Working To Defeat Combat Stress

May 29, 2009

When a service member is in a deployed environment, regardless of the job they do and regardless of whether they even leave the FOB, there are certain things that occur in that environment that can lead to combat stress. Our Troops who have been deployed in Afghanistan and Iraq can attest to the fact that it’s not uncommon for mortars and rockets to fall on the FOBs, so even those who never leave the FOB have the potential of developing combat stress. That’s where the combat stress centers come in. I realize that lately there’s been a focus on those centers, due to the horrific incident that occurred where 5 service members were murdered by a fellow Soldier. The staff at the combat stress centers are dedicated professionals who are there to help anyone seeking their help to combat and manage their stress. They are well aware of what our Troops experience in the combat zone and are there to help those who are struggling.

“We are able to see any service member that is stationed at FOB Kalsu and anyone who needs assistance is sent here to this location,” said Air Force LTC (Dr) Alicia L. Tschirhart, a psychiatrist who is commander of the Kalsu Combat Stress Control Center. The center serves several provinces in Iraq. “I have two enlisted personnel here as well, that do individual counseling, screen patients and do outreach to the community.”1

Approximately 25-30 service members a week are seen at the Kalsu Combat Stress Control Center. Issues that they see the staff there, range from anxiety, depression and even marital problems. Others may be having difficulty sleeping due to the stress they’re experiencing. Confidentiality is very important to most patients, especially who self-refer, or seek help of their own accord. Many still fear that if they seek help, it will cause them problems in their jobs. The stigma of seeking help that the military is working hard to eradicate. According to Tschirhart, they shouldn’t allow those fears should not keep Troops from seeking help.

“For the most part, a Soldier is treated right here at Kalsu with little interruption to their work schedule,” she said. “We try to protect the patient’s confidentiality as much as possible.”2

Keep in mind, that’s standard proceedure in all mental health services, be it military or civilian. However, if the mental health professionals feel that the service member is a danger to themselves or others, then they are obligated to report those concerns. Many different services are available, such as anger management, stress management, tobacco cessation assistance, and other services.

“Most people just need assistance in managing their thoughts, and we do offer therapy as well as prescription medicine treatment,” Tschirhart said.3

I would highly encourage anyone downrange who is experiencing troubles with these types of problems to seek help at their combat stress center. If you’ve still not decided to seek help there, yet feel that you do need help, there are also resources online that can be helpful. A couple of years back, a website was created to assist service members experiencing difficulties. Called simply,Combat Stress Center it offers many resources for those seeking help, as well as providing the locations and phone numbers for the Combat Stress Centers in Iraq. For our Troops, I strongly encourage you to seek help if you’re experiencing difficulties. The combat stress centers are someplace that you can do so.

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Pay It Forward … Real Warriors Campaign

May 22, 2009


We’ve covered the topic of Post Traumatic Stress Disorder quite often here and it’s something that is likely to continue being in the news due to the frequency of deployments that our Troops are seeing, as well as the experiences that they’re encountering in combat. PTSD is something that has affected service members throughout all of the conflicts that our military has been involved in, though in the past, it’s been called by different names. Since the current conflicts began, the military has worked hard to attempt to change the stigma that has been attached to our Troops seeking help for this ailment. In the past, when our Troops have had difficulties dealing with what they experienced in combat, they’ve been told to ’suck it up, and drive on.’ That’s no longer the case. Our Troops are being encouraged to seek mental health help to aid them in dealing with their experiences. Unfortunately, the stigma still remains and the battle to get Troops to seek help is one that continues.

The Defense Department announced yesterday that’s it is launching a new campaign, aimed at encouraging Troops to seek help for PTSD. That campaign is called “Real Warriors.” One Marine sergeant who is participating in the campaign is someone that, at a glance you’d not think would be suffering from PTSD. It’s obvious that he is a body builder. Yet he suffers from PTSD. He’s served 3 tours in Iraq, in 2003, 2005 and 2006. He’s a purple heart recepient, due to injuries that he received after a roadside bomb injured him in Anbar province. He’s been in many firefights and he has PTSD because of what he experienced.

“Real Warriors is a program aimed at wiping out the stigma associated with getting mental health care in the military,” said Army Brig. General (Dr) Loree Sutton. “We want people to seek help the same way they would if they had a physical wound.” Sutton is a psychiatrist and heads the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.1

When Hopper first got back home, he suffered from difficulties sleeping and tended to concentrate on the negative aspects of his deployments. Though he tried to hide the symptoms and did a pretty good job of it, by those close to him, his wife and other family members knew that he was struggling. That eventually affected his work as well.

“My big thing was outbursts and mood swings,” he said. “I had a bad, bad temper that didn’t take much to get me there. I used alcohol as a way to comfort everything, and that was big-time out of the norm for me.”2

Things quickly came to the forefront when he was receiving an award from his battalion commander. The symptoms that he had tried so hard to hide, burst out into the open.

“When I received the award, I replayed what happened that day,” he said. “I sort of got into another world. I started shaking, got the cold sweats - everything. That’s when my commander sat me down and offered help.”3

Like many of our Troops, Hopper had many preconceived notions about what it meant to admit that he had a problem and ask for help. Like many others, he felt that he was supposed to be a warrior, a strong, tough guy who was supposed to be able to deal with it and soldier through the difficulties. Luckily he swallowed his pride and sought help. He went to Walter Reed Army Medical Center for help. Specialists there realized that he was in need of more intense treatment than what they could provide.

“The place that really changed my life was at the Martinsburg, West Virginia Veterans Affairs Hospital,” Hopper said. “I was lucky enough to get the help I needed there.”4

There he met many other Veterans who were dealing with the same demons that he was. He quickly bonded with Veterans from Vietnam, Desert Storm, Iraq and Afghanistan all who were at the hospital getting help for PTSD. They understood what he was going through and they were there to support him. When he returned to Camp Lejeune, everyone noticed the difference. Upon his return, his unit was deployed, so he was temporarily assigned to another unit.

