Mental health care hit and miss, troops say

By Kelly Kennedy - Staff writer
Posted : Friday Mar 14, 2008 20:23:28 EDT

Service members told Congress Friday that mental health care for post-traumatic stress disorder is good — if they can get it.

In one case, a suicidal soldier asked for help and got it. In another, a soldier deployed to Iraq asked for help, and when he didn’t get it, he killed himself.

While military surgeons general told the House Armed Services personnel subcommittee about new programs designed to provide a safety net to catch troops with mental disorders, they also talked about issues that still must be addressed — recruiting and retaining mental health providers, ensuring leaders understand suicide, and finding proper treatment for PTSD.

“I think we are grappling with this about as hard as we can,” said S. Ward Casscells, assistant defense secretary for health affairs. He said the Defense Department is working to improve screening, implementing more resiliency training — teaching troops to be mentally strong as well as physically strong — and figuring out how to define and treat PTSD.

“Treatment is a struggle,” Casscells said. “We don’t know very well what treatments work.”

But they have — or will have by May — implemented most of the recommendations of the Defense Department’s Task Force on Mental Health.

Casscells said early intervention, before symptoms develop into a full-blown disorder, could save the Defense Department 80 percent of their mental health care costs.

“We are making progress, and we do have a ways to go,” he said, a theme that re-emerged in the testimony of the service surgeons general.

Service members and family members who appeared before the subcommittee had their own recommendations.

Army Pfc. Jason Scheuerman, 20, started acting differently when he was in Iraq, his father, Chris Scheuerman Sr., said.

Jason sat slumped on his cot with his head banging into the butt of his rifle. Some saw him put the barrel in his mouth. He slept in the fetal position. He sent his family an e-mail saying he wanted to kill himself. A chaplain noticed the behavior and reported it to the brigade psychologist.

“[The chaplain] said in a sworn statement that he believed Jason to be possessed by demons and obsessed with suicide,” Chris Scheuerman said.

Soon after, Jason took his own life.

The elder Scheuerman said he had to file Freedom of Information Act requests to get copies of the Army’s investigation of the incident, and what he saw infuriated him.

“Jason’s psychologist stated that he was capable of feigning mental illness in order to manipulate his command,” Scheuerman said. “Jason’s chaplain clearly believed him to be extremely troubled and told Jason’s mother in a conversation after his death that they had been watching Jason for some time.”

After the diagnosis, Jason was counseled that he could ask for a second opinion at his own expense — a virtually useless option as long as he was in Iraq. His father asked that service members have the opportunity for a second opinion, as well as better communication between leaders who know when their troops are troubled and the mental health workers who can help them.

Army Maj. Bruce Gannaway lost his left foot Dec. 22, 2007, when a bomb exploded while he was on patrol. Upon arriving at Walter Reed Army Medical Center in Washington, D.C., he said he was immediately evaluated for mental health issues — while he was heavily medicated.

He called it a quick “Q&A” session and said it determined his mental health care for the rest of his stay. Because he’s a midlevel officer, he said he was able to work as his own advocate to get the care he needed, but he suggested providing follow-up mental health consultations for people who seem fine in the first cursory check. He also said mental health workers should make rounds the same way chaplains do.

His wife, Sarah Gannaway, is an occupational therapist. She asked that civilian mental health workers within the Tricare system be better reimbursed so they feel it is worth the effort to help service members. The system is “overwhelmed,” she said, and she never sees the same doctor twice — and neither does her husband. She also asked that some of the bureaucratic rules be looked at, such as requiring an office visit to renew prescriptions — even for prenatal vitamins.

Army Chief Warrant Officer 4 Richard Gutteridge said he returned from his second tour in Iraq in February 2007 just fine and wanted to go on leave, so he quickly made his way through his redeployment sessions.

Then he began having nightmares, feeling angry and withdrawing from his family. His doctor said he had chronic PTSD and combat stress, so he began therapy in August. But when he needed to readjust one of his medications because of a bad reaction to it, he was told he couldn’t be seen for 20 days. He called the Wounded Warrior Hotline and said he needed help immediately.

“If this was how I was being treated, how would a young infantry guy be handled?” he said.

A doctor called him and worked with him on his medication, and he began feeling better. But autumn brought the anniversaries of violence he experienced in Iraq, and he started drinking alcohol and having suicidal thoughts.

“I’m not proud of this ... it’s difficult to admit,” he said. “I felt as if my condition would never change.”

He called a nurse, but said he “knew my career would be over.” The next day, he met with the nurse, but she had called his brigade commander and chaplain to have him admitted to the mental health ward at Landstuhl Regional Medical Center in Germany on New Year’s Day. Then he was sent to the mental health ward at Walter Reed. There, he heard about a special program for people with PTSD.

“I had hope for the first time,” he said.

But he had to wait. Only nine people were in the program when he went through. In the meantime, he attended group therapy with a bunch of newbie troops dealing with “adjustment issues” and complaining about why they didn’t get along with their drill sergeants, Gutteridge said.

Finally, on Feb. 4, he began the three-week intensive program, which he called “awesome.”

He requested that substance abuse programs be incorporated into PTSD therapy, not “in a distant, separate building.” He also asked that mental health workers be embedded at least at the battalion level with the troops in Iraq. Taking the time to visit the rotating team of people nobody knows that passes through occasionally is “setting yourself up to be ostracized,” he said.

And Scheuerman, Gannaway and Gutteridge all said they thought the military, as it has in the past with racial and sexual integration, could work harder to get rid of the stigma that surrounds mental health and set a standard for civilian care.

Gutteridge suggested replacing “behavioral health” with “combat stress” units.

“Everybody likes the word ‘combat,’ ” he said. “It’s manly. It’s OK. Something as simple as changing the wording could help.”

Scheuerman, who retired from the Army after a 20-year career, took the suggestion a step further. “The Army has gone through a lot of cultural change,” he said. “Stigma exists in the Army today because we allow it to exist.”

Drunk driving used to result in 14 days of extra duty, he said — until the military took on a zero-tolerance policy and offenses went down significantly. Sexual harassment and racism were addressed the same way, he added.

Gutteridge said the military could use its values-based culture to address the problem. “The Army can lead society down the correct path of taking away the stigma,” he said.

Suddenly, the hearing had become a brainstorming session with Lt. Gen. Eric Schoomaker, the Army surgeon general and his staff leaning forward and taking notes: Maybe a PTSD support group, similar to bereavement groups? No tolerating supervisors telling a subordinate to tough it out rather than seek help?

“The only thing I want to say is, this is a problem we have to get to grips with, because as our kids come home, it’s only going to get worse,” Scheuerman said. “We have to find a way to make this better.”
Air Force Times

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