Psych Central will again be partnering with The Carter Center to bring you media coverage of the 26th Annual Carter Symposium on Mental Health Policy. This year’s symposium focuses on the unique challenges for mental health care and community reintegration faced by National Guard and reserve veterans returning from Iraq and Afghanistan. The event will also be webcast live on The Carter Center’s website.
Recently, I had the pleasure to sit down with Thomas H. Bornemann, Ed.D., the Director of the Carter Center Mental Health Program to talk to him about this year’s symposium agenda.
John M. Grohol, Psy.D.: So talk to me a little bit about the theme of this year’s symposium. I understand it has to do with policy surrounding helping vets gets access to mental health care?
Thomas H. Bornemann, Ed.D.: That’s correct. This is our 26th Annual Symposium on Mental Health Policy, so we have been at it a while. Each year we try to focus on an issue that has come to our attention of major national importance from a public policy standpoint. And we certainly think the long conduct of these wars warrant that kind of attention. We are now into one of the longest conflicts in American history with around 1.7 million veterans who have gone over there.
We are certainly seeing a number of mental health consequences of the type of warfare that these people are exposed to, the frequency with which they are exposed, and such other risk factors. So we thought it was an opportune time to raise some attention to these issues.
We specifically decided to focus on two groups in particular — the National Guard and the Reserves, in part because the Reserves and Guard are faced with their own unique problems as returning veterans. While they have had similar exposures to their colleagues who are regulars, they return to environments quite different, as you know, than the regulars.
The regulars return to their bases, stateside, often they live on that base, they have support systems and networks on that bases for them and their families. And probably more importantly, their neighbors know what they went through because their neighbors went through it too. So there is a kind of a built in support network for a lot of the regulars who are going back to their stateside.
For the Reserves and Guard, they are going back to jobs, to family, and to their communities as different people by virtue of the experiences they have had. They often may not have the same level of network support available to them that regulars would have.
We wanted to take a look at what were the specifics and concerns of the Guard and Reserves and decided to focus on three domains: a reintegration into (1) community, (2) family and the (3) workplace. And these are three areas of significant challenge.
We know by the data that we have had a lot of difficulties, Guard and Reserve, from issues such as increased rates of completed suicide, which is very troubling. When they represented roughly one‑third of the troops deployed, there were over 50 percent of the completed suicides of those having deployed. So obviously, there is a serious problem there and we are concerned about that, and want that to kind of run through the entire symposium.
We are concerned about a lot of workplace related issues, given the kinds of exposures these people have had such as concussive injuries. And the use of explosive devices throughout these wars with lingering consequences from that, not only the more dramatic cases of TBI but maybe some subclinical cases — lesser disabling but no less troubling as people began to think about going back to work.
Also, with the multiple deployments that many of these men and women have experienced, there is number of family issues that have come up. We are seeing increased rates of domestic violence and divorce and other kinds of marital problems. We wanted to take a look at that and see what light might be shown on it.
And in the community, there are a lot of community ideas now. We want to seize on them, on ideas in education and in treatment services that are kind of grassroots oriented. We wanted to take a look at a lot of those services that are being made available. We are little bit concerned I must say though that so many are not evaluated at this point. So we can’t really give many of them, most of them a stamp of approval. But at least it reflects a strong community interest in accepting our responsibilities towards these courageous people who are coming back to our communities.
So that’s really it as a backdrop to why we chose this topic and why we think it is vitally important national issue at this point.
Dr. Grohol: How does mental health care access differ between regular service vets and those in the Guard and the Reserves?
Dr. Bornemann: While they have enhanced access to services particularly through the veterans administration, when regulars return they live on bases where services are immediately and readily available, right on their bases. And people with issues have priority as veterans within their own networks. For example on bases, the first priority is active duty troops. They get first priority, even over family, and that’s appropriate. That’s the mission of the military. You are not going to have that same type network in communities that you are going to have when you return as a Guard or Reserve member.
If you had a disabling injury, potentially you have access to the VA of course and support there. But just as likely you are going to use community based care, whether it’s through private insurance plan or some other kind of care.
And many of the providers out there and we want to address this to some degree in the symposium maybe pretty ill equipped to deal with the specific needs of this group. They may not be experienced in, for example, concussive injuries. What they may look like, and what would be the natural course of these conditions and effective treatments for them.
They may think that they are getting somebody who for instance even among mental health providers who have depression, that any qualified mental health provider ought to be able to handle depression. But if you complicate it with the kinds of exposures these people have had. Combat is a real different kind of experience, it is important to know what all that might mean to the person you are seeing.
So, the systems that they are going back to are not as organized as a system. There are really a lot of systems that they could go back to, and we have some evidence that they may be falling through the cracks.
Dr. Grohol: Is it necessarily a bad thing that these troops don’t have access to traditional military mental health care given the stigma and fear surrounding access to official services, such as the impact on future career advancement or downgrading of security clearances?
Dr. Bornemann: I think that that’s an absolutely compelling question frankly and an age old question, that’s as old as I know of, and I have been working on these issues for 40 years as a veteran of the Vietnam era. These questions I don’t think have been overcome. I was at a meeting some months ago with a lot of folks from VA and DoD and we talked about the stigma of seeking mental healthcare that remains within the military and the military culture. And it certainly is an issue. It is not trivial.
So you have raised an interesting point that very likely there are significant numbers of people that maybe avoiding using officially available resources, because they feel the need to protect their privacy in order to ensure that their careers and career advancement is not impaired by their willingness to seek care.
I see some creative efforts at breaking some of that down in a more systematic way than I have ever seen before. The military is acutely aware of it and are trying different things to encourage people to seek care. You recall there was a successful program some years ago in the Air Force around suicide prevention where they were able to do it.
Now, one could argue the Air Force has the highest rate of education of anybody and did that have something to do with it and what not. I don’t know that I would get into that kind of argument in the absence of real information. But they were able to launch a successful suicide prevention campaign in the Air Force. And it started at the command level structures right on down to the unit level.
And I think it takes that kind of commitment by command to really begin to break down some of those barriers to seeking care. I know there are exemplars out there that have done a good job of that and tried to address those issues. I am not sure that it has really changed that dramatically the perception that this will be career damning.
I do also want to point out certainly in the context that I have had with DoD and VA leadership that they do “get it,” they do understand it, and they understand what its implications are better than I can ever remember. That’s the good news. Do they have effective ways of breaking it down completely yet? I don’t think universally they do, but they have some examples of having done it better.
Dr. Grohol: What are some of the goals of this year’s meeting of getting policymakers together to talk about this issue?
Dr. Bornemann: We are telling all of our speakers and panelists and participants that we want this to be solution focused. We need a statement of the problem and we will do some of that as we always do. You got to set the stage here and we will do that. But, at the end of the day I want us to come up with some ideas on what people can do, can take back to their communities and can do whether it’s improving access to care, whether it’s addressing the needs of special populations such as the inordinate number of women who have been exposed to fire in the combat, in these wars.
Nobody has known a whole lot about what that is going to mean for families and communities. Yet so many women will come back with these same exposures that the men have historically had, and not a trivial number of them either. So we want to know more about that.
We want to know more about rural access to care, and what people have done cleverly to overcome that access problem. So, solution focused is our biggest concern that people walk away learning something that they may do back in their communities.
Dr. Grohol: Thank you very much for your time today, Dr. Bornemann.
Dr. Bornemann: Thank you and I appreciate the opportunity to share some of my ideas with you.