“They all knew where I had been, but everyone was great to me,” he said. “They didn’t tiptoe around me as if I were some crazy guy. They treated me like any other new Marine to the unit.”5

When his unit returned from deployment, Hopper was there to welcome them home. He pulled aside his commander and thanked him for encouraging him to get help and expressed that he could never pay him back for that encouragement.

“And he told me, ‘There are a lot of people who are coming back from these wars that are going to be in the same shoes you were, and you’ll recognize what they are going through. All I ask is that you pay it forward. If you can help one person, you’ve paid me back,” Hopper recalled.6

For Hopper, participating in the Real Warriors campaign is one way that he can ‘pay it forward.’ His is a story that many others who are suffering from PTSD can relate to. Hopefully, knowing that he was willing to swallow his pride and ask for help, will encourage others who are suffering to seek the help they need.

I’m impressed with the insight of SGT Hopper’s commander. I only hope that other commanders in all branches of the military, will follow his lead and encourage their Troops that they know are suffering, to get the help they need. To find out more about the Real Warriors campaign, just click on the Real Warriors widget in the sidebar and it’ll take you directly to the webpage.

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A New “Classic” Approach To Addressing PTSD

May 6, 2009

The topic of PTSD and how to deal with it, has been forefront in the media over the past few years, as our Troops have served multiple deployments in the combat zones of Afghanistan and Iraq. Not only has repeated deployments taken it’s toll on our Troops, but the events that they’ve experienced while in combat zones has played an even bigger role in the symptoms that are being seen, as our Troops return home. In past conflicts that our military has been involved in, PTSD, while present, had been virtually ignored and our Troops told to “suck it up” and “soldier on.” It’s been known in the military, that to ask for help dealing with their “mental demons” was a career killer and a sign of weakness, so many ignored what was going on with them and refused to seek help.

With the advent of the wars in Afghanistan and Iraq, the military has taken a totally different approach and is attempting to address the mental health concerns of our Troops who return suffering from PTSD. New programs across the military have been implemented and even civilian agencies and non-profit organizations are creating services are working to provide services to our Troops who suffer from PTSD.

First Sgt. Lorenzo Zamora draws parallels from his personal experiences to the characters in ancient plays before an audience that includes the brass at Fort Drum, N.Y.

At Fort Drum, last week, a new program called Theater of War, which was conceived by Bryan Doerries, who is a New York theater director, funded by Respect-Mil, a Walter Reed Army Medical Center program, took a different, classic approach to addressing PTSD. The program was brought first to Fort Drum by the 10th Mountain Division command, intent on getting Soldiers to recognize PTSD and how it affects them, as well as their family members.1

After nine grinding years of war, the once-mighty soldier abruptly comes unglued. Denied an honor he thinks he’s due, he goes to kill the officers he holds responsible, but after his night of rage finds he has slaughtered barnyard animals, not generals. Shamed beyond endurance, he plans suicide. ‘A great man must live in honor or die an honorable death,’ he tells his wife. ‘That is all I have to say.’ The soldier is Ajax, fighter of the Trojan War, his downfall portrayed in a Greek tragedy written more than two millennia ago.2

For many who watched the play last week in a bar located on Fort Drum, it was like watching a scene from their own life. It definitely struck home with them and even brought back memories of the struggles they themselves have had with PTSD. Even then, during the Trojan War, Soldiers faced the same problem, the psychic trauma of war. The performance is designed to provoke soldiers into more awareness of the emotional toll that deployed place on themselves as well as their family members.

“We’re calling it PTSD now … but it’s timeless,” General Kevin Mangum tells the audience of brigade commanders and their spouses. “Ajax’s ego drove him to his ‘divine madness’ … I know a hell of a lot of Ajaxes out there.”3

There are several plays in the series, each addressing the important issues regarding PTSD. In one play, a wounded soldier is abandoned by his fellow troops. Another portrays a warrior chief who goes mad and kills himself, despite the pleadings of his wife. That warrior chief is Ajax. In the play, Ajax’s wife says, “He sits shellshocked in his tent, glazed over, gazing into oblivion. He has the thousand-yard stare.”4 1SG Jeffrey Birgenheier was one of the senior leaders present at the pilot performance. The performances will be eventually presented for enlisted Troops as well.

“Although the technology of war has changed over the years, the basic concept behind that has remained the same: a lot of gruesome stuff going on and people having to deal not only with what they’ve done and what they’ve seen but also being apart from their families,” he said.5

The military is attempting this new and novel approach to PTSD, in the hopes that Soldiers suffering from PTSD and who haven’t yet sought help due to the stigma, will do so. The hopes are that if Soldiers who are suffering will recognize the symptoms and seek help, that they can stem the record high numbers of suicide that have been plaguing the military. Perhaps, by viewing this play, Troops will be encouraged to seek help, instead of taking the ‘final way out of suicide.’ This new approach, similar to the Army’s approach to sexual assault with the Sex Signals show is encouraging to me. Instead of the typical ‘death by power point’ approach of the past, the military is approaching these problems from a whole new direction, one that’s more likely to grab and keep the attention of the Troops whom the training is geared towards.

“This is not new territory that we’re in,” says Col. Charles Engel, director of the Respect-Mil program. The story’s age makes the message easier to take for Troops worried about admitting weakness,” he said. “It helps us get over the sense that we are flawed.” About three quarters of Soldiers who have PTSD have not sought help for it, fearing it will hurt their military career,” he says. “In some ways, seeking help is counter to Army training. We’re taught self-sacrifice,” Engel says. “It’s a value. Part of self-sacrifice means you learn to ignore your own needs at times.”6

The play served it’s purpose in reaching those who might be suffering from PTSD and reminded several of the times where they felt they were spiraling out of control into their own form of ‘divine madness.’ One, Capt. Christopher Tramontana thought about the day he was in the motorpool at Fort Drum when suddenly a fleet of Humvees fired up their engines. The sound caused him to panic and it brought back memories of his time on deployment.

