Pre and post deployment support
Soldiers deploying and returning from deployment’s are run the gambit of “helpful” briefings and screenings by the DOD and VA. Unit FSGs and the community service agencies of each branch have greatly increased the benefits and support available to both soldiers and their spouses. While these programs all seem positive in and of themselves, (Battlemind, Yellow Ribbon, PDHRA, Strong Bonds, WTU’s, etc etc.) they have all been created ad-hoc, and some have limited public awareness, such as the strong bonds program. My focus is social service needs and mental health, though medical treatment falls into this. My question is, if you were to create a comprehensive program for the returning vets, what programs would you keep or model your plan on; what programs are redundant or of negative benefit? All feedback is beneficial
Reed
At the risk of seeming unduly uncaring and callous,
let me suggest with personal AND family experience at returning from several wars that the current focus on such support assumes everyone needs pretty much the same thing and the need or desirability for such support is universal. I strongly doubt that. Predeployment or post deployment, tour location, length and efforts / job while deployed all have an effect and every individual and family situation is different.
My assessment of today's efforts is that it is significant overkill for most. I understand the (presumed?) difficulty in a large organization of tailoring such support as opposed to offering high volume, one size fits all solutions but I would also suggest that many people are being exposed to ideas they might never get on their own. The current processes offer excessive support that is excessive for most, adequate for a few and inadequate for a few more; the effort needs to be tailored and that, to me, means a psychological assessment for each person -- a very difficult but not impossible task -- or, better yet, such an assessment before service entry and rejection of those likely to need heavy support.
An idea which ought to fire up the PC crowd...:wry:
SME you may be but you're taking my comment in the
wrong direction. Don't look for pre-existing issues, they're obviously not reliable as a forecast mechanism, not what I intended at all.
Look for the mental outlook that can and will tolerate stress. Hire more sociopaths -- and yes, I'm quite serious.
Quote:
Originally Posted by
reed11b
...while a history of pre-existing mental health issues make PTSD more likely, the majority of soldiers diagnosed with PTSD have had NOsignificant MH history.
Obviously.
Quote:
...There is also a large body of deployed soldiers w/ MH histories that have had no Combat related MH troubles.
Also obviously. I'd add that the combat flip out is variable, can occur early or later and that the number of triggers available on the battlefield is vast. MH issues in general do not show how well combat stress will be tolerated, people are too variable -- but the sociopathic trend, if not total, can aid in acceptance of most combat stressors.
Quote:
...I appreciate your participation in the subject Ken, but on this matter I am closer to being a SME.
Gee, thanks. I appreciate your appreciation. Always good to deal with experts even if they do go in the wrong direction..:rolleyes:
Quote:
...Prevention of disciplinary failures in basic and early in enlistments may be more achievable through pre-screening however.Reed
Nothing to do with combat stress; in fact the guy with minor disciplinary problems is probably more tolerant of combat stress than the average straight arrow. We probably should stop trying to throw 'em all out of the service and exercise a little leadership. :cool:
If it is, you took it there
Quote:
Originally Posted by
reed11b
...This thread is now waaaaay of target, I'm looking for what social service and mental health programs that exist should be kept, wich can go and what needs to be changed. Reed
I merely suggested that a focussed psychological screening to detect those who may be better able to tolerate combat stress might be worth exploring. That seems consistent with what you asked.
IIRC, several recent research projects using a variety of methods including MRIs have determined that many people have a distinct aversion to violence while others seem to tolerate it well. That tracks with my observation over a number of years. The Sociopath tendency should not be totally rejected; most of us have a variety of little pathys in there and it seems to me that screening merits consideration.
With that, I'll leave you the floor.
Sociopath don't quite do it ...
for me because I think immediately of sociopaths as we think of that term in the criminal justice system - serial criminals (whether murder, rape, robbery or theft), who lack any empathy and are extremely self-centered.
I don't think that is what you are really saying, Ken - since IMO none of the criminal sociopaths I've known would have been at all useful in the military.
Slap may well have an opinion on this which is based on more experience - despite his relative youth.
