Gaps in Mental Care Persist for Fort Carson Soldiers An NPR investigation last December found that supervisors at Colorado's Fort Carson punished soldiers who suffered mental anguish. Leaders at the base now attend mandatory training on spotting troubled soldiers, but mental health experts say it may be doing as much harm as good.

Gaps in Mental Care Persist for Fort Carson Soldiers

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Corey Davis was a machine gunner in Iraq; he was featured in NPR's December 2006 investigation on mental health care at Fort Carson. He told NPR that he began "freaking out" after he returned to the base; when he sought help at the base hospital one day, he says he was told he'd have to wait more than a month to be seen. Daniel Zwerdling, NPR hide caption

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Daniel Zwerdling, NPR

Browse NPR's previous reports on mental-health care at Fort Carson:

Mixon: Army Will Take 'Disciplinary Action' Against Leaders Who Show Bias Against Mentally Anguished Soldiers

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Command Sgt. Maj. Terrance McWilliams at Fort Carson says he has verbally reprimanded a few supervisors for their treatment of soldiers with mental health issues. Daniel Zwerdling, NPR hide caption

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Daniel Zwerdling, NPR

Williams: Soldiers' War Experiences Can't Be 'Justification for Breaking Law'

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Knorr's Memo

Dr. Steven Knorr, director of mental health at Evans Army Community Hospital, wrote a memo warning commanders that trying to save every soldier is a "mistake." Knorr says he wrote the memo to help commanders deal with soldiers with emotional problems. Read excerpts.

Six months ago, an NPR investigation found that leaders at Fort Carson, Colo., were punishing some soldiers who returned from war with serious mental health problems — and were preventing them from getting the treatment they needed. In some cases, officers kicked the soldiers out of the Army.

Those stories sparked ongoing investigations of the post, including one by a bipartisan group of U.S. senators and another by Pentagon officials.

Early this year, commanders at Fort Carson responded by launching what they described as an important new program: They required every leader, from sergeants up to generals, to attend a training course on how to spot and help soldiers who potentially have post-traumatic stress disorder. Officials say more than 2,200 leaders have taken the course so far, most of them early this year.

But during a recent return trip to Fort Carson to see whether conditions for troubled soldiers had improved, the most significant changes appeared to be rhetorical.

More troubling is that independent mental health specialists who work with troops told NPR that Fort Carson's heralded new training course might even make things worse. And it seems as though the commanders' stated goal of helping every soldier conflicts with the military's demand for discipline.

Officials at the base say they've been trying to teach leaders about the importance of mental health problems linked to combat since the United States invaded Iraq, but the workshop is the most important new strategy designed to make sure that every leader gets the message.

Treat Troubled Soldiers, or Discipline Them?

On the face of it, the training program seems like a good step.

"One of the things that's extremely important in our jobs is minimizing the stigma associated with PTSD," the director of Fort Carson's medical center, Dr. John Cho, told dozens of supervisors at a recent session.

He told them that NPR's reports had taught the base that there were "a number of sergeants" who "did not allow their soldiers to come to our hospital" to get proper psychiatric treatment.

In fact, during a previous visit to the post, NPR spoke with a half-dozen sergeants who expressed contempt for soldiers with PTSD. They said such soldiers were "weak," called them "s—-bags," and said they didn't belong in the Army.

In the new workshop, a psychiatric nurse, Laurel Anderson, led the audience through a presentation of about 40 minutes designed to get leaders with those types of views to change.

"Combat stress should be viewed as a combat injury," she told them, clicking through slides. PTSD is "a bona fide psychiatric disorder."

But as she progressed through the slides, Anderson's message seemed confusing.

On the one hand, she told them several times that "admitting to a mental health problem is not a character flaw," and that "it's not OK" for soldiers to not get proper help. As leaders, she told them, "Do not ignore the warning signs — excessive drinking, marital problems, domestic abuse, suspected drug use, declining work performance. Make sure you are aware of those signs and symptoms. They are often the first ones."

In fact, studies from past wars predict that 20 percent to 25 percent of troops with PTSD might abuse alcohol or drugs, and that significant numbers might commit domestic violence and other destructive behaviors.

But, on the other hand, Anderson then seemed to minimize the problem.

"The fact is," she declared, "most soldiers who have PTSD do not beat up their families, they do not take drugs – they just don't do that. The Army is always going to be a disciplined organization with no room for that kind of conduct. The truth is, the Army has one mission: Kill the enemy. Its mission is not long-term care."

Reinforcing Negative Views of PTSD?

NPR sent the audio and slides from the entire training workshop to four mental health specialists who work with troops and their families; they all denounced the program. At best, they said, it's so boring and dry that it's unlikely to change anybody's mind.

"I would be worried that it would turn them off," said Dr. Stephen Xenakis, a retired brigadier general who used to supervise all the Army's medical centers in the southeastern United States.

"I would say [the training] is a failure," another psychiatrist, Dr. Judith Broder, told NPR.

