Do Soldiers Receive Adequate Mental Health Care? Earlier this week, NPR's Daniel Zwerdling presented two reports looking at the difficulties some soldiers face getting treatment for mental health issues in the military. He discusses his reports, and Dr. William Winkenwerder, head of the military health system, talks about military efforts to try to take care of the mental health of soldiers.

Do Soldiers Receive Adequate Mental Health Care?

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NEAL CONAN, host:

This is TALK OF THE NATION. I'm Neal Conan in Washington.

On Monday, NPR's Daniel Zwerdling broadcast two reports on the issues of soldiers and mental health. According to the military's own studies, tens of thousands of soldiers return from Iraq with symptoms of serious mental health problems, including depression, suicidal tendencies, substance abuse, and post-traumatic stress disorder, or PTSD.

The military contends it has learned the lessons of Vietnam and now has extensive programs - both in Iraq and back home - to help soldiers with emotional wounds. But after an investigation at Fort Carson, Colorado, our reporter found that some desperate soldiers were not getting the help they need. He also found evidence to suggest that officers at Fort Carson punish soldiers with mental health problems and even get them kicked out of the Army. And part of the problems, Zwerdling reported, is the conviction of some supervisors that soldiers who claim they have PTSD are faking it. First, Sgt. Drew Preston.

First Sergeant DREW PRESTON (U.S. Army): They don't want to go back to Iraq, and they're trying to blame all of their life's problems on PTSD.

Sergeant TRAVIS PLATT(ph) (U.S. Army): The order comes down that, you know, we're going back, and then all of a sudden, oh, I got PTSD. PTSD is pretty much like the backdoor to get out of the military right now.

CONAN: And that second voice was Sgt. Travis Platt. Officers at Fort Carson declined to speak with NPR. In a moment, Danny Zwerdling joins us. And a bit later, the assistant secretary of defense for health affairs.

Later in this hour, Wal-Mart's top-selling audio book "The Bible Experience," and cops in Virginia drop their familiar radio jargon. We'll find out why 10-4 is over and out.

But first, soldiers and mental health. If you're - if you or a family member has experience with the military mental health system, give us a call: 800-989-8255. That's 800-989-TALK. Or you can zap us an e-mail: talk@npr.org.

NPR senior correspondent Danny Zwerdling is here with us in Studio 3A. Nice to have you on the program, Danny.

DANIEL ZWERDLING: Neal, nice to be with you.

CONAN: So why'd you go to Fort Carson?

ZWERDLING: Well, I wanted to see what is the relationship between what policymakers say is supposed to happen to soldiers when they come back and what is actually happening to soldiers on the ground. So I started calling mental health specialists around the country who work with soldiers. I called some veterans groups.

And one of my first calls, I reached somebody who said, you know, it's interesting you call me, because I just got off the phone with a former soldier in Colorado who says he's talked to two or three soldiers at Fort Carson who say they've been having terrible problems. So, of course, as any reporter would, I said, well, could I talk with them? And low and behold, a few of the soldiers said I could talk with them and I could meet with them, so I got on a plane and went.

So I want to make clear, we did not do an exhaustive survey of every Army base in America. You know, that would take a far bigger organization than NPR. I wanted to look at one slice of the pie. What is happening at Fort Carson in Colorado Springs, Colorado?

CONAN: Mm-hmm, and what did the soldiers tell you? What did you find out? And did you find out stuff to corroborate their stories?

ZWERDLING: Well, this is not a he-said versus she-said story. I ended up talking with 20 soldiers who've come back recently from Iraq. Some knew each other, most did not. A number of them were able to give me their Army records, their medical records, so there was nothing in my program that I could not corroborate with documents and/or witnesses who were there that day.

So when soldiers would say to me, you know, the commander of our company said to me, you are a disgrace to the military, you know, rip that Army patch off your shirt. And this is a guy who had serious emotional problems and was acting out. I didn't, you know, I would get somebody who was there that day, in that room, who told me the exact same story. So, you know - and I told Fort Carson. I went to Fort Carson after I had gathered all this, and I said I'm hearing very troubling reports and getting corroborating evidence. Please, tell me your side of the story. And they flatly refused.

