Hardened Army Stigmas Shifting to Accommodate PTSD, Health Official Says

Army efforts to appraise mental health complicated by security clearance issues.

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More than a decade of war has forced the Army to heed the dangers of mental instability more than ever before, an official with the Army Surgeon General's office says.

A newfound understanding of the lasting and serious effects of combat-induced conditions such as PTSD has caused commanders to take pause in recent years, says Army Col. Rebecca Porter, chief of the Surgeon General's Behavioral Health Division. These commanders are now heeding advice from professionals such as Porter who weigh in on decisions to send mentally injured troops back in to harm's way, she says.

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"I've had commanders say, 'Thank you for your input,' and take the soldier anyway," Porter said at a breakfast meeting with reporters on Tuesday. She recounted an instance 16 years ago when a commander ignored her advice and deployed a soldier suffering from PTSD, only to return her home after seeing her relapse on deployment.

"Today I think if I made the same recommendation to a commander, I think they would heed the behavioral health professional's input a lot more than they did 16 or 17 years ago," she said. "I don't feel the same kind of pressure from commanders to get soldiers back into the fight if their mental health is at risk."

The military has no firm policy toward redeploying someone diagnosed with behavioral issues. Traumatized individuals or those with PTSD are much more vulnerable than those who are mentally healthy, Porter said.

"If I were a behavioral health professional who was treating somebody, I would think long and hard before making that recommendation to allow them to deploy again," she added.

Porter credits an experimental military unit with much of the success in changing military stigmas toward mental health. The 4th Brigade Combat Team of the 4th Infantry Division, based at Fort Carson, Colo., was in 2009 the first unit to include an Embedded Behavioral Health Team, which consists of two behavioral health providers and two technicians.

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These specialists working closely within a combat unit allowed commanders to better understand and trust their recommendations, Porter says. The military has expanded the program and these units are currently forward deployed to Afghanistan, working with Combat Stress Control Teams that operate in a specific area. But behavioral health still faces many challenges in the military. On the near horizon, Porter said she is concerned about the effects of sequestration on her staff. More than half of the roughly 400 behavioral health staffers are contractors or civilians, who would be subject to as many as 22 days of furloughs before September. Roughly 60 percent of all of the Army's healthcare force are civilians, Porter said.

Mental Health Advisory Teams have also faced difficulties conducting their work of deploying to war zones to study the status of mental health among troops, she said. MHAT reports, such as this one from 2011, documents "significant decline" in individual moral and "significantly higher" rates of acute stress.

MHAT teams had "some difficulties coordinating permission to get into theater to do the evaluations," Porter said, who traced these difficulties to theater commanders.

When asked by E-mail which theater commanders had impeded MHAT's efforts, a spokesman responded with this written statement from Porter, clarifying earlier remarks:

"When asked about why the MHATs do not appear to be happening annually any longer, I said that there had been some delay in a recent MHAT team going into theater because of difficulties coordinating for permission with command. This is not to imply an intent to keep the teams out, but simply to point out that there are many issues that go into a team receiving clearance to go into theatre. It's a complicated process. There could be security and safety issues of which we're not aware, to name a couple of examples."

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