Broder runs a network called The Soldiers Project, which includes more than 100 therapists in California and New York who offer free services to troops and their families. After listening carefully to the lecturer's choice of words and tone of voice, and analyzing the slides, Broder said the training could actually reinforce leaders who feel that soldiers with PTSD deserve to be punished.

If the critics heard any "mixed messages," they were "inadvertent," said Dr. Stephen Knorr, the chief of Fort Carson's mental health center. He added that the training would reach leaders even if it were boring, because whenever commanders call soldiers into an auditorium and tell them " 'this is important stuff, we've got to take care of our soldiers, we've got to take care of each other,' it has a tremendous impact."

New Reports of Punishment for Mental Anguish

There are other signs that the climate at Fort Carson hasn't changed as much as the commanders say it should.

Five soldiers who spoke to NPR during a previous visit to the post had similar, troubling stories: They had been falling apart, psychologically, since they came home from the war. Their supervisors had been punishing them and, in some cases, taking steps to kick them out of the Army. The soldiers' medical and personnel records corroborated their accounts.

Commanders at the base would not talk to NPR about the soldiers, citing medical privacy. Commanders also stressed that it's unrealistic to expect every leader at Fort Carson to change as a result of the new training on PTSD. Still, the base commander, Gen. Robert Mixon, insisted that he'll punish leaders who mistreat soldiers who are troubled.

"We expect leaders to support soldiers' getting care and treatment without bias," Mixon said. "And if we see evidence of bias, we will take disciplinary action against the leaders." Mixon said the Army has already held some leaders "accountable."

But Mixon's right-hand man, Command Sgt. Maj. Terrance McWilliams, said, "No, we have not taken disciplinary actions."

McWilliams said he has merely "reprimanded" a few leaders "verbally." As McWilliams explained his approach to running the post day-to-day, he shed light on the dilemma that seems to be causing controversy around Fort Carson. The training sessions on PTSD teach leaders that some of the most common side symptoms include "excessive drinking, marital problems, domestic abuse, suspected drug use, [and] declining work performance," but McWilliams insisted that he'll punish soldiers who misbehave in those very ways — even if the Army's doctors have diagnosed them with disorders like PTSD.

"We have an obligation to maintain good order and discipline," McWilliams said. "We just can't ... say that 'my experience in Iraq or Afghanistan is a justification as to why I broke the law' " — including military rules.

Mental health specialists who work with PTSD patients say that Fort Carson's policy in effect punishes many soldiers for their illness — because a minority of soldiers with PTSD do act out in destructive and even illegal ways.

'We Can't Fix Every Soldier'

The Pentagon's message is clear: Assistant Secretary of Defense William Winkenwerder told NPR last year that the military's goal is to heal every soldier who comes back from the war with emotional problems, or at least heal the soldier enough to return to active duty or live a good life outside the military.

But Knorr has written a memo warning commanders that trying to save every soldier is a "mistake."

"We can't fix every soldier," Knorr's memo states. "We have to hold soldiers accountable for their behavior. Everyone in life — besides babies, the insane, and the demented and mentally retarded — has to be held accountable for what they do in life."

Knorr's memo, which he posted on his office bulletin board, also warns commanders not to make another mistake: "Procrastination on discipline and separation." Translation: Officers should get rid of troubled soldiers, quickly. "From a commander's standpoint," Knorr explained, "a staff sergeant may have 30 officers in his platoon, and he has to get them trained and ready and working on a cohesive team. If he has one or two soldiers who are not showing up for work, showing up intoxicated, using illicit drugs, or going AWOL, that soldier with the misconduct problems is dragging behind the whole platoon — and they don't have time for that."

NPR recounted Knorr's comments for Dr. Xenakis. "It really saddens me" to hear that policy, Xenakis said. "It's inhumane."

Knorr's Memo

Dr. Steven Knorr, director of mental health at Evans Army Community Hospital, says he wrote this memo to help commanders deal with soldiers with emotional problems. As a condition of giving us a copy, he asked us not to post the original document on NPR's Web site; we agreed. Here are excerpts:


1. TRYING TO SAVE EVERY SOLDIER. We can't fix every Soldier, and neither can you. Everyone in life beyond babies, the insane, and the demented/mentally retarded have to be held accountable for what they do in life.

2. PROCRASTINATING ON DISCIPLINE AND SEPARATION: Delaying administrative separation and NJP [Editor's note: Nonjudicial Punishment] is counterproductive. We see Soldiers monthly that had their Chapter evaluation [Editor's note: performance evaluation] six months ago, and now are worse off and more of a management problem than before. Get rid of dead wood ...

3. ASSUMING PSYCHIATRIC HOSPITALIZATION WORKS LIKE A REFORM SCHOOL OR MP HOLDING CELL. Psychiatric hospitalization has its limits. We can't put them there just because they break barracks restriction and go get drunk, or get in fights, or engage in similar misconduct …

5. ASSUMING PSYCHIATRIC DIAGNOSIS IS JUST A COMMON SENSE PROCESS: Prematurely concluding a Soldier's complaints and symptoms are invalid or malingered. We're not naïve, and shouldn't automatically believe everything Soldiers tell us. The truth is usually somewhere in the middle.