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HELP FOR SOLDIERS
Here are the increases in the Army’s stock of civilian mental health professionals since 2001:
Psychiatrists: 209 percent
Social workers: 266 percent
Psychologists: 113 percent
Psychiatric technicians (a nonprofessional support position): 1,000 percent
As soldiers have increasingly struggled with post-traumatic stress, suicide and drug abuse, the Army has added thousands of civilian mental health specialists to treat troops and their families.
Army Medical Command reports it has more than doubled its inventory of civilian behavioral health care providers since 2007, with 1,985 hires. In five years, the service's civilian corps gained 819 social workers, 510 psychologists and 73 psychiatrists, in large part due to an increase in congressional funding after the patient-care scandal at Walter Reed Army Medical Center in 2007.
Amid lengthy deployments and 10 years of war, the Army has seen behavioral health needs rise among troops. Since 2003, more than 70,000 soldiers have been diagnosed with post-traumatic stress. Last year alone, 278 suicides were reported in the active force, National Guard and Reserve, and more than 24,000 soldiers were referred to the Army Substance Abuse Program.
Lt. Col. Edward Brusher, a behavioral health official with the Office of the Surgeon General, said the Army's push to reduce the stigma associated with seeking mental health care has in part led to increased demand for care.
The Army is balancing the demands placed on uniformed behavioral health professionals by hiring civilians.
"We have hired more providers and assessed more into our uniformed inventory primarily as a result of 10 years of conflict and a recognized increase in behavioral health demands from both soldiers who have deployed, but also family members and soldiers who are being assessed into our system," Brusher said.
Since 2001, the Army has increased its civilian behavioral health workforce by 169 percent.
In fiscal 2011, the Army spent $5.9 million on incentives for psychologists and $4.4 million on incentives for psychiatrists. The financial rewards are meant to help the Army compete with the private sector, Brusher said.
Demand has risen as methods of screening soldiers for behavioral health issues have become more regular and comprehensive, and amid efforts to reduce the stigma associated with seeking help for such problems, Brusher said.
Congressional defense spending legislation in 2010 mandated that Army primary care doctors administer behavioral health assessments during annual physical screenings, and pre- and post-deployment screenings. Soldiers who present emotional problems are referred to behavioral health care.
According to Brusher, civilian studies show patients are typically more honest in these settings, and the Army is studying the effects of this approach, including whether it is leading to more referrals of soldiers to behavioral health treatment.
"For some reason if you put them in front of a mental health provider, they may report lower than they are actually feeling," Brusher said. "Will we be able to achieve better outcomes as a result? That's the fundamental question and we are still trying to answer that."
New Army programs to get care closer to soldiers are expected to increase the requirements for mental-health workers, Brusher said.
For example, the Army is rolling out a new program that "embeds" behavioral health clinics within brigades that traditionally have not had such providers. Each brigade gains two behavioral health providers and two behavioral health technicians.
The Army is still falling short of its own access-to-care standards for active-duty soldiers. Though nearly all soldiers are usually seen within 24 hours — which is required for emergency cases, Brusher said — the time it takes to be seen for follow-up care has climbed from 12.3 days to 13.4 days in the last year.
"What we want to do … is to make it meaningful for you to want to come to us, ask for us to help and have us help you in as quick a time as possible without having to answer questions again because a new provider was put in front of you," he said.
The advantage of hiring civilians over contracting for these services is the lower cost, continuity of service and the greater flexibility of managing these workers, according to Army officials. Continuity is a problem with contractors because the contracts for these positions have to be re-competed on a recurring basis, and cannot be re-awarded to the same personnel.