YOKOSUKA NAVAL BASE, Japan — Gaps in care — combined with the stress of combat in Iraq and Afghanistan — are creating a “perfect storm” within the U.S. military mental health system, according to a Navy commander who spoke at Yokosuka Naval Base on Wednesday.

Quick to say that his opinions are unofficial — the product of his 24-year military career and not the U.S. Navy or Department of Defense — Cmdr. Mark Russell gave a well-attended lecture called “Broken Promises: The Unspoken Truth of Mental Health Care in the DOD” during the final day of the Multinational Medical Conference.

Russell, a child psychologist and director of Educational and Development Intervention Services for bases across Japan, painted a picture of unmet needs and unrecognized opportunity stemming from the global war on terrorism.

“We are in a crisis situation,” Russell said. “And it’s going to get worse.

“We’re making progress but are far from making good on our promise to provide the best mental health care possible for the men and women we send to war,” Russell told the gathering.

More than 56,000 troops, or 10 percent, have returned from Iraq and Afghanistan with a mental health diagnosis, making up a third of those in Veterans Affairs care. The cost of mental health care is high, he said — the VA spent $4.3 billion on post-traumatic stress disorder alone in 2004.

Also, of the 9,145 (out of a possible 178,644) veterans who showed signs of PTSD between 2001 and 2004, only 22 percent were referred on to mental health care. That creates a chasm between a need for care and actually getting it, Russell said.

Another gap falls between DOD guidelines for mental health treatment and the training given to mental health workers, he said.

“Out of 133 mental health providers I surveyed, 90 percent of them had no training in the top four treatments the DOD recommends for PTSD,” Russell said.

There also are problems with leadership, high burnout rates among caregivers and the tendency to treat those suffering from hyper-arousal compared to those who disassociate, he said.

“The bottom line is that we have increased demand and fewer resources to meet that demand,” Russell said.

But the DOD has made significant strides, especially in terms of front-line combat mental health care, he added. The military’s PIES system — basing combat mental health care on proximity, immediacy, expectancy and simplicity — is working, he said.

“The numbers of mental health workers on the front lines is unprecedented,” Russell said. “This is an all-out effort.”

More troops are using front-line mental health services, with 40 percent getting help in 2005 compared to 29 percent in 2004. And, most importantly, 90 percent of those who get front-line help return to duty, he said.

The DOD also has improved screening programs, has established deployment centers with quality information, is conducting more surveys and is getting more information out to veterans after they come home, Russell said.

But the DOD could be doing more for the troops, caregivers and for combat mental health in terms of treating the “invisible wounds of warfare,” he said.

“Right now, the DOD is in an historically unique position to lead the world in understanding, assessment, prevention and treatment,” Russell said. “Have we advanced science?”

The military has a “love/hate relationship” with mental health care, he added.

“We like it in war and know that increased mental health is a force multiplier,” Russell said. “But in peacetime, mental health falls to the low end of the totem pole.”

It’s up to the military health professionals today to “take up the sword,” he said.

“I’ve already turned in my retirement paperwork,” he said.

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