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is the military doing enough?
In a time of overstretched resources, re-deployed troops going into an urban guerrilla war where they are nowhere safe, and a VA confronting thousands of Iraq combat veterans returning with emotional problems, is the military and the government capable of keeping its soldiers in good mental health condition? Here are the views of Vietnam vet and VA mental health counselor Jim Dooley; psychiatrist and author Jonathan Shay; David Grossman, a former Army Ranger and author; VA chief of mental health services Andrew Pomerantz; Fred Gusman, a director of the VA National Center on PTSD; veterans' advocate and former Army Ranger Steve Robinson; and Col. Thomas J. Burke, director of mental health policy for the Dept. of Defense. These excerpts are from their extended FRONTLINE interviews.

Jim dooley
Mental health counselor, U.S. Department of Veterans Affairs

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Let's just talk about you, and the fact that you're already overwhelmed. … How do you expect to deal [with] the folks who really are going to start to come home, hopefully in the next few years?

It will certainly be a challenge. You know, I think that the realistic answer is that you look at the need of the person, and you look at how you can best serve that need, and you prioritize the intensity of the services, the scope of the services. You look at auxiliary services. You look at who else would be able to support this person. …

…I think it will be a challenge, though, how to deal with the numbers that are coming home. I'm already beginning to deal with Iraq vets, and they will receive services from me. It's really that simple. That's what has to happen. …

But why don't they invest more in person-to-person mental health treatment?

Money. Web sites are all low-cost issues. That can be set up and deployed worldwide at very low cost. To be able to assess for trauma, you have to have live human beings doing it. You cannot do it through systems, and that costs money that the military does not necessarily [want to] invest in. They would rather invest in hardware. They underestimate the destructive nature of war, and I think that's a major policy mistake.

What do you mean when you say they underestimate the destructive nature of war?

They think it goes away; it just goes underground. It doesn't go away. And 50 years later, it can reemerge. What have we done in those 50 years to that family? …

…I think what the military doesn't invest in is the responsibility to assist with the adjustment of the veterans to the emotional reactions to war. I think they're investing in the wrong product. They should be investing in their most valuable resource, which is their people.

And how you protect that is by allowing at-the-minute help. You don't postpone it. You don't say, "It isn't there." You don't say, "You'll get it when you become a civilian again." You say: "We really care about you, and here's somebody that we want you to talk with. We [don't want you to have] this 'emotional blood.' We want you to function in a way that you can function better. We're really interested in helping you with that, and ... we're not going to punish you if you seek that."

I think that in American society in general, there is a real difficulty with acknowledging that [in addition to] medical illnesses, we also have mental illnesses. ... Then, if we can look at the military as just an extension of the society bias, then we really ought to take a look at how we prepare soldiers for war and how we prepare soldiers to become civilians again. And I don't think we do justice to the middle all that way. …

I look at the other VA centers around, and I'm not seeing the same level of just giving that I hear from you. ... The system is already so overburdened. So I'm looking to the future; all of these guys coming home over the next three or four or five years, and I'm wondering how an already overburdened system can even begin to reach out to these folks.

The reality is that the VA is committing resources to be able to help. Do they have the funding from Congress? No. Has Congress approved the mandatory funding of the VA? No. And it should; it's desperately needed. That would end the chronic underfunding. I think that if people can reach out and seek help, they'll get it. There are a lot of people, actually, like me in the VA that do care. I found as a patient of a VA ... that most people do care.

... There will need to be decisions made by individual people on how they're going to handle the increase. For some it will be a system shift. They will rearrange whole teams of people. For others, for myself, for example, in an isolated outpatient clinic, I'll need to reprioritize how I divide my work, who do I prioritize and what time goes to who[m]. It's already happening now. But I need to be able to serve those that are in most need. To do otherwise is to betray them. I won't do that. ...

