Thousands strain Fort Hood's mental health system
By Gregg Zoroya
USA TODAY
FORT HOOD, Texas — Nine months after an Army psychiatrist was charged with fatally shooting 13 soldiers and wounding 30, the nation's largest Army post can measure the toll of war in the more than 10,000 mental health evaluations, referrals or therapy sessions held every month.
About every fourth soldier here, where 48,000 troops and their families are based, has been in counseling during the past year, according to the service's medical statistics. And the number of soldiers seeking help for combat stress, substance abuse, broken marriages or other emotional problems keeps increasing.
A common refrain by the Army's vice chief of staff, Gen. Peter Chiarelli, is that far more soldiers suffer mental health issues than the Army anticipated. Nowhere is this more evident than at Fort Hood, where emotional problems among the soldiers threaten to overwhelm the system in place to help them.
Counselors are booked. The 12-bed inpatient psychiatric ward is full more often than not. Overflow patient-soldiers are sent to private local clinics that stay open for 10 hours a day, six days a week to meet the demand.
"We are full to the brim," says Col. Steve Braverman, commander of the Carl R. Darnall Army Medical Center on the post.
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That doesn't even count those soldiers reluctant to seek care because they are ashamed to admit they need help or the hundreds who find therapy outside the Army medical system, Braverman and other medical officials say.
Officials worry the problems may worsen — for the military and the country.
"If Fort Hood is representative of the Army — and 10% of the Army is assigned to Fort Hood — then if you follow the logic, our numbers should be scalable to any other post in the country," says acting base commander Maj. Gen. William Grimsley.
"I worry that if we don't see this through the right way over the long haul ... we're going to grow a generation of people 10 or 15 years from now who are going to be a burden on our own society," he says. "And that's not a good thing for the Army. That's not a good thing for the United States."
Statistics provided to USA TODAY by Fort Hood commanders show the explosion of mental health issues here:
•Fort Hood counselors meet with more than 4,000 mental health patients a month.
•Last year, 2,445 soldiers were diagnosed with post-traumatic stress disorder (PTSD), up from 310 in 2004.
•Every month, an average of 585 soldiers are sent to nearby private clinics contracted through the Pentagon's TRICARE health system because Army counselors cannot handle more patients. That is up from 15 per month in 2004.
•Hundreds more see therapists "off the network" because they want their psychological problems kept secret from the Army. A free clinic in Killeen offering total discretion treated 2,000 soldiers or family members this year, many of them officers.
•Last year, 6,000 soldiers here were on anti-depressant medications and an additional 1,400 received anti-psychotic drugs.
"I don't think we fully understand the total effect of nine years of continuous conflict on a force this size," Chiarelli says, reacting to those statistics.
"Those numbers are pretty staggering," says Kathy Beasley, a health care executive with the Military Officers Association of America. She wonders what will happen when those soldiers leave the military. "Do we have the supply and the people in our systems to take care of that?"
Every time more counselors are hired here, their schedules immediately fill up with patients. "It's almost like a Field of Dreams," Braverman says, referring to the famous line from the 1989 film about a baseball field on an Iowa farm that spontaneously draws crowds. "If you build it, they will come."
'Life can slowly slip away'
Staff Sgt. Josh Rivera came back from his third tour in Iraq this year eager to save his marriage.
"When a soldier is constantly gone and actually fighting, not just deploying and sitting in an office, life can slowly slip away," says Rivera, 32, a native of the Bronx, N.Y.
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Thirty-nine cumulative months of war had left him distant from his family and confused about his role in their lives, Rivera says. All that made sense was the infantry, which he loves. Rivera resisted seeing a counselor until his marriage was in real trouble, he says.
The Army therapist who met with Rivera and his wife, Julie, gently guided them back to basics — what brought them together 10 years before, why each mattered to the other and what they wanted out of life, the couple say.
Chaplains provide marriage counseling, but for soldiers who want to see a licensed marriage counselor, the base's social work department has two, each with a caseload of 60 couples, says Lt. Col. Nancy Ruffin, department director.
She has to refer some troubled marriages to private clinics, and not all the soldiers are willing to do that, Ruffin says.
The demand for other types of counseling also far exceeds supply. There are not enough social workers to treat soldiers suffering the emotional effect of sexual assault. Ruffin says she has one social worker, who is handling 50 cases.
Fort Hood has an intensive, three-week therapy program, followed by eight weeks of group therapy, for soldiers suffering stress-related issues, including post-traumatic stress disorder. It has a waiting list of 80 soldiers.
The child and adolescent psychiatric services at Fort Hood handle more than 1,000 visits, assessments or counseling sessions with military children each month, up from about 800 in 2004. It refers about 30 overflow cases off base each month, up from zero in 2004, the base statistics show.
