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Monday, May 19, 2008

Attempts to Remove PTSD Stigma Gain Steam Under Secretary Gates

From the Billings Gazette:

Defense Secretary Robert Gates recently has been urging troops to seek treatment instead of trying to ignore the problem. "You're tough and you go into the hospital when you receive a physical wound," Gates said on a visit to a Texas Army post. "That doesn't mean you're weak in some way, and so why wouldn't you when you've received a psychological wound? It's the same difference. They're all wounded."

To make it easier for soldiers to seek treatment, Gates has announced a change on the application for a government security clearance that asks: In the last seven years, have you sought mental-health counseling? That question will no longer be asked. National Public Radio reported that studies show that the fear of losing a security clearance is one of the biggest reasons that combat veterans do not seek mental-health care. Under the new policy, applicants who seek mental-health treatment could still obtain clearances if the treatment was for problems stemming from service in a combat zone.

Earlier this month, the American Forces Press Service reported that Gates is willing to consider awarding Purple Heart medals to combat veterans suffering with PTSD.

John E. Fortunato, who runs the Recovery and Resilience Center at Fort Bliss, Texas, told reporters that awarding the Purple Heart to PTSD sufferers would go a long way toward chipping away at prejudices surrounding the disease. Because PTSD affects structures in the brain, it's a physical disorder, "no different from shrapnel," Fortunato said. "This is an injury."

In educational interest, article(s) quoted from extensively.

PBS' NewsHour coverage on this issue:

PBS NewsHour segment, Part 2:

Another related editorial in the Dallas Morning News:

A mental health crisis has been brewing for years in the U.S. military, despite commanders' best efforts to hide it. At long last, Pentagon leaders have begun speaking openly about post-traumatic stress disorder and encouraging troops to seek help.

As recently as last year, according to a Pentagon study, the prevailing mentality at U.S. bases was to deny PTSD's existence and even punish service members who sought help. The attitude was reminiscent of World War II, when Gen. George S. Patton slapped soldiers seeking help for "combat fatigue."

Troops say they fear losing promotions or security clearances if they mention PTSD. Many have suffered in silence, often with such tragic consequences as suicide, homicide or fits of violent rage. Attempted suicides among veterans now run about 1,000 a month, a grim statistic the Veterans Administration tried to keep secret until recently.

Studies indicate that a quarter to 38 percent of the 1.6 million who have served in Iraq and Afghanistan suffer serious mental health problems, but fewer than half are willing to seek help.

Defense Secretary Robert Gates and Adm. Michael Mullen, chairman of the Joint Chiefs of Staff, launched a campaign last week to change the military's outdated attitude. ... Adm. Mullen told reporters in Washington that "it's way past time" for the military to recognize the war's toll "inside our minds, as well as outside our bodies." But it's unrealistic to "expect a private or a specialist to be willing to seek counseling when his or her captain or colonel or general won't do it."

By ending its own state of denial, the Pentagon is taking a healthy first step toward ending PTSD's stigma and getting troops the treatment they deserve.

More on Gates' visit to Ft. Bliss' Recovery and Resilience Center and the questionnaire change from the American Forces Press Service:

Gates announced the new policy after touring the Restoration and Resilience Center that opened in July to treat combat veterans diagnosed with post-traumatic stress disorder. The center, part of Fort Bliss’ Beaumont Army Medical Center, uses treatments ranging from group and individual therapy to yoga, acupuncture, massage, chiropractic and hot-stone therapy. Its goal, officials at the experimental facility explained, is to help troops recover so they can stay in the Army.

Gates told reporters he had an “extraordinary experience” visiting the new center and seeing work under way to help soldiers deal with combat stress.

“They are doing some amazing things here in terms of helping soldiers who want to remain soldiers but who have been wounded with post-traumatic stress disorder,” he said. “It is a multi-month effort by a lot of caring people, and they are showing some real success in restoring these soldiers.”

Gates said he’ll take the idea of possibly replicating Fort Bliss’ prototype program to other posts. He also noted other techniques being developed in the combat theater to give troops additional tools to deal with the circumstances they face. “These are clearly worth additional attention as well,” he told reporters. Gates called additional resources and capabilities to treat troops dealing with PTSD just one aspect of a two-part effort.

“The second, and in some ways equally challenging, is to remove the stigma that is associated with PTSD and to encourage soldiers, sailors, Marines and airmen who encounter these problems to seek help,” he said.

