Coming to a military clinic near you.

| February 5, 2012

Coming this Monday the military will be starting a program called The goal of the program is to incorporate additional screening for mental health issues that are affecting the military. The idea is that if the screening is in place, there would be a greater chance of identifying those who would go to behavior health. According to page six of the PCC plan this is how it is expected to work at the initial visit.

Soldiers • attending primary care clinics for sick call and other reasons are routinely
screened for depression (two questions) and PTSD (four questions);
• Those with positive screens complete appropriate diagnostic and severity instruments
before seeing the PCC;
• If the instruments suggest that behavioral health issues require exploration and the
PCC’s diagnostic interview confirms the diagnosis of depression or PTSD, treatment is
initiated by the PCC who will continue to follow the patient closely;

But that is not how it is going to happen. You come to the clinic to check into your appointment and receive a colored questionnaire about symptoms from lost of interest to thinking about hurting yourself or others. Once you do that if you answer any questions that say you are given another different colored paper when you get into the room with more detailed questions. Then if you answer a certain way then you fill out another color paper which goes to the provider who will judge if you need to see a specialist in behavior health.

How this will be incorporated so that it does not increase a already long wait time for patients will be interesting to watch. So expect some longer wait times in the near future before these problems have been ironed out. But I have some personal concerns about a disconnect between getting to get men to open up against women. Something that I see a lot since I have been working in a clinic.

A guy is going to act defensibly if you put him in a closed off space, in a unfamiliar/unconformable place talking to a person who he does not really know. What makes it worse is the different concepts and jargon of day to day life. If you have to explain minor details in their story about what is troubling them, the person will not want to continue the story. Once that happens it does not matter how many questionnaire you give him, he will just answer the “correct” answers so that he can be left along. I have been told this directly by a patient. This is a big problem. If you want to reach him you need to be mobile. How many times have issues have come up where one guy tells the other “lets take a walk”. I know it is something that will not happen, but this is the best way for a guy to communicate.

I want to expand more on this problem. It comes when the person telling the story may be reluctant to tell it in the beginning. So the restarts from the listener not understanding or not relating can be frustratingly distracting. This giving the person talking more an more reasons to want to say “Forget it”. Also is a discontent over coping methods. The use of tobacco is the biggest on that I have seen. If you are deployed and used it to help with hairy situations like oh say using your vehicle that your in to roll over a possible IED to test that theory then no one is going to give you a hard time if you light one up after the mission. But in CONUS you will be lectured on quitting regardless of what anti-stress benefits it gives. Also it does not help getting a lecture on why people smoke due to it’s effects on stress reduction from a non-smoker makes me want to light up one right there. If I am feeling this way about tobacco, then imagine the thoughts going inside the person’s head who is reading these forms. It is another person slipping though the cracks.

Also another concern that may not be written on the website is that during the briefing, it was asked what role would the screener (medic) play in all of this. The reply was that the medic was not expected to or asked to perform additional roles in giving behavior health support. That if a person was positive that they would be handed off to the provider who would manage the issue from there. My concern is that is will create a attitude of “that is not my problem” or “That is not in my scope of practice”. I have seen this first hand during a deployment when a person had voiced a honest intent of wanting to hurt himself that another person present looked at me and told me and I quote; “Sounds like your problem” and “Sucks to be you”. That kind of attitude should not be encourage be it direct or indirect. But moving on.

Also as a guy, there will be a reluctance to mention anything that is viewed as unnecessary. For example if they are here for flu symptoms that they may be questioning why you are asking things that are not directly related to the visit. Also they may view the questions about their mental health as offensive or trick questions. For example it would be like someone asking you if you had thoughts about cheating your your spouse or had fantasies about cheating on your spouse every time you entered the clinic would be frustrating. Because it could be said that this would be valid due to the high rate of divorces in the military. The person would just not be actively listening/reading and give the “correct” answers again. Similar to the way most people read the licensing agreement to most computer software so they can install it. The speakers claim that the repeated visits will break though this but I refer to any women about the endurance of the stubbornness of the male ego and see if that logic has worked for them.

All in all, in the fight to find and help those who need it, it must fall on the medic. To listen to their gut and being willing to break away from the conventional to reach them. But most of being a person with genuine concern and kindness. But also be able to call BS on someone when they know they are hiding something. Because a person will reply to a person acting like a person rather then one that is imitating a power point presentation.