CONAN: I assume you also went to the Pentagon to get some information.

ZWERDLING: Yes, and I did end up talking with Dr. William Winkenwerder - who's going to join us, which we appreciate - the assistant secretary of defense, and, well, I'll let Dr. Winkenwerder speak for himself.

CONAN: Well, one of the things he said in your piece is - and we don't have to wait for this - is that the military has learned its lessons, that emotional wounds are just as serious as physical wounds and need to be addressed promptly, urgently, in the same way.

ZWERDLING: And I think that's why part of the theme of this investigation is the gap between what the policymakers say, and, you know, probably truly want to happen on the ground - I don't doubt his motives - and what actually happens on the ground.

There's no question that the military is doing more today for soldiers, in terms of mental health, than it has ever done in history. And at Fort Carson, on paper, it looks like they have great programs to help the soldiers. They have individual counseling, group counseling. They have counseling for substance abuse. They do all these surveys that are supposed to spot which soldiers might be having serious problems.

But the problem the soldiers on the ground kept telling me - which I was able to corroborate - is that, number one, the mental health unit at Fort Carson has been overwhelmed by soldiers coming back from Iraq. So as we heard in the little clip from the interview you played, people go and have to wait for weeks, frequently, for appointments. And number two, when they admit that they're having problems and try to get help, their officers, their supervisors, the sergeants who run their lives day to day often turn against them.

And I heard stories - which I was able to corroborate - from the supervisors themselves of like - treating soldiers who had emotional problems as outcasts. So that you, Neal, would walk into the company headquarters - you had PTSD - and people would literally refuse to talk with you, refuse to look at you. That's one thing that happens to them. Number two, soldiers told me they would be put on view 24 hours at a time, so everybody in the unit would walk past and just see them sitting there. And I asked some sergeants about this. They said, yes, it's like the dunce's corner...

CONAN: Mm-hmm.

ZWERDLING: ...you know, when you were back in school. So - and then I found what seems to be a pattern in which the officers at Fort Carson are kicking out soldiers with PTSD and other emotional problems stemming from the war, but they're not saying, oh, we're kicking them out because they have PTSD linked to Iraq. They're saying we're kicking them out because they're goofing off. And this raises a whole new set of problems, because when you get kicked out in that way, you leave in disgrace and you get much - many fewer or no benefits that you would have gotten if they said, you know, you have PTSD.

CONAN: Well, they say they're goofing off. Do the records show that they were indeed goofing off and exhibiting bad behavior?

ZWERDLING: Yeah, and I brought with me a file. Here's one young man named Alex Orum who was diagnosed with PTSD. I got his medical records, his Army records. And at the very same time that he was going to the mental health unit - and you can read in the mental health - in the medical records that this guy is completely falling apart. I mean, he's flipping out. At the very same time - on some of the same days, same weeks - his supervisors are issuing him formal demerits. They don't call them that in the Army. They call them counseling statements.

Here's one. November 3rd, 2005 - in that you who knew of your duties at Fort Carson on or about 31 October, blah-blah-blah, were derelict in the performance of those duties, in that you willfully failed to keep your haircut to standard I-A-W-A-R-670-dash-1, as it was your duty to do so. November 4th - you knew your duty was to be at formation by the appointed time and failed. November - and here's another one. You failed to keep sensitive items with you. You failed to keep sensitive items, remember?

CONAN: Mm-hmm.

ZWERDLING: Your pen and notebook with you all the time you are at work. Now mental health specialists told me that people who get PTSD commonly act out. They lose their focus, so they do badly at work. They frequently don't sleep all night, they have, you know, such terrible nightmares and flashbacks, so they don't show up at formation in the morning. They don't keep their hair cut. They don't bathe. They lie. They don't trust authority. And that these are associated with the symptoms of their mental illness, yet what seems to be happening at Fort Carson is that they're kicking people out on the basis of the symptoms instead of giving them the help they need to cure the disease.

CONAN: Those can also be - you know, we think they're petty, those of us not in the military - you know, the haircut at the right length, keeping the equipment with you at all, I mean, getting to formation on time. Discipline is obviously extremely important in any military organization, and no matter whether it sounds petty or not. And those kinds of infractions could be the kinds of infractions of people who are just goof-offs.