“They have a very distinct motor sound,” Tramontana says. “That brought back everything.”7

He panicked until a SGT told him that he could ride in a different truck, if he wished. In an effort to help remove the stigma of seeking help for PTSD, Tramontana doesn’t hesitate to tell others in his support maintenance company that he suffers from PTSD.

“The Army’s putting a lot of focus on it now,” said 1SG Stanton Brown, “but why did it take 2,500 years for us to say this is a real problem?”8

I’m looking forward to following the Theater of War program and hopefully being able to see it when it comes to the installation I work on. Hopefully other military audiences will be as receptive as the Fort Drum Soldiers were. I think that programs like this have much more potential than the typical power point trainings. Soldiers are more likely to pay attention and hopefully learn something, than they are with the power point trainings. I applaud the Army for recognizing this and finding different and new approaches to getting this important information out there to our Troops.

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Fort Hood Reset Program Teaches Soldiers To Leave ‘Battle Mind’ Behind

March 25, 2009

When someone is in a stressful situation, one of the body’s natural response to stress, fright, or danger, is what is called the fight or flight response. This is a very natural and inborn reaction to stressful situations that we all experience when we’re in stressful situations. It is our body’s primitive, automatic, inborn response that prepares the body to “fight” or “flee” from perceived attack, harm or threat to our survival.1

When our fight or flight response is activated, sequences of nerve cell firing occur and chemicals like adrenaline, noradrenaline and cortisol are released into our bloodstream. These patterns of nerve cell firing and chemical release cause our body to undergo a series of very dramatic changes. Our respiratory rate increases. Blood is shunted away from our digestive tract and directed into our muscles and limbs, which require extra energy and fuel for running and fighting. Our pupils dilate. Our awareness intensifies. Our sight sharpens. Our impulses quicken. Our perception of pain diminishes. Our immune system mobilizes with increased activation. We become prepared—physically and psychologically—for fight or flight. We scan and search our environment, “looking for the enemy.2

When in deployed to a combat zone, our Troops experience this ‘fight or flight state’, due to the situation they’re in, they remain in that hypervigilant state for the entire time they’re deployed and many times after they return home. It becomes second nature to them to be in that constant hypervigilant state and it’s often difficult for them to just turn that switch, if you will and return to their normal state, before they were deployed. Some struggle with that and some never learn how to turn that switch. That often creates difficulties for our Troops, when they return home, away from the combat zone and with their families. Often family members don’t understand, why their Soldier appears to always be on edge, jumpy and not themselves. That’s where Battle Mind Training comes into play, both for the Troops and for their Family Members.

Recoginzing that it’s very difficult for Troops to turn off that ‘hypervigilance’ and relax and get back into the routine of everyday living outside the combat zone, the Carl Darnall Army Medical Center at Fort Hood has created what they call the Warrior Combat Stress Reset Program, to help teach Soldiers how to leave behind the “Battle Mind” and return to the “Peacetime” state of mind. The program at Fort Hood is designed to help reduce the hyper-arousal symptoms and inappropriate reactions to normal everyday events.

“We use a variety of body and mind healing techniques along with group and individual counseling,” said Oregon native Maj. Lynette Heppner, officer-in-charge of the reset program. The two-week program is for Soldiers struggling to adjust to being home. “Soldiers do not need to be diagnosed with Post Traumatic Stress Disorder to attend the program,” Heppner said. “The name of the clinic is really fitting, warrior combat stress,”3

The program at Fort Hood lasts for two weeks and is designed to help Soldiers ‘reset’ and help them heal from traumas that they may have experienced during their time in the combat zone. By providing the Soldiers with the right tools to help them begin the emotional healing process, Soldier’s are learning to cope with those feelings and learning to relax and get back to their normal existence at home. Being able to do so, becomes more difficult for the Soldiers as they are sent on repeated deployments. Events have occurred that are painful for them and thus talking about them or dealing with the feelings are difficult as well and are often buried deep inside.

“We have powerful tools to help with adjusting, resetting, and with Post Traumatic Stress Disorder. Yes, service members are scared but they are not disabled,” said Dr. Jerry Wesch, a clinical psychologist from Nebraska. Before enrolling in the reset program, Soldiers are screened and later scheduled for the next available two-week session.4

The sessions are open to all Soldiers both officers and enlisted personnel. The sessions are held from Monday through Friday from 7:30 am to 4:30 pm for two weeks. It’s important that if Soldiers enroll in the program, that they are personally committed to following through. They must also provide a consent form from their chain of command, to attend the sessions.

So far, the feedback from those who have attended has been positive. It’s great that such a program is available to the Troops at Fort Hood, the largest military installation. Staff members and Soldiers who have attended the program, stress that for a Soldier to seek help, is a definate sign of strength. A sign that they’re ready to leave the ‘battle mind’ behind and return to a sense of normalcy in their lives.

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Wounded Warrior Care In The Army

March 18, 2009


After problems were revealed in 2007, relating to the treatment of wounded warriors at Walter Reed Army Medical Center in Washington DC, the Army created Warrior Transition Units (WTUs) across the Army and in communities across the country as well. The mission of the WTU’s is to provide a single Chain of Command to ensure quality of care and support to Warriors in Transition and their families. From the point of injury or illness or disease to their return to duty or transition from active duty. To synchronize existing care and services available and provide a knowledgeable and carind Triad and Chain of Command capable and committed to treating Soldiers and their families with honor and respect.1

Recently in the media, there has been numerous stories about overly harsh discipline methods at Fort Bragg’s Warrior Transition Unit. Taking these charges seriously, the General in charge of some 9,000 wounded soldiers in the units across the Army, told the media on March 11th, that he is ordering a review into how the members of the Warrior Transition Unit (WTU) at Fort Bragg are being punished for minor violations. Brig. Gen. Gary Cheek said he is asking the Army Surgeon General to look at all discipline that has been taken against soldiers in the base’s Warrior Transition unit to make sure each case was fair.2

Cheek’s comments come a day after The Associated Press reported that soldiers in the unit are being disciplined three times as often as those assigned to the base’s main tenant, the 82nd Airborne Division. The AP also found that discipline rates vary widely across the Warrior Transition system; some units punish their soldiers even more frequently than the one at Fort Bragg, while others are far more lenient.3

In a bloggers roundtable held on Tuesday, Col. Jimmie Keenan, Chief of Staff of the Army’s WTUs and Col. Patrick Sargent spoke about the mission of WTU’s the successes that have occurred and how the reported problems at Fort Bragg are being addressed by the Army and reviewed. According to Col. Keenan, each disciplinary action at taken at Fort Bragg will be reviewed by the 18th Airborne Corps Judge Advocate General office to ensure it’s appropriateness.