Category: Veterans Issues

Comments (11)

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  1. Ben says:

    One of the biggest problems with the mental health system is that we stigmatize anyone who has ever seen a counselor. It can, for example, put a security clearance in jeopardy. They want to know if you’re cookoo for cocoa puffs, you know?

    So if you don’t want people to think that you’re cookoo for cocoa puffs, you never seek help. It’s that simple.

  2. Elric says:

    This is not going to work. Just look at the color coded paper. What soldier is going to wander around the TMC with that clutched in his hand? What about a leader? Ain’t going to happen.

    I’m going to beat this horse. Until commanders and CSMs lead by example and make it a unit priority to identify and help solders, while at the same time protecting their privacy AND putting them in the key leadership roles they ought o be in. Until we back up what Big Army is saying, its all just BS.

    When I took battalion command, I sat my officers and NCOs down and told them that I had PTSD, depression, and some smaller associated quirks. However….I had leaders who didn’t lose faith in my ability to lead soldiers. The take away being is that I encouraged soldiers to come to me directly if they felt they had no other option. It took some doing, and hammering behavioral health services until I found a psychologist that would let me fast track individuals directly to her, avoiding the cattle call at division behavioral health.

    Fortunately I had a supportive battalion CSM (don’t ask about the bde csm), and we worked to ensure soldiers who sought help continued to be competitive for assignments and schooling and they were fairly evaluated. In large part this worked, although I know that I had guys who would not seek help under any circumstances. I ran into a few after a DUI, domestic disturbance etc… After the discipline, leaders must dig deeper to determine why the soldier acted as he did.

    What I’m trying to say is there is no form or check list that will in any way help. The standard sick call checklist already has these questions on it and soldiers blow right through them. Leaders at every level must invest the time and energy to follow through on the big Army’s promises. It used to be called taking care of your soldiers.

  3. AW1 Tim says:

    You see this institutional crap at the VA all the time. Sorry, DVA. It’s hard to keep up with changes after years in the system.

    However, what you see is some sweat-suit wearing pencil-necked bean counter gets an idea about6 how to save money and streamline things. It also gets folded in with the latest PC kewl idea and the next thing you know is another set of forms, and another layer of bureaucracy to wade through.

    A guy who needs to see someone NEEDS TO SEE SOMEONE. He isn’t going to open up to whatever admin type is handing out the colored forms, and he sure as hell isn’t going to carry around something that will ID him as having this or that or needing this or that, etc.

    One of the biggest complaints I have is what I’ve witnessed happened to a friend: Because he mentioned to the doc that he had considered “harming himself” he suddenly found himself in the Mental Health ward being kept for observation. He was escorted by two DVA rent-a-cops to the ward, with a nurse following behind him. Why did this happen? Because, as my own doctor told me, the law requires it. Once again, you have elected officials and well-intentioned bureaucrats fvcking up the system with legal requirements.

    Now what happens is that the word gets out that, unless you WANT to get sent to Mental health and have that all over your record, then when the doc asks is you are/have considered harming yourself, you say “no way”, and let it go.

    My medical needs should remain private, between me and my doctor, and not flaunted around through the waiting area, the hallways, etc. Yet, once the government gets it’s hands into something, that’s what happens.

    The DVA and the Government has made certain that, should I feel depressed, they’re the LAST folks who will ever know about it. I’m happy to seek solace with my good friends Evan Williams, Jim Beam, Ezra Brooks and my Old Grand Dad.

    I am not a number. I am not a file folder. I am not a statistic. I am a man, a citizen, a veteran, and I intend to maintain what dignity I can, as it seems to me to be about all that I am allowed to have for myself anymore.

  4. Bubblehead Ray says:

    This is not only a new requirement for the VA. Civilian hospitals are now mandated to screen all patients for depression and suicidal ideations. We just recently changed our triage screenings to cover this.

    Trust me, you get some strange looks from people in the ER for a splinter in their finger when you ask them if they’re suicidal.

  5. Flagwaver says:

    In the 141 BSB, we had this from our Charlie-Med guys and gals. We were a test program for it about five years back. And, yup, people did just give the “correct” answers.

    It wasn’t the medics that referred people to the shrinks, it was the Chaplain and the UMT. I think the Chaplain’s assistants both referred more people than an entire company of medics.

  6. OWB says:

    But, but, but – you are ALL missing the point here! The bureaucrats and assorted do-gooders get to go home feeling sooooo good about themselves because they have DONE something for the hapless, helpless vets. Aren’t they wonderful?????

  7. Joe Williams says:

    Feel free to use my answer to the sucide question.Not only NO but HELL NO. If my kinfolk are told that I committed sucide,Imediately start looking for my killer. Have not been asked since.