Mr. ZWERDLING: They could be. And, in fact, there's no question - according to the mental health people I've talked with - that some soldiers do tries to fake their mental health problems. There's no question about that. But I've talked to many specialists who work with victims of trauma, including soldiers. And they say that this is not something where - where Neal Conan walks in and says, I'm having nightmares and I'm beating my wife, so, you know, diagnose me with PTSD and don't make me go back to Iraq.

CONAN: Back to Iraq. Yeah.

Mr. ZWERDLING: They say - all right, you could say they're maybe being self-serving. But every mental health specialist I've talked to says we know how to diagnose and distinguish between the people who are faking it and the people who are not, and I can tell you that of the records I've seen, of the soldiers I, you know, put on the air or used as background, their medical records show that, you know, respected psychiatrists who deal with this issue diagnosed them with PTSD or other mental health problems associated with the war.

CONAN: Did you talk to anybody who did get help?

Mr. ZWERDLING: I got - now, I've talked to a couple of soldiers who did not want to be named, who said I saw what was happening to my colleagues, how their lives were being ruined by the supervisors and others around them. I did have trouble getting help at the military, and so I started, you know, I just found help on my own - in the private sector - and I think I'm doing better now.

CONAN: Doing better now.

Mr. ZWERDLING: Yeah. But I didn't mean anybody at Fort Carson who said, oh yeah, they're doing a great job. Now, are there people there who really feel they're doing a great job? I'm sure there are. You know, we're not saying that we've done and exhaustive study that shows that everybody doesn't get help. But the point is, a lot of people who needs help don't seem to be getting the help they need.

CONAN: And did you find evidence that this is a - something that happens on an individual basis or is this a systemic problem?

Mr. ZWERDLING: Well, this is just my gut feeling based on the evidence. It seems to be a systemic problem at Fort Carson. Can I prove it? No. Now, since these stories were on the air on Monday, we've been - hearing at NPR - we've been getting hundreds of e-mails from people all around the country, many of them from people who are in the military now or who are in the military recently.

Just an hour ago, literally, I got a call from a mother in Oregon, almost crying, who said my son is a Marine; he has been in Iraq on two tours. He was diagnosed with PTSD almost instantly when he came home. He took - they caught him with a drug test taking cocaine once. And she says he was court-martialed and thrown in the brig. He never got any mental health support. I talked with an officer yesterday at Fort Benning here...

CONAN: In Georgia. Yeah.

Mr. ZWERDLING: Here on the East Coast, right - who said, let me just tell you, I came back from Iraq earlier this year. I'm a physician, and I can tell you that what you talked about Fort Carson is happening in other places, including Fort Benning. And he told me an amazing story, which I won't go into detail here, because he hasn't give me permission yet, about what happened to him personally, because he was diagnosed with PTSD eventually as a result of his service in the war. And I got a letter from people at Fort Bragg. So again, do we have absolute proof this is happening everywhere? No. But you know, we're hearing a lot of troubling stories.

CONAN: Danny, thanks very much.

Mr. ZWERDLING: Neal, thank you.

CONAN: NPR's senior correspondent Daniel Zwerdling with us here in Studio 3A. When we come back from a short break, the assistant secretary of defense for health affairs will join us, and we'll take your calls. 800-989-8255. 800-989-TALK. E-mail us talk@npr.org.

I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION. I'm Neal Conan in Washington.

We're talking today about two reports by NPR's Daniel Zwerdling this week on the issue of soldiers and mental health. Listeners had a lot to say about each of these stories. To read and hear the full reports and look a variety of your comments, you can go to npr.org/talk.

And right now, if you or a family member has experience with the military mental health system, join the conversation. 800-989-8255. 800-989-TALK. E-mail is talk@npr.org.

Dr. William Winkenwerder is assistant secretary of defense for Health Affairs, the top doctor at the Pentagon. He joins us today from his office there at the Pentagon.

Doctor, nice to have you on TALK OF THE NATION.

Dr. WILLIAM WINKENWERDER (Assistant Secretary of Defense for Health Affairs): Neal, thank you. Thanks for the chance to join you.