There are personality types (probably galore) who can hack violence - even when it is of the cold-blooded kind. I think of three friends over the years (two still with us in the Copper Country) who were Marine snipers in Nam and who seem to have been relatively untouched by the experience. If anything, it seems to have been a positive thing - that from an outside observer who is not into their heads, but just a guy who drank a fair amount of beer with them.
On the other hand, there are personality types (again probably galore) who cannot hack violence. And, a bunch in between. So, it would seem useful to expand on some personality profiles as you guys know them (no need for shrink jargon).
Both Ken and Reed recognize what they are willing to call "sociopathy" - Ken in other threads as well as here; Reed here:
Quote:
OK, but not eneogh sociopaths exist to fill the Army's need, and many of us "straight arrows" develop sociopathic traits in service.
I conclude that what you must mean as "sociopathic traits" are different from how I would use the term as a lawyer.
If what Reed said was meant, it seems to me that "sociopathic traits" or lack of same is an issue which is far from off-topic - since the support required will vary with the personality profile (METT-TC, to borrow from you guys).
Dude, have you seen my car?
On monday, I'm so gonna find a psychiatrist to explain my sociopathic tendacies in warfare when I positively identify my enemy. It must be something to do with the way my mom treated me as a child.
Reed- despite my lack of humor (my daughter will probably not attend college now that the economic sky has fallen; hopefully, y'all have at least smiled if not laughed so we can get back on topic), I would encourage you to take a knee and allow us to get back to your original discussion.
IMO, Ken is right-outside of his so-called PC crowd. Freudian SME's thought and regard evolved throughout the last 65 years. From shell shock to PTSD to TBIs, advances are being made.
Futhermore, I would assert that the answer to your original question is the typical timeless Ken statement of METT-TC coupled with leadership. A Patreaus/Odierno/Caldwell must be tasked with this very important subject if we hope for some resolve on our wounded (and yes, I have plenty of wounded that I care deeply about).
Initially, Ken was only suggesting that we have a holistic approach during the recruitment process and post-deployment period.
cheers,
mike
Research proves what researchers want it to prove
Quote:
Originally Posted by
reed11b
Research says that is difficult and unlikly. One study that supports that shows higher rates of PTSD among LEO's then comabt vets! Emotions are addictive in a sense. Open those flood gates and it is hard to close them again. I'm as type "B" as one can get, but I have been restless and wanting to go back ever since I deployed to Iraq in '03. I think the "instant" mode switcher is a myth or at the very least, very very rare.
Reed
and little more.
My estimate is that the number of folks who can successfully make that switch is about 30%. Another 30% are not designed for combat or LE like stress (though many can and will do it if forced with varying MH results) and the remainder can hack it and are generally but varyingly successful in tolerating the trauma. Willingness or ability (desire or wishes have little to do with it) to accept violence is the issue; that simple.
Interesting how those estimates track with the 1/3 Rule on wars... :cool:
Joint Chiefs chairman wants PTSD screenings
Looks like universal screening is coming...I'm interested in who the "mental health professionals" will be.
http://www.usatoday.com/news/militar...-12-ptsd_N.htm
Quote:
The Pentagon's top uniformed officer is calling for all returning combat troops, from privates to generals, to undergo screening for post-traumatic stress with a mental health professional, a move aimed at stemming an epidemic of psychological issues among veterans.
Quote:
"I'm at a point where I believe we have to give a (mental health) screening to everybody to help remove the stigma of raising your hand," Mullen said. "Leaders must lead on this issue or it will affect us dramatically down the road."
No scientific backing just a thought
I have wonder for quite some time now about PTSD in todays services vs those in the past. I know there are entirely too many variables to really put a finger on it. My biggest questons are is it more widespread today because now people know what PTSD is and diagnose it as such or is it because society today is much easier than it was 20, 30, 50 years ago therefore people are not as desensitized as they were before. Having led easy, stress free lives today compartively to previous generations. I know the stresses today are different than in the past but generally speaking life is easier than in the past for most. Ultimately is it a combination of both? The services themselves are falling into the trap in mind as well of taking the stressors away that very well may have been the reasons for fewer cases in the past.