To ask someone to do something that they can no longer do condemns them. At some point, we have to really look around at why we can't have a humane command. Is it all or nothing? Why? I think it sends the clear message to other soldiers in that unit that you have no option, and we'll let you know when you're done. Otherwise, there may be encouragement of malingering: "I don't feel well. I have a headache. I don't want to go on patrol today. It's a rainy day. It's cold." This is not the way the military operates. They say "go," you go. They tell you to jump, you ask, "How high?" It's raining? You sit in the mud. What's the problem?

I think this thing will challenge some of those authority issues on humane issues. It may actually encourage some of the restructuring that needs to happen as far as the counseling, to be on site within the theater in the division, and not just window dressing.

Tell me about the range of care that's offered for mental health.

The question of quality of counseling services and triage is a really interesting one. Walter Reed has been in the news a lot. Actually, I got a call about a month and a half ago, two months ago, from Walter Reed, looking for a Vermont vet. They were looking to see if we had satellite transmission uplink capability, and I needed to let them know that we didn't have it; [rather,] we had it, but we didn't have it currently, and the nearest one that we had for the VA would be an hour and a half away for the soldier.

They had a psychiatrist that wanted to do telemedicine talking via television to the veteran to continue the therapy. I also offered services at the clinic, which is about three miles away from him. The VA is beginning to understand the need to focus on this.

I think there [are] PTSD specialty teams at each of the medical centers. I think that's a help. The long-range planning of increasing the medical team with counseling in the more remote areas such as my outpatient clinic is very helpful.

So those things are moving forward. There's going to be, in the next five years, a real effort to put the telemedicine technology in the smaller clinics. That will broaden expertise; that will allow an increase in timely services.

But ultimately, it really comes back to the issue of funding; that if there was money, the VA would spend it to help veterans. I truly believe that. But I think until Congress sees that as a national policy shift, the VA will continue to try to do what they can do with what they have. And that may not be good enough. That's the real problem with them. The VA becomes looked at in negative light, when in effect, if you look at the reasons why, it's pretty apparent why.

Jonathan Shay
Psychiatrist and author of Odysseus in America

…. There are some things that the military is astonishingly deficient in educating and training people on. For instance, fear. You'd think that fear would be a major topic in the training of officers and NCOs, how to recognize it in other people, how to recognize it in yourself, how to help other people deal with it, how to deal with it in yourself.

Gen. Don Starry, one of the most illustrious soldiers of the second half of the 20th century, retired as a four-star, has said to me -- and he said this on the basis of a very broad knowledge of military educational institutions, having been commander of TRADOC, the Army Training and Doctrine Command -- that there is not a single Army school that teaches about fear.

Now, there are certainly Army schools and training sequences that teach people to kill and attempt to overcome any reluctance that they may have to kill. But there's an interesting feature of American institutions, that if someone is injured in the line of their military service, whether it's physically or psychologically,the military services take responsibility for the immediate stabilization and treatment. And then they are transferred to the VA for long-term care and for any disability payments that they may be due. It doesn't come out of the hide of the military to pay the downstream costs of the injuries that soldiers acquire physically or psychologically.

David grossman
Lt. Colonel, U.S. Army-Ret.

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…Modern training makes … it possible for people to kill without conscious thought. And frankly, at the moment of truth, they need to be able to do that. Those who are not properly trained are going to be killed. And so we're teaching them to kill without conscious thought. And they at an unconscious level, at the muscle-memory reflex level, have grasped killing: Gun. Shoot. He's dead.

I can trick your body into killing. But if your mind is not ready to come along in this ride, who's the next victim? You are.

I have tricked your body into doing something that your mind is not ready to do.

So when I teach, one of the things I believe we need to do is embrace this word "kill." You will read 100 military manuals, and you'll never see the word "kill." It's a dirty four-letter word. It's an obscene word. And yet it's what we do. ...

There are those out there who say, "Well, if we truly embrace the word 'kill' and understand the magnitude of what we do, then we can't do it, and we're undermining the soldier." And that's absolute baloney.