CONAN: Sure. Danny's piece that aired on ALL THINGS CONSIDERED on Monday, there's a tape of you saying that soldiers who are wounded emotionally need help just like soldiers missing limbs. Do they get the care they need as compare to physically wounded soldiers?

Dr. WINKENWERDER: They do get the care they need. Though I will say right upfront - let me just respond to the specifics in Dan's story. He mentioned 15 or 20 soldiers at Fort Carson that said they were not getting the treatment they needed, that their unit leaders were not supporting them and that in some cases their care wasn't easily accessible. I want to say right upfront, as I listened, because I listened myself to those stories, and I was able to do that actually after I gave Dan my interview - in other words, I didn't have the benefit of hearing these stories when he interviewed me...

CONAN: Yeah.

Dr. WINKENWERDER: ...but what I heard concerned me. It really truly did concern me. It did not sound like the Army program for mental health that I know that so many of our talented and dedicated professionals have really worked hard to make the best possible program.

I have spoken with Lieutenant General Kevin Kiley, who is the surgeon general of the United States Army, and asked him, requested that he look very carefully into this particular situation at Fort Carson and to provide a thorough report on it. Gen. Kiley is a - not only is a good man and a great professional and outstanding doctor, he's somebody that really cares about mental health. He's, in fact, leading our task force on mental health for the Department of Defense.

So I know that he's going to be, you know, looking very carefully into this situation. I thought, you know, based on all the facts and information, that Dan did a thorough job. He presented, you know, facts, individual cases, some well-documented stories. But as much as I know that he worked hard to present a thorough picture, I'm not sure that, you know, all the facts or the whole story was there in every case. They always is, you know, another side of the story.

CONAN: Sure.

Dr. WINKENWERDER: So - but I think even if all that had been there, it still, you know, in some respects it still wouldn't matter, because I would say we've not done our job if soldiers believe, you know, for whatever reason that they're not getting the care and support that they need. That's our goal, is to have everybody feel that, believe that, and to actually receive that kind of care.

CONAN: Is it to a degree a resource problem? Danny was saying that, for example, the mental health facility there at Fort Carson was overwhelmed.

Dr. WINKENWERDER: You know, that's possible. But I think, more important, frankly, is - and he kind of alluded to it. You know, and he spoke about the gap between policy and actual execution on the ground. And I have no doubt there is some level of gap in some places and in some ways. This is a massive cultural change, right...

CONAN: Uh-huh.

Dr. WINKENWERDER: ...military - to embrace mental health problems. Our leadership has embraced it. I'm not just speaking about myself. I'm talking about the entire Army, Navy, Air Force, Marine leadership. They do. And on down in the ranks. But you know, does every unit leader accept this? I'm sure that every, every single unit leader hasn't yet, you know, sort of gotten it, gotten the message.

So it's not easy. We've come a long way. And I know that based on my personal visits to a number of bases and personal discussions, that we are making real progress. I see that. We have reports of, you know, sort of blinded surveys that we do of service members where we ask them questions about whether they think they're getting level of support that they need and do they think the programs are working. And probably two-thirds to three-fourths of them say yes. So...

CONAN: Are supervisors, sergeants, officers evaluated in any way on how they treat these issues? I mean, for example, in one of Danny's stories he talks to a sergeant who says, you know, my job is to get this soldiers trained up. If a guy comes to me and says I've got an appointment for alcohol, you know, problems, you know, my job is get the training done. I say you have to cancel that.

Dr. WINKENWERDER: Yes. Well, you know, I think a mature leader would understand that if that soldier ultimately is not able to perform his job effectively because he or she has, you know, a serious mental health problem, then they're actually losing the full benefit of that person, not just showing up for training. They may lose them completely.

CONAN: Yeah.

Dr. WINKENWERDER: And so - but it's an educational process and I do believe that we are making great strides. We have good evidence for that. But you know, clearly he's identified a group of people at Fort Carson who, you know, believes strongly they did not get the support they need. And that's a failure if we don't achieve the support that they need.

CONAN: One other question and then we'll get to phone calls, and that is about the use of these patterns of bad behavior...

Dr. WINKENWERDER: Right.

