Military trying to get mental health care right
Published by Florida Times-Union on June 5, 2009.
Mike Murray got back to Mayport Naval Station from Afghanistan eight months ago, but his experiences there haven't faded.
"I haven't had a good night's sleep once since I've gotten home, " said the petty officer first class who spent a year in Kabul helping the Afghan air force.
Murray volunteered for the assignment as an individual augmentee, the Navy's term - commonly abbreviated IA - for a sailor sent to serve with the nation's ground forces. The job was fun, he said, but there was the constant sound of rocket-propelled grenades hitting the NATO base where he worked and regular high-pitched explosions. Such things have a far-reaching impact.
"You become numb to it, " he said. "You get used to throwing on your body armor, to throwing your flight suit on over your pajamas."
When he came home, he had trouble even driving, the result of leading around two or three dozen convoys through the crowded streets of Kabul.
"The first time I drove by myself [at home], I had to pull over twice because of anxiety, " he said. "I would pull up to crowded stoplights, and instinct and urge would make me want to drive around the cars and through the intersection. We never stopped with convoys."
The long-lasting aftershocks of his experiences aren't unusual.
"We're not equipped to go and see that stuff and then come home and drop it, " said Marianne Chapman, a mental health counselor who has spent much of her career working with the military in Jacksonville and Miami. "What they need to recognize is they're having a completely normal reaction to an abnormal situation."
That's a message the military has been pushing hard as it fights to preserve the mental health of its warriors. The cost of losing that battle was shown a few weeks ago when a soldier in Iraq who had been sent for counseling grabbed a gun and shot five fellow troops, including a Navy officer working at the mental health clinic there.
The totality of the military, particularly the Army, is struggling with rising rates of post-traumatic stress disorder and issues stemming from traumatic brain injury. It's a situation that has been worsening for years as more soldiers experience more - and more close-quarters - combat.
Studies have shown that a quarter or more of returning troops had some sort of mental health issue, particularly post-traumatic stress disorder, substance abuse and depression.
The problem often spikes six months or so after the service member returns, when the initial relief at being home subsides.
To be clear, dealing with combat-related trauma doesn't mean a service member suffers from debilitating, or even visible, symptoms. While some, due to either physical injury or mental trauma, do end up catatonic, suicidal or dangerously violent, the majority deal with less severe issues: trouble sleeping, feelings of anger, impatience, alcohol abuse.
"I cannot imagine anyone escaping combat unscathed, but there are varying degrees, " Chapman said.
The situation is worsened for front-line troops and those who return to the war zone multiple times. Army researchers estimate about 60 percent of a typical unit going to Iraq has deployed before.
"All Army leaders recognize at every level that repeated deployments are difficult for our soldiers, " said Lt. Gen. Eric Schoomaker, commander of the Army Medical Command.
A different kind of fighter
The situation facing those providing help in Jacksonville comes with an additional twist.
Most of those who return to the area after spending time at war stand apart from the typical fighter who deals with the issues as part of a regular unit. Here, they're often IA's - sailors plucked from their ship or squadron and sent to the front lines.
They're National Guardsmen, deployed as a unit, but split up upon their return.
"I think the hardest part about being in the Guard is that there is no central support structure, " said Capt. Brian Wilkins of the Jacksonville-based 146th Expeditionary Signal Battalion, which is stationed in Iraq. "At least when you are on active duty and based out of a particular location, your family can meet with other families who are going through the exact same thing."
The Guard does a good job of reaching out, said Wilkins, who lives in Rockledge, "but it is impossible to capture every piece of Florida."
The Navy is dealing with its own version of that issue, trying to help individual augmentees. Rather than dealing with a shipload of sailors returning as a group from deployment, the Navy is working one-by-one.
"Isolation is a big problem, " said Lisa Whitaker, a counselor at Mayport. "They don't have the same sort of command support."
To help with that, the Navy centralized last year how it deals with IA's. Fleet Forces Command took over responsibility for sailors and their families during the deployment, communicating through Twitter (Navy_IA) and Facebook as well as having staff members tasked as a point of contact.
For mental health issues, the Navy has required pre- and post-deployment counseling.
"We've focused recently on making sure IA's get proper training in stress control before they go into theater, " said Alfred Gonzalez, who heads personnel development and allocation at Fleet Forces Command. "Our interest in keeping our sailors healthy has always been there."
Such deployments can be hard because it's so different from the typical experience.
"They're used to being on a ship, which is a whole different level of stress, " Whitaker said.
For Murray, the job in Afghanistan was similar to what he's done for the 15 years he's been in the military, spending his days working on a flight line.
"It was something I wanted to do, " he said. "I'd been watching the war on TV the whole time."
Similarly, Petty Officer 1st Class Nicholas Schaaf raised his hand when his command was asked to supply a helicopter mechanic to work with special operations teams in Iraq. Spending time with the service members from other branches was instructive, he said.
"In a way, I think it helps everyone understand what other services do, " he said.
Both men said they would return to the war zone if needed, although with Murray a single parent and Schaaf recently married, it wouldn't be either of their first choices.
"If I was needed, I would go, " Murray said. "I'm a serviceman. That's what I do. I enlisted in the military knowing I could be put in harm's way."
Removing the stigma
Returning from any deployment is difficult, Whitaker said, as the sailor works to fit back into a family that is readjusting to having the service member back home. Intimacy issues, marital problems, parenting stress build on the issues stemming from the war.
"Once removed from combat, that stress doesn't just go away, " she said.
Throughout the services, the goal has been to remove the stigma of seeking help, particularly those dealing with minor symptoms that could turn into more serious problems.
The message is that mental health issues are no different from physical ones, said Brig. Gen. Loree Sutton, director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.
"You're tough, and you go into the hospital when you receive a physical wound, " he said. "That doesn't mean you're weak in some way. So why wouldn't you seek treatment when you've received a psychological wound?"
It's an idea that appears to be gaining some traction.
When Murray returned from Afghanistan, for instance, he said he had no problem talking through the issues he was dealing with.
"The first week back, I went in and talked to the chaplain, " Murray said. "Am I going crazy? No. I've talked to people I went over with and they're going through the same thing."
Whitaker is seeing an increased number of individual augmentees come to her office.
"They're a lot more willing, " she said. "In the past, coming to therapy would be punished."
Now, seeing a therapist isn't reported to the sailor's command. Although if the situation escalates - the sailor is prescribed drugs, for instance, or the counselor thinks he's a danger to himself or others - it would be.
The key, said Staff Sgt. Brent Brown with the 146th ESB, is for troops to avail themselves of the resources that are available.
"Right now, the military as a whole is really focused on stress and suicide as well as PTSD [post-traumatic stress disorder], " he said. "They offer a lot of different programs to help. You just have to go or let a buddy know you need help."