MILITARY MENTAL HEALTH and CONTRACTED CARE

Military Mental Health and Contracted Care
One Woman’s Opinion
  By – Sheri de Grom

 Contractors are known for hiring mental health counselors, social workers, psychologists, and psychiatrists that have no previous relationship or experience with military culture. Mental health professionals are hired by contractors for the lowest pay possible and, more often than not, the mission is quantity not quality. They are told to see the client and get them out the door. Saving money is the name of the game.

The Armed Forces has reached critical mass in the need for mental healthcare providers. The results of being at war for over a decade are staggering. The ruination of multi-generational military families has become an everyday occurrence.

The divorce rate for military families has risen to forty-two percent and suicides now outnumber combat casualties. Child abuse and sexual abuse are being reported at alarming numbers. The Marines have instituted a twice-yearly unannounced alcohol breathalyzer test along with the standard drug tests due to the unusually high number of on-the-job impaired Marines. Substance abuse is at an all time high in all military branches and is catastrophic among newly-discharged veterans. Substance abuse is also common among family members.

Add Post Traumatic Stress Syndrome (PTSD) at the rate of eleven to twenty percent of all veterans of Iraq and Afghanistan, ten percent of Gulf War veterans, and thirty percent of Vietnam War veterans and the need for mental healthcare grows exponentially.

More than 244,000 US troops have been diagnosed with Traumatic Brain Injury (TBI) over the past twelve years, according to Pentagon statistics.

A therapist or psychiatrist may not consider that their client is living in a different cultural environment than one they themselves have ever experienced or studied. Learning the language of the military can be baffling and, if a therapist is expected to provide services for more than one branch of the service, the culture changes accordingly.

A common mistake counselors make when working with military service members is not taking the time to learn basic information such as rank structure and the differences between military branches. The military client will not expect a nonmilitary counselor to know everything about the military lifestyle, but it can quickly become a distraction and an annoyance if the client has to stop regularly to answer a counselor’s questions about the military, clarify a word or phrase, or address the confusion written across the counselor’s face.

By the time a military client reaches a mental healthcare provider, he may have withdrawn into himself so far it’s difficult for the client to communicate or trust anyone. At the other extreme, if the client is angry, he may be ready to explode and has had no one to talk with about a situation that’s intolerable. The mental healthcare provider doesn’t have time to play catch-up about his client’s environment. A basic understanding must already be present.

Often a soldier or civilian has spent years holding his emotions close. This is seen as having composure or being stoic within the military environment while the counselor may interpret the individual’s behavior as robotic or cold.

Of particular concern to the active duty military member or civilian employee is that privacy of the medical record doesn’t really exist, despite the fact that the medical profession insists medical files are protected and information is only provided on a need-to-know basis.

It’s a sad reality that a service member’s or civilian’s supervisor or leadership may see the mental healthcare record (especially diagnosis) as a weakness or even use this information against the service member or civilian.

If the family member is fortunate enough to stay in one location for a length of time, it’s still unlikely they’ll have care beyond the band-aid approach. There are too many clients waiting for treatment. Pills are used instead of therapy.

The existing lack of communication that arrives with contracted care for active duty, veterans, and their family members has made the current state of all healthcare a disjointed and frustrating exercise. Add in a lack of understanding of the military culture and even the best provider can easily damage patient rapport, limit the quality of care and even misdiagnose.      

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About Sheri de Grom

Retired Fed/JAG, 5 yrs. on Capitol Hill. Former book buyer for B and N. Concerned citizen of military drawdown. Currently involved in mental healthcare reform, health care strategist and actively pursuing legislative change wherein dual retirees are exempt from enrolling in Medicare at their own discretion without losing tertiary healthcare benefits. Monitor and comment on Federal Register proposed legislation involving Mental Health, Veterans Affairs, Health and Human Services, Medicare and rural libraries. Licensed OSHA Inspector to include Super Fund sites. Full time caregive to Vietnam era veteran. Conceptualized, investigated possible alternatives, authored, lobbied for, and successfully implemented Title X, Section 1095 (known as the Third Party Collection Program of Federal Insurance).
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16 Responses to MILITARY MENTAL HEALTH and CONTRACTED CARE

  1. iamforchange says:

    An intriguing and insightful post. It is a rather unique coincidence that at the moment I am remodeling a VA Hospital Mental facility. I have observed over the last few years the amount of contracted doctors and specialists. I am no politician or business owner yet the reason is obvious as to why these positions are contracted out. Money! Our tax payer dollars are delegated in such a way that the cost of hiring a full time staff of qualified doctors and specialists would put a drain on already stretched resources. That said it seems that as a governing body the tough choices to be made financially while appeasing the public by cutting government jobs is somewhat tying the hands of Hospital administrators forcing them to hire contractors. Even the housekeeping in most VA facilities that for the most part provides employment for veterans many disabled is in the process of being contracted out. I am a peace time veteran so the effects of war for me are purely vicariously lived through the stories shared mostly by vets in the drug and alcohol rehab programs. It is not always a bad thing when we contract out certain tasks yet one would wonder why such an important thing as mental health would be handled in such a way. Thank you for sharing your post and your heart in doing so, it is an honor to read such a post. Thank you!

    • Thank you for your thoughtful response. You are so right – it’s all about the money. It’s much cheaper to pay one contractor than to hire employees for the VA or any health clinic for that matter. Additionally, when the contract is up for renewal, we’ll go with the lowest bidder and the military members, veterans, and their families will be the ones to suffer again. There’s precious little continuum of care presently and each time staff turns over, the cycle begins all over again. The hopelessness that prevails within military mental health will continue until Congress recognizes that one size does not fit everyone.

