PTSD Looms Large; Access to Mental Health Still at Issue

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Since September 11th, 2001, 30,177 active duty members and veterans died by suicide. It’s a jaw dropping number compared to the 7,057 killed in what I will label “military operations.” Anyone who is going to tell me that those 30,177 suicides aren’t part of active duty deaths isn’t being serious about this issue.

Mental health, and access to it, remains one of the most difficult and broken aspects of our healthcare system. It’s a second class system, within a second class system. Instead of applying parity to mental health issues, treating mental health with the same seriousness and severity as physical health issues, it is still too often hidden from view from those most likely to be able to do something constructive about it.

Even after two decades and 30,177 losses by suicide, the Veterans Administration still has not bridged this divide for so many retired and returning service members and veterans.

“We are taught to mask anything that is wrong with us, to adapt and overcome. Military culture looks at asking for help as a liability, from recruitment to training to the rest of one’s career.”

—Sherman Gillums Jr, New York Times

At times, there is extreme resistance to admit that the need exists for mental health services. What official, elected or not, would want to concede that their efforts have, up to this point, failed to address this issue effectively while simultaneously openly acknowledging that veterans and active military continue to struggle with mental health issues? How can that not impact combat readiness and effectiveness?

It actually does hamper our combat readiness and lethality of active and reserve units within the military. Officers in active units do have access to the CRRD, the Commander’s Risk Reduction Dashboard, which identifies “soldiers who may be at risk.” The Army Reserve is urged to use the Soldier-Leader-Risk-Reduction Tool, SLRRT, as it currently doesn’t have access to the CRRD. The SLRRT helps commanders build a dialogue with soldiers that might be at risk.

It is clear that there are efforts to address mental health and suicide in the military, however, at times it seems more like adding checks or numbers on a ledger than addressing the underlying human issues.

“If your sleep is not good enough, you’re more likely to have relationship problems, financial problems, or behavioral health problems. It just seems to be a common trend. If we can improve Soldiers’ sleep quality, we probably could improve other areas of their life – without over-medicating them,” McGrady said in U.S. Army Reserve.

This problem is not isolated to the military either. A retired Marine and former senior executive with Paralyzed Veterans of America, said it clearly.

“We are taught to mask anything that is wrong with us, to adapt and overcome. Military culture looks at asking for help as a liability, from recruitment to training to the rest of one’s career.”

-Sherman Gillums Jr, New York TIMES

Despite all of our disagreements, despite all of our misgivings about sharing our mental health struggles with one another, it appears the pandemic has had one positive impact on public sentiment. There is broad and wide agreement that America has a mental health crisis. “80% of Republicans, 91% of Democrats, and 93% of Independents,”

If there is ever an opportunity to work together on a problem, to coalesce behind an issue, and come to a serious agreement that brings together resources, training, education, prevention, and dedicated people, this is the moment and opportunity to pass legislation that can save lives.

If there ever was a moment we needed to remember how to work together, this is also that moment.

It is clear that the current system does not have enough capacity to effectively manage the number and severity of mental health issues in America. The actual data is far worse than a ‘simple access’ issue.

At least awareness of the problem amongst all demographics has increased significantly.

Awareness, when applied individually, can have enormous benefits for the individual. The benefits do not stop where a person ends.

In fact, when stated in just that way, we see the absurdity in our current healthcare system that lacks recognition of our interconnectedness. Any beneficial impact to our mental health, just like any increase in our awareness individually, will have an expanded impact witnessed within the greater community. We should be investing in each of us. That investment in the individual’s wellbeing is an investment in all of us. Increase awareness in one person, it is more likely it will increase the awareness in some people that person interacts with daily.

However, this individual type of awareness is not able by itself to produce the results necessary to adequately tackle the nationwide mental health crisis that so many Americans now recognize is our day and night reality. This reality is systemic, sustained, and involves limited access, concerns of affordability, and layers of longer term broken trust.

We need a strategic approach that is as comprehensive as it is targeted geographically. It can only be stitched together when local jurisdictions work in unison with both state and federal agencies. Perhaps, it is time to discuss a completely new system. This new system must be linked directly into the education system, providing training and services for both K-12 and higher education in a coordinated fashion that naturally leads students to careers with growth potential within their own communities. It also would have natural linkages into law enforcement and the court system.

Currently, we have a patchwork quilt of drug courts throughout America that mitigate minor and first-time drug offenses through a rigorous set of benchmarks and timelines. If you don’t qualify, you’re out of luck and back into the criminal justice system that is well known for incarcerating mental health issues over hardened, violent criminals.

Too often, any mental health treatment linked with the criminal courts is so skewed in its focus. Treatment as punishment often loses all effectiveness if not being completely counterproductive. These addiction industries are ethically challenged as their financial lifeblood is directly linked to more drug cases pumping their rooms full of mandated addicts. Is this why Department of Corrections drops off busloads of convicts nearby? Is this why no one mentions the success rate of their interventions. No one mentions the focus on addiction-only instead of dual diagnosis.

“There is limited scientific literature evaluating compulsory drug treatment. Evidence does not, on the whole, suggest improved outcomes related to compulsory treatment approaches, with some studies suggesting potential harms. Given the potential for human rights abuses within compulsory treatment settings, non-compulsory treatment modalities should be prioritized by policymakers seeking to reduce drug-related harms.”

International Journal of Drug Policy, V 28 Feb 2016, Pages 1-9

Separating this new system from the past is critical, as it must incorporate the most vital lessons learned from past structural failures and previous program successes. The differences and opinions on that last sentence alone will leave no doubt as to the entrenched special interests and anecdotal accounts of miracles and horror stories that will lay siege to any reform effort, with the goal of rematerializing the decay and rot that were hallmarks of the last 50 years.

Anyone who believes that reform efforts are going to suddenly be galvanized, focused, and breakthrough all of the bureaucratic failures, the institutional inertia, and the people’s capacity to just keep looking the other way while someone simply laughs when someone is in mental health distress would be convinced of nearly anything you told them. Tell them something important, at least.

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