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Hearing of the Military Personnel Subcommittee of the House Armed Services Committee-Defense Mental Health Overview


Location: Washington, DC

Hearing of the Military Personnel Subcommittee of the House Armed Services Committee-Defense Mental Health Overview


REP. PATRICK MURPHY (D-PA): Thank you, Ms. Chairman -- Chairman.

I saw the 2004 New England Journal. It had the numbers that 16 percent of Iraq veterans have major depression, anxiety or post- traumatic stress disorder. Would you all like to elaborate on that? Do you think that's an accurate number or do you think it's higher? I'd like -- I'd enjoy your comments if it's possible.

GEN. SCHOOMAKER: That was a derivative of -- again, the earlier -- one of the earlier iterations of the Medical -- Mental Health Advisory Team -- and that alluded to the incidents among redeploying units of symptoms associated with post-traumatic stress. And every one of these four, I like -- I try to make sure that we highlight the fact that this is post-traumatic stress symptoms. It's not well- established post-traumatic stress disorder, which is what most people in the press often reports on. That is a mental health diagnosis from unresolved, unidentified and untreated symptoms of post-traumatic stress that -- which can result from combat, from major childhood trauma, from natural disaster, motor vehicles -- I mean, any amount of -- any cause of stress.

What the report showed us was that soldiers redeploying from a combat zone, dependent upon their exposure to combat and trauma, had somewhere between 10 (percent) and 30 percent rates of symptoms of -- associated with post-traumatic stress that, if we did not screen for a properly treat would, we feared, emerge or evolve into or mature into post-traumatic stress disorder.

Our experience is that with good screening after the fact -- and this is in fact why Dr. Casscells' predecessor mandated a policy of post-deployment health reassessment at the 90 (day) to 180-day period. You'll hear our soldiers talk later about the fact that at redeployment, frankly, the reintegration excitement obscures many of the symptoms. But 90 (days) to 180 days later, they emerge. The families see this, the unit leaders see this. And so we've -- we screen for those symptoms and then address those symptoms through specific training -- treatment.

REP. MURPHY: And I applaud that, General and I thought that Chief Gutteridge's testimony -- written testimony so far has been very enlightening to us. But what do you think as far as a number --

GEN. SCHOOMAKER: Yes sir, I think that accurately reflects it. I think it would be higher in units that have higher combat exposure and it would be lower in those that don't. I mean, in a unit that may be restricted to the FOB -- to the -- to a Forward Operating Base and not work outside the wire and not work in an area of intense combat -- I think you would expect that it would be lower.

REP. MURPHY: How about -- as far as the majority of our soldiers now and our troop -- and our Marines married, unlike in Vietnam. How about the -- it's not so -- it's just the individual trooper that's affected. And that suffer from this, but it's also family members. What has -- what have we done as the Department of Defense to help and assist the families as well? I know -- I applaud the 90 (days) to 120 day review for the troopers, but what are we doing for the families as well? If you could elaborate on that, I'd appreciate it --

GEN. SCHOOMAKER: Well, I saw -- real quickly and then my colleagues can speak to the family-centered care as the Army does, too -- that we extend Battlemind training to families. We recognize that families are often the first to identify problems with the redeploying soldiers and try to make them, obviously, a part of the solution as well as a recipient for services. The Army has spent a fair amount of effort as well into providing martial and family counselors on our installations, and that's been very effective; in other words, to go to the root causes of many of our problems.

You spoke earlier, Madam Chairwoman about suicide. We know that one of the major causes of -- or precipitants of suicide is a ruptured relationship with the wife, husband, girlfriend and the like, or with the Army itself. We know that misconduct that results -- let's say, in UCMJ -- can precipitate a suicidal gesture in a soldier who sees the relationship with the Army as one of their most important and fragile relationships. So we're doing exactly that.

REP. MURPHY: Roger. I'm tracking that, but I get -- I think my question is, is there -- or, more specifically, let me ask, is there some type of mandatory screening where we contact, and be proactive in contacting the spouses to make sure that they're okay? I know there's centers there that it seems like react to the ones that call, or come to the doors, or the website. But is there the screening of the spouses of the loved ones of our troopers?

GEN. SCHOOMAKER: I think the operative word there is "mandate." We don't have authority to mandate for family members. But we certainly offer the services to those families, and we make them -- we sensitize them to the need for them to receive that care. Yes, sir.

GEN. ROUDEBUSH: And I think we can speak to the activities, particularly on departure and then reintegration. For the Air Force, we use very much a community-based approach, which is inclusive of the families. And the commanders are -- that remain at the station of origin, are also responsible for tracking with those family members during the period of deployment to assure that needs are being met, that issues are there.

I agree with General Schoomaker, there's not a mandate for that, but our programs are structured to do that. And I would offer, relative to the screening tools -- the post-deployment survey and the resurvey, 90 (days) to 180 (days) out, those have been continually refined to increase the sensitivity, to elicit any symptoms, to assure that if assistance is required, that we get those folks to the assistance that is needed in the most expeditious way.

GEN. ROBINSON: Congressman Murphy, the Navy has two programs -- Navy Medicine. Actually, it's Navy and Marine Corps because the Marine Corps key volunteer member, and also the Navy ombudsman work with families, and work with families pre-deployment and post- deployment. There's nothing mandated, but there's certainly a close relationship.

I think we're trying to get a little bit more proactive, particularly in the Special Ops community which have huge numbers of deployments, related to other folks, and that's the focus program, which is the families overcoming and coping under stress. And that's a program we're trying to get into place, that will do counseling and very, very early intervention with families. Because we know that deployment time -- length of deployment, and also number of deployments are direct factors in psychological stress, and we're trying to deal with that using that program.

REP. DAVIS: Thank you.

REP. MURPHY: Doctor -- (inaudible) --

Ma'am, can he just answer -- he had his hand up -- real quick?

Doctor Casscells -- Casscells?

MR. CASSCELLS: Congressman Murphy, first, thanks for your service. And I can tell you're politely hinting at this issue that we have not yet got a rigorous program to identify all of the lost sheep, particularly among the reserve who are drilling IMAs, and I'm one of them -- Guardsmen, Guardswomen. And they go home and they sometimes either don't have a family, or the family's got plenty of other things for them to do besides, you know, offer a shoulder to cry on.

So we -- I'm talking to all of our chaplains together in a few weeks and asking them for their help in reaching out to these people and making sure that the family's doing okay and that the servicemember's doing okay. Because if we don't hear back from them on our Post-Deployment Health Reassessment tool -- and we, about a quarter never -- just go home and we don't hear from them, we've got to reach out and identify every single one of them. And how to do that -- you know, because they move, it's not that easy but we're working on it. So, thank you.


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