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Tuesday, March 27, 2007

Military Funding, Mental Health Provider Shortfalls Causing Long-Term Morale Problems

From the Associated Press:

The Army's new acting surgeon general said Tuesday she is concerned about long-term morale because the military lacks money to hire enough nurses and mental health specialists to treat thousands of troops coming home from Iraq and Afghanistan.

"When the original plans were made, we did not take into consideration we could be in a long war," said Maj. Gen. Gale Pollock. She became surgeon general earlier this month after Kevin Kiley was forced to resign in a scandal over poor treatment of war-wounded at Walter Reed Army Medical Center. "We have not been able to do the hiring," Pollock told a House Armed Services subcommittee.

She testified at the first of two congressional hearings Tuesday on veterans care during which lawmakers expressed impatience with the Bush administration's efforts. They said years of communication gaps between the Defense and Veterans Affairs departments have yet to be fixed.

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Pollack is not the first military official to sound such an alarm.

In January, Navy Cmdr. Mark Russell warned that the military lacks enough mental health care providers to treat combat forces serving in Iraq and Afghanistan. He's been speaking out for three years of the coming mental healthcare crunch.

Low morale rate -- called 'compassion fatigue' or 'provider fatigue' by the Army -- isn't a problem we'll have to tackle in the future. It already exists today. In a recent internal military survey, "33 percent of behavioral-health personnel (counselors and psychiatrists) and 45 percent of primary-care specialists (doctors and nurses) complained of high or very high burnout."

First, a few stats that came out of testimony given to a recent Pentagon Task Force on Mental Health hearing:

Mental health trauma is on the rise. Army studies show that more than a third of combat-deployed troops seek mental health care when they return home.

Training for mental health professionals is inadequate. A survey by Russell of 133 military mental health providers done from 2003-05 shows that 90% of the psychiatrists, psychologists and social workers reported no formal training or supervision in four PTSD therapies recommended by the Pentagon and Department of Veterans Affairs.

Staffing is down. Russell says vacancies remain for mental health providers in the Navy. In addition, psychiatrists and psychologists deployed overseas deplete resources at home, and burnout makes it hard to keep skilled therapists on staff, he says. His concerns were supported by a 2005 Army study showing one of three mental health providers deployed in the war zone report high burnout or low motivation or morale.

The Navy has 72% of the psychologists and 62% of the psychiatrists it needs, although trainees will raise staffing levels to 85% for psychologists and 91% for psychiatrists.

Army staffing levels for uniformed psychiatrists and psychologist are at 80%-85%, but the Army has contracted with large numbers of civilian mental health officials to help in assisting soldiers.

Two weeks ago, medical providers at Bethesda Naval Medical Center testified to a Pentagon review group formed by Defense Secretary Robert Gates in the wake of the Walter Reed scandal:

Lt. Cmdr. Brandt E. Rice, a family medicine practitioner at the naval hospital, testified that doctors are saddled with too many administrative duties, lack enough time to devote to patients and face bureaucratic hassles. "My vocalness about this need has been met by some degree of resistance and also retaliation," Rice said.

Ursula Henry, a former Navy worker at the hospital, said some staff members have been "so frustrated with the whole scenario that they left to go across the street" to work at the National Institutes of Health.

Of course, compassion fatigue is hardly limited to military mental health providers; caregivers in the wake of Hurricane Katrina were also found to suffer from it. Even the general public was said to have suffered from compassion fatigue following successive natural disasters: the Asian tsunami, the Kashmir earthquake.

So, what is compassion fatigue? From Military OneSource:

"Compassion fatigue" is a fairly new term that describes certain emotions and behavior that people, often clinicians such as psychologists and therapists, sometimes experience as the result of hearing about and knowing about the traumatic experiences of others. It is part of the "secondary post-traumatic stress" family of responses that people may have when they help trauma victims. The symptoms, which are similar to the symptoms of post-traumatic stress, can interfere -- sometimes profoundly -- with a person's personal and work life. Compassion fatigue has also been described as "vicarious traumatization."

Signs of possible compassion fatigue include nervousness and anxiety, irritability and anger, moodswings, flashbacks, difficulty concentrating, lowered self-esteem, feeling less trusting of others and the world, withdrawing, changes in appetite or sleep habits, physical changes and/or depression.

Advice for those dealing with compassion fatigue:

  • Get support from people you love and trust.
  • Participate in debriefing sessions specifically for clinicians.
  • Try not to compare yourself with others.
  • Set more boundaries during this stressful time.
  • Avoid using alcohol or nonprescription drugs to handle your emotions or to relax.
  • Take care of yourself.
  • Crisis management may not be your primary area of expertise.
  • Limit your news coverage.
  • Exercise.
  • Practice deep breathing.
  • Try to make your office area as comfortable and soothing as possible.
  • Write down your feelings.
  • Consider joining a support group.
  • Balance objectivity and empathy.
  • Give yourself time.
  • Know and honor your own limitations.
  • Remember to focus on the powerful impact you're having on the people you're helping.
  • Seek professional help if you are not yourself.

Read the full description of above tips, available either online or via downloadable PDF.

You can find more tips in the Army's Battlemind brochure, 12 Tough Facts for Army Helping Professionals [downloadable PDF]. And to gauge your own stress level, the Compassion Satisfaction and Fatigue (CSF) Test is one handy tool you can use.

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