One of the priorities for WTU’s is quality of care of each Soldier assigned to a WTU. The men and women assigned to the WTU’s remain Soldiers and thus it’s necesary to balance the need for order and discipline and the individual need of the Soldiers. Since the inception of the first WTU at Walter Reed almost 2 years ago, many things have been put into place by the Army to ensure the needs of these Soldiers are met.

Each month, commanders from the WTUs across the Army participate in videoteleconferences, to address problems, update on new policies that have been put into place and review what’s going on at each installation. Training for the cadre (staff) of WTUs is an on-going process. Initially, as the WTUs stood up across the Army, mobile training teams were sent out to the various sites to ensure that the cadre were aware of the intricate needs of the soldiers assigned to their WTU. This was supplemented by online training. Things such as education on TBIs, PTSD, stress, medication interactions as well as many other things were covered with the cadre, most whom were moved from more traditional Army MOSs (jobs) to be part of the WTU cadre. Family involvement is a huge part of recovery for wounded and ill Soldiers, and the cadre is provided with training on how to deal with the families of the Soldiers assigned to the WTU as well. As of October, the first class participated in a 2 week course for cadre, at Fort Sam Houston in San Antonio to provide them with additional formal training. Other on-going training that is provided throughout the year are things like suicide prevention, medication resolution, and medical conditions.

One practical application of the training resulted in a chain of command taking a look at a Soldier who was experiencing difficulty making his 0730 formation every morning. After looking at the types of medication this particular Soldier was taking, it would be very difficult to make a 0730 formation, so his report time was changed to a later time.

It was stressed during the Roundtable discussion, that the key component of the Warrior Transition Units, was the Triad of Care. What is that, you might ask? In each WTU, there are 3 components to ensuring the appropriate care, treatment and transition of the Soldiers assigned there. Those components are, Nurse Case Managers, Primary Care Managers and the Soldier’s Squad Leader. Each Soldier has a care plan that is individualized for them, based on the goals of that Soldier and their family. Things that are looked at, are, does the Soldier want to stay in the Army? If so, will he or she need to be trained into a new MOS? If he or she choses to transition from the Army to the civilian sector, does he or she need civilian job training? Under certain circumstances, if a Soldier is judged physically unfit to remain in the Army, they can apply to stay in anyway. Those circumstances are that they must meet one of the following criteria:

1. 15 years of service.
2. Shortage of their occupational skill set.
3. Their injury was related to combat.

Currently, there are 9,000 Soldiers who are part of the WTU’s. While that number is amazing in itself, Col. Keenan informed us that since the inception of the WTUs, and 24,000 have been transitioned through the WTUs Army-wide. Not all of those in WTUs have combat-related injuries. Some (about 1/3) may have injuries or illnesses that become apparent while they’re training to be deployed or during demobilization, thus are related to the Global War on Terror, but didn’t occur during actual deployment. Another 1/3 are not active Global War on Terror related injuries. These typically occurred at home, perhaps a car or motorcycle accident. The other 1/3 are Global War on Terror related. 11-12 % of those are wounds caused by IEDs, gunshot, etc. 6 % are non-battle related, but occurred during deployment, such as a fall or accident that occurred while on a FOB, and 16 % occurred while down-range but were non-battle related injuries such as PTSD, heart problems, etc. For National Guard or Reserve Soldiers who have injuries or illness, they are automatically assigned to a WTU to ensure that their medical needs are taken care of. Some may be assigned eventually to a Community Based WTU, in areas of the country where there may not be a military installation nearby that has a WTU stood up.

There are many other government and private agencies and organizations that work closely with the Army to develop programs specifically for Soldiers coming from the WTUs. These things include but are not limited to: working with the VA and other agencies to develop internship programs to assist them in retraining in new job skills. Other programs such as business mentoring, with universities such as University of Syracuse and TexaS A&M provide education, and mentoring to those who may wish to open their own business. Another program mentioned was one in which the Secretary of the Army has partnered with the University of Kansas to provide wounded Soldiers and Veteran’s the avenue to enter a Master’s Level program. Upon graduation, they will be instructors at the Command Staff General College at Fort Leavenworth, Kansas.

Other things being explored are establishing Community Covenants with various communities across the country to welcome Soldiers into their communities, provide them with resrouces and reach out and help them with their transition.

Taking care of our Wounded Warriors is and should be a top priority of this country, as well as our military services. I was very pleased to have the opportunity to participate in this roundtable. I feel like I walked away with a much better understanding of the WTUs across the Army. We all need to remember that each of these units was stood up very quickly, as soon as the need for them was identified. Thus, the Warrior Transition Units a work in progress as they should be, as long as there is a need for them. I appreciate Col.’s Keenan and Sergant taking time out of their busy schedules to speak with us about this important topic and patiently taking the time to answer all of the questions that those participating had.

  1. Information supplied from Army’s Office of the Chief for Public Affairs in preparation for a Bloggers Roundtable held on March 17, 2009 []
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The Army’s Continuing Commitment To Suicide Prevention

March 16, 2009


According to the World Health Organization, more than one million people commit suicide each year. They go on to say that suicide is one of the leading causes of death among teenagers and adults under 35. There are also an estimated 10 to 20 million non-fatal attempted suicides every year worldwide.1 Those are pretty frightening statistics, when you think about it.

