Fighting for hearts and minds

We read it in the news and hear it on television: The U.S. is not prepared to meet the growing demands of military personnel for behavioral health services for post-traumatic stress disorders (PTSD) and traumatic brain injuries (TBI). Clearly, the strain on military resources is showing:

• A 2011 Military Times survey of active-duty service members reported that it could take them more than a year to get treatment for mental health problems.
• This same survey reported that access to treatment seems to be increasingly a source of frustration. It’s just a sign the systems are overwhelmed.
• There is a shortage of clinical psychologists who have served or who have specialty training and relate to our war veterans.
• As a group, veterans continue to suffer above-average rates of psychological problems, substance abuse, homelessness, and suicide.

  Alarming statistics for TBI, PTSD, and alcohol abuse Veterans of the Vietnam War—as well as those returning from service in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF)—often experience serious challenges, even while they seek treatment for mental health and substance use problems.  These include reintegrating into society, preparing for additional deployment, recovering from a traumatic injury, advancing their education, and finding work. To date, 2.3 million military members have been deployed to Afghanistan and Iraq, according to a recent Rand Corporation report commissioned by the Defense Department. The report also states that 19 percent of service members report receiving a TBI, and 20 percent have either been diagnosed with or report symptoms of PTSD. A recent study by the Armed Forces Health Surveillance Center showed the increasing medical burden that alcohol abuse and alcoholism places on the military health care system. The report described as “striking and troubling” its findings that more troops are being hospitalized for alcohol abuse. In the past 10 years, the number of days that active-duty service personnel were hospitalized for alcohol abuse or dependence has quadrupled. Meanwhile, a 2008 Defense Department health survey of active duty military members showed that about 20 percent engaged in heavy alcohol consumption.

In response to increasing needs the last several years, the U.S. Army, Navy and Air Force have significantly increased the number of positions for Licensed Clinical Psychologists—across the active duty, reserve and National Guard components of the armed services.

The Veterans Administration also sees the rising demand for services and increased the budget for behavioral health programs by $1 billion, to a total $6.2 billion in the 2012 budget. The number of behavioral health professionals working in the V.A. system has increased from 14,000 in 2004 to more than 21,000 today. The VA also has increased the number of Vet Centers that provide outpatient counseling from 200 in 2007 to 300 this year.

Preparing psychologists to treat military personnel

Responding to the needs of the military, and of interest by a group of students who created an interest group, and after discussion with faculty, in 2010 the Adler School of Professional Psychology (Chicago) proceeded to establish an elective course of study in military clinical psychology within the School’s doctoral program in Clinical Psychology. Our first class of 21 students, including a number of students with military experience, began in fall 2011.

The Military Clinical Psychology track of the Adler School’s Psy.D. program prepares students to work as clinical psychologists, either as members of the uniform services (Army, Navy, Air Force or Public Health Corps), or as civilians in the Departments of Defense, Veterans Administration, or in public and private-sector programs serving active-duty military, retirees, veterans, and their families.

The track’s coursework includes a general survey course which is an introduction to the field of military psychology. The next two courses in the track examine the psychological and physical impact of combat, conflict, and terrorism. In preparing students to work in the various health care systems they are given an introductory course in defense and veteran’s healthcare systems.

It is also important for them to understand both mental health law and the military’s Uniform Code of Military Justice (UCMJ) which is addressed in its own course instructed by a faculty member who is both a Vietnam veteran and an attorney. The final course in the track is specific education in mental health disaster response.

Apart from the academic coursework, graduate students engage in community and clinical training practicum. Some of these training settings provide direct work with the veterans’ community, while others are clinical settings that include inpatient psychiatric hospitals, community mental health centers, or primary care settings where students might well find themselves working in the future.

Help for marginalized population

Adler’s Military Clinical Psychology track trains the student in clinical psychology that they need to understand that today’s veterans have long been a marginalized population within society. Collectively they suffer above-average rates of behavioral health problems. One of the most recognized veteran populations is from the Vietnam War, a population of people who were often marginalized the minute they stepped off the plane following their combat tours of duty.

Veterans of that war, as well as the veterans of the current conflicts, often experience challenges with reintegration into society, preparing for additional deployment, recovering from a traumatic injury, trying to further their education, and trying to manage all of the above while attempting to seek treatment for mental health or substance abuse problems. Our military, retirees, veterans, and their families can be greatly assisted by trained clinical psychologists who have completed this specialty track.

According to social worker Richard Lessor, ACSW, the value of those who have served is that “They are willing to go into battle and confront hell.” We must value our warriors by seeing to it that they are provided the behavioral health services that they need and that these clinical services are provided by appropriately educated and trained psychologists. We as a nation owe them that much for what they have done for us.

Joseph E. Troiani, PhD, is an associate professor of Clinical Psychology and Founder of the Psy.D. Military Clinical Psychology Track at the Adler School of Professional Psychology, and a retired U.S. Navy Commander.