Fort Hood shooting renews questions about demands on mental health care

More than 1 in 5 combat vets may have symptoms

WASHINGTON, D.C. - The fatal shootings carried out by a soldier at Fort Hood underscore lingering concerns that the military mental health system is unable to meet the needs of troops carrying invisible wounds from more than a decade of wars.

While both the Defense Department and Department of Veterans Affairs have ramped up programs to diagnose and support troops suffering from brain injuries and mental health problems including post-traumatic stress disorder, critics say significant barriers remain toward service members getting mental health care.

One report for the Army last year noted that despite an increase in the behavioral health workforce of more than 100 percent, “some military treatment facilities still cannot meet the need for behavioral health services.”

More than one in five veterans of Iraq and Afghanistan may have symptoms of post-traumatic stress disorder or depression and at least as many report having experienced a traumatic brain injury while deployed, with about 7 percent reporting both, researchers have found.

Officially, the Pentagon’s count for TBI diagnosis is about 260,000 and nearly 119,000 PTSD diagnoses among all service branches.

Although many questions remain about the background and motives of the attacker, Spec. Ivan Lopez, a great deal of focus has been placed on the revelation from military officials that he was undergoing evaluation for PTSD and being treated for anxiety, depression and sleep problems.

Mental health professionals interviewed stressed repeatedly that diagnosis for any of those conditions is not a red flag in predicting violent behavior, but expressed worry that the attack may increase stigma toward PTSD and discourage some from seeking help for their symptoms.

“The system is swamped, there are still far too few mental health professionals available to work with active duty service members and veterans,’’ said Dr. Melissa Earle, a clinical social worker who works with veterans and is associate dean at Touro College Graduate School of Social Work in New York City.

“But PTSD does not equal violence, and I’m very concerned that this event not somehow get connected in a way that discourages people from coming in because they’re labeled a prospective shooter.”

Many members of the military are reluctant to seek mental health care due to concern that it may harm their career by affecting security clearances or other qualifications, or force retirement if the condition is deemed disabling by a review board,  Earle and other experts said.

The Army Task Force on Behavioral Health, in a January 2013 report,  noted that while there are more providers, medical treatment facilities have not restructured and trained leaders to keep up with the increased demand.

It was also critical of record systems that don’t match diagnostic terms used in mental health and the lack of an officer specifically assigned to behavioral health issues on many installations.

Army officials did not immediately respond when asked to comment on changes since the report’s release.

A February report from the Institute of Medicine said while the VA and Defense Department are in some ways at the leading edge of treatment for psychological health problems, both systems still face “inconsistencies in care availability, quality and a lack of systematic evaluation.”

Just outside Fort Hood, in Killeen Texas, clinical social worker/therapist Janet Tuohy said she sees an average of 12 clients from the base each week, and many come in with PTSD symptoms.

Some, she said, are referred because they’ve turned to alcohol abuse to cope.

“Others are coming in with depression anxiety, nightmare, flashbacks, difficulty with startle response -- so they hear loud noises,” she said. “It’s that feeling of continued lack of safety.”

Tuohy and others agree that while more effort is being made to help troops who have PTSD symptoms, the scale of the problem remains daunting.

“While we’re getting better at learning how to treat PTSD and we’re getting better at identifying it, there are a lot of places where they’re slipping through the cracks because there are just so many of them that are coming back with these symptoms,’’ she said.

The Iraq and Afghanistan Veterans of America is one of many veterans groups calling for mandatory mental health and TBI screening and greater access to care.

“While the vast majority of our military is not in crisis, we must all acknowledge that there are indeed problems with the way mental health and transitional support is managed,’’ said the group’s founder, Paul Rieckhoff, in a statement.

Spec. Lopez reported  sustaining a head trauma while he was deployed to Iraq in 2011, although there was no record of his having been treated for one, according to Lt. Gen. Mark Milley,  Fort Hood’s  senior officer. In a press briefing,  Milley said there was “a strong possibility” an argument may have set off the shootings.  Lopez had seen a psychiatrist within the past month and was prescribed Ambien, a sleep aid, Army Secretary John McHugh said Thursday at a U.S. Senate Armed Services Committee hearing.

Researchers have only recently begun to find apparent links between traumatic brain injury and PTSD in some patients, and the overlap is further complicated because most brain traumas occur from activity outside combat, like vehicle accidents and sports, and may be poorly reported and documented.

“It’s an active area of research, but there’s often no good way of knowing if or how someone sustained one,’’ said Terry Schnell, a senior behavioral scientist at the RAND Corporation who specializes in PTSD care.

``Assessment for PTSD is complex, and it’s entirely possible someone can have symptoms as a result of another condition, like depression, and not be formally diagnosed. If you treat that condition, those other symptoms will likely go away.”

Scripps News National Correspondent Thomas Hargrove contributed to this report.


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