Well, my friends it’s time for me to get on the PTSD soapbox and go “Smedley” on the military mental health system. The fact is the system is broken, maybe not as bad as the VA, but broken nonetheless. The biggest part of the problem is not that there are not enough providers, there are not even though many more have been hired. The biggest part of the problem is that the system has lost any humanity that it once had, all in the name of efficiency and the budgetary bottom line. The fact is that the bottom line actually matters more than people and bean counters, not providers have the final say.
Marine Corps Major General, and two time Medal of Honor winner, Smedley Butler wrote after he retired in his classic book War is a Racket:
“I have visited eighteen government hospitals for veterans. In them are about 50,000 destroyed men- men who were the pick of the nation eighteen years ago. The very able chief surgeon at the government hospital in Milwaukee, where there are 3,800 of the living dead, told me that mortality among veterans is three times as great as among those who stayed home.”
Two years ago, the Navy seeing a increase in healthcare costs decided to bring as many people back into the Navy Medicine system as possible and cut back on referrals for active duty personnel. I understand that, money is short and Lord knows we need to save it wherever we can in order to buy aircraft like those in the grossly over-budget, behind schedule and substandard F-35 Lightening stealth fighter plane program, or ships like the Littoral Combat Ship which are over budget, under armed and not designed to survive the slightest combat. Mind you, none of the F-35s are in service, despite a decade of tests and production delays, costing hundreds of billions of dollars. But I digress…after all, war is a racket.
Now let me be honest and as fair as possible. There are many great mental health providers in the military and the Navy Medicine system; active duty, reserve, civilian and contractors. These people actually do care, but often they don’t get to make decisions that they think are right for their patients. At the same time there are others working in the system that are just in it for job security or the money. However, all of them are at the mercy of commanding officers that decide how they want to spend their budget, and dictate to their providers, sometimes at the threat of their job, contract renewal, a positive fitness report or promotion recommendation what they will approve, or more likely, deny. Thus in some cases commanders will support their providers doing whatever possible to get patients help, while others look at the bottom line. I have had both experiences.
I have been getting mental health treatment for PTSD since July 2008 when my life fell apart after Iraq. I have had mental health providers in the Navy Medical system. I also had a civilian psychiatrist who I was allowed to see when I was at Camp LeJeune, even after Navy Medicine decided to bring people back into the Navy Medicine system.
You see at Camp LeJeune, the old hospital commander, who I worked for, and the Director of Mental Health who I worked with realized that as a Chaplain that my personal and professional privacy, and my need for continuity of care was important. They realized that I needed to feel safe. There I was treated with professional courtesy, with humanity and I felt like people actually cared about me. That was was something that I needed then, and still need now. Unfortunately that is not happening now.
When I returned to the Hampton Roads area I knew that I still needed mental health care. I finally got my first visit and intake evaluation in June. My first appointment with a psychiatrist came on July 7th. The psychiatrist herself was not the issue. You see I used to work at the Naval Medical Center for two years and continued to work at the Naval Hospital Camp LeJeune for another three. I am fairly well known in the Navy Medical Region East.
I suffer a tremendous amount of anxiety. I admit it, I am still bat-shit crazy. I have the PTSD “Mad Cow.” The night before my first appointment I could not sleep, most likely because of being anxious about going to the Naval Medical Center outpatient mental health clinic. The fact is, it is really big and impersonal, and frankly that scares the hell out of me. I can’t go to big churches for the same reason. I feel terribly unsafe in them.
My worst fears were borne out. The waiting room was crowded, and after waiting I had my name and rank called out for everyone to hear, so much for the expectation of privacy, in fact I think that was a HIPPA violation. In the intake room I was met by three very junior hospital corpsmen. I didn’t even get a “hello, how are you doing sir?” from them. Instead one told me to take off my shirt, one told me to step on a scale and after that I was told to sit down, and got my blood pressure taken. My blood pressure was twenty points, actually almost 30 points higher than normal, even after I have just had a bunch of caffeine, which I did not on July 7th. I have to attribute the rise in blood pressure to the anxiety of just going in to the clinic, there is no other reason. After I had my vitals checked, I was asked a series of rapid fire questions that were very personal in nature and that I would prefer a doctor or nurse ask. I was then told to go back and wait.
The whole process was impersonal, embarrassing and dehumanizing. But it was very efficient, and the bean counters should be happy. That being said it was the absolute worst experience I have had with military medicine, and that includes having a thumb stuck up my ass and having to duck walk at the Military Entrance Processing Station. That was a rite of passage, but this scared the absolute hell out of me, I did not feel like I mattered as a person to anyone in the clinic.
When I saw the doctor she was pleasant. I told her of my experience and requested that I be referred to a provider in town as I had at Camp LeJeune. I was told that she would submit the request to her division officer who is a doctor that I know, and get back to me in a day or two. I didn’t hear from her. I waited two and a half weeks, and finally decided to e-mail the doctor on July 24th asking what was going on. Today I got an e-mail telling me that “my case could not be sent to the civilian network.” No reason was provided. The time between that appointment and the denial of my request was almost four weeks, totally unacceptable by any standard of care, military, civilian or even Klingon.