My book On Killing is being used by these folks that I train, the law enforcement groups, worldwide. And it empowers them; it enables them to be able to function at a cognitive level and at a body level at the same time. They have the muscles and the mind all focused on doing the same thing.

If you're truly prepared to kill, number one, you're less likely to have to [kill] them. [The enemy] will look in your eyes; they see the steely determination; they back off. A predator smells fear, they attack. They see uncertainty; they see fear; they attack. If they see the steely determination to turn your brains into a flying pink mist, they tend to back off. ...

Number two, you're less likely to panic. If you're a cop or a soldier and you pretend you'll never have to kill, and the moment comes to pull the trigger, you bought yourself a deluxe first-class, one-way ticket to panic and all the bad things that come with it. So if we embrace that word "kill," number one, we're better able to deter; number two, we're less likely to panic.

And number three, we're better able to live with it afterwards. …

So that necessity to embrace a dirty four-letter word, "kill," that is in one way at the command [level], and at the psychological level is one area where we still need to make some progress, I think.

Do you feel like the military is doing enough to help soldiers and Marines embrace that idea?

They're increasingly doing it. There are many different resources available. Jonathan Shay's book [Achilles in Vietnam: Combat Trauma and the Undoing of Character] is so vital in understanding how we must not be berserkers. You know, there's two things that destroy you: running amok and running away. And inappropriate aggression is impossible and so difficult to live with. My book On Killing and my new book, On Combat, which are being used in a vast array of different places, these are tools that are being used.

The military is making progress, but it's an incremental process. And the truth is, the Marines will go one way, the Army will go another way. One division does this, and another division doesn't. One commander will institute something, the next commander will stop it. We think of the military as this great monolithic entity marching through history. In reality, what they are is a million different people, all of them taking two steps forward and one step back at any one time. And it is this great mass that slowly, slowly seems to be inching forward, and the quicker the better

andrew pomerantz
Chief of mental health services for the VA in Vermont

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…What do you see in the future for your program?

I was at a regional meeting a couple of weeks ago, and I was saying to somebody, "Well, when they tell us it's time to reengineer, that's just another way of saying you're going to get screwed." You hear a lot of talking about reengineering mental health services, which tends to fall under the same ballpark as things like "Well, we're going to rightsize; we're going to only do what we have to do with what we need to get the job done," and so on. The sad fact is that there has been a lot of attrition in mental health services, at least in New England, and I think some parts of the country have been hit harder than others. We've been coping with fairly level budgets and staff losses for a number of years now. ... The net result here in White River Junction, [Vt.,] is that we have about the same number of staff now, maybe a little bit less, as we did 10 years ago. And we now have 3,000 patients that we treat in my service, and 10 years ago we had 1,000. ...

Congress did pass a bill within the last year to provide some extra funding for mental health, to help try to rebuild capacity, and I'm hopeful that that will be of help to us. We have a lot of people in my department doing lots of different things. We all do lots of things, and we're constantly shifting what we do based on what's coming in the door. If we're going to start seeing a lot more people with early PTSD, we will learn how to treat early PTSD. Almost all of the therapists in my department have been learning cognitive processing therapy, and when that first soldier went to Iraq in March of '03, I think it was -- it seems like forever -- when that first soldier went to Iraq in March of 2003, we started planning what do we need to know, what do we need to be able to do. And so a lot of people who have been doing other things for a number of years are now shifting back and are ready to provide therapy for PTSD. ...

It's very clear that unfortunately, we're going to have more than enough veterans to keep us in business. The question is whether we'll have enough staff. I'm confident that nobody in my department is going to let people go untreated. What is of concern to me is the number of people who are still there working after I go home at night, the number of people who are coming in on Saturdays, who are not paid to do that. This is a dedicated group of people.

How much funding do you get?

I haven't bothered to look at the numbers because they give me indigestion. I have not looked in a couple of years. We spent a fairly low percentage of our facility dollars on mental health as compared to similar facilities, and by similar facilities, I mean general medical and surgical hospitals, as the VA calls them, that have mental health services, that have training programs. Any time I look at those numbers, we are on the low end.

