Coming this Monday the military will be starting a program called Respect.mil. 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.