Fort Hood has one of the most robust mental health programs in the Army. It has 171 behavioral health providers and 28 new hires are on the way, says Lt. Col. B. Kirk Phillips, a psychiatrist and director of mental health care at the Darnall medical center. This is up from about 50 mental health workers in 2004.
Because of war and deployments, not only are there more soldiers suffering emotional problems, they are sicker than ever and require more counseling sessions, Phillips says. Even after the latest round of hiring, Phillips says, a recent internal analysis showed the mental health staff will need an additional 58 counselors to meet the demand.
Suicides outpacing 2009
Despite the increase in mental health resources, there have been 14 confirmed or suspected suicides among Fort Hood soldiers this year. That figure outpaces 2009 and matched each of the three worst years for suicides in recent base history, 2006-2008. In June, the Army recorded 32 suicides overall, the highest monthly total since it began keeping records.
Army Sgt. Douglas Hale Jr., 26, was one of the most recent Fort Hood suicides.
On July, 6, Glenda Moss received this text message from Hale, her son: "i love u mom im so sorry i hope u and the family and god can forgive me."
Her son had tried to kill himself in May. She feared he might try again. She immediately called the Army and then drove the 90 minutes from her home in King, Texas, to the base.
It was too late. Hale had walked into a restaurant across Highway 190 from Fort Hood, asked to use the bathroom, locked the door and shot himself in the head with a newly purchased handgun, according to a police report. He was removed from life support a few days later.
Moss knew her son was very troubled. When his second combat tour to Iraq ended in 2007 after 15 months, he was diagnosed with PTSD and severe depression, began drinking heavily, saw his marriage disintegrate and, finally, left the base without permission last year.
He was brought back to Fort Hood in May after being taken into custody by police in King for being absent without leave, his mother said. He attempted suicide in his barracks that month.
The Army sent him to a psychiatric hospital in Denton, Texas. Army doctors told him "we don't have enough people here (at Fort Hood) to help you," his mother recalls.
A statement released by Fort Hood in response to questions about Hale's case says, "Space and staff shortages prevent us from treating all our patients on post. While it is our intent to treat patients within our facilities, the reality is we cannot at the present time."
Base officials declined to discuss the specifics of Hale's case while an Army investigation continues.
Moss says her son seemed to be in good spirits after leaving the Denton hospital following a month of treatment in June. He spent the July 4th weekend at his mother's home before she drove him back to Fort Hood on July 5.
Moss says the Army can do more to watch over troubled soldiers like her son. "They need to do as much as they can to stop this, because if they don't, the Army's going to be responsible for a lot more (suicides)," she says. "I don't want another family to have to deal with what I went through.
'Stigma was still a problem'
After the mass killings in November, Fort Hood launched a campaign to gauge the psychological health in the community. The goal was to see how many people needed help, whether they were getting it and how many counselors were needed. Part of the effort was an online, confidential survey in February to get soldiers' views. Troops were offered incentives such as a day off from work to participate. More than 5,000 responded.
One in four said they would be viewed as weak, treated differently or harm their careers if they admitted suffering emotional issues, says Col. William Rabena, who led the campaign. The attitude was particularly strong among majors, lieutenant colonels and full colonels.
"Stigma was still a problem," Rabena says.
For those soldiers afraid to seek help, who decline to go to Army therapists or private clinics that contract with the military, there are alternatives.
A Pentagon program offers soldiers a limited number of counseling sessions with private therapists that will remain off their medical records. The program is called Military OneSource, and it provides up to 12 free and confidential therapy sessions when soldiers call a toll-free hotline. From May 2009 to May 2010, there was a 72% increase in sessions provided by the program in the Fort Hood area, from 822 to 1,412, says Air Force Maj. April Cunningham, a Pentagon spokeswoman.
Another option for Fort Hood soldiers who want to keep their psychological problems secret from the Army is a free clinic in Killeen called Scott & White Military Homefront Services. The therapy provided at this clinic does not show up as a mental health diagnosis on a soldier's medical record.
The five therapists at the project are booked solid, says the director, Maxine Trent, a psychotherapist and the wife of a retired Navy SEAL.
The clinic has seen 7,117 soldiers, spouses and their children since it opened in 2008, says Matthew Wright, a director with Scott & White Healthcare of Temple, Texas, which operates the project.
Soldiers, many of them officers, come into the clinic seeking therapy for the first time in their careers, Trent says.
"Generally, you have the parade rest," she says, demonstrating how they sit with backs straight, arms outstretched and palms on knees. The tension in their bodies, she says, is palpable.
"Those who have been back-to-back deployed vibrate. ... There's different energy. There's hyper-vigilance that you won't see anywhere else," Trent says. "They walk in here not sleeping. They walk in here having mood disruptions, angry driving, explosions at wife and/or husband and kids."