CONAN: ...to get men who were, you know, with symptoms of PTSD basically thrown out of the Army for their symptoms. Is that something you're going to look into as well?

Dr. WINKENWERDER: Well...

CONAN: With an eye - I'm not sure whether this is even possible, but to say maybe this was a miscarriage of procedure.

Dr. WINKENWERDER: Yes, we will look at that. Now, some of those things are difficult. They really truly are difficult to sort out. Let's say, for example, somebody comes back that they don't check positive on a screen or they do but they haven't gotten in for their appointment...

CONAN: Yeah.

Dr. WINKENWERDER: ...have to go down the street, and they get in a fight, you know, and do something bad, you know, domestically or, you know, and - on the street, they're in jail, you know. And boom, you've got, you know, a discipline problem, a law and order issue, before you even identify that, you know, there's a mental health component there.

CONAN: Yeah.

Dr. WINKENWERDER: So those things happen. At the end of the day, we want to try to distinguish and ferret out, you know, the difference between things that are truly just disciplinary and those things that have a mental health component. But obviously it takes a pretty skilled person to discern that difference. And also, the individual has a responsibility now, and we shouldn't forget that. They need to come in for their appointments. They need to get and seek their care that they need and overcome any, you know, sense of stigma that they may feel about that, that sometimes it's not easy.

But we need to support them and create a environment where, you know, it feels like not a bad thing to do or a stupid thing to do or something they're going to be an outcast for. That's what we're trying to, you know, change that environment.

CONAN: Let's get some listeners in on the conversation. 800-989-8255. 800-989-TALK. E-mail is talk@npr.org. We'll begin with Jim. Jim is calling us from Fayetteville in North Carolina.

JIM (Caller): Hello.

CONAN: Hi, Jim. You're on the air. Go ahead, please.

JIM: Hello. Assistant Secretary, gentleman, thank you for taking my call.

CONAN: Sure.

JIM: I just wanted to comment to the assistant secretary. Sir, you're - the mental health program is fine and intact, as you perceive it. I have spent time in the 3rd Infantry Division, 4th Infantry Division, 82nd Airborne, Special Operations, and several other units. And the mental health is available to soldiers who want it, and they will also reach out and have great programs that I've seen work very effectively.

The question that I have and the problem that I've seen is that when recommendations are made by the mental health care provider, they are oftentimes not followed through by the commanders. And what is going on that I've seen is that the commanders are taking the recommendation and saying, well, I still need to have this guy in any case. Though I know he has some - you know, and there are few cases that this occurs. But they say, you know, I need to have this person on the ground. In any case, I know there maybe problems. We'll try to find a job that's suitable for him, but I need the numbers.

So my question is that, are the mental health care provider is going to get additional power or do we just need to educate the commanders to take the recommendations?

CONAN: Or both? Dr. Winkenwerder.

Dr. WINKENWERDER: Well, that's a great - thank you for sharing your observations and your personal experience, and thank you for your service as well. We hope - we expect that the recommendations of the mental health professionals would be followed. Obviously, however, in the way our system works, the commander, because of the chain of command, does have the final say - the final decision. But again, I think this is probably a matter of just needing to educate people more fully, more completely, to help them understand that if that person is going or deploying and they have a significant problem, that they could be a risk to themselves or other people, or they might not perform well in their job.

And I also might take this opportunity to note, we just issued, about two weeks ago, new guidelines for deployment - for screening of mental health conditions. And those guidelines are much more precise. They were developed by the mental health professionals, with some command input, to clearly identify those individuals who should not deploy, or individuals who are taking certain kinds of medications who shouldn't deploy. And also individuals who are in theater who need to come back, based on the symptoms or their particular condition.

And we've already heard good feedback from our mental health community, that these are very good guidelines, that they're helping them to make better decisions.

NEAL CONAN, host:

Jim thanks for the call. We appreciate it.

Let's go now to - this is Lisa. Lisa calling us from Penngrove in California.

LISA (Caller): Yes, hi. My question has been answered, at least on the fringes. Your topic that you've been discussing over the past few moments has touched on some of the answers. I am an ex-military dependent. I worked for the Army Corp of Engineers, stationed in Germany in the late 80s. And I am a liberal, which causes a conundrum, I think, for me with respect to the military.

