Blackwater PTSD Care Questioned
From ABC News:
Along with congressional hearings on allegations of recklessness against Blackwater USA security forces in Iraq, questions are also being raised about the way military contractors deal with traumatic stress while overseas and upon returning home.
The House began hearings Tuesday on the military contractor Blackwater following reports about the company's employees in Iraq who were linked to the killings of 11 Iraqi civilians in September...In light of the high-profile incidents, possible explanations for the company's actions are emerging, including psychological harm such as post-traumatic stress that led to erratic behavior by some contractors.
"I have never heard of a company offering psychological counseling," a military contractor who works for another company said on the condition of anonymity because of his firm's involvement with the Blackwater investigation.
In February we looked at the mental health care given to private government contractors returning from work in combat zones like Iraq. While the focus at that time was on insurance coverage denial, related questions are rising from the current Blackwater story.
One problem area is the responsibility private companies have -- or do not have -- for providing returning employees access to sufficient health care resources (to treat PTSD, for example, if necessary). And how proactive do these private companies need to be in designing and delivering such a health care system?
In educational interest, article(s) quoted from extensively.
In February, NPR Day to Day looked at the experience of recently-returned contractors, including those coping with PTSD. The San Francisco Chronicle introduced us to a private contractor who'd worked in Iraq:
No one knows how many of them have been injured and killed. No one keeps track of how many contractors there are in Iraq. And when they come back, many find themselves abandoned. "Nobody ain't doing nothing for us," said [Steven] Thompson, 43, who for six months in 2004 drove a supply truck in Iraq for Halliburton subsidiary KBR, the largest corporate contractor in Iraq.
Thompson was paid $1,850 a week while he was there -- far more than he had been earning before the war. "And I'll tell you right now, it wasn't worth it," he said. Thompson said he survived several roadside bombs, mortar and rocket attacks, and countless small-arms firefights as he transported supplies for U.S. troops along Iraq's perilous roads. He returned from Iraq without physical injuries.
But his war wounds are evident in the cocktail of prescription medications he takes every day -- for hostile behavior, hallucinations, depression, insomnia, anxiety, anxiety-related tics and spasms, and hypertension, all symptoms he says he developed during his time in Iraq.
Two doctors in North Carolina have independently diagnosed Thompson with post-traumatic stress disorder, a psychological ailment with symptoms that typically include anxiety, loss of sleep and flashbacks. The government has acknowledged that he is disabled, and he receives a $1,224 monthly Social Security payment.
But Thompson says his claim for treatment for post-traumatic stress disorder was denied by American International Group Inc., or AIG, the insurance company for KBR, on the grounds that there was not enough medical evidence of his trauma.
In the case of Blackwater, the company has stated that their employee insurance covers contractors who return with PTSD:
Chris Taylor, a former Blackwater vice president now studying at Harvard University's Kennedy School, said the State Department -- with which Blackwater has an exclusive security contract to protect diplomats -- requires the company to screen all its personnel for mental health problems before deployment.
He said employees in the field are regularly reviewed by their peers and leaders and the company had recently hired a former Marine chaplain to provide counseling services. He also said Blackwater employees' insurance covers post-traumatic stress treatments once they return home.
Later in the article Taylor added, "Blackwater has a good safety net for dealing with PTSD type disorders." So that is good news.
ABC News, however, says the problem is not one of insurance coverage in this case, but of being proactive enough about getting the tools employees might need to deal with the expected stresses of having worked in a combat environment:
Unlike soldiers, however, who can access resources through the military and the Department of Veterans Affairs, companies typically provide contractors little in the way of counseling on the ground or treatment once they return home.
"There are thousands of guys coming home untreated," said Paul Brand, a psychologist who consults for DynCorp, one of the few companies that offer post-traumatic stress screening and in-country counseling to its employees. "These are private businesses out to make a profit. Most companies make money by not putting systems in place to take care of their employees' mental health… Frankly, it is a travesty that not enough has been done to give contractors the support they need."
Psychologists who treat contractors say the lack of immediate resources for employees in Iraq augment the effects of post-traumatic stress disorder and can lead to erratic and dangerous behavior.
The earlier you move to counteract PTSD in its early stages, the more successful your overall efforts will be.
By not having a proactive system in place, the article goes on to say, Blackwater is missing a great opportunity to protect the mental health of its workforce.
After being introduced to a few (non-Blackwater) contractors having a hard time getting the care they need because their insurance companies are denying their claims, one employee raves about the PTSD care she got from her employer, DynCorp.
Alece Davis, a 30-year-old police officer who went to train Iraqi police in April 2006, said the constant stress of living in a war zone led her to become increasingly stressed and ultimately set off a series of seizures.
"Just being over there was traumatic and stressful. Period. Seeing friends not come home, watching IEDs explode in front of my eyes, seeing kids without limbs or kids walking by dead bodies in street. It got to me."
Davis said she left Iraq and through her company, DynCorp, received treatment first in Germany and then followed up with her when she arrived at home.
Unlike most companies, DynCorp has its own experts in place to screen contractors for post-traumatic stress and recommend they seek treatment. But she said she had met with resistance from her insurance company, which has been reluctant to fully fund her treatment.
So, while Davis' employer was supportive, her insurance company was somewhat adversarial. Similar stories played out in a July New York Times piece on contractors coping with PTSD:
Contractors who have worked in Iraq are returning home with the same kinds of combat-related mental health problems that afflict United States military personnel, according to contractors, industry officials and mental health experts.
But, they say, the private workers are largely left on their own to find care, and their problems often go ignored or are inadequately treated.
A vast second army, one of contractors — up to 126,000 Americans, Iraqis and other foreigners — is working for the United States government in Iraq. Many work side-by-side with soldiers and are exposed to the same dangers, but they mostly must fend for themselves in navigating the civilian health care system when they come back to the United States.