The funding has changed back and forth a couple of times in the last seven years. ... You know, in 1993 I had three substance abuse counselors; right now I have half a substance abuse counselor. In 2003 I still had one and a half. But because one died, I lost that position. I don't know how $5 million available nationally is going to play out. I think the VA does the best it can with what it gets, but it doesn't get much.

…Is it a move in the right direction to have therapists in the field?

I wish I knew. I don't know the answer to that question. I've heard conflicting stories. There are conflicting views of this, of course, like anything that we do. …

In general, how well is the military dealing with mental health?

The military is a large organization, and within that organization there are a lot of individuals in positions of authority, and you may have a general policy set down, but it is still the individual carrying out that policy who gets to demonstrate whether it's a good one or not. And you know, as long as there are different individuals in positions of power and authority, there are going to be different responses. I would like to think that there are some commanders who on hearing somebody who just couldn't do it would say, "Well, let me help you get to our stress consultant; let me help you get the help you need." And that [would] be the end of it. There are others who I could imagine are not going to play it that way. When you come right down to the individual situation, it's still the people, and we all have our own biases. ... We have not removed the stigma of mental illness from society, and I doubt very much that we've removed it from the military. …

Fred Gusman
Director, education and clinical laboratory division, VA National Center for Post-Traumatic Stress Disorder

Does the VA have the resources to take care of the people who are already on its rolls, in addition to these new soldiers returning from Iraq and Afghanistan?

… There are few answers to that. One, we're blessed that we have all this knowledge now, things that we've learned from other wars, including Vietnam. We now have different kinds of treatment interventions and even some medications that have been studied and that seem to be helpful. But like any organization, you constantly have to be aware of the change and the change of need. …

One of the things that is unique, in some ways, to the Iraq-Afghani returnees, particularly Guard and Reserve, is the number of them that are married. … Now we're talking about doing more outreach to families and working with the DOD because they do a pretty good job of pre-deployment interventions with families, preparing them to take care of themselves while their loved ones are gone and so on, and [they do] a fairly decent job of post-deployment when they come home, and trying to prepare the families as to what to expect in terms of how somebody might be when they come home, how emotionally intact will they be and what should we do? All those kinds of questions.

The VA is starting to do a good thing. They're starting to realize that they are extenders to the veteran, that it's not just about providing a service to the verteran. They impact our whole society. … When somebody comes home they're not just a veteran, they're an employee, they're a citizen, they're a husband, a brother, they're a member of a parish or a synagogue or whatever. It really calls for a different kind of activity than we did with Vietnam, because with Vietnam we were in a reactive mode.

For these new folks, they're fresh out of combat and what we I think have to do is engage not just the VA or DOD, but share this. This is a community-wide, country-wide responsibility. … We have to bring the military to the table. We have to bring employers, the state and the county, vocational rehab, federal vocational rehab for jobs and so on and so on. That is something that we didn't do for many, many years as we were trying to help Vietnam veterans. But that's something that I think that people are talking about right now. … We really need partners. We need the community involved. …

Recently the GAO was released and it stated that the VA might not have enough funding for this role. Do you feel a funding crisis coming on?

Every once in a while you'll hear somebody ask the question: Does VA have the capacity to take care of all these people? And my answer to that is that we're going to take care of everybody that comes to us. And the next question will be: But what will the quality of care be? And my answer to that is: It's going to be the best we can provide. And then the next question is going to be: Well, don't you think more money will help you to provide that? And my response to that is: Yes and no. It depends on how we use our resources. It depends on how good we are at identifying what the problems really are. …

Right now I'm witnessing something that in my 28 years working for the VA and my other time in the military that I've never seen before. And what I'm seeing is the Department of Defense, the VA, working together. … So there's this serious, dedicated movement to really try to improve the VA's ability and the military's partnership with us in providing the best possible care. It's not going to be perfect, but its going to evolve.