  2. Sheri, I’m glad you separated the numbers and approach regarding those vets who served during the Vietnam War. I feel for all our servicemen and the care they should be receiving. Poor to dismal is what comes to mind … but the general feeling of hostility regarding those men and women who served in Vietnam was potent then and stinks now. We have never given them … not before, during or after much more than a wall of granite and lip service. You know this is something that I feel very strongly about. In general, the government really wishes our injured and damaged soldiers from all wars would simply fade away. As long as their are those few like you who work towards decent health and mental care … there is always a glimmer of hope for those who continue to suffer. Thanks for caring 🙂

    • Florence – It’s our duty to care for the men and women that fight for our freedom each and every day. I’ll never once understand why we’ve entered into so many of the wars that we have but that doesn’t offer up an excuse for not taking care of veterans when they come home and need our help. I’m heavily invested in the Vietnam era veteran and will not give up advocating for them or any veteran while I still have the ability to speak or get attention in DC. The contracted mental health workers are making a larger salary than mental health professionals employed by civil service, yet the contracted workers have no loyalty to the military, their families or veterans they serve. Contracted health care is one of the biggest frauds in US accounting abuse.

  3. Your blog is, as always, thoughtful, thought-provoking and, in this case, very, very disturbing. When I think of the hundreds of thousands of military who have mental health issues and/or TBIs and extrapolate that to their spouses, children and parents the numbers are staggering. The social and economic costs are huge for a country that is already struggling to retain its global leadership role. Your passionate advocacy is so needed, Sheri.

    • Mary – Thanks for your support on this critical issue. Recently I visited what the military is calling a ‘Same Day Mental Health Clinic’ to gather information for advocacy work I was preparing. One of the staff psychiatrist made the comment to me that the clinic was not a ‘Same Day Clinic’ but more a ‘One Year Clinic.’ What I discovered that day, the active duty military were being given appointment slips for approximately nine months from the date they initially visited the clinic with an emergency (suicide ideology was at the top of the list). It baffles me that we can turn an individual away when they state they are suicidal and that they have a plan. Those standards meet all guidelines for automatic admission and for a full psych workup. Further, the individual soldiers will more than likely be deployed again before their appointment time ever rolls around. It is a tragedy.

  4. Denise Hisey says:

    Mental Health needs to get the same attention so many other “diseases” and conditions have. It is an epidemic!

    • Denise – You are so right about mental health needing to get the same attention as all other diseases. As long as any health care is contracted out, it will never be treated with the same due diligence as a health care provider that is part of the internal team. The military finds it far easier to contract out mental health care for a sum certain than to hire competent mental health workers for the population that needs their service.

  5. Oh, this is so sad, Sheri. And how can it change? I would imagine it would have to happen by having top officials getting involved or perhaps laws being passed? To think of the thousands of people struggling with their lives, living unhappily and having drugs shoved at them as a cure. Oh my goodness.

    • Patti – The screening process for mental health professionals working with the military must include a component on understanding of the military environment. Think of how little I would know about taking care of your horse, although I love animals. I don’t have the background about the special breed although I grew up on a working ranch and around horses until I left home. I believe this analogy is true for people. We can be with individuals on a daily basis but if we don’t know the environment they interact in on a daily basis, we can’t truly know how to help them in a crisis. I don’t think you would leave your horse with a contractor to care for him and military health care is far too important to be contracted out. The employees have to satisfy the contractor and not the patient.

  6. Wow, the ONLY good news in there is how the divorce rate among military people is lower than among the rest of America…but that’s a pretty small bit of light in a dark situation, drat it. 😦

    • Hi Laurie – I know, the overall numbers are staggering. The divorce rate for active duty military used to hover in the twenty percentile range and then we hit the multiple deployments and families were torn apart by the repeated separations, additional financial hardships caused by the deployments, family members taking on new roles that were constantly shifting, and the list goes on. Many families have hit the poverty level and this rarely happened before in military history. We were always able to take care of our own. The strong are now barely able to take care of themselves, let alone someone else.

  7. Hello Len – It’s a tragedy when mental health professionals find it impossible to communicate with our veterans. None of our veterans ‘should’ be disrespected but for whatever reason, our Vietnam vets are the individuals that get the blunt end of the stick. There’s a ‘blanket thought’ by many in the health profession that all Vietnam veterans have substance abuse problems and we know that’s simply not true. An interesting statistic that’s now showing up is that veterans of the Vietnam era that came home and were able to get on with their lives and became workaholics are now retiring. Because of their retiring and not having the workaholism to drown themselves in, their PTSD is rising to the surface for the first time. They have more time to think and reflect. It’s an unfortunate situation. We are now seeing more suicides in this age group of veterans as well. The numbers are hard to track as most of them have always used private pay insurance. Now that they are turning 65 they are eligible for Medicare and the VA has started telling veterans that are eligible for Medicare to go to the ‘outside’ for care. Of course, there’s no place for the veteran to get mental health care on the ‘outside’ when it’s combat related. Many are caught in a catch-22 situation. Most of the veterans served less than 20 years and are not eligible for Tricare.

  8. Jane Sadek says:

    Well said! I agree with you 100%.

  9. My brother a disabled vet of ‘nam, has been required to see a mental health professional for the last five years , it was due to his contracting a terminal disease which ended up being a wrong diagnoses, thank you Lord.. Anyway, the dr kept accusing my brother of being in denial of his alcoholism and they nearly came to blows several times as my brother WAS denying it..our father died from the disease and as kids we suffered the results of many in our family and the results of their drinking. consequently none of has ever drank much if at all, my brother hasn’t in over 30 yrs. but this dr insisted he did. It was a horrible mess I certaintly see and agree with your point in this post!

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