Tri-Service Combat Stress Conference Continues

The 14th Annual Tri-Service Combat Stress Conference kicked off this past Saturday (and runs through May 4, 2006) at Camp Pendleton, CA. It's the largest and oldest gathering of its kind, bringing together leading military mental health professionals and chaplains to share their knowledge of the latest techniques in combat stress treatment. The San Diego Union-Tribune interviews Bart Billings, the event's co-founder, and the results are informative and quite illuminating.

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From the San Diego Union-Tribune:

Bart Billings and Richard Lynch started a combat stress conference in 1993 after watching the toll the Persian Gulf War took on their military friends and colleagues. Accounts of bankruptcy, divorce and suicide compelled them to bring together top researchers and counselors to help service members and their families.

Vietnam vets – and to a lesser degree those from the Gulf War – had slipped through the federal government's mental-health net, Billings and Lynch said. They were determined not to let that happen to the next generation of U.S. combat troops.

Thirteen years later, they and some of the nation's foremost experts in the field contend that the military's mental-health care remains hobbled by anemic budgets, poor and often inexperienced staffing and an overreliance on prescription drugs at the expense of holistic care.

In short, they see another lost generation in the making. “I would give the Pentagon a less than adequate grade for its mental health efforts,” said Lynch, a retired brigadier general and a radiologist at the Brooke Army Medical Center in San Antonio. His criticism is shared by psychiatrists, social workers and specialists in integrated medicine.

The event's co-director is less than satisfied with the current veterans healthcare landscape.

“I don't think we are OK where we are,” said William Marshal, a primary care doctor for the Veterans Affairs system in West Los Angeles and co-director of the conference with Billings. “I am concerned that we aren't cranking up to care for (the newest veterans') needs. If we don't provide the necessary support, we could lose a large number of these veterans to homelessness, drugs and joblessness.”

Marshal, a retired Army colonel, estimated that a third more doctors, nurses, psychological technicians and social workers are needed to handle the military's growing mental-health needs as more and more veterans come back from Iraq and Afghanistan. Twenty percent to 40 percent of such troops suffer mental illness, several studies in the past year and a half have documented.

That percentage is roughly what Vietnam veterans reported long before the Pentagon officially recognized post-traumatic stress disorder, or PTSD, and other forms of combat stress.

The article continues to offer up a rich selection of statististics: the VA has been underfunded over the past 3 years to the tune of $1.2 billion to $2.6 billion yearly. The reasons given include the increasing burden placed on the system by our returning OEF/OIF veterans, as well as higher-than-expected costs associated with caring for both World War II and Korean War vets.

Money aside, assembling and keeping a mental-health staff are challenging because the pool of qualified people is relatively small and in high demand, said Col. Bob Ireland, program director for mental health policy at the Pentagon. “There has been a joke around for years that . . . we are always 100 percent manned if you keep dropping the number of what 100 percent is,” Ireland acknowledged.

Mental-health care ranges from an A+ to a D-on bases nationwide, Ireland said. But overall, he argued, the military has improved its services. He noted that innovative mental-health programs promising greater access and confidentiality are coming, though he didn't elaborate.

Ireland also said the military has recently improved its mental-health screening of troops before and after they deploy. For example, the Pentagon has encouraged military health providers to use a detailed questionnaire on mental conditions for interviewing troops up to 18 months after they return home.

Billings wonders if the efforts will be backed with enough funding. In 1997, he pitched his Human Assistance Rapid Response Team program to Pentagon officials as a way of assessing spiritual, mental and economic needs that could become distractions in combat.

The Pentagon incorporated it into a Defense Department directive on combat stress prevention but never funded it, Billings said. “No one picked it up because there was no money, but they have money for other things,” said Billings, a clinical psychologist in La Costa, a retired military medical officer with 33 years of service and a psychologist for the California Department of Rehabilitation.

The issue of prescribing anti-despressant medication to returning troops coping with posttraumatic stress disorder symptoms is also examined.

Some doctors believe strongly in using antidepressants and other medications to treat conditions like PTSD, said C. Scott Saunders, director of the Trauma Psychiatry Service at the University of California Los Angeles. However, Saunders doesn't advocate the practice because, “You can't medicate it away. It is a way to lessen the symptoms . . . but I don't think medications go to the heart of the problem.”

Billings, Lynch and Saunders, among others, believe an interdisciplinary strategy is the most effective way to heal the mind, body and soul of people suffering from mental illness. This broader approach can pretty much restore patients' conditions to the way they were before a traumatic event, but the recovery process is often long, expensive and mentally taxing, Saunders said.

A lack of experienced health providers, including a shortage of counselors, makes it more likely that physicians will resort to prescribing medications instead of using multiple therapies, the experts agreed. “A doctor can see four or five patients an hour if all he or she does is write prescriptions (for drugs), which don't work about 50 percent of the time,” Billings said. “You need large numbers of trained counselors to handle those problems.”

Billings urged veterans and active-duty service members to demand more or better counseling if their mental illness doesn't improve, and to seek help outside of the military if necessary.

Great advice. You bet we have to agitate and demand for better funding, more attention, and real progress re: veterans healthcare. Please consider contacting your elected officials and asking them where they stand and what they're doing on this issue.

And join me in thanking the San Diego Union-Tribune for this informative and important piece of reporting.

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