Steve robinson
Exec. Dir., National Gulf War Resource Center

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…What we're dealing with is wounded soldiers coming back from Iraq and Afghanistan. And during this time in which the soldiers are coming back, they're being met by the VA [Department of Veterans Affairs] system, which is underfunded and inadequately prepared to meet the physical and psychological demands that are going to be placed upon them. There's not enough doctors. There's not enough resources for the VA to even meet the demands of veterans from previous wars, much less those that are coming back from this war. So the VA's underfunded.

We know that soldiers were sent to war without proper equipment in many cases. In fact, in 2004, the Army finally reported that every soldier in Iraq now has the proper body armor. We know that there was an instance in which Congress was considering reducing the soldiers' combat pay. All of these things are important efforts, [and] we need to look at that [and] revolve around what is our commitment to soldiers when they come back from war. What's the nation's commitment to soldiers?

How would you answer that? How is the nation doing so far?

I don't think we're doing a good job. I told someone the other day that it wouldn't matter to me if George Washington were president and Abraham Lincoln were vice president right now, today. If their policies were the policies that were instituted and were having the [current] effect on soldiers, we would criticize them.

And we believe that you don't shortchange soldiers on their medical needs, their compensation needs, their psychological needs, their spiritual needs when they come back from war. You don't save money on their backs. …

The numbers of suicides are definitely higher than any war ever in our history. Can you talk about that? Is there any reason why?

Well, suicides happen in the civilian world, and they happen in the military. They're happening more during this war. ... [The military] reported, I think as of today, that there have been 29 suicides in Iraq. But there's always been a question about whether this problem is even bigger than what they're reporting, because there are people that are coming home from Iraq that have killed themselves one week, one month, six months after the war. And the [Defense] Department says, "Well, we don't count stateside suicides, because we see no connection to them serving in the war." I don't understand that methodology. It seems like the big elephant in the room that nobody wants to talk about.

If there's something we can do to prevent a suicide -- if we need to do more than just have a bunch of programs, if we actually need to physically make contact with each one of these people and have a clinical encounter with a trained physician who's treated PTSD [Post-Traumatic Stress Disorder] before or treated severe depression, that's what we need to do.

But I think the [Defense] Department is quite frankly not interested in any more bad news stories, and they want to talk about the good. There's good things happening in Iraq, but that's not what we're talking about. We're talking about people who have come home and killed themselves. It ought to make the hair on the back of your neck stand up. ...

We were just at Walter Reed. Let's talk about the psychological care that service members receive. Is it on the excellent side of the spectrum, or in the middle?

Walter Reed Army Medical Center, in terms of how they care for the psychologically injured soldier, they are definitely not leading edge in terms of their treatment. For example, there are group therapy sessions in which there are combat soldiers, females who are civilians that have had hysterectomies, grandmothers who have had surgery, all in the same therapy session talking about their PTSD. You've got soldiers who didn't deploy commingled with soldiers who saw combat.

What Walter Reed doesn't do that I think they could do better at is individualized, tailored care for the individual and their specific needs. What they have is a Burger King mentality: to get as many people together as you can, put some information out to them and get them out of the hospital as quickly as you can, because tonight, at 1730, there's going to be another busload of wounded soldiers coming in. ...

What we're calling for ... is a refocus on getting face-to-face contact with the veterans. Handing them a piece of paper and saying, "Here's a number you can call," is not the kind of care they need. ... I've said that if we would aggressively and proactively meet every single veteran that comes back and give them a face-to-face clinical encounter with someone who is educated about the special needs of returning combat veterans, we could save this nation billions of dollars over the next 50 years for any long-term disability payments that may come out of not treating PTSD. And [lawmakers] seem to get excited about that. So maybe if we kind of refocus them, they'll take it seriously. But it is going to cost this nation billions of dollars to take care of these [veterans] -- not only the psychologically injured, but the amputations, the broken backs, the fused spines, the kidney disorders. It's going to cost billions.

The VA system already seems completely overburdened.

