Military Mental Health and Contracted Care
One Woman’s Opinion
By – Sheri de Grom
Contractors are known for hiring mental health counselors, social workers, psychologists, and psychiatrists that have no previous relationship or experience with military culture. Mental health professionals are hired by contractors for the lowest pay possible and, more often than not, the mission is quantity not quality. They are told to see the client and get them out the door. Saving money is the name of the game.
The Armed Forces has reached critical mass in the need for mental healthcare providers. The results of being at war for over a decade are staggering. The ruination of multi-generational military families has become an everyday occurrence.
The divorce rate for military families has risen to forty-two percent and suicides now outnumber combat casualties. Child abuse and sexual abuse are being reported at alarming numbers. The Marines have instituted a twice-yearly unannounced alcohol breathalyzer test along with the standard drug tests due to the unusually high number of on-the-job impaired Marines. Substance abuse is at an all time high in all military branches and is catastrophic among newly-discharged veterans. Substance abuse is also common among family members.
Add Post Traumatic Stress Syndrome (PTSD) at the rate of eleven to twenty percent of all veterans of Iraq and Afghanistan, ten percent of Gulf War veterans, and thirty percent of Vietnam War veterans and the need for mental healthcare grows exponentially.
More than 244,000 US troops have been diagnosed with Traumatic Brain Injury (TBI) over the past twelve years, according to Pentagon statistics.
A therapist or psychiatrist may not consider that their client is living in a different cultural environment than one they themselves have ever experienced or studied. Learning the language of the military can be baffling and, if a therapist is expected to provide services for more than one branch of the service, the culture changes accordingly.
A common mistake counselors make when working with military service members is not taking the time to learn basic information such as rank structure and the differences between military branches. The military client will not expect a nonmilitary counselor to know everything about the military lifestyle, but it can quickly become a distraction and an annoyance if the client has to stop regularly to answer a counselor’s questions about the military, clarify a word or phrase, or address the confusion written across the counselor’s face.
By the time a military client reaches a mental healthcare provider, he may have withdrawn into himself so far it’s difficult for the client to communicate or trust anyone. At the other extreme, if the client is angry, he may be ready to explode and has had no one to talk with about a situation that’s intolerable. The mental healthcare provider doesn’t have time to play catch-up about his client’s environment. A basic understanding must already be present.
Often a soldier or civilian has spent years holding his emotions close. This is seen as having composure or being stoic within the military environment while the counselor may interpret the individual’s behavior as robotic or cold.
Of particular concern to the active duty military member or civilian employee is that privacy of the medical record doesn’t really exist, despite the fact that the medical profession insists medical files are protected and information is only provided on a need-to-know basis.
It’s a sad reality that a service member’s or civilian’s supervisor or leadership may see the mental healthcare record (especially diagnosis) as a weakness or even use this information against the service member or civilian.
If the family member is fortunate enough to stay in one location for a length of time, it’s still unlikely they’ll have care beyond the band-aid approach. There are too many clients waiting for treatment. Pills are used instead of therapy.
The existing lack of communication that arrives with contracted care for active duty, veterans, and their family members has made the current state of all healthcare a disjointed and frustrating exercise. Add in a lack of understanding of the military culture and even the best provider can easily damage patient rapport, limit the quality of care and even misdiagnose.