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Months before 12 soldiers and a civilian were shot and killed at Fort Hood, Texas, Carlsbad psychiatrist Dr. Stephen M. Stahl visited there. His job was to learn and teach.
Learn he did. His experiences on the military base formed the basis of a scathing report that will be published in full this month, in which he accuses the Army of giving short shrift to mental health. Soldiers and those who care for them suffer the consequences, says Stahl, chairman of the Neuroscience Education Institute and former chief of psychiatry for the VA San Diego Healthcare System.
We talked with Stahl about what he sees as the Army’s dismissive approach to psychological problems and why working in an understaffed mental-health system can be like drowning.
What is the main problem with mental-health care in the Army?
The main themes are understaffing and the consequences it has for the quality of health-care delivery. It also has consequences for the stress experienced by the people in the trenches actually providing the health-care services as professionals.
No matter how well staffed you are, people can get what’s called compassion fatigue.
What does that mean for the psychiatrists, psychologists, counselors and others who deal with those with psychological issues?
When you see a lot of suffering, it’s straining. Sometimes it’s not so much that you’re giving too much at work, but that you’re not having your own life and balance outside of work. And sometimes, even if you have balance outside of work, you have problems because there’s so much sorrow and sadness and difficulties at work.
At Fort Hood, the needs are so high and the resources are so low that you might feel like you don’t matter. It’s like drowning: You tread water until you just can’t do it anymore.
How can these people be helped?
One way is for them to take better care of themselves and realize that the situation isn’t their fault. The other is to put more resources in so people don’t get that way.
That’s my point: You’re asking for compassion fatigue if you’ve got so many soldiers with needs but not enough resources. The fix to that is more staff. The Army has perhaps the world’s best medical care in so many other areas. It’s just a marvel to me that there’s such good medical care, but in the face of that, there’s been no increase in psychiatrists since the beginning of the Iraq and Afghanistan wars.
There are 10 times more psychiatrists in Manhattan than in the Army, and there are about as many psychiatrists as there are in San Diego.
How has the Army reacted to your report?
The Army either believes there isn’t a problem, or if there is one, they can handle it.
It was our sense that the Army wasn’t completely agreeing with our assessment that there was a problem with staffing and training. If they thought if there was any problem, they’d handle it with their own internal training resources instead of going outside the Army for expertise and training of their people.
The Marines and Navy have a huge presence here. How do you rank their ability to treat their troops?
My suspicion is that the lack of resources is a systemic problem in the Army, which has few psychiatrists and many vacancies. These problems are not shared by the other services, according to the information I have.
The Marines are taken care of by the Navy. In my estimation, the Navy doctors have more resources, and they use primary-care physicians more effectively. I know this is the case at the Naval Hospital and Camp Pendleton.
When mental-health professionals treat service members, what sorts of problems do they see?
The main issues are substance abuse, post-traumatic stress disorder and depression.
Are these problems mainly among those who serve in combat?
The data don’t really show what you would expect, that being in combat and firefights would be the worst things. If you look at the need for mental-health services and at suicides, they’re not related to deployment and combat versus staying in the United States.
There must be something inherently stressful about being in the military service in the 21st century which causes people to have needs for mental health services
Ultimately, is it possible to fix what you see as poor care?
Yes, it’s fixable, but it would require attention and priority to be given. It’s not to take away from physical injuries in the Army, but to devote the same kind of effort to mental injuries.
But I’m not quite sure the Army believes these illnesses are real.
Interview conducted and edited by RANDY DOTINGA