… As this war moved on, the veterans' service organizations like myself and others began to question the government's commitment to returning soldiers when they purposefully underfunded the Department of Veterans Affairs by billions of dollars, not even addressing the needs of future veterans that are coming back from this war, but underfunding the needs of veterans from previous wars. ...

George Washington said this, and I'll paraphrase it: The willingness of future generations to serve in wars directly depends on what we do for those who just came from war. …

Thomas burke
Director of Mental Health Policy, U.S. Dept. of Defense

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…Should we be doing more to help them?

It's difficult to answer the question, "Should there be more?" There are people who believe that it would be useful to follow [up] with the group, not just at the time that they get off the plane, but then periodically afterwards. There are problems with being able to do that because so many of the soldiers are Reserve [or] National Guard. They separate. They go their different ways. It's a difficult task to be able to go back and re-screen every soldier who has been deployed, but it's still an issue that comes for discussion. It may be that, in the future, that will need to be done.

Can you force them to seek medical care?

That's something of a philosophical issue. ... We don't force people in the United States to get mental health treatment unless they're violent. It requires a great deal of social intervention to force people to get mental health treatment. There's no credible scientific evidence that doing some sort of mandatory intervention -- two hours of counseling for everybody regardless of whether you have symptoms or not, whether you want it or not -- is going to be helpful.

There's some scientific evidence that those interventions for groups -- critical incident stress debriefings or critical incident stress management -- if it's not handled properly, can do more harm than doing nothing at all. I'm not saying that this is a reason not to do anything for the soldiers, but I think what we try to do is catch them while we have them all together and do the screening, do the post-deployment health assessment there. ...

I think that the questionnaire, the screening kind of approach, is probably the most effective way of asking a large group for that kind of information given the time and resources that are available. ... Then if people have problems, if they say, "Yes, I've been having trouble sleeping; yes, I've been feeling sad, depressed," ... they do have the opportunity to see a health care provider then -- not necessarily a mental health person, but a health care provider who will go into a little bit more depth in the questionnaire and find out if they've been having trouble sleeping because they've shifted from the day shift to the night shift, or that there's some kind of non-mental health issue that can be addressed. [But] if they're not sleeping because they can't get to sleep no matter what, because the nightmares keep them up, because they're afraid that if they go to sleep, the mortars will come, and they won't be able to get away, then those people can be referred on.

So I think that it's an attempt to make the best use of our resources, and if the problems are such that we need more resources, then we can address that as we find the problems. But to sit everyone down with a mental health counselor for an hour isn't the best way to approach the problem.

Is there a difference in access to care for career military and for reservists?

... You're right. The situation is different, and it has been a concern to the senior DOD [Department of Defense] leadership that there be resources available and access, and that families of [the] Reserve and National Guard be aware of the resources that are available to them while their spouses are activated.

Once they're on active duty, the families have the same benefits as the soldiers who are on permanent active duty. There are outreach programs for the families of the Reserve and National Guard that are the equivalent of the Family Support Centers. The Navy has them, the Marine Corps -- each service has its own version of Family Support Center. And there are Family Support Centers on base. So if the reservist lives within a reasonable distance of a military base, they can get direct, physical access to those resources.

But there are reservists who live far away from a base, and they can't get to those resources just by driving there. The Internet is a means of access. All of the services in their family support functions have Web pages that provide links and access and information on where you can find services: what numbers to call, who you have to see in order to get health care, financial problems straightened out, any of the variety of services that the military provides.

The military also has the One Source program, which is the 1-800 number. It's a 24-hour-a-day, seven-day-a-week hot line. There's also Internet access. There's a Web page that provides referrals and advice on a whole spectrum of issues. I had an opportunity to talk to one of the One Source counselors [who] said that she had talked to everybody from a person sitting with a gun in their lap, threatening to kill themselves, to somebody who wanted information on how to can tomatoes and everything in between. And they're ready to try and provide information. They're trained [in] how to deal with the really serious things: the suicidal people, domestic abuse and child abuse -- all of the serious things. And they try to help out on the simple things as well. Each service did have its own One Source program; they've now been consolidated into this single, Military One Source program.