People commit suicide for many reasons, including depression, shame or guit, desperation, pain, financial problems, relationship problems and often other undesirable problems. The predominant view of modern medicine is that suicide is a mental health concern, associated with psychological factors such as the difficulty of coping with depression, inescapable suffering or fear, or other mental disorders and pressures. Suicide is sometimes interpreted as a “cry for help” and attention, or to express despair and the wish to escape, rather than a genuine intent to die. Most people who attempt suicide do not complete suicide on a first attempt; those who later gain a history of repetitions have a significantly higher probability of eventual completion of suicide.2

Recently, the number of suicides in the military has been increasing at an alarming level. So much so, that the Army and other branches of the military are taking proactive steps to decrease and hopefully eliminate suicide altogether. Because of the increased numbers in the Army, a suicide prevention campaign has been launched and a task force has been formed in address these very real issues. In a recent news release, US Army Forces Command talks about the steps the Army is taking towards the prevention of suicide.

U.S Army Forces Command
Directorate of Public Affairs, 1777 Hardee Ave SW,
Attn: AFCS-PA, Fort McPherson, Ga. 30330 1062, 404-464-6381,
Fax 404-464-5628, DSN 367-6381


By Jessica Maxwell
FORSCOM Public Affairs

Considered an ongoing battle to decrease the Army’s suicide rates, commanders brainstormed how to reduce the rising numbers and push prevention training.

The number of suicides in 2008 totaled 128 confirmed cases from all Army components. This is the highest figure since the Army began tracking this alarming statistic.

The Army G1, which manages and develops Army personnel programs, is the proponent of the Army’s suicide prevention program and works as part of a joint effort with Installation Management Command (IMCOM), leaders of U.S. Army Forces Command (FORSCOM), mental health professionals from Medical Command (MEDCOM), and the Chief of Chaplains office.

To continuously track suicide data, FORSCOM G1 personnel chief, Brig. Gen. Eric Porter, formed a bi-monthly summit in October 2008. In addition to fostering communication between commands, the goal is to provide appropriate human resources to installations and forecast the needs of brigade combat teams post-deployment.

“Gen. Porter directed his staff to look into the circumstances around which the Soldiers committed suicide,” said CH (Col.) Brad Fipps, FORSCOM staff chaplain.

FORSCOM G1 is developing data that will show where in the deployment cycle suicides may be more likely to occur. Once these have been identified, commanders can apply mitigation strategies at key points to counter them through preventive training and reinforcement activities that promote resiliency.

“Soldiers and Families are remarkably resilient,” said Fipps. “Even though they are under tremendous stress from all the demands of current operations, including multiple deployments, most of them bounce back with incredible fortitude. With supportive emotional backing from their Families and friends, Soldiers are better able to withstand the emotional challenges, such as feelings of severe hopelessness and helplessness, which often lead to suicide,” he said.

Ongoing data from G1 shows that one-third of suicides occur during deployment, one-third occur a full year post-deployment, post-deployment, and a third of the Soldiers never deployed. However, Col. Mike Freville, a behavioral health officer at FORSCOM said, 70 percent of the suicides appear to be relationship-based. “It’s a mystery. Whether it’s in the civilian world or military, suicides are a mystery,” said Freville.

He added that commanders are dedicated to the battle and large amounts of energy and resources are being pooled to decrease the rates.

“Nothing is more important than the well-being of our Soldiers and Families,” said Gen. Charles C. Campbell, commanding general, FORSCOM. “We will do everything in our power to address the underlying causes that have contributed to the increase in suicide rates. We will make every effort to provide the necessary resources and training to help our units deal with this problem.”

On February 15, an Army stand-down began and continues through March 15. In a press conference Jan. 29, Vice Chief of Staff of the Army Gen. Peter Chiarelli said the stand-down allows commanders to take a direct approach to the issue. The stand-down teaches peer-to-peer recognition of suicide warning signs and is available to all Army components and Department of the Army civilians.

Read more

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Their Hope Is That Their Experiences Will Help Soldiers To Heal

March 10, 2009

In the military, a General is consider a strong and stoic leader. They lead their Soldiers with a firm hand, most lead by example. The decisions that they make can affect the thousands of Troops in their command. They don’t achieve their rank by mistake, but instead by their actions both on and off the battlefield. They command respect from the Soldiers that they lead and their very presence can make the lowest rank Soldier shake in their boots. They are expected to be in charge, firmly making sound decisions without hesitation, with the hope that the decisions they make is the correct one. They serve as an example of what a Soldier should be, and they definately don’t talk about their feelings. Especially when doing so might make them appear to be weak.

General Carter Ham

Brig. General Gary S. Patton

Recently, two Generals opened up on national television and talked about their feelings, talked about the problems the faced in dealing with PTSD. Their hopes are that by doing so, they can help remove the stigma attached to seeking help for psychological problems. One of the largest hurdles that the military faces in dealing with Troops returning from combat, suffering from PTSD, is the social stigma that has always been placed on people who sought help with mental health problems. For military officers, that stigma is even more pronounced, as they’re looked upon as leaders.

Brigadier General Gary S. Patton and General Carter Ham, both have sought counseling to help them deal with their PTSD and they’ve stepped forward, to tell their stories and hopefully show the thousands of servicemembers serving, that it’s okay to ask for help. The emotional traumas that each man suffered from their time in Iraq, was more than what they could deal with by themselves, and they both readily admit that they sought help in dealing with these issues.

“One of our Soldiers in that unit, Spec. Robert Unruh, took a gunshot wound to the torso. I was involved in medevacing him off the battlefield. And in a short period of time, he died before my eyes,” Brig. Gen. Patton told a CNN reporter. “That’s a memory that will stay with me the rest of my life.”1

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General Ham was a commander in Mosul in 2004 and also dealt with a traumatic incident that haunts him even today. He was in Mosul when a suicide bomber detonated a bomb inside a mess tent. That incident resulted in the deaths of 22 people.