Lack of experience in treating the aftereffects of military combat in the civilian health care world is problematic as well. Paul Brand, a psychologist and chief executive of Mission Critical Psychological Services, a Chicago firm hired by Dyncorp International, estimates that "thousands, maybe tens of thousands" of returning contractors may need reintegration help:
“Many are going undiagnosed. These guys are fighting demons, and they don’t know how to cope,” [Brand says.]
Jana Crowder, who runs a Web site for contractors seeking help, says she gets new evidence of that every day in phone calls from desperate workers.
“In the first few years of the war, we were seeing a few trickle in,” said Ms. Crowder, of Knoxville, Tenn. “Now, as contractors start coming home, you are starting to see a lot more.”
Workers tell haunting tales of their psychological torment. Tate Mallory, a police officer from South Dakota who worked as a Dyncorp police trainer, was grievously wounded by a rocket-powered grenade last fall. After returning home, he was so mentally scarred, he said, that he begged his brother to kill him.
Kenneth Allen, a 70-year-old truck driver from Georgia whose convoy was ambushed in Iraq, says he endures mood swings and jittery nerves and is often awake all night. And Nathaniel Anderson, a Texan whose truck was hit by rockets while hauling jet fuel, lost a contractor friend to suicide. Though suffering from stress-related symptoms himself, he has yet to see a doctor.
The Times delved into the insurance coverage problems:
Federal law requires employers to provide medical insurance for workers in a war zone. Workers have filed about 205 claims for treatment of post-traumatic stress disorder, or P.T.S.D., according to the Department of Labor, which monitors the data. Industry officials say that number significantly underrepresents the problem because many troubled people do not file claims.
Of those who do, many have been denied coverage and have filed lawsuits. Gary Pitts, a Houston lawyer, says insurers have challenged almost every claim filed by about 50 clients, even though the insurance companies paid for medical care involving their physical injuries.
“The contrast between the way the military and the civilian contractors are handled on P.T.S.D. is like night and day,” Mr. Pitts said. “The contractors have to figure it out on their own, and they often have to litigate it with the insurance company.”
Some other stats (from November 2006):
The toll of the war on contractors has largely been hidden from public view. About 1,000 have died since the conflict began, and nearly 13,000 have been injured. While some are well compensated for their work in Iraq, many more collect modest wages and provide support services vital to the military. ...
Although no U.S. agency keeps track of how many civilians are employed by U.S. contractor companies in Iraq, some reports estimate the number to be in the tens of thousands of Americans, Iraqis and citizens of other countries. Mann said KBR has 50,000 workers in the Middle East.
Between March 1, 2003, and Nov. 16, 2006, at least 673 civilian contractors -- Americans and foreigners -- were killed in Iraq, according to Labor Department spokesman David James. The number is based on the amount of death claims filed by relatives and may not represent all contractor fatalities.
By February 2007 it was being reported that 800 contractors employed by the Pentagon had been killed while working in Iraq, and another 3,300 were injured.
DynCorp's proactive reintegration efforts again stood out:
Dyncorp, a firm based in Texas that has a State Department contract to train the Iraqi police, is sponsoring its first conference Friday and Saturday on post-traumatic stress for former employees. The company is also treating workers in Iraq after bringing in Mr. Brand’s firm to determine the extent of problems.
Twenty-four percent of the Dyncorp police trainers showed symptoms of post-traumatic stress disorder after their deployment, Mr. Brand said. He and others said they knew of no other studies that formally assessed the problem among private workers in Iraq.
Those findings parallel an Army study earlier this year that about 17 percent of personnel in Army combat units in Iraq showed symptoms of P.T.S.D. one year after their deployment, said Dr. Charles W. Hoge, chief of psychiatry at the Army’s Walter Reed Institute for Research.
If marital problems, alcohol abuse and other adjustment problems are counted, the number rises to 30 percent to 35 percent, said Col. Elspeth C. Ritchie, a psychiatric consultant to the Army surgeon general.
The Chicago Sun-Times editorial board chimed in :
While getting help and benefits to war veterans suffering from post-traumatic stress disorder can still be hit or miss, the federal government has become more sensitive and responsive to vets suffering from this problem. Since PTSD entered the public consciousness during the Vietnam era, a diagnosis of it has been accepted as the basis of an indemnity claim by a returning soldier. Troops back from the war in Iraq, a psychological and emotional pressure cooker with its constant threat of suicide and roadside bombings, have access to a network of specialists to screen them for combat-related stress and assign them treatment.
But as reported in the New York Times, thousands of American contractors who worked in Iraq, often alongside troops and exposed to the same dangers, have a much more difficult time getting treated for the same disorders after they return home. With no access to the military or VA health system, in which returning soldiers are routinely screened for mental or stress problems, they have to cope with a civilian health system that lacks experience and expertise in this field. Left untreated, an increasing number of these workers have trouble coping. ...
With many people viewing companies like Halliburton as opportunists using clout to make quick money in Iraq, contractors there have to contend with an unsympathetic image. And some people consider the individuals working for the contractors to be hired guns, so to speak. Had the contractors and their employees been able to help rebuild the infrastructure of Baghdad and set up basic services -- impossible tasks in the absence of proper security -- their efforts in Iraq might have been viewed more favorably. Sympathetic or not, contractor employees are at great risk, doing the jobs they were hired to do, and deserve the same attention and treatment as returning soldiers. Their employers owe it to them to make that a reality -- and not ask the government for more money to get that job done.
If you'd like to dig into the contractor issue more deeply, check out Susie Dow's incredible writing at ePluribus Media and blogging at The Missing Man.
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2011: Jan