Sen. Joe Lieberman on Sunday said he wants to look at the question of whether alleged Ft. Hood shooter, Army Major Nidal Hasan, gave off any warning signs, missed by the Army, that he had extremist Islamist views that made him capable of committing what the senator said is possibly an act of terrorism. The senator said he will conduct a hearing on the question.
That's an interesting line of inquiry. But as I wrote Friday, a question that likely has more relevance to the thousands of military patients suffering from post traumatic stress disorder, and their families, has to do with why Hasan was allowed to treat patients when his behavior had deeply disturbed colleagues at Walter Reed Army Medical Center in Washington, D.C.
A congressional hearing on this question and the larger issue of quality control in the provision of military mental health could go a long way towards answering some important questions now have a spotlight hon them after last week's shootings.
For instance, according to a Washington Post story over the weekend, it appears the demand for competent and compassionate mental health professionals in the military is great, but the supply isn't.
Since the shooting, officials have been looking for warning signs in Hasan's career that could have tipped them off to his potential to carry out the attack. Some of his Walter Reed colleagues said patients complained that Hasan seemed uncomfortable talking about soldiers' emotional needs and was himself a loner. He was also not very productive but was gentle in nature and showed no signs of potential for violence, they said.
A former Walter Reed social worker, Joe Wilson, said problems in the mental-health department were usually not discussed openly. "Of course you miss the red flags, you can't talk openly about mental health," Wilson said. "You complain about it to each other, but not to anyone else." The opinion was shared by another mental-health worker who asked not to be named.
Switching a soldier who is unhappy with his psychiatrist to another doctor can backfire and delay the medical board process that determines whether the soldier remains in the service. "It's a complete disincentive to complain" about any particular health-care provider, Wilson said.
At Walter Reed, some soldiers and health-care professionals complain that there are not enough mental-health providers, and senior Army officials have acknowledged that finding enough people to work with the military is a persistent problem. They say patients diagnosed with PTSD and other war-related emotional problems are far too likely to be treated with sleeping aids and mood-altering medications. Many still go without regular one-on-one therapy or meaningful group sessions.
The wife of an amputee soldier recovering at Walter Reed with traumatic brain injury and PTSD said that mental-health services are so uncoordinated and ineffective that the couple decided to pay for private psychotherapy sessions with a civilian provider at $130 an hour.
The couple sought private treatment elsewhere after spending a few minutes with a Walter Reed psychiatrist, who then referred the soldier to a social worker for treatment.
"It was a joke," said the wife, who asked not be identified because her husband, a sergeant, is still recovering at Walter Reed. "She was a lovely person, but we have a serious problem here and she just didn't get it . . . She essentially directed me to a Web site."
Meanwhile, the New York Times examined military mental health from the perspective of the professionals. The portrait that emerges is very troubling.
Major Hasan was one of a thin line of military therapists trying to hold off a rising tide of need. So far this year, 117 soldiers on active duty were reported to have committed suicide. The Army has only 408 psychiatrists — military, civilian and contractors — serving about 553,000 active-duty troops around the world. As a result, some soldiers home from war, suffering from nightmares and panic attacks, say they have waited almost a year to see a psychiatrist.
Many military professionals, meanwhile, describe crushing schedules with 10 or more patients a day, most struggling with devastating trauma or mutilated bodies that are the product of war and the highly advanced care that kept them alive.
Some of those hired to heal others end up needing help themselves. Some go home at night too depressed to talk to their children. Others, like Bret A. Moore, a former Army psychologist at Fort Hood, ultimately quit.
"I planned for a career in the military, but I burned out" after about five years, he said.
Given these sorts of pressures it would seem that military mental health professionals might need more monitoring and support than their civilian counterparts.
But it's unclear from the story exactly how much oversight there is of military mental health professionals, to among other things, frequently assess their fitness to treat some of the most challenging psychiatric medical cases that exist.
A later passage in the story suggests why it could be very helpful for Congress to investigate the state of mental health care in the military with a focus on how mental health providers are screened. There are conflicting versions of just how much oversight actually exists.
Two civilian psychiatrists familiar with military mental health indicate that there is relatively little oversight of mental health professionals once they're out of training. Meanwhile, an Army psychiatrist at Walter Reed said there was quite of bit of oversight. A congressional hearing could help bring some clarity to this conflict.
The relevant excerpt:
Whatever the facts in Major Hasan's case, some therapists who work with the military agree that the tragedy is likely to have a "lasting impact on how we look at mental health providers," said Dr. Martin Paulus, a psychiatrist at the University of California, San Diego, and the Veterans Affairs San Diego Healthcare System.
The Army has added to their ranks in recent years, as the number of soldiers with the diagnosis of post-traumatic stress disorder has climbed to 34,000. But the shooting has raised a pressing question: Who counsels the counselors? Dr. Moore and other therapists who have worked in the military or for Veterans Affairs said that mental health evaluations of therapists themselves were virtually nonexistent.
"I have worked with the Army, the Navy, the V.A., and I'm not aware of any formal, systematic process to evaluate professionals," said Dr. Andy Morgan, a psychiatrist at the National Center for P.T.S.D.
At Walter Reed, where Major Hasan was in training until recently, Lt. Col. Brett Schneider, a psychiatrist, described a complicated system of checks and balances, including a training committee with superiors and civilians who evaluate residents and mental health staff members.
"There is a lot more built into the processes to keep tabs on each other," said Colonel Schneider, who spoke on the condition that he not be asked any questions about Major Hasan. "If somebody is starting to get to the point where these things are a problem, there are a number of ways we can intervene."
Generally, though, the military, like many large civilian employers, relies on self-evaluation and voluntary employee-assistance programs.
"Once training is over, you're basically on your own," Dr. Paulus said.