  8. WOTN says:

    Want to “help” Veterans with their challenges, STOP trying to force a diagnosis, STOP sending them to civilian shrinks that haven’t a clue what is and is not normal for a Veteran, much less a combat Veteran.

    An NCO I know was recently diagnosed with severe PTSD. Why? Because he NO symptoms of it, and the shrink decided that it must be abnormal and severe that he could possibly have done his job, without negative effects.

    But, this is about to get worse. As the Obama Administration slashes 100,000 Soldiers and Marines from the force, they want to “retain the best” and send the trouble-makers to the unemployment lines. In their “Gold Book,” which builds on the “Red Book” of 2 years ago, they identify those of “high risk” as the target to remove.

    High risk includes those with behaviors no longer politically correct, such as an alcohol related incident (this includes both the attacker and defendent of an altercation, if any alcohol has been consumed), a ticket for no seat belt, excessive speeding, or no helmet, or “behavioral health issues,” which includes PTSD.

    For those that went through the slashes of the 90’s, this flashback will almost certainly remind them of Good Soldiers cut because of small black marks on their records. Of course, those that played it safe, and have “clean” records are safe.

  9. Chockblock says:

    Commanders need to stop thinking that PTSD is “made up” or that soldiers with mental health problems are “faking.” Seen too many commanders whip out UCMJ if they suspect a soldier has mental problems. They’ll try and deploy with basket cases.

    Rule of thumb: people either get better or get worse in treatment. If they stay the same, especially after a year ,it’s a good chance they’re faking it.

    All this grief for mental problems and you see senior NCO’s, officers and many coddled lower enlisted with bogus “profiles” or who can’t even do their job. Yet they get cushy assignments awards and promotions.

    I understand that malingering is punishable under UCMJ, but a doctor should make that determination AND forward that to the commander.

    Commanders tried to use the Warrior Transition Units to dump their scum being chaptered out. They got caught and now the requirements are tighter.

    Commanders and senior NCO’s need to realize that some soldiers just aren’t going to stay in the army. They need to plan accordingly instead of whining that “he’s the only one who can do X” or “We need her to certify”.

    Until the Army comes to grips with mental health issues many good soldiers will get smeared and many bad apples will get coddled by bad CO’s.

  10. Anon says:

    @Ben (#1) – It has been my understanding that seeking counseling for PTSD as well as for family problems can no longer be a reason for being denied a security clearance. While I don’t recall what the source is or when the change took place, I’m fairly sure I saw that right on the lengthy online form you have to fill out when applying for a security clearance.

  11. fm2176 says:

    I honestly answered a questionnaire pertaining to PTSD once. I was doing an Airborne physical at Walter Reed when an attractive young female doctor approached me and asked if I’d be willing to answer it. It was for the Deployment Health Center and completely confidential, so I completed it and was called back and asked to participate in an acupuncture study treatment. I let my leaders know what I was doing, all the while maintaining a facade of normalcy while on duty with TOG. I knew what could have happened if I admitted to any “flaws” officially.

    A couple of years ago I actually answered semi-honestly about my drinking during a Periodic Health Assessment. I think I put down that I drank 5-6 drinks a few times a week and the doctor chastised me about my heavy drinking. Ever since, I drink 1-2 drinks 1 or 2 nights a week. Funny thing is, the beer fridge stays empty…

    The Army is trying to put stigmas associated with PTSD, depression, and other issues behind us, but it is an uphill battle. We had a safety stand-down day when I first got on recruiting (just after yet another suicide in Houston battalion) and were shown a video of various leaders talking about their problems with PTSD and depression. There was a brigade CSM and a number of other NCOs and officers, and the point was that it is “okay” to come out about problems. At the Army level, perhaps, especially if you are to be the subject of a training video. At lower echelons, I think the stigmas associated with personal issues are exceedingly strong. When I report to my CSM and 1SG in the coming weeks, I will do so as a highly motivated career NCO who survived a tour in recruiting, served honorably in TOG, and was an opening player in the war in Iraq. I won’t be reporting as a depressed SSG who’s grown disillusioned with what he saw in USAREC and who is concerned over his value to the Soldiers he must lead in the coming months.

    Perception is everything, and I’ll already be behind my peers to an extent as it’s been over seven years since I was in a line company. It will be hard enough adjusting to the tactics and equipment that will be new to me; the last thing I’ll need is my 1SG thinking I’m a detriment to the unit.