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Down & Up Show #49: Military Mental Health
DR. REEF KARIM:
Today we're lucky to have Dr. Mary Helen Davis on the show. Dr.
Davis is currently the director of Behavior Oncology at the Norton
Cancer Institute in Louisville, Kentucky. She's currently on the
board of trustees of the American Psychiatric Association and she's
chaired a workgroup for the APA that focused on the mental health
needs of active duty military, veterans and their families.
Today Dr. Davis will be speaking with us about new data released
by the American Psychiatric Association on military mental health.
It's great to speak with you Dr. Davis.
DR. MARY HELEN DAVIS:
Thank you.
DR. REEF KARIM:
Alright so tell me about the APA has just conducted on military
mental health.
DR. MARY HELEN DAVIS:
Well this is a study that actually looked at three issues, it looked
at what were the areas of stress and distress in military personnel
and their families. And then it looked at what was their awareness
or... of mental health issues and treatment. And then finally it looked
at what were the barriers to treatment including stigma, that would
be a disincentive or... people who needed treatment to seek it.
DR. REEF KARIM:
Okay and... what did you find that military members in regards to
common mental...
DR. MARY HELEN DAVIS:
Well there's good news and bad news. What we found that about 75
percent of... military... personnel and their families actually felt
that they had fairly good mental health. However there were a number...
about a third felt that they had a significant level of... stress
or distress.
And what we found in that population, the common things were problems
were sleep disorder, anxiety, feelings and mood or loss of interest
in terms of their activities and... different active... and activities
of daily living.
DR. REEF KARIM:
Alright, do military members and spouses understand the warning
signs of mental illnesses that may result from... from being deployed,
say to wars or somewhere where there's... a lot of chaos?
DR. MARY HELEN DAVIS:
That was one of the very interesting... findings of the study... while
they find that most of the military members and spouses often thought
that mental illness can be successfully treated, it was about half
of them really were not aware of what were the specific types of
problems that could come as a result of deployment or repeated deployment.
So there obviously is a level of education that needs to be attended
to among... military personnel and their families.
DR. REEF KARIM:
Oh... what resources exist for military members seeking information
about mental illness? So obviously we know the VA... what other resources
are there?
DR. MARY HELEN DAVIS:
Well I think there are... the resources are the VA, some of them...
other resources maybe the Veterans Association, other resources
maybe the community mental health system. You know I think that
there are problems obviously with the resources as a lot of the
state budgets have had cuts and have deficit budgets that sometimes
funding to help in human services... is compromised.
And... and that that is one of the things, just as we prepare our
military and try to protect them in their Humvees by providing chem...
Kevlar and their equipment, we need to protect them when they're
back stateside and their pickups by having an adequate mental health
delivery system. And that includes an interface between the Veterans
Association and the state mental health association.
And... and the other thing I think in terms of... resources, a lot of
people are using online resources to get basic... medical education
and information. The APA has healthyminds.org... there's military
one source. I know the Veterans Association has battle mind program
that a number of things... and battle mind for spouses, a number of
things that help patients and their families at least get education
and... and that that may give them more details about what resources
are available on their state and local levels.
DR. REEF KARIM:
Yeah, I really like the way you put that... just... just as protecting
them with Kevlar overseas, we have to protect them stateside upon
their re-entry, specifically with their mental health concerns.
DR. REEF KARIM:
So what barriers to treatment do you believe exist for military
members and spouses?
DR. MARY HELEN DAVIS:
Well from the study that the APA just conducted, we do find that...
military do see a lot of stigma still associated with seeking treatment
and that a significant percentage of military feel that to seek
treatment for mental health could have an adverse consequence on
their... military career.
And so I think that although we've come a long way in reducing...
stigma in the general population and as they survey said, even in
the military base population, 90 percent of them have the belief
that treatment is helpful and it works, there's still this deterrent...
to seeking treatment and whether it's education, change in military
culture or whatever, we do need to continue to address that issue
and encourage people to seek treatment when they need it.
DR. REEF KARIM:
Now because our military... is supposed to be protecting us, whether
here or it's overseas, there's this, I don't want to say bravado
but there's this sense of we are the protectors, and... and when you
are protecting you often don't focus on, as you said, the invisible
symptoms whether you're deployed somewhere else or you're here upon
re-entry.
That things like mental health concerns are... probably at the bottom
of your list as far as really worrying about those kinds of things
cause you're focused on so many other things around you. So how
can... how can a soldier... actually... feel like they're a protector
and at the same time be focused on internal anxiety, rage, depression,
sleep all that kind of stuff?
I mean how... how do you educate somebody in your... in your opinion
to really... bring about mental health as an important aspect of being
a protector?
DR. MARY HELEN DAVIS:
Well I do think that that... that's an interesting and complicated
question because you're absolutely right, people don't focus on
something they don't think they need. And when you're geared up
going to fight a war or a battle, you're absolutely right, you're
internally focused on your own mental health needs.