“The 21st of December 2004, worst day of my life. Ever,” Ham said. “To this day I still ask myself what should I have done differently, what could I have done as the commander responsible that would have perhaps saved the lives of those Soldiers, Sailors, civilians.”2

Even though both of them have been back from Iraq for several years now, they are both still dealing with some of the symptoms of the traumatic events that they witnessed. Both recognized that they were having problems and both sought help. Their hope is that by going public with their experiences, that others who are suffering from PTSD will realize that it’s okay to ask for help and seek it.

“I felt like that what I was doing was not important because I had Soldiers who were killed and a mission that had not yet been accomplished,” Ham said. “It took a very amazingly supportive wife and in my case a great chaplain to kind of help me work my way through that.”3

Immediately after returning from Iraq, Ham and his wife made the drive from Washington State of Washington DC. There was little conversation in the vehicle during that cross country drive. He didn’t talk about what he experienced and he still can’t talk to his wife about much of what he saw in Iraq. For Patton, it was a bit different. The stress of what he experienced usually came to him in the middle of the night.

“I’ve had sleep interruptions from loud noises. Of course there’s no IEDs or rockets going off in my bedroom, but the brain has a funny way of remembering those things,” Patton said. “Not only recreating the exact sound, but also the smell of the battlefield and the metallic taste you get in your mouth when you have that same incident on the battlefield.”4

While vast improvements have been made in the military when it comes to seeking mental health help and the military is working overtime to erase the stigma that goes along with it. Both Patton and Ham say that there is still a stigma attached when you admit to and seek help for mental health problems. That stigma has been in place for many years and it’s going to take a lot of hard work and people such as Ham and Patton stepping forward, to erase it completely from the military mindset.

“If you go ask for help, somehow you believe it or you might believe others think it of you, that you’re somehow weak. That’s wrong and intellectually we all know it’s wrong, but it’s still there. It’s still palpable in some communities,” Ham said.5

Both Generals would like to see a change in how PTSD is viewed by the military. Both have hopes that by talking publically about their experiences and battles with PTSD, that others will see that it’s okay to ask for help. Both emphasize how counseling helped them, and want other service men and women to know that it’s okay to come forward to seek help. That it’s the right thing to do and it will help them to be better Soldiers in the long run.

“We need all our Soldiers and leaders to approach mental health like we do physical health. No one would ever question or ever even hesitate in seeking a physician to take care of their broken limb or gunshot wound or shrapnel or something of that order. You know, we need to take the same approach towards mental health,” Patton said. “Know absolutely that your chain of command and your leadership in the military at our highest levels recognize this issue and want to encourage our Soldiers to seek out that mental health assistance.”

General Ham agreed, saying, “I think, frankly, I think I’m a better general because I got some help.”6

It’s fantastic that General Ham and Brig. General Patton are so willing to speak out about their experiences with PTSD and are able to acknowledge that they sought help to deal with the trauma. PTSD is not an easy thing to speak about, especially for someone in their position. To do so, both General Ham and Brig. General are doing what Generals are supposed to do, lead by example. So often, Soldiers look upon their leaders as unyielding and unbending icons of power that nothing whatsoever will shake. This allows them to appear more human to those under them and also shows that seeking help does not mean the end to ones’ career in the military. I think that by allowing their stories to be told in the media, General Ham and Brig. General Patton have shown Soldiers at all levels that they too are human and experience the same effects from traumatic events that everyone else does. Hopefully, by leading by example, they will be able to help change the climate in the military, to one that is more accepting of people seeking mental health assistance. I applaud both General Ham and Brig. Gen. Patton for their courage in allowing their stories to be told publically, in order to help the thousands of men and women serving in the military, who also suffer from PTSD.

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March Is Brain Injury Awareness Month

March 8, 2009

Traumatic Brain Injury is something that I’ve written about often here. With the amount of deployments that our servicemembers are being tasked with, Traumatic Brain Injury has quickly become one of the signature wounds of the wars in Iraq and Afghanistan. Therefore, it’s important that our Troops, and their families are aware of the causes, the signs and symptoms, the treatments and the fact that most who suffer from this type of injury, will recover without any lasting side effects.

The month of March is designated each year as Brain Injury Awareness Month. It’s a month each year that professionals and those who have suffered from brain injuries, work to educate the public on what a brain injury is, the importance of quick treatment and the fact that most people who suffer from a brain injury of some sort, will fully recover.

The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, is actively taking part in educating the public, as Mild Traumatic Brain Injury or what is commonly known as a concussion, affects from 10-20 percent of servicemembers who are returning from combat in Iraq or Afghanistan. According to the center’s director, Brig. General (Dr) Loree Sutton, more than 90 percent of servicemembers who suffer from a TBI have concussions and they recover from those injuries quickly.1

“I can’t stress this enough,” Sutton said. “The vast majority of people with TBI will get better. Certainly, the moderate or more severe cases will take longer to recover, but it is also important to recognize this is not an individual concern alone. That’s where family comes in, the unit comes in and the community comes in.”2

Mild Traumatic Brain Injuries are caused by a blow to the head. They are characterized by disorientation, headaches, dizziness, difficulty with balance, ringing in the ears, blurred vision and memory gaps. The Army and other branches of the military screen for concussions or mild TBIs with a tool that’s called the Military Acute Concussion Evaluation. Recently, that tool has been supported by the Institute of Medicine. It was first released for use in August 2006. Another tool that the military uses, according to Brig. General Sutton is the Automated Neurophychological Assessment Metric (ANAM), which is used to set the baseline for a Soldier’s reaction time, short-term memory and other cognitive skills. Care providers are able to use the tool as another critical piece of information when evaluating and managing the care of injured servicemembers.