The question revolves around how is the military or the Department of Defense going to balance the need for strong mentally and physically fit armed forces, with their - what I see - as their responsibility to care for that mental and physical health? I think there's responsibility on both sides, which is what I think many people won't see.

The responsibility on the part of the Department of Defense is to make sure that the people they're sending, wherever they're going, are the best fit for the job at hand. And the responsibility on the part of the soldier is to make sure that they do their part, whether it's going to, you know, outside services or making sure that they're persistent in getting their mental health or their physical health concerns taken care of - internal to the military.

But it's still a conundrum. It's still a problem. The military needs numbers, and those numbers have to be fit. But you may not be able to fill it. How do you balance that? And I'll take my answer off the air. Thank you.

CONAN: All right, Lisa. Thanks for the call.

Dr. WINKENWERDER: Well, she raises a great issue. Let me inform the audience that we do have a set of measures for medical readiness, and we did not used to have such measures. So we attempted a broad view for the department and for each service, down to the unit level, look at a set of six different measures that relate to the medical readiness of the individual to deploy. You know, which is what she was touching on. It covers a number of areas.

The responsibility is the department's, it is the unit's and the commander's responsibility. It's also the individual's responsibility. So it is shared. The individual has to go in and get their treatments, and exams, and blood draws, and mental health evaluations and vaccinations and so forth. They've got to take that action. And so it's their responsibility.

On the other hand, we hold our commanders accountable if the numbers show that, you know, significant percentages of their units are not medically fit and ready to deploy. I mean, so it really is a shared thing, and that's the way we do it. We believe, again, that we've made great progress in this area in the last three to four years. It's just a better way to take care of your people.

CONAN: We're talking with Dr. William Winkenwerder, the Assistant Secretary of Defense for Health Affairs. You're listening to TALK OF THE NATION from NPR News.

And let's get another caller in. This is David. David with us from Denver, Colorado.

DAVID (Caller): Hi. Thanks for taking my call. I served in the Army in the 80s, in some of the most prestigious units in the Army. And I can tell you that, all across the Army, there was a prejudice against soldiers with mental health issues at that time. That people were discharged for patterns of behavior when they knew that they had mental health issues, that they had PTSD.

And I have a very close friend who just came back from Iraq, who is a medic, who tells me that he can identify two-thirds of the men that he has worked with that have mental health issues who will not get treated because they know their career is over. And it's not a - the problem isn't the mental health professionals. The problem is a cultural one with the command structure of the Army.

CONAN: I don't mean to cut you off David, but I wanted to give Dr. Winkenwerder a chance to respond before our time runs out here.

Dr. WINKENWERDER: I think he's right. I think, again, we've said that it's a culture issue. We are making strides. And one of the ways we're doing that is to make the checkups, so to speak - which now, by the way, is not just a check up right when people redeploy or come home, but we've instituted about two years ago, and we've gone through over 200,000 individuals being evaluated - a required visit with an evaluation by a professional at three to six months after they get back. So everybody has to do it. So it's not like (unintelligible) think you're OK if you don't...

DAVID: (Unintelligible)

CONAN: But that stigma that David is talking about, that fear that their career is over.

Dr. WINKENWERDER: Well, this makes it something that everybody needs to do. And I'm not saying that it totally eliminates, you know, any stigma, but it goes a long way towards saying, you know, this is a routine thing just like showing up to get your shots or showing up to get your physical exam.

You show up to get this checkup, you know, at three to six months after you get back to see how you're doing. It's a mental health reset. A, you know, a total how are you doing? How's your family doing? How are things going? Now some people may not relate, you know, what's really going on, but we're doing our best to reach out to each and every person.

CONAN: Dr. Winkenwerder, thank you very much for your time today. We appreciate it.

Dr. WINKENWERDER: Thank you. Appreciate the chance to be with you.

CONAN: Dr. William Winkenwerder is the Assistant Secretary of Defense for Health Affairs and the top doctor at the Pentagon. He joined us today from his office at the Pentagon.

When we come back from a short break, why some of Hollywood's biggest actors are reading from the Bible. Plus, police say so long to 10-4. It's the TALK OF THE NATION from NPR News.

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