Your externally focused on what you've been trained to do and what
you job description is and there's kind of that phenomena I think
that of... bravado or invincibility or whatever, that there's... part
of the culture of military life is... that those... those emotional
issues are not things that are on the front burner.
And they don't have to be on the front burner, but I do think you
kind of have to be aware that some of the exposure of the things
that you have may cause these things to move from the back burner
to the front burner at various points in times in one's career.
And I think the military tries to do some things in terms of educating
people in their transitioning back home and different types of things.
And so it maybe that we need to continue to do that level of education
so that the resources are there at the point in time that someone
needs them.
DR. REEF KARIM:
Yeah... if we ever... as much as we care about mental health concerns,
if we have a bunch of soldiers worried about getting four hours
of sleep versus eight hours of sleep, we're constantly about anxiety
over separation from their family, they're not going to be good
soldiers.
DR. MARY HELEN DAVIS:
Well and I... and I do think that does become part of their training,
is that they have to look at shifting their focus on what they have
to do at that point in time. And you know I think that it... it... you
then... we know as... from our medical data of looking what becomes
both the short-term and long-term effects, for example, of sleep
deprivation.
Or looking in terms of what happens with prolonged separations in
terms of stresses that it puts on relationships and that even... even
though that may not be their job to focus on that, the medical providers
in their care, have to be an awareness of that and look at trying
to figure out... at what point do those issues constitute a problem
or at what point is someone at the breaking point where the cumulative
effects of those issues are impairing their... their functioning.
DR. REEF KARIM:
Let's talk about spouses real quick. Are there any unique stressors
military spouses face?
DR. MARY HELEN DAVIS:
Well, I think we mentioned a little bit, particularly for the spouses
of reservists, who — traditionally military spouses may have been
living together, and might have had the support of similar experiences.
And when you look at... In the — the small percentage across the nation
of people who are actually in the military, and have military spouses.
So we do have problems with isolation in some of the military spouses,
now that they're living in a civilian community, who may not understand
the unique conflicts and stressors that they face.
With multiple deployments, many of them are facing being single
parents, many of them are facing... A whole host of financial stressors,
or — or domestic issues, in terms of trying to balance and — and
manage multiple roles, and — and certainly you can appreciate the
level of role-strain that many of these military spouses have when
their spouses are deployed for long periods of time.
And then... You know, they do have a high level of distress, and then
looking at what is their access to formal treatment and support
when they need it, and, you know, they depend either on the integrity
of the mental health system, or on Tricare, which has had problems
of its own, and particularly in terms of mental health, and having
a sufficient number of providers across the nation, due to all of
the administrative hassles of a, becoming a Tricare provider, and
b, managing all the paperwork that goes with it.
And so these are all — all issues that — that they face, as well.
DR. REEF KARIM:
What — okay, what is the APA doing to support military members who
may be facing mental health issues?
DR. MARY HELEN DAVIS:
The APA has done a number of things. I think — the APA has a division
of advocacy, which tries to make our decision-makers in Congress
aware of the mental health needs of military and their family, and
fights for funding.
The APA has done surveys of its membership on Tricare. The APA does
continuing medical education to make its general membership more
aware of what are the unique mental health issues that military
families and... Face, and so we do that continuing education at our
annual meeting.
We have encouraged our members to do a volunteer program of "give
an hour," in which they can sign up to provide free care an hour
a week for a military member or their family. And the — and the
APA has a number of committees and councils that are looking at
what are thee issues related to military deploy- the mental health
issues related to mental health deployment.
So I think that we're very aware of the problems, and are actively
looking to be a participant in the solutions of providing care and
information on this issue.
DR. REEF KARIM:
Great, that's great. Any last thoughts that you wanna convey?
DR. MARY HELEN DAVIS:
I... Just to put into place that... That this is an important issue.
Our military have served us, and we need to serve them, and we need
to have an intact mental health system available for them, both
through the military, the veterans, and back in the States, in terms
of a functioning community mental health system.
DR. REEF KARIM:
Yeah, and I'd — I'd just like to reiterate your — your comments
that we... When we discussed the — the invisible symptoms of war,
like mental health issues, are just as life-threatening as loss
of limbs in battle.
I think that's a very important statement.
DR. MARY HELEN DAVIS:
Absolutely.
DR. REEF KARIM:
Right. So thank you so much for spending time with us today.
DR. MARY HELEN DAVIS:
Thank you! It's a delightful interview, Dr. Karim.
DR. REEF KARIM:
Okay, take care. For the Depression Is Real Coalition, I'm Dr. Reef
Karim, psychiatrist, addiction medicine specialist, and relationship
therapist. Join us next time for another segment of The Down And
Up Show, on depressionisreal.org.