“We’ve directed a lot of research and time and energy to identifying the knowledge gaps for the entire range of traumatic brain injury, which spans from concussion or mild TBI, all the way through to severe TBI,” Sutton said. “The good news is that for 80-85 percent of people that experience TBI, it is a concussion, and most folks will recover quickly - particularly if they pay attention early on and get the rest they need. Early intervention is important.”3

The Defense and Veterans Brain Injury Center which was established after the first Gulf War, reports that around 33 percent of patients who needed medical evaluation for battle-related injuries at Walter Reed in 2008 had TBI. That gives some indication as to the reason TBI is considered one of the signature wounds of these wars. The Center’s sites have seen more than 9,000 people who suffer from TBI. Brig. General Sutton stressed the fact that it’s very important for Soldier who think that they may have suffered from an injury that might lead to TBI to report these injuries to ensure that they receive the appropriate care and have the best chance for recovery. I concur and can’t stress the importance of receiving care as quickly as possible. My youngest son, at the age of 6, ran out in front of a car on his way home from school one day and was hit by the vehicle. He suffered from a concussion or mild TBI. To this day, he doesn’t remember what led up to his injury. He recovered quickly due to receiving immediate treatment and care for his injuries. I credit the quick action of bystanders in calling the paramedics and their quick action in getting him to the hospital for treatment, in ensuring that his recovery from the injury was without complications.

“Our troops are very motivated and want to stay in the fight.” Sutton said. “But our message is if you hurt your arm or you hurt your leg, you’d get it taken care of. Well the same thing applies to one’s brain. So asking for help is an act of courage and strength, and we have a great system set up both within the Defense and Veterans Affairs departments and in partnership with our civilian colleagues.”4

The sooner a Soldier gets help for a TBI, the sooner they will be able to recover and rejoin the fight. As Brig. General Sutton said, often are troops are motivated to stay in the fight and not leave their brothers and sisters doing the mission without them. However, without treatment, conditions may worsen and their return to the fight could be even longer. With the creation of the National Intrepid Center of Excellence for Psychological Health and Traumatic Brain Injury, the Defense and Veterans Brain Injury Center and their partnership with experts around the country and the world, the Department of Defense is making it clear that treating these injuries is a priority and they are ensuring that our Troops who suffer from these injuries receive the very best care in the world.

To find out more about Traumatic Brain Injuries in all forms, it’s diagnosis and treatment, there are many resources available for our readers. Each of the sites I’ve provided the links for below should offer plenty of information for those interested in reading more about Traumatic Brain Injuries, it’s diagnosis and treatment.

Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury

The Defense and Veterans Brain Injury Center

The Brain Injury Association of America

Institute of Medicine-Health of Veterans and Deployed Forces

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Suicide Among The Ranks: What The Army Is Doing

January 22, 2009

Suicide is a tough topic to discuss. In it’s wake, it leaves so many victims, who often blame themselves for what happened. With the death of the person who committed suicide, come many questions, often the survivors blame and beat themselves up, because they didn’t recognize the signs or discounted them. Over the past several years, suicides in the military services, especially in the Marine Corps and the Army have seen a dramatic increase. In the Army it’s become a huge concern, from the highest ranking officer, to the lowest enlisted servicemember. Just this past year alone, there have numerous suicides reported among the recruiting cadre in the Houston area. It’s a trend that’s become extremely alarming. The question has been asked over and over again … ‘What are we doing to prevent suicides amongst the ranks of the Army?’ In the past, the stigma attached to a Soldier seeking psychological help has been something that has kept many of them from seeking help. They didn’t want to be labeled as a coward, a wimp or a wuss. Leadership often told these Soldiers to ’suck it up and soldier on.’ Psychological problems were seen as a weakness in the military culture. Because of this stigma, many would not seek help for their problems, and might feel that suicide was the only answer for them to be able to escape the emotional pain that they were dealing with.

The Army is working hard to change the mindset and eradicate the social stigma that comes with seeking psychological help. This past week, the Army held the 2009 DoD/VA Annual Suicide Prevention Conference in San Antonio, Texas. More than 750 people attended the 4 day conference, from specialists in the field, active duty Soldiers, to VA and private groups such as Social Workers, Chaplains, Researchers and family members who have been affected by military suicide. The goal of the conference was to find ways to reduce suicide amongst the ranks and to prevent the needless tragedy that suicide is.

“The secretary of Defense and chairman of the Joint Chiefs of staff have both emphasized, ’seeking help is a sign of profound courage and strength. Truly, psychological and spiritual health are just as important for readiness as one’s physical health,” said Brig. General (Dr) Loree K. Sutton, special assistant to the assistant secretary of Defense Health Affairs and Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury director.1

According to Sutton, the Soldier’s ethos of never leaving a comrade behind should apply to psychological wounds as well as physical wounds. Just because you can’t see a wound, doesn’t mean that it doesn’t exist. Sutton stressed things that fellow Soldiers can do to assist with suicide prevention. As she stated, everyone deals with problems in their lives and it’s important to be able to recognize the warning signs when a friend or comrade isn’t coping well with their problems, to reach out and offer assistance and intervene early … before it’s too late.

Each day of the conference was filled with breakout session workshops and training that was focused on different suicide related topics. Topics covered were things such as crisis intervention, crisis negation of a suicide in progress, prevention strategies and mental health initiatives. The keynote speaker at the event was Major General Mark Graham. Graham had an especially poignant message, as a Soldier, a husband and a father who experienced the effects that the suicide of a loved one has on a person. Graham himself lost one of his sons to suicide. Since then he has been active in speaking openly about mental health issues, especially PTSD. In 2003, Graham’s then 23 year old son Kevin was ranked as a top cadet in his ROTC class. Kevin hung himself after struggling with depression for some time. His son was afraid to disclose to anyone about his mental health issues out of fear for his own military career. A year after losing Kevin, Graham’s oldest son Jeff, who was also serving in the Army, was killed by an IED in Iraq. Graham and his wife made the decision to continue to serve, in memory of their sons.

