HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Saturday, November 8, 2008

Army General Defies Culture of Silence on Mental Health

The Washington Post reports on an Army General who spoke out from the culture of silence on mental health by seeking treatment and advocating for others to do the same.  Pauline Jelinek writes,

HelicopterIt takes a brave soldier to do what Army Maj. Gen. David Blackledge did in Iraq.

It takes as much bravery to do what he did when he got home.

Blackledge got psychiatric counseling to deal with wartime trauma, and now he is defying the military's culture of silence on the subject of mental health problems and treatment.

"It's part of our profession ... nobody wants to admit that they've got a weakness in this area," Blackledge said of mental health problems among troops returning from America's two wars.

"I have dealt with it. I'm dealing with it now," said Blackledge, who came home with post-traumatic stress. "We need to be able to talk about it."

As the nation marks Veterans Day on Tuesday, thousands of troops are returning from Iraq and Afghanistan with anxiety, depression and other emotional problems.

As many as one-fifth of the more than 1.7 million who have served in the wars are estimated to have symptoms. In a sign of how tough it may be to change attitudes, roughly half of those who need help are not seeking it, studies have found.

Despite efforts to reduce the stigma of getting treatment, officials say they fear generals and other senior leaders remain unwilling to go for help, much less talk about it, partly because they fear it will hurt chances for promotion.

That reluctance is also worrisome because it sends the wrong signal to younger officers and perpetuates the problem leaders are working to reverse.

"Stigma is a challenge," Army Secretary Pete Geren said Friday at a Pentagon news conference on troop health care. "It's a challenge in society in general. It's certainly a challenge in the culture of the Army, where we have a premium on strength, physically, mentally, emotionally."

Adm. Mike Mullen, chairman of the Joint Chiefs of Staff, asked leaders this year to set an example for all soldiers, sailors, airmen and Marines: "You can't expect a private or a specialist to be willing to seek counseling when his or her captain or colonel or general won't do it."

Brig. Gen. Loree Sutton, an Army psychiatrist heading the defense center for psychological health and traumatic brain injury, is developing a campaign in which people will tell their personal stories. Troops, their families and others also will share concerns and ideas through Web links and other programs. Blackledge volunteered to help, and next week he and his wife, Iwona, an Air Force nurse, will speak on the subject at a medical conference.

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The Air Force devised history's most successful suicide prevention program. It cost 1 hour of training of all supervisory personnel a year. It consisted of reporting suicidal statements or depressed appearances, and forced treatment. It paid off not only in reducing the suicide rate, but also in reducing the murder rate and other consequences of mental illness in such a demanding environment. People were not punished, just made to receive ordinary evaluations and care.

This model of identification of people at risk, and mandatory evaluation and treatment can cut the suicide rate around the world, at no additional cost, and with the same side benefits. Mental health treatment costs 1/1000th as the replacement cost of a highly specialized person in the military.

The resistance of the other branches of the military and of corporations to this approach is puzzling. The military population is a superior population compared to the general population. It has a low rate of mental illness by pre-screening. The effects would be far greater in the general population were this approach to be applied.

There are around 30,000 suicides. And paranoid schizophrenics murder 1000 people a year. Thank the lawyer. The Supreme Court has blocked their getting treatment until actual injury has taken place. That dark day in 1976, the rent seeking lawyer took over a vital decision point in mental health to increase lawyer employment and empowerment over a major area of medicine. A million people have perished by violence stemming from untreated mental illness, thanks to the crass rent seeking lawyers on the Supreme Court. No one would get needed treatment without first providing jobs to three lawyers, a prosecutor, a defense attorney, and a witless appointed political loser-has-been in the middle.

Suicide takes away the greatest number of productive years of almost any other illness because it happens to middle aged people at the top of their skills and responsibilities. Thank the Supreme Court for this devastation. The Air Force experiment verifies that cutting out these lawyer, rent seeking, cult criminals from mental health care, has a major impact on the suicide and murder rates.

Posted by: Supremacy Claus | Nov 8, 2008 10:56:52 AM

Everyone knows that the earlier a cancer is detected, the easier it is to treat, the greater the chance of survival and of full recovery, and the less harsh the required treatment.

The same is true of PTSD. It can actually be blocked by taking anti-depressants, steroid, or propranolol (a cousin of alcohol) after a trauma and before the symptoms have appeared. There is also evidence that allowing PTSD symptoms to persist may cause them to "burn in" and to become impossible to stop later.

So early, aggressive treatment should become military policy as would the early arrest of an infectious disease or any other health condition that affects preparedness.

Posted by: Supremacy Claus | Nov 8, 2008 11:17:30 AM

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