I wanted to touch on a previous post about the VFW and what therapy a case of beer and some good BBQ with those you were there with you can do for one. In my opinion it should be built into rotations, 2 weeks as a unit with lots of alcohol and good food, in some sweet resort for all in the unit to decompress and support each other. Part of the issue in my mind is that too many today have lost sight of what a "team" truely is. If only I was the hog with the fuzzy nuts.
Just curious what others thoughts are on these.
I am of the thought if we can figure out who is most and who is least suspect to PTSD then we assign them accordingly throughout the services. In my opinion prevention vs rehabilitation is where we need to look.
Couple of points on your good post.
First, recall that in WW I, WW II, Korea and Viet Nam, rotation was individual and not by unit. So you went to war, got through as part of a unit -- and then returned to CONUS as a single soul. What you then did was work through any problems pretty much on your own; most people just sucked it up and kept on plugging along. A few had severe problems and got local or VA help, most did not and worked things out for themselves. Most were content with that.
After Viet Nam, as a result of many things (not least getting a diagnosis insurers would pay for), interest in PTSD rose and for the first time, counseling was offered. A really relatively small percentage of Viet Nam veterans were involved in that -- most just drove on as had their equally numerous Korean War predecessors and their far, far more numerous WW II forebears...
Secondly, I agree that society has lost many stressors and that treatment for mental aberrations is more acceptable and those two factors conspire to raise the acceptability and thus the number of 'sufferers.' Times change and so do mores an attitudes.
Not always for the better... :wry:
As an aside, I agree with your idea on unit rotations decompressing on the way home. :cool:
And I really agree with your 'prevention is better than treatment...'
Oh goody gumdrops, a topical news article.
Will this be labeled 'PTSD'?
Army to probe 5 slayings linked to Colo. brigade
By P. SOLOMON BANDA
Associated Press Writer
Oct 18, 10:12 AM EDT
DENVER (AP) -- Fort Carson soldiers returning from deployment in Iraq are suspects in at least five slayings, and officials want to know why.
Commander Maj. Gen. Mark Graham announced Friday a task force will examine any commonalities in the five killings, all allegedly committed by soldiers from the post's 4th Brigade Combat Team in the past 14 months. A sixth BCT soldier faces an attempted murder charge.
http://hosted.ap.org/dynamic/stories...TAM&SECTION=US
But wait, there's more.
The issue of homicides by combat-stressed veterans gained national prominence in January, after The New York Times reported that at least 121 Iraq and Afghanistan war veterans had committed a killing in the United States or been charged in one.
But then we read this...
Pfc. Jomar Dionisio Falu-Vives, 24, and Spc. Rodolfo Torres-Gandarilla, 20, face attempted murder charges in the May 26 wounding of Capt. Zachary Zsody, who was shot twice while standing at an intersection. An arrest affidavit released in August said an AK-47 used in the Zsody case was found in Falu-Vives' apartment and it was also used in the June 6 deaths of two people gunned down on the street while putting up signs for a garage sale.
Killed were Cesar Ramirez Ibanez, 21, and Amairany Cervantes, 28. Prosecutors filed murder charges against Falu-Vives on Sept. 15.
Anyone care to be that these two were scumbags before they enlisted and simply reverted back to their default personalities when they got home?Anyone care to bet that the accused have UCMJ actions signed by the above officer in their jackets?
No, I would not care to bet ...
Quote:
Anyone care to bet that these two were scumbags before they enlisted and simply reverted back to their default personalities when they got home?Anyone care to bet that the accused have UCMJ actions signed by the above officer in their jackets?
on either of the above propositions - that is my professional lawyer mode talking.
If I were the prosecutor (or defense counsel, for that matter), I would be very interested in their priors (if any) - both pre- and during military service. I would also be interested in any prior psychological workups of record.
The article suggests, as to one of these gems, definite pathology:
Quote:
The affidavit said Marko told investigators he had violent sex with Lawrence before slitting her throat and leaving her to die in the foothills west of Colorado Springs.
That (to me) does not mean "not guilty by reason of insanity". All jurisdictions should have the alternative verdict form of "guilty, but mentally ill" - which means the criminal is first treated for the mental illness and then serves out the balance of the sentence for the crime.
There are not enough facts in what we know (from the article) to make hasty assumptions. Those facts will develop for those who want to follow the case.
