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Military health care changes suggested

The Baltimore Sun

All troops should undergo annual psychological screenings, no veteran should wait more than seven days for a mental health appointment, and the military and Congress should act immediately to begin adding hundreds of mental health workers to a system now at the breaking point.

Those were among the key recommendations a Pentagon task force announced yesterday in calling for the Defense Department to correct "fundamental weaknesses" in its approach to mental health -- or risk staggering social consequences.

"The time for action is now," the report by the panel of military and civilian experts stated. "The human and financial costs of un-addressed problems will rise dramatically over time. Our nation learned this lesson, at a tragic cost, in the years following the Vietnam War."

The task force's report, prepared for Defense Secretary Robert M. Gates and Congress, called for restructuring how the military oversees mental health care. It proposed creating in each service branch a director of psychological health who would report to the surgeons general.

The National Guard in each state would also appoint a chief of psychological health, who would leverage community mental health resources for Guard members and families.

The structural changes were among 95 recommendations to improve treatment of mental health for troops and their families. Some of the issues addressed in the report were the subject of a May 2006 series in The Hartford Courant, which found myriad lapses, sometimes with tragic consequences, in the military's screening and treatment of soldiers who have psychological problems.

The task force recommended that all service members undergo an "annual psychological health needs assessment," conducted by a trained professional who would promptly refer troubled troops to mental health clinicians. The military has no requirement for annual face-to-face psychological screenings and relies on brief questionnaires filled out by service members before and after they deploy to war to gauge their mental fitness.

Although the task force acknowledged that the questionnaires were inadequate, it did not recommend expanding those forms, opting for annual examinations as the best way to gauge troops' mental health.

The 14-member panel, created by Congress, also urged the military to devise "reliable and valid measurement tools" for assessing new enlistees' psychological strengths and weaknesses. But the group stopped short of recommending that all recruits undergo a psychological assessment to determine their mental fitness to serve. The military does not screen enlistees for mental health, relying on them to self-report any psychological problems.

The task force said mental health problems have an "overwhelming" stigma in the military. It said commanders and medical providers need better training to recognize and treat service members in psychological distress. The panel also called for changing military policies to make it easier for commanders to refer troops for mental health treatment and to encourage those with alcohol problems to get help.

The task force found that the pool of mental health providers at U.S. bases and in Iraq was badly strained. Children of troops were especially hard-hit by the shortage, the task force found.

"It was not unusual for a parent to report waiting six to nine months for an initial child psychiatry outpatient appointment, or for providers to report that children had to be sent to another state for inpatient treatment," the report said.

The task force urged the Defense Department and Congress to "immediately correct the systemic funding and personnel shortfalls that are adversely impacting service members ... and their families." Noting that the military has "dramatically reduced" the number of active-duty mental health professionals in recent years, it recommended attracting clinicians through more incentives and recruiting.

The task force report emphasized the importance of using mental health workers employed by the military. Uniformed specialists understand the military better and are more likely to be respected by service members, it said. To improve the odds that service members receive mental health care, the task force recommended "embedding" mental-health workers in primary-care medical offices.

Lisa Chedekel and Matthew Kauffman write for The Hartford Courant.

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