When her offices opened, Trent canvassed the wives of Fort Hood commanders to get a sense of what she was facing. "They told us basically, 'We know everything we need to know about deployment. Please don't set up any programs to teach us about deployment,' " Trent recalls. " 'What we don't know how to do is to keep doing it (deployments). We're tired. We're exhausted.' "
Even this program struggles to cope with all those needing help and getting the money to pay for it.
A $750,000 grant from the Dallas Foundation and the Association of the U.S. Army for the project is nearly gone and officials are trying to secure more funding, Wright says.
Adam Borah, who runs the outpatient psychiatric clinic at Fort Hood, sees progress in the many soldiers stepping forward to seek help. "The bad news is that there are a lot of people out there who need behavioral heath care," he says.
Braverman worries that if the number of patients keeps climbing, soldiers will give up waiting to see someone and avoid seeking help. Private clinics that contract with the military to handle overflow patients are overworked, says Chuck Lauer, a senior administrator at Darnall Hospital. "These guys (local private therapists) are putting in six days a week. Some of them have their practices open 10 hours a day," Lauer says.
Staff Sgt. Rivera, who got the marital help, worries for the soldiers. "The military needs to know that they are losing very good soldiers and squads and platoons to multiple deployments," he says. "The amount of help needed is actually overwhelming."
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There Are No Heroes In Illegal And Immoral Wars
By Robert Jensen
August 24, 2010 "Information Clearing House" -- When the 4th Stryker Brigade, 2nd Infantry Division rolled out of Iraq last week, the colonel commanding the brigade told a reporter that his soldiers were “leaving as heroes.”
While we can understand the pride of professional soldiers and the emotion behind that statement, it’s time for Americans -- military and civilian -- to face a difficult reality: In seven years of the deceptively named “Operation Iraqi Freedom” and nine years of “Operation Enduring Freedom” in Afghanistan, no member of the U.S. has been a hero.
This is not an attack on soldiers, sailors, and Marines. Military personnel may act heroically in specific situations, showing courage and compassion, but for them to be heroes in the truest sense they must be engaged in a legal and morally justifiable conflict. That is not the case with the U.S. invasions and occupations of Iraq or Afghanistan, and the social pressure on us to use the language of heroism -- or risk being labeled callous or traitors -- undermines our ability to evaluate the politics and ethics of wars in a historical framework.
The legal case is straightforward: Neither invasion had the necessary approval of the United Nations Security Council, and neither was a response to an imminent attack. In both cases, U.S. officials pretended to engage in diplomacy but demanded war. Under international law and the U.S. Constitution (Article 6 is clear that “all Treaties made,” such as the UN Charter, are “the supreme Law of the Land”), both invasions were illegal.
The moral case is also clear: U.S. officials’ claims that the invasions were necessary to protect us from terrorism or locate weapons of mass destruction were never plausible and have been exposed as lies. The world is a more dangerous place today than it was in 2001, when sensible changes in U.S. foreign policy and vigorous law enforcement in collaboration with other nations could have made us safer.
The people who bear the greatest legal and moral responsibility for these crimes are the politicians who send the military to war and the generals who plan the actions (editor's bold emphasis throughout), and it may seem unfair to deny the front-line service personnel the label of “hero” when they did their duty as they understood it. But this talk of heroism is part of the way we avoid politics and deny the unpleasant fact that these are imperial wars. U.S. military forces are in the Middle East and Central Asia not to bring freedom but to extend and deepen U.S. power in a region home to the world’s most important energy resources. The nation exercising control there increases its influence over the global economy, and despite all the U.S. propaganda, the world realizes we have tens of thousands of troops on the ground because of those oil and gas reserves.
Individuals can act with courage and compassion serving in imperial armies. There no doubt were soldiers among the British forces in colonial India who acted heroically, and Soviet soldiers stationed in Eastern Europe were capable of bravery. But they were serving in imperial armies engaged in indefensible attempts to dominate and control. They were fighting not for freedom but to advance the interests of elites in their home countries.
I recognize the complexity of the choices the men and women serving in our military face. I am aware that economic realities and the false promises of recruiters lure many of them into service. I am not judging or condemning them. Judgments and condemnations should be aimed at the powerful, who typically avoid their responsibility. For example, a journalist recently asked Ryan Crocker, former U.S. ambassador to Iraq, to reflect on U.S. culpability for the current state of Iraqi politics. Crocker was reluctant to go there, and then refused even to consider the United States’ moral responsibility: “You can ask the question, was the whole bloody thing a mistake?” he said. “I don’t spend a lot of time on that.”
It’s not surprising U.S. policymakers don’t want to reflect on the invasions, but the public must. Until we can tell the truth about U.S. foreign policy, and how the military is used to advance that policy in illegal and immoral ways, we will remain easy marks for the politicians and their propagandists.