· For more information about services, see the "Support & Services" section of this web site.

Does the military provide funding for access to counseling outside of these programs?

And that's the benefit that used to be unique to the Army and has now been expanded. There are six face-to-face counseling sessions that are outside of the Tricare benefit and are almost completely confidential. The exceptions to the confidentiality rule are imminent danger to self or others, so if a person is suicidal or threatening violence to someone, that gets reported and taken care of -- also domestic abuse, spouse abuse, elder abuse, child abuse. But beyond that, what is said in the counseling sessions is confidential. It doesn't go back to the person's chain of command. A lot of the problems can be resolved within six sessions. If not, then the person is referred back into the Military Healthcare System for further care. ... …

Is there immediate access to care for any soldier who needs it?

Depending on the location, for most active-duty personnel, mental health [treatment] is a walk-in: You just walk in and you can be seen. ... They'll set up appointments once you get established with a provider. That will all be an appointment system. But in an emergency, there's always the emergency room. Here in the Washington, D.C., area, there's emergency rooms at Bethesda, Walter Reed, Malcolm Grove. You walk in. If you've got a mental health issue, they have the psychiatrists available 24 hours a day that can be called in, [who] may not be right there in the emergency room at that moment, but [are] available.

So access to care may not be immediate, especially for simple outpatient kind of issues. But if you have a serious problem, you can go to your local emergency room, go to the nearest military emergency room. You can even dial 911, and they'll come and get you and take you to the emergency room. For the most serious persons, thinking about hurting themselves or hurting somebody else, killing themselves, if they dial 911, they'll deal with it the same way they would deal with a person who's complaining about chest pain and believes they're having a heart attack.

Do individuals ever fall through the cracks?

I think that it's always possible, especially at the biggest health care system in the world, that occasionally individuals will fall through the cracks. We try and minimize that possibility [by] working very hard, within our own system and with the transition between DOD and the Veterans Health Administration, to make sure that nobody falls through the cracks. And if somebody does, as soon as we find out about it, then we get them the care that they need.

We're always looking for ways to improve that. We are working on educational approaches, research collaboration. We have done clinical practice guidelines between DOD and VA, joint clinical practice guidelines in post-deployment health and on PTSD, so that we have a standard best practices documented for the health care providers in both systems to use to look at these problems.

Yes, it is possible, but we try and minimize it. And as soon as we find out that someone has fallen through the cracks, we try and get them the care that they need.

But some families get the impression that the system is unresponsive to the needs of their loved one.

…In some cases, it may be true that they have fallen through the cracks, but the system is not ignoring that person. They need to keep trying. Get in contact through all of the avenues that we talked about to get them back into the system to get them the care they need.

It may also be that the soldier, Marine, sailor, airman actually is plugged into the system already, that they are engaged, but that the results are not coming as quickly as the families would like. We understand that that's part of the process. Sometimes this takes a long time, and I would encourage the families, the soldiers, the sailors, the airmen, the Marines to stay with the process, to keep engaged, to keep coming back. The care may take a long time, but we'll be here for a long time to provide that care. ...

Do we provide enough resources to care for our soldiers?

Yes, I believe that our country has the resources to provide the care that the soldiers returning from Iraq and Afghanistan need. [I believe] that the senior leadership of the DOD, ... the senior leadership of the VA, the Congress, the administration are all very concerned about finding the resources, having the resources available.

If the soldiers are concerned in this democracy, they can talk to their elected representatives if they have those concerns. They can talk to their chain of command. It's particularly important that they not suffer in silence. ... We find out that they need help by them coming to ask for help, so come to ask for help. If it takes a little while to get into the system, try another avenue of getting into the system -- we discussed several -- but don't give up; don't walk away; don't suffer in silence. Come back and keep trying to get the care, and we'll find the resources.


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posted march 1, 2005

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