But he acknowledged that not every soldier returning from Iraq and Afghanistan is getting the treatment they need. He cited an Army inspector general report’s findings that troops often forgo mental-health care because they’re concerned it could prevent them from getting a security clearance and potentially could damage their careers.

Gates cited “Question 21” on Standard Form 86, the government security-clearance form that specifically asks applicants whether they have ever received treatment for mental-health issues. The question asks if the person has consulted with a mental-health professional or other health-care provider during the past seven years about a mental-health related condition. Respondents who answer “yes” must provide dates of treatment and the provider’s name and address.

“For far too long and for far too many, this question has been an obstacle to care,” the secretary said. The Defense Department has been working with other agencies for eight months to strike a balance that enables troops to get the treatment they need and the intelligence community to get the information it needs, he said.

“It took longer than I would have hoped, but it is done,” Gates said. “Now it is clear to people who answer that question that they can answer ‘no’ if they have sought help to deal with their combat stress in general times.”

New language for “Question 21” asks if the person consulted with a health-care professional during the past seven years regarding an emotional or mental health condition. It specifies, however, that the answer should be “no” if the care was “strictly related to adjustments from service in a military combat environment.”

Gates directed in a policy letter dated April 18 that the revised language be used by anyone completing the SF 86 form. A letter being distributed throughout the military explains the new policy and its rationale.

“Seeking professional care for these mental health issues should not be perceived to jeopardize an individual’s security clearance,” states the memo, co-signed by Undersecretary for Intelligence James R. Clapper Jr. and Undersecretary for Personnel and Readiness David S.C. Chu.

“On the contrary,” they wrote, “failure to seek care actually increases the likelihood that psychological stress could escalate to a more serious mental condition, which could preclude an individual from performing sensitive duties.” The letter urges men and women in uniform who are exhibiting symptoms of PTSD to seek help and makes clear that this is not going to put their security clearances or their careers in jeopardy, he said.

“The most important thing for us now is to get the word out as far as we can to every man and woman in uniform to let them know about the change, to let them know the efforts under way, to remove the stigma and to encourage them to seek help when they are in the theater or when they return from the theater,” Gates said. “So this is a very important issue for us.

“We have no higher priority in the Department of Defense, apart from the war itself, than taking care of our men and women in uniform who have been wounded -- who have both visible and unseen wounds,” he said.

Gates called the new Restoration and Resilience Center an example of new approaches the military is taking to provide that care. “This center here is illustrative of what can be done,” he said. Thirty-six volunteers participating in the program, all diagnosed with PTSD after serving in Iraq or Afghanistan, receive care that combines group and individual therapy sessions with meditation, yoga, acupuncture, massage therapy, chiropractic and hot-stone therapy treatments.

Background on Purple Heart issue from Stars and Stripes:

The veterans group for combat wounded troops whose mission is to preserve the integrity of the Purple Heart has come out against giving the award to troops suffering from post-traumatic stress disorder.

"I don’t think people should get the Purple Heart for almost getting wounded," said Joe Palagyi, of the Military Order of the Purple Heart. PTSD does not merit the Purple Heart, according to an Army regulation that lays out the criteria for the award. Recently, a military psychologist at Fort Bliss, Texas, told reporters during a roundtable that making troops with PTSD eligible for the Purple Heart could help destigmatize the disorder.

"These guys have paid at least a high — as high a price, some of them — as anybody with a traumatic brain injury, as anybody with shrapnel wound, and what it does is it says this is the wound that isn’t worthy, and I say it is," said John E. Fortunato.

When asked about Fortunato’s suggestion later, Defense Secretary Robert Gates called it an "interesting idea," adding the matter is "clearly something that needs to be looked into." But Palagyi, who was awarded the Purple Heart for service in Vietnam, said PTSD does not meet the standards for the award, the forerunner of which was established by Gen. George Washington.

"The Purple Heart was set up for combat wounds, for those who have shed blood, and I believe that although PTSD is a physical disease and is an injury ... [it] does not qualify for the merit of Purple Heart based on that," he said Tuesday.

Injuries that merit the Purple Heart must happen in a combat theater and must be a direct result of enemy action, said Jack Leonard, also of the Military Order of the Purple Heart. The group’s concern about PTSD is that it can be caused by other factors, not necessarily the enemy.

A brief collection of "person on the street" comments on the Purple Heart/PTSD issue from WMAL News:

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