“Both of my sons died fighting different battles,” Graham said. Graham is the commanding general for the Army’s Division West and Fort Carson, Colorado.2

As he began his speech, he asked the members of the audience to think about three questions that he posed to them. Those questions were: ‘Who is that person who had wounds that you can’t see? Should they be ashamed? Are they less of a man or woman?’

“I can think of few subjects more important than this one,” Graham told the audience. He shared that people need to be able to talk about the challenges and stigma that is associated with mental health and thoughts of suicide. “Leaders, be compassionate. Soldiers, it’s OK to get help,” Graham said. “Untreated depression, PTSD and TBI deserve attention. Encourage those who are afflicted to seek help with no embaressment,” he added.3

As General Graham told the audience, suicide is something that knows no boundaries. It can affect anyone, regardless of race, their rank, their social status, people from all walks of life and regardless of their socio-economic position. He emphasized the ACE program, which is the Army’s suicide prevention program. ACE stands for: A=Ask your buddy. C=Care for your buddy. E=Escort your buddy. He also emphasized that the DoD/VA operated a 24/7 national suicide prevention hotline. That number is 1-800-273-TALK(8255)

Below is information that the Army provides to all Soldiers about the importance of suicide prevention and what they can do. The information instructs them on what they should do if their buddy appears depressed, what to look for. It also provides information on what they should do if they find themselves feeling depressed as well.

• Have the courage to ask the question, but stay calm
• Ask the question directly, such as, “Are you thinking of killing yourself?”

Care for your buddy:
• Remove any means that could be used for self-injury
• Calmly control the situation; do not use force
• Actively listen to produce relief
• Never leave your buddy alone
• Escort to the chain of command, a chaplain, a behavioral health professional or a primary care provider

An information card is also distributed by the Army called:
Suicide prevention: Warning signs and risk factors

Warning Signs: When a Soldier presents any combination of the following, the buddy or chain of command should be more vigilant and consider help:

• Talk of suicide or killing someone else
• Giving away property or disregard for what happens to one’s property
• Withdrawal from friends and activities
• Problems with girlfriend, boyfriend or spouse
• Acting bizarre or unusual (based on your knowledge of the person)
• In trouble for misconduct
• Soldiers experiencing financial problems
• Soldiers who have lost their job at home (such as Reservists or Guardsmen)
• Soldiers leaving the service

When a Soldier presents any one of these concerns, the Soldier should be seen immediately by a helping provider:

• Talking or hinting about suicide
• Formulating a plan to include acquiring the means to kill oneself
• Having a desire to die
• Obsession with death (music, poetry, artwork)
• Themes of death in letters and notes
• Finalizing personal affairs
• Giving away personal possessions

Risk factors are those things that increase the probability that difficulties could result in serious adverse behavioral or physical health. The risk factors only raise the risk of an individual being suicidal - it does not mean they are suicidal.
Risk factors often associated with suicidal behavior include:

• Relationship problems (loss of girlfriend or boyfriend, or divorce)
• History of previous suicide attempts
• Substance abuse
• History of depression or other mental illness
• Family history of suicide or violence
• Work-related problems
• Transitions (retirement, permanent change of station or discharge)
• A serious medical problem
• Significant loss (death of a loved one, loss due to natural disasters)
• Current/pending disciplinary or legal action
• Setback (academic, career or personal)
• Severe, prolonged and/or perceived unmanageable stress
• A sense of powerlessness, helplessness and/or hoplessness

Suicidal risk is highest when:

• The person sees not way out and fears things may get worse
• The predominant emotions are hopelessness and helplessness
• Thinking is constricted with a tendency to perceive his or her situation as all bad
• Judgment is impaired by use of alcohol or other substances

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Group Offers Resources For Women Servicemembers & Veterans

January 8, 2009

Women who serve in the military often have a unique set of problems that they deal with coming out of a combat situation. The military is working hard to ensure that women military members have resources available to meet their specific needs, however, because the military is comprised of predominately males, those resources are sometimes difficult to find. One group has recognized the special needs of women servicemembers and veterans and created an online resource center solely for women servicemembers and veterans. Grace After Fire is a resource website devoted entirely to women veterans and servicemembers.

Grace After Fire is a resource solely for women veterans to support their need to connect with each other and share yet remain anonymous. These women can reach out to others who have experienced the same concerns of re-entry, alcoholism, drug addiction or prescription addiction due to chronic pain. Post Traumatic Stress Disorder (PTSD), incidents of service time rape, depression, unwarranted anger, or Traumatic Brain Injury (TBI) due to war time trauma.
Created by women for women veterans returning home from service.1

Grace After Fire was created by the group, The Woman’s Heart. Focused primarily on women who are recovering from drug or alcohol addiction, The Woman’s Heart provides a wealth of information, as well as forums where women can reach out to other women who may have or are experiencing the same difficulties. Grace After Fire will be a sister site to The Woman’s Heart, which will focus only on women service members and veterans.

Women have been gathering at the river since the beginning of time. The river is where we raised the babies and helped the village stay well. We taught the young boys to have confidence, then the men raised them up to be warriors. We taught our girls how to be young women, loving wives and caring mothers. We learned to communicate and share with each other to become wiser women.

At The Woman’s Heart you have found the river. A safe place to build relationships that will help you find recovery so we can all stay clean and sober together. Too many times women are left to themselves to figure out how to put the pieces back together. While in treatment you may have talked about coming home and the relapse triggers that may come up. Often times we come home to the same madness we left, and now that you’re actually there and in recovery, it seems worse than before. The Woman’s Heart provides a place to communicate those feelings and discuss solutions that can help prevent relapse.

We have overcome the seemingly hopeless state of mind and body, and we are reaching our hand out to women like you to help you stay clean and sober – together. Founder’s Story.2

I think this is a wonderful idea and one that has been a long time coming. Too often, things that are focused on male Soldiers just don’t work with female Soldiers. Too often, female Soldiers and Veterans feel isolated and forgotten, when attending male oriented programs. Hopefully this resource will help to bridge the gap and provide a much needed service to our female Soldiers and Veterans.

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