I was given the option of seeing a provider at an outlying clinic however the one close to where I work would be similar to the main hospital, crowded and impersonal. The other option was using a resource called “Military One Source” where I could get up to 10 or 12 appointments with a civilian provider in town with no guarantee that I would be able to see them after those visits were up without approval from the same people who just told me that I couldn’t be seen in town. If I do that my medication would then be managed by my PCM instead of a shrink. At this point I no longer have any trust in the military mental health system, at least for me, and the Military One Source providers are not really there to deal with long term chronic conditions.
I knew that I was being blown off. In military speak it is the old adage that “a mission passed is a mission completed.” The fact is that I do not matter to these providers. Unlike the people at Camp LeJeune, they have no personal investment in me as a patient or as a professional colleague, so why should it matter to them? I don’t write their evaluations, the bean counting admiral does so, why would an old and broken chaplain who doesn’t work with them matter?
Likewise I am being treated like a child in regard to medication. I have no history of drug abuse, prescription or otherwise. Unlike LeJeune where my doctor put refills on my as needed PRN anxiety medicine, I now have to subject myself to the industrial “production line” inhumanity of that clinic, just to get a refill each month. Even if I didn’t want therapy I would have to endure the ignominy of the inhuman treatment at the clinic 12 times a year just to get a pittance of very low dose anti-anxeity medication. I don’t need that kind of abuse, and that it exactly what it is no matter what the bean counting admiral calls it.
But here’s the deal. I am a senior officer. No wonder so many senior officers decline treatment, attempt to hide their symptoms and self-medicate. The treatment in the system is demeaning and the stigma is there. I have known of a good number of senior officers, Marines, Navy and Army who have ended up losing their careers or lives over untreated PTSD. Right now I am debating even if I should go back to therapy. I know I need it, but if it is a choice of the abuse I am going through at the mental health clinic or maintaining a semblance of human dignity, a good craft beer tastes far better than Xanax.
Not only that, but an even far more important reason than me and my needs, that of the junior enlisted personnel who seek help or are directed by their commands to get help from mental health. Now I cannot imagine what it would be to be a powerless junior enlisted soldier, sailor, Marine or airman. But wait I can, I enlisted in the National Guard back in 1981. However, back then I wasn’t broken, and I cannot now imagine what is is for young, powerless enlisted personnel have to go through what I am going through when getting mental health treatment. That is the bigger issue.
Is it any wonder that the military suicide rates are still high and that this year the Navy is up from the same time as last year? According to statistics released last week, there have been 36 Navy suicides this year, last year at this time there were just 24 with 43 for the entire year. I wonder if that has something to do with pushing people into an often uncaring bureaucratic system that is more concerned with saving money than meeting the needs of patients.
I was talking to a friend, an officer at the Medical Center today while at a different clinic where I am treated with great compassion, care and dignity, a clinic that is not afraid to get me the medical help that I need, even though it is expensive. This officer and I served at Portsmouth together back in 2008-2010 and that officer told me today that the place has changed. He said it was all about business, impersonal and machine like, devoted to the bottom line, with lip service being given to actual patient needs by those in senior leadership.
Thank God I won’t have to stay in the military medical system the rest of my life. The good news is that when I retire I get to go to the amazingly proficient VA system for that care. Won’t that be grand?
No it won’t. Not for me or any of the tens of thousands, maybe hundreds of thousands of military personnel with PTSD, TBI or Moral Injury. We’ve all read about the problems in the VA, they are persistent, endemic and won’t change anytime in the near future. That is shameful.
General and former Secretary of State Colin Powell famously said “you broke it, you buy it.” Of course he was talking about Iraq, but the same principle should apply to those who have put their lives on the line during the last 13 years of war and come back broken. It is a moral obligation, it is something that we as a nation promised. The country pledged to care for those who served, and the fact that it is barely a half percent of the population who have served in war for the last 13 years, men and women who now have to fight for the basic care that a civilized, and as the Religious Right likes to call a “Christian nation” should provide as a matter of basic human decency. It is not special treatment that broken veterans deserve, it is simple decency and honoring a commitment that we made as a nation.
Yes I am going “Smedley” here, because war is a racket, and it is a racket that those inside the military, the government and the private sector promote.
I’m sure that I will get some blowback from this from some in the system, but I don’t care. The system is broken and until we as a nation stop bullshitting and admit there is a problem and elect to do something about it won’t get better. The bean counters, war profiteers and bureaucrats need to be held accountable by our elected representatives.
I am going to be contacting the Admiral that commands the medical center as well as my Congressman, and probably the chairmen of both the House and Senate Defense committees because I suspect from what I hear from soldiers, sailors, Marines and airmen around the country that this is not an isolated instance. So, if someone like me, a senior officer still in the system doesn’t do this who will?
I hope that this post will become viral so that our sailors, Marines, soldiers and airmen get the quality care, delivered with compassion and humanity that they deserve. For some it will be a matter of life and death.
Pray for me a sinner.