Military Mental Health

"I'm all over it, because I'm looking for something to help," declared Army Vice-Chief of Staff General Peter W. Chiarelli, quoted in USA Today News September 20, in his response to a study finding an increased risk of suicide in US military personnel with low Omega-3 fatty acid serum levels.

Depression, PTSD, panic disorder, and abuse of alcohol and drugs are more insidious, quieter forms of illness that can cause the same desperation and disability as psychotic disorders.

In 2009, Maj Matthew P. Houseal, a psychiatrist, was in Iraq attempting to help suicidal soldiers when a fellow soldier killed him, a clinical social worker and 3 others at a combat stress center near Bagdad. Paradoxically, Houseal’s accused killer, US Army Sgt John Russell, had earlier threatened to take his own life, according to witnesses’ testimony during a recent investigative Article 32 hearing.

What part do mental health professionals play in the lives of veterans?

President Obama announced that he would begin sending letters of condolence to the families of troops who kill themselves in combat zones. He noted that this was a decision that was made after a difficult and exhaustive review of the former policy.

Although we would all like to believe otherwise, war is not over when a service member returns home. For many, returning home may be where the harder battles begin. Intensive training prepares troops for warfare, but what training do they have to readjust when they return home?

The VA provides the largest network of care facilities in the world, specifically aimed at our nation’s veterans. The DoD is another large provider of resources for this cohort. Military One Source offers 24/7 assistance for troops, families, and veterans.

Members of the military returning from combat operations have high rates of substance abuse. They also often exhibit a co-occurring triad of posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), and pain, which complicates the problems with substance abuse.

The suicide rate in the US military has steadily climbed over the past 5 to 7 years despite aggressive efforts by the military and the mental health community to counter this trend.

This article addresses the epidemiology, diagnosis, and treatment of mild TBI among combat veterans, with a particular focus on blast injury and the presence of comorbid posttraumatic stress disorder (PTSD).

Most military families successfully adapt to a service member's deployments for military duties. Nevertheless, almost a decade of wartime stress associated with the current wars in Iraq and Afghanistan has presented unprecedented challenges for military families.

This Special Report aims to address those symptoms and syndromes most commonly seen by clinicians who treat service members. The 5 articles of the Special Report cover the most challenging aspects of their care, and the authors hope to expand the reader’s understanding of the recent conflicts’ tragic consequences.

The New York Times of February 14 carries the disturbing news of an alarming increase in deaths from accidental overdose among our active duty military personnel and our war veterans.

Dr Stone's vivid description of the military's abusive use of ECT 50 years ago -- while compelling to read from an historical perspective -- should in no way be confused with ECT today.

The latest information released by the US Army reveals that last year American soldiers attempted suicide at the rate of about 5 /day. There were 160 successful suicides last year and during June the rate was 1/day. Military research has reported that one in 10 Iraq veterans may develop a severe case of PTSD.

The subject of physician participation in interrogations continues to surface as an issue of debate.

The subject of physician participation in interrogations (either military or law enforcement related) continues to surface as an issue of debate. Why? Allow me to state what I believe undergirds most debates on this issue: terror. No, not terrorism per se, but terror of death.

While the Army considers what, if any, disciplinary actions to take against those who directed the medical training of MAJ Nidal Hasan-the accused Fort Hood shooter-one psychiatrist’s legal counsel faults the military for blaming a handful of officers for a broader institutional failing.

I can almost hear Albert Ellis saying “Amen” to the data I am about to share. To explain his reaction, I have to talk about war.

Army personnel responsible for supervising the Army psychiatrist now accused of the November 5, 2009 shooting rampage at Fort Hood, Tex, may find themselves accused of failing to follow Army policies and regulations and taking appropriate actions.

When a soldier is killed while in the military service the President writes a condolence letter to the family. However, if a soldier is psychologically injured and then commits suicide, there is no Presidential letter of condolence.

The details may, by now, be familiar but they are no less shocking: Army psychiatrist, MAJ Nidal Malik Hasan, MD, accused of killing 13 people and wounding 33 others-including fellow behavioral health providers- is recovering from gunshot wounds and meeting with his attorneys.

Virtual reality (VR)-facilitated exposure therapy for posttraumatic stress disorder (PTSD), recently evaluated under combat conditions in Iraq, appears to be safe and effective, according to LCDR Robert McLay, research director for mental health with the US Naval Medical Center San Diego (NMCSD). Speaking at the 17th Annual Medicine Meets Virtual Reality (MMVR-17) Conference in Long Beach, Calif, McLay said that military providers need to make PTSD treatments available in such military theaters as Iraq and Afghanistan, as well as stateside. (McLay was speaking as an individual, not as a US Navy or Department of Defense representative.)

The following medical and behavioral health providers were killed or wounded during the November 5 Fort Hood shooting rampage that left 13 dead and 29 wounded.

Some would ask whether the psychiatric system at Ft. Hood adequately assessed the mental state of Army Maj Nidal Malik Hasan, the man accused of yesterday's shooting rampage on the base.

A 43-year-old woman presented to the ED at 5:30 am on a weekday. While being triaged, she indicated she was hesitant to speak with anyone. The patient reported to the consulting psychologist that she had been deployed to Iraq as reservist nurse 2 years earlier. During that time, an unknown assailant whom she believed to be an Iraqi national working with military security forces sexually assaulted her. The veteran confided that she had been too embarrassed and ashamed to report the assault.

A 24-year-old veteran of Operation Iraqi Freedom (OIF) presents to the ED mid-morning on a weekday. While the veteran is waiting to be triaged, other patients alert staff that he appears to be talking to himself and pacing around the waiting room. A nurse tries to escort the veteran to an ED examination room. Multiple attempts by the ED staff and hospital police-several of whom are themselves OIF veterans-are unsuccessful in calming the patient or persuading him to enter a room.

A 29-year-old veteran came to the ED complaining of headaches and uncontrolled pain in his upper quadrant. He had been discharged from the military after he sustained a blast injury during duty as a Marine in Iraq. His right arm had been amputated.

Alarmed by the rising suicide rate among soldiers returning from Iraq and Afghanistan and “wanting to help,” Matthew “Matt” Houseal, MD, a psychiatrist with the Texas Panhandle Mental Health Mental Retardation Center (TPMHMR), reenlisted as an Army Reservist and volunteered to serve in Iraq.

An array of military-related presentations were given at this year’s American Psychiatric Association (APA) conference, addressing the rise of psychiatric issues in returning veterans and their families.