There sure ain't enough facts to speculate that these crimes were proximately caused by the perps' military service - or even that military service was a "but for" causational factor.
PS: A few years ago, a small Houghton County village had four murders in one year (two by a serial killer who killed elsewhere in the area). Based solely on the bare statistics, one could conclude (falsely) that place was the Murder Capital of the USA.
GBMI (Guilty, but Mentally Ill) ....
is the name of a Detroit rock band; but more important here is an alternative verdict to "not guilty by reason of insanity". Here is the background:
Quote:
Physicians' Weekly
Point/Counterpoint
October 27, 1997
.....
Michigan was the first state to enact guilty but mentally ill. It was a [1975] reaction to a 1974 State Supreme Court decision holding that after 60 days’ confinement, someone acquitted by reason of insanity had to meet the standards of civil commitment. As a result, 64 persons were released, and two committed vicious crimes shortly afterward. ....
http://www.physiciansweekly.com/arch..._27_97/pc.html
The statute as it now stands is a bit lengthy (I've broken it into its parts for comment); but you have to have it before you to understand its logic and the comments.
As a practical matter, the statute will come into play only where (1) the defendant pleads not guilty by reason of mental illness ("insanity"); (2) proofs are offered to support mental illness; and (3) the proofs fail on the element of "lack of substantial capacity".
Quote:
768.36 Defense of insanity in compliance with MCL 768.20a; finding of “guilty but mentally ill”; waiver of right to trial; plea of guilty but mentally ill; examination of reports; hearing; sentence; evaluation and treatment; discharge; report to parole board; treatment as condition of parole or probation; period of probation; psychiatric reports.
Sec. 36.
(1) If the defendant asserts a defense of insanity in compliance with section 20a of this chapter, the defendant may be found “guilty but mentally ill” if, after trial, the trier of fact finds all of the following:
(a) The defendant is guilty beyond a reasonable doubt of an offense.
(b) The defendant has proven by a preponderance of the evidence that he or she was mentally ill at the time of the commission of that offense.
(c) The defendant has not established by a preponderance of the evidence that he or she lacked the substantial capacity either to appreciate the nature and quality or the wrongfulness of his or her conduct or to conform his or her conduct to the requirements of the law.
OK, so three basic elements; of which, the last one is all important. It is particularly important if "PTSD" is alleged as the mental illness.
E.g., if a defendant could prove by a preponderence (50 yds + a nose) that he had flashbacks so delusional that Mr. McCarthy appeared as an AQ terrorist in Iraq trying to kill the defendant and his unit, he may well get a jury to find the "lack of substantial capacity" element.
On the other hand, if the PTSD proof is that Mr. McCarthy by his big mouth set off the defendant's irresistible submerged anger, leading him to wring McCarthy's neck, I expect the jury might be less agreeable (depends on what they thought of Mr. McCarthy). That defense worked in Anatomy of a Murder (the real case was tried in Marquette, MI, with defense counsel a guy who was usually county prosecutor - later sat on the Michigan Supreme Court - had awesome talents with the ladies, so twas said).
Quote:
(2) If the defendant asserts a defense of insanity in compliance with section 20a of this chapter and the defendant waives his or her right to trial, by jury or by judge, the trial judge, with the approval of the prosecuting attorney, may accept a plea of guilty but mentally ill in lieu of a plea of guilty or a plea of nolo contendere. The judge shall not accept a plea of guilty but mentally ill until, with the defendant's consent, the judge has examined the report or reports prepared in compliance with section 20a of this chapter, the judge has held a hearing on the issue of the defendant's mental illness at which either party may present evidence, and the judge is satisfied that the defendant has proven by a preponderance of the evidence that the defendant was mentally ill at the time of the offense to which the plea is entered. The reports shall be made a part of the record of the case.
I can't see why a defendant would plead to guilty but mentally ill; unless the bargain was for outright probation, or a much reduced sentence followed by probation. See section 4 below. E.g., if the crime sentence is life or a long term of years, why not bargain for a set term of years under a pure guilty or nolo plea ?
