DOD Leaders Discuss Critical Troop, Family Health Care Needs

By Karen Parrish

American Forces Press Service

WASHINGTON, Jan. 24, 2011 – Military health care has improved troop survival, recovery and rehabilitation, but providers, patients, families and leaders must keep investing time, effort and communication, Defense Department leaders said today.

Clifford L. Stanley, undersecretary of defense for personnel and readiness, and Deborah Mullen, wife of Navy Adm. Mike Mullen, chairman of the Joint Chiefs of Staff, spoke on these issues to an audience of thousands at the 2011 Military Health System Conference opening session.

Stanley is a retired Marine Corps major general, and recounted his family’s experience with the military health system.

In 1975, Stanley was stationed at the U.S. Naval Academy in Annapolis, Md., with his wife and their 3-month-old daughter when his family was the victim of a sniper attack. Stanley’s uncle was killed, and his wife was left paralyzed.

“I’m not a physician, but I was immediately introduced to the health care system in a unique way for us,” he said.

During the years that followed, Stanley said, his family learned a great deal about military health care, and experienced “a couple of close calls.”

“We … had to be engaged personally in the process,” he said. “At the time, I was lower-ranking, but the bottom line was that I insisted, and continue to insist, that we do our very best to take care of our people.”

Defense leaders do their best now to ensure the highest quality care for service members, but must connect with military medical professionals to know “what’s going on out there in our world,” he said.

His family now is happy and doing well, Stanley said, but still monitors the state of military health care.

“We care very deeply about what’s happening to our sailors, soldiers, airmen, Marines and Coast Guard -- our wounded, ill and injured,” he said.

One of the challenges in defense health care goes beyond medicine, Stanley said.

“It’s how we communicate, or don’t communicate,” he explained. “People mean well [and are] doing well, but it’s hard sometimes in a bureaucracy to figure out how that matrix works.”

One topic that left him “unbelievably frustrated,” he said, was the disability evaluation system, which the Defense and Veterans Affairs departments have been working to streamline since 2007.

“To find a system that was taking 500 days, and got down to 200-some days and now maybe 180 or whatever number of days it might be … can we do better? And can we do better now? Not next year, not next week, but can we do better now?” he asked.

Improving military health care “is not going to be, and should never be, something just done by DOD,” he said. “Anything we do is part of this great nation that we serve in. There are lots of people who want to help. … Let’s do it together.”

Stanley urged the health professionals in the audience to learn and share ideas during this week’s conference.

“We owe our troops our very best,” he said. “We owe them our heart and our soul and our commitment.”

Mullen built on Stanley’s remarks by emphasizing what the military medical system can do for service members’ spouses and children. The challenges these families face are not new, she said, but can be profound.

Mullen started by quoting from a letter written by a young military spouse: “It is infinitely worse to be left behind, and prey to all the horrors of imagining what might be happening to the one you love. You slowly eat your heart out with anxiety, and to endure such suspense is simply the hardest of all the trials that come to an Army wife.”

Those words are from a letter written by Elizabeth “Libby” Custer in 1876, shortly after her husband, Army Gen. George A. Custer, left for what became the Battle of the Little Bighorn, Mullen said.

“They could have been written, and probably have been written, by any of the hundreds of thousands of young spouses who have watched their soldier, sailor, airman or Marine march off to war these last 10 years,” she added.

Mullen said she doesn’t believe society yet fully understands the cumulative effects of stress, anxiety and worry on military families. “But we need to try, and we need to do so quickly,” she said. “A whole generation has now been impacted.”

Today’s military families have the advantage over Libby Custer of greater general understanding of combat stress, and programs in place to help them manage it, Mullen said.

“But we are still discovering, still revealing, fissures and cracks in our family support system,” she added, citing the need for “new ways to seal them.”

The first of those cracks is what families call secondary post-traumatic stress, Mullen said.

“Not unlike our troops, our families experience the same depression, anxiety, sleeplessness and headaches,” she said. “They break into cold sweats, lose concentration, suffer panic attacks, and come to dread contact with the outside world.”

Some spouses do not get out of bed, prepare meals or care for their children, she said, adding that some turn to the same “remedies” troops with post-traumatic stress do: alcohol, prescription drugs, even suicide.

“I am convinced that much of the desperation these drastic remedies represent is rooted in the stigma still attached to mental health issues,” Mullen said. “Not only are they embarrassed to seek help for themselves, spouses worry that in so doing they will negatively impact their husband’s or wife’s military career.”

The services have worked hard to eliminate that stigma in the ranks, but need to do more to remove it from families, Mullen said, noting that for some spouses who seek help, the result is “all too often disappointing.”

In two separate cases at one military hospital, spouses seeking help for post-traumatic stress symptoms and suicidal thoughts were given prescriptions – five in one case, seven in another – with no follow-up treatment or consultation scheduled, she said.

“You do not have to put on a pair of boots and patrol outside the wire to suffer the effects of war,” Mullen said. “If it is keeping you from living your life and loving your family, you owe it to yourself – and frankly, the military owes it to you – to get you the help you need.”

Military children represent another crack in the care system that needs sealing, Mullen said, noting the military services are working to understand the effect 10 years of war is having on those children.

“There is evidence of elevated emotional and behavioral difficulties and lower academic achievement,” she said. “Anxiety and depression have led to a rise in the use of psychiatric medication.”

In 2009, she said, 300,000 prescriptions for psychiatric drugs were given to military family members younger than 18.

“Some were no doubt warranted, but I worry that we don’t fully understand the long-term consequences of these medications,” she said.

Family stress happens after as well as during deployment, Mullen said, when reintegration and reunion add their own challenges.

“The Army … recently released information that spouse and child abuse cases are rising,” she said. “We have come to understand that while a combat tour may last a year, the effects of that tour on a service member and family may last much longer.”

Military families are strong and patriotic, and pride themselves on their resilience and readiness, Mullen said.

“But we didn’t fully understand that these wars would last as long as they have, and that resilience and readiness are not necessarily permanent,” she said. “After multiple deployments, they begin to break down.”

Building resilient families involves listening to their needs and challenges, she said.

“It’s about looking at things through their eyes, and trying to find solutions that work in their unique circumstances,” she said.

Following up on programs, assessing how they’re working, incorporating lessons learned and instituting best practices across the services are all critical to improving family care, she said.

“Often, spouses tell me they don’t need another program. … What they need is time: time with their spouse, time together with their families, time with a counselor, or a doctor, or a minister,” she said. “They want time to explore and understand what is happening to them, and the patience and understanding of loved ones, and friends, and the system itself.”