Part of that propaganda campaign is suggesting that critics of the war don’t support the troops, don’t recognize their sacrifices, don’t appreciate their heroism. We escape the propaganda by not playing that game, by telling the truth even when it is painful.
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Black Hearts: One Platoon's Descent into Madness in Iraq's Triangle of Death
by Jim Frederick
The Guardian
August 21, 2010
Vietnam veteran and novelist Edward Wilson finds chilling echoes of that war in a US platoon's Iraq killing spree
This isn't a book for armchair war junkies. It's about what Wilfred Owen called "the pity of war". The centre and the pity of Jim Frederick's account is the murder of the Janabis, an Iraqi family, and the rape of their 14-year-old daughter by four US soldiers. The most chilling aspect of the crime was the casual manner in which it was carried out. It was almost a jape – something to break the boredom of endless hours at a checkpoint. The soldiers did it because they had the power to do it; they didn't need a reason why – almost the invasion of Iraq in microcosm.
The rapists were from an infantry platoon in the US army's most elite division, the 101st Airborne, which provided "the Band of Brothers". It was the division sent by Eisenhower to enforce civil rights legislation and ensure that nine African-American children could attend Little Rock Central High School. It is associated with honour, not atrocity. It was only natural that it would be tasked with the most dangerous area of operations in the Iraq of 2005-06: the "Triangle of Death".
There are three basic things to avoid in war: getting killed, being convicted of war crimes and having a commanding officer who thinks you are useless. B Company's ill-fated 1st Platoon avoided none of these. By the end of their deployment, 11 of 1st Platoon's 33 members were dead or in jail for murder. Why? According to their commander, Lieutenant Colonel Thomas Kunk, it was all their fault: "You 1st Platoon are fucked up. Fucked up! Every single one of you!" Colonel Kunk was straight out of Catch-22. His officers referred to his control-freak outbursts as "getting Kunked" or being under the "Kunk gun". He seemed to have had every tact and empathy instinct removed: 1st Platoon's seven killed in action "were dead because of their failings", and the survivors were "quitters, crybabies and complainers". Such leadership is not unknown in the US military. Sometimes it works, but when it doesn't, the results can be bloody.
Everything that could go wrong did go wrong. The platoon's best leaders were killed early on, and the remaining soldiers were a mixture of seething resentment, indiscipline and combat exhaustion. Young soldiers on a battlefield packed with civilians need constant and close supervision. This didn't happen.
The best of 1st Platoon's lost leaders was Sergeant Kenith Casica. A photo shows James Barker, one of the rapists, with his arms around gentle giant Casica. The expression on Barker's face as he hugs Casica is pure bliss. Barker has found a replacement for the father who died when he was 15, but soon afterwards the surrogate father is dead as well. Casica was openly friendly to the Iraqis. When he was teased as a "hadji hugger" he reminded his men that they were there to help the Iraqis. If Casica had lived, Abeer Janabi and her family would also be alive today.
The most toxic of 1st Platoon's leaderless soldiers was Steven Green. His psychosis seemed obvious to all except the army's mental health professionals. On a combat stress report, Green's statement of "interests" as "none other than killing Iraqis" was dismissed as "normal". The alarm bells began to ring only when he killed a puppy by throwing it off a roof. At every step the army failed to protect the Iraqis from Green and Green from himself. His discharge papers, citing a pre-existing personality disorder marked by "indifference to the suffering of others", came too late. He had already committed rape and quadruple homicide.
In retrospect, it was obvious that Green was a troubled youngster whom the army couldn't redeem. There was something that went beyond drug offences, ADHD diagnosis and his mother kicking him out of the house at 14. Before dropping out of high school, Green entertained classmates at lunchtimes by smashing drinks cans on his forehead. After the murder-rape it was reported that: "Green was jumping up and down on a cot and they all agreed that that was awesome, that was cool."
Frederick acknowledges the adrenaline buzz of battle but does not attempt to gloss over war's inherently brutal and dehumanising nature. He is also a master at describing the psychological effects. The most feared weapon of today's wars is the ubiquitous IED (improvised explosive device). "There is nothing you can do . . . no release for the anger and adrenaline." The IED saps morale and spawns hate for the population: "How could you not want to kill them, too, for protecting the person who just tried to kill you?"
Inevitably, there are echoes of Vietnam, the most chilling of which comes from a 1st Platoon soldier: "You can't think of these people as people." The same dehumanisation that led to My Lai led to the murder of the Janabis. And in both wars, the soldiers who refused to tolerate dehumanisation were the real heroes. To his credit, Colonel Kunk, unlike his Vietnam predecessors, acted quickly and decisively. He may not have handled the matter tactfully – he immediately revealed the names of the whistleblowers, Justin Watt and John Diem, who risked retribution and scorn by reporting the murders – but he did the right thing.
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