90 days. The division’s extension allowed coalition commanders in Iraq to maintain a strategic reserve and cover shortfalls when Spanish troops pulled out of the coalition.
But 1st AD leaders wanted more support, not on the ground in Iraq but at home.
The MFLC Program provided licensed clinical counselors who could help Soldiers and their families deal with issues such as anger management, conflict resolution, communication and relationship issues.
The most innovative part of the program is that the counselors, who rotate every four to six weeks on military installations, do not keep records of who they meet or what the issues are.
But one of the most common issues MFLCs tackle is relationship issues – specifically adjustments for families of Soldiers who are about to leave or are returning from deployments.
In some cases the counseling is mandatory for Soldiers returning from active duty. And some military installations have embedded counselors that reach out to Soldiers stationed there.
Soldiers and family members contact MFLCs by phone to set up appointments. The MFLC Program is not facility constrained so counselors can meet clients anywhere. And the service is free. MFLCs cannot counsel on domestic violence or sexual assault.
Counselors have a limit of six consultations for each client and can issue referrals to behavioral health professionals for serious or ongoing issues.
According to MHN, the behavioral health subsidiary of Health Net Inc. contracted to provide the MFLC Program, the network of counselors has grown to more than 2,400.
“In May 2009 alone, for example, we provided problem-solving counseling for over 35,000 individuals,” said Juanell Hefner, MHN president and CEO.
Today the MFLC program is heralded as a highly successful collaboration and has been replicated military-wide to include Army National Guard and Reserve units.
Let’s talk behavioral health
“It’s not always easy for a Soldier with needs to decide when, where or how to get help,” said Lt. Col. Robert Wilson, U.S. Air Force psychologist and deputy director of the Deployment Health Clinical Center at Walter Reed Army Medical Center.
“The beauty of RESPECT-Mil is the way it brings the help right to the Soldier.”
Once the program is in place, every time a Soldier, family member or civilian enters an Army primary-care facility, he or she is asked six questions – the first two questions screen for depression and the last four screen for PTSD.
As Army officials continue work for implementing RESPECT-Mil programs in every medical treatment facility, officials in places such as Wiesbaden are moving forward. As directed by Europe Regional Medical Command, primary care providers in Wiesbaden completed a two-hour familiarization training program for the RESPECT-Mil initial questionnaire.
“We decided to move forward in implementing RESPECT-Mil in our facility once we’d done the training,” said Lt. Col. Matthew Mattner, Wiesbaden clinic commander.
And because of that decision, “if you come into the clinic for something as simple as a broken toenail, you will be asked to take the (mental health) questionnaire,” said Dr. Scott Bodine, director of behavioral health services on U.S. Army Garrison Wiesbaden.
Based on work supported by the Uniformed Services University of the Health Sciences, RESPECT-Mil is designed to give a systematic primary care approach to the management of depression.
Working as a Three Component Model that screens, implements severity instruments and finally diagnoses, the RESPECT-Mil program gives a blueprint to primary care clinics for identifying and following up on cases of depression and PTSD.
“It promotes a dialogue between patient and doctor for mental health issues,” said Bodine, something he said that Soldiers aren’t always eager to engage in.
The Army rolled out RESPECT-Mil pilot programs at 15 major sites in 2007.
Currently, the program is fully in place in three Army Europe locations. All treatment facilities in the ERMC family of Army health care have completed the two-hour training that introduces providers to using the questionnaire.