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US unprepared for military mental-health caseload, senator says

WASHINGTON — The Army’s mental health caseload has doubled since 2007, and Sen. Dick Durbin says the United States is not “up to that challenge” that “may be with us for some time.”

“What we are learning,” the Illinois Democrat said in an interview, “is that the cost of war goes way beyond the end of conflict.”

The mass shooting at Fort Hood in Texas this month, in which Army Spc. Ivan Lopez killed three fellow soldiers and wounded 16 others before taking his own life, brought back into focus the mental health strains on soldiers, sailors and Marines in the wars in Iraq and Afghanistan. Lopez had served in Iraq and had sought treatment for post-traumatic stress, the base commander told reporters.

Lopez’s attack came less than five years after Major Nidal Malik Hasan killed 13 and wounded 32 in a 2009 rampage at the same military installation. He has been sentenced to death.

Congress and the Pentagon have been struggling to provide resources and focus to address the problem of mental health among military veterans. Army spending on mental health has gone from $322.6 million in fiscal year 2013 to $358.4 million in the current year, with just under $375 million requested for next year.

Although Durbin said “we may never know” what provoked Lopez to turn his gun on fellow soldiers, the shock is especially deep because improved prevention and treatment programs at Fort Hood had given the base one of the best reputations on mental health treatment in the military.

“It was considered one of the leaders when it came to providing this kind of counseling, and unfortunately, even its resources couldn’t stop this tragedy,” Durbin said.

Even before this latest Fort Hood shooting, Congress was trying to confront expanding needs in civilian mental health care, prompted in part by a mass shooting at Sandy Hook Elementary School in Newtown, Conn., in 2012, in which 20 children and six adults died.

Congress approved this month and President Barack Obama signed into law a pilot program pushed by Sen. Roy Blunt, R-Mo., that will make federal funds available to states willing to expand mental health services at clinics. It also encourages treatment of mental health in tandem with physical health. Eight states will test the program, and Blunt said that Missouri could be one of them.

“This is a huge step in the right direction because it does begin to talk about the totality of health as opposed to mental health as somehow a different topic,” Blunt said. He said experts have told him that 1 in 4 Americans has some form of mental health issues.

At a Senate Appropriations Committee hearing on Pentagon health programs, Army Surgeon General Patricia Horoho told Blunt that that she thinks the same estimate applies to members of the military.

George W. Bush’s presidency was framed by the wars in Iraq in Afghanistan. In part, Obama’s has been framed by their aftermath. For the second time in his presidency, Obama last week addressed grieving families of Fort Hood soldiers who had been killed by a fellow soldier.

“As commander in chief, I’m determined we will continue to step up our efforts to reach our troops and veterans who are hurting, to deliver to them the care that they need and to make sure we never stigmatize those that have the courage to seek help,” Obama said.

But there are steep trend lines on meeting those challenges. Demands for mental health services have risen as the stigma of post-battle stress diminishes. Part of the problem, mental health experts say, is there is a national shortage of psychiatrists.

The Army thought it was making progress in dealing with its rising caseload before the new round of horrific headlines came out of Fort Hood.

Horoho said in a Senate appropriations subcommittee hearing that although the number of “behavioral health care” encounters between Army personnel or their families and mental health doctors and other professionals rose from 900,000 in 2007 to almost two million in 2013, there also was a significant drop last year in the number of days that Army personnel were hospitalized in cases related to mental health.

The Army changed the way it asked about mental health in security checks to erase the stigma of soldiers stepping forward, Horoho said. As a consequence, “encounters” between mental health professionals and Army personnel jumped to as high as 2.2 million in 2012. But Horoho’s office expects that number to go down to 1.9 million this year. One soldier can have multiple encounters.

Horoho said that since the Army began stressing behavioral health at the brigade level, “soldiers accessed outpatient behavioral health care more frequently, had fewer acute crises and required 25,000 fewer inpatient psychiatric bed days in 2013 compared to 2012.”

Her office said that the drop in inpatient psychiatric stay days at the 10 largest continental Army installations fell from 103,904 in fiscal year 2012 to 78,847 in fiscal year 2013.

Horoho did not dispute Durbin’s claim that the Army has not met its goal of hiring 10 additional psychiatrists annually, and that it had added just six over the previous five years. A shortage of psychiatrists nationally is part of the problem, she and Durbin agreed.

The Army has 5,351 behavioral health providers, including psychologists, social workers, mental health nurses, counselors and other licensed providers. Of those, 405 are psychiatrists, Horoho’s office said.

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