Caregiver Clips: Military Combat Trauma Counseling Statistics, November 2009

This month's clips cover the current state and strain of military mental health counseling in the wake of last week's Ft. Hood shooting. First, from Emily Mullin, Scripps News Service:

Questions are emerging about how a few hundred military mental health counselors are treating thousands and thousands of men and women in the armed forces in Afghanistan and Iraq.

According to official Army figures, 308 military psychiatrists serve 1.4 million active-duty members. On average, 200 behavioral-health personnel - including psychiatrists and other mental-health counselors - are deployed in Iraq and about 30 in Afghanistan.

Dr. Nancy Sherman, a military ethicist at Georgetown University, said the military and mental health care systems in general are "very stressed."

"We are a military fighting two wars at once with a non-drafted army," she said. Sherman said there has been a shortage of military doctors throughout the wars in Iraq and Afghanistan and likely a scarcity of military psychiatrists and therapists.

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

Mark Mueller, Star-Ledger:

Experts call it "compassion fatigue," "vicarious trauma" or "secondary trauma." By any name, it is a phenomenon that has gained wider attention in recent years. ...

[W]hile mental health workers are taught well how to care for others, "sometimes we’re not taught very well how to take care of ourselves in the process," [said George S. Everly Jr., an associate professor of psychiatry at the Johns Hopkins School of Public Health and a leading authority on stress and trauma].

"It is a problem that affects my industry," he said. "If there is a call to action, it is that we must take better care of ourselves. This takes a toll on you."

It’s been two decades since the American Psychiatric Association recognized vicarious trauma, but it has received little attention outside the field.

By empathizing with victims, by trying to picture and understand what they have gone through, caregivers sometimes feel as if they have experienced the trauma themselves, experts said. As a result, they may experience some of the same symptoms, including nightmares, panic attacks, depression and withdrawal from friends, relatives and colleagues.

In a study published two years ago, University of Georgia professor Brian Bride found that social workers who regularly work with victims of trauma are twice as likely to develop PTSD as members of the general population. Military spouses and nurses also are known to experience the problem, Bride said.

Gregg Jones and Lee Hancock, Dallas Morning News:

An acute shortage of trained mental health workers in the military has left these therapists emotionally drained and overworked, with limited time to prepare for their own war deployments.

A military mental health task force in 2007 expressed concern about the stress on nondeployed mental health personnel because of the shortage, which it said was leading to high attrition rates. "A vicious cycle has formed that will probably continue to worsen before it improves," the report said.

Dr. Layton McCurdy, a psychiatrist and dean emeritus at the Medical University of South Carolina who served on the task force, said the shortage is compounded by the thousands of troops suffering combat-related stress. "The psychiatrists are working with more people than they have time to work with," McCurdy said. ...

Secondary trauma causes similar symptoms [to PTSD]: sleep disruptions, nightmares, depression and jumpiness. Sufferers may avoid situations that remind them of past stresses. A mental health practitioner also may feel guilty about not having done more to help a patient or may obsess about individual patients – particularly those with whom they identify.

One noted study found that social workers who treated survivors, victims' families and first responders at the World Trade Center after 9/11 were most susceptible to secondary trauma if they lacked social support.

Doctors generally have relatively high suicide rates, with psychiatrists having the highest rates. Both male and female physicians are significantly more likely to commit suicide than the rest of the population, according to a 2004 article in the American Journal of Psychiatry. Among all physicians. Psychiatrists are considered to be at greatest risk for suicide, according to the 2007 version of Kaplan and Sadock's Synopsis of Psychiatry.

Secondary stress poses more potential risks for military personnel – especially psychiatrists, said the study's principal investigator, public health researcher Joseph Boscarino of the Geisinger Health System in Danville, Pa. ...

Many military professionals describe crushing schedules with 10 or more patients a day, most struggling with devastating trauma or mutilated bodies.

Benedict Carey and Damien Cave, New York Times:

The Army has added to their ranks in recent years, as the number of soldiers with the diagnosis of post-traumatic stress disorder climbed to 34,000. But the shooting has raised a pressing question: Who counsels the counselors? [Bret A. Moore, a former Army psychologist at Fort Hood] and other therapists who have worked in the military or for Veterans Affairs said that mental health evaluations of therapists themselves were nonexistent.

Military therapists face an added pressure: they can be overruled by commanders who need soldiers in the field. Since 2001, the military has deployed many soldiers with post-traumatic stress disorder or other ailments. The military has made big strides in taking mental health issues seriously, but "the focus in the military is readiness," said Charles Figley, a psychologist at Tulane University. "There is an inherent conflict that will always be there."

At Fort Hood, where traffic in and out of war zones is a constant, the work conditions were especially stressful, according to at least one report provided to the Army.

Dr. Stephen M. Stahl, a psychiatrist at the University of California at San Diego who worked on the report, said the base’s program for soldiers returning from Iraq and Afghanistan lacked the staff it needed. He said there were about 15 psychiatrists on staff, treating hundreds of inpatients and outpatients. Generally, the psychiatrists did not do therapy but prescribed medication.

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