Quote:
(3) If a defendant is found guilty but mentally ill or enters a plea to that effect which is accepted by the court, the court shall impose any sentence that could be imposed by law upon a defendant who is convicted of the same offense. If the defendant is committed to the custody of the department of corrections, the defendant shall undergo further evaluation and be given such treatment as is psychiatrically indicated for his or her mental illness or retardation. Treatment may be provided by the department of corrections or by the department of community health as provided by law. Sections 1004 and 1006 of the mental health code, 1974 PA 258, MCL 330.2004 and 330.2006, apply to the discharge of the defendant from a facility of the department of community health to which the defendant has been admitted and to the return of the defendant to the department of corrections for the balance of the defendant's sentence. When a treating facility designated by either the department of corrections or the department of community health discharges the defendant before the expiration of the defendant's sentence, that treating facility shall transmit to the parole board a report on the condition of the defendant that contains the clinical facts, the diagnosis, the course of treatment, the prognosis for the remission of symptoms, the potential for recidivism, the danger of the defendant to himself or herself or to the public, and recommendations for future treatment. If the parole board considers the defendant for parole, the board shall consult with the treating facility at which the defendant is being treated or from which the defendant has been discharged and a comparable report on the condition of the defendant shall be filed with the board. If the defendant is placed on parole, the defendant's treatment shall, upon recommendation of the treating facility, be made a condition of parole. Failure to continue treatment except by agreement with the designated facility and parole board is grounds for revocation of parole.
Here is the key to the statute: sentence for the crime, with mental health evaluation and treatment ancillary to the conviction.
Quote:
(4) If a defendant who is found guilty but mentally ill is placed on probation under the jurisdiction of the sentencing court as provided by law, the trial judge, upon recommendation of the center for forensic psychiatry, shall make treatment a condition of probation. Reports as specified by the trial judge shall be filed with the probation officer and the sentencing court. Failure to continue treatment, except by agreement with the treating agency and the sentencing court, is grounds for revocation of probation. The period of probation shall not be for less than 5 years and shall not be shortened without receipt and consideration of a forensic psychiatric report by the sentencing court. Treatment shall be provided by an agency of the department of community health or, with the approval of the sentencing court and at individual expense, by private agencies, private physicians, or other mental health personnel. A psychiatric report shall be filed with the probation officer and the sentencing court every 3 months during the period of probation. If a motion on a petition to discontinue probation is made by the defendant, the probation officer shall request a report as specified from the center for forensic psychiatry or any other facility certified by department of community health for the performance of forensic psychiatric evaluation.
This part is a diversion path for a defendant who committed a less serious crime, but has a serious mental illness. This portion of the statute was attacked, but held constitutional.
Quote:
History: Add. 1975, Act 180, Eff. Aug. 6, 1975 ;-- Am. 2002, Act 245, Eff. May 1, 2002
Constitutionality: The Michigan supreme court found that subsection (4) of this section, governing the grant of probation to guilty but mentally ill persons, does not violate the equal protection and due process clauses of the federal and state constitutions. People v. McCleod, 407 Mich. 632, 288 N.W.2d 909 (1980).
You might want to check on whether your state has such a statute; and, if not, ask your favorite legislator "why not".
PTSD and the Canadian military
Too many stressed soldiers slipping through cracks: report
'Canadian Forces members are strained almost to the breaking point,' says military ombudsman
Last Updated: Wednesday, December 17, 2008 | 11:41 AM ET
CBC News
Quote:
Some Canadian military personnel who have post-traumatic and operational stress injuries are not getting the care and attention they need, according to a report released Wednesday by the military ombudsman.
While senior military leaders have talked about a strong commitment to deal with post-traumatic stress disorder, or PTSD, and its devastating effects, the commitment hasn't reached down to the community level, interim ombudsman Mary McFadyen said.
There is a lack of care and support for soldiers across the country, she said in the 62-page report.
When one mother said her son was on the verge of committing suicide, she went to his supervising officer in Petawawa, who told her to suck it up, Susan Ormiston of CBC News reported. It's an experience the ombudsman confirmed is happening, based on interviews with 360 people across the country.
The full report can be downloaded from the DND/CF Ombudsman here:
A Long Road to Recovery: Battling Operational Stress Injuries
Second Review of the Department of National Defence and Canadian Forces’ Action on Operational Stress Injuries, December 2008.