The Military Health System

A study published on July 1, 2004 in the New England Journal of Medicine outlines some of the negative mental health consequences of being a participant in and/or perpetrator of war. Exposure to combat was significantly greater among those who were deployed to Iraq than among those deployed to Afghanistan. The percentage of study subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq (15. 6 to 17. 1 percent) than after duty in Afghanistan (11. 2 percent) or before deployment to Iraq (9.

3 percent); the largest difference was in the rate of PTSD. Of those whose responses were positive for a mental disorder, only 23 to 40 percent sought mental health care. Those whose responses were positive for a mental disorder were twice as likely as those whose responses were negative to report concern about possible stigmatization and other barriers to seeking mental health care. (Psychological Needs, 2007). This study provides an initial look at the mental health of members of the Army and the Marine Corps who were involved in combat operations in Iraq and Afghanistan.

The findings indicate that among the study groups there was a significant risk of mental health problems and that the subjects reported important barriers to receiving mental health services, particularly the perception of stigma among those most in need of such care. Another study has investigated the prevalence rates of mental health problems among soldiers, as well as barriers to and the stigma associated with seeking care for these problems. It showed that soldiers deployed to Iraq and/or Afghanistan had higher rates of mental health problems (major depression, PTSD, alcohol misuse) than before deployment.

Among Soldiers who screened positive for a mental health problem, only a small percentage (23-40%) received professional help from a mental health professional, chaplain, or primary care professional. Concerns about stigma were highest among the Soldiers who were in the most need of help from mental health services. (Hoge, 2006). Even as the military continues to identify the deployment-related behavioral health needs of service members and their families, efforts are underway to address those needs. However, there is no evidence of a well-coordinated approach to providing behavioral health care to service members and their families.

This appears to be the case both across and within each of the military branches in the United States. Rather, installation-level military medical treatment facilities and the larger military medical centers and clinics rely on assigned psychologists or local civilian providers to develop and implement programs focusing on deployment issues. The availability, coherence, and quality of such programs seem to vary across various sites depending upon the number of mental health professionals assigned to the unit, their training and experience, and command support for behavioral health programs.

There is a consensus that, overall; relatively few high-quality programs exist. In addition, while psychologists working for the military, i. e. , uniformed, government service (GS), or contracted, are adapting evidence-based treatment programs from civilian treatment centers for application with military personnel, there is a shortage of evidence to support the utilization of these techniques with soldiers and their families around deployment issues. Finally, those programs that do exist are predominantly for service personnel rather than for their family members, who may also require treatment.

Despite local efforts to develop and implement behavioral health services for service members and their families, the Task Force is concerned about the apparent lack of centralized oversight and well-coordinated efforts throughout DoDs medical facilities to meet the broad range of needs. Another concern involves the care provided to service members as they transition from the Military Health System to the VA system. The military is short of services for behavioral health for family members. This is evident from a survey of the facilities offered by various behavioral health departments.

For instance the Fort Drum Behavioral Health Department indicates that it will not be able to treat family members with Mental Health Disorder and these will have to be refereed to the civil services. (Behavioral Health, Nd). The trend of relative neglect of Behavioral Health Services to families is confirmed by the American Psychological Association (APA) in a report released most recently. The APA has indicated that the military is not prepared to meet the behavioral health needs of service members and families though efforts are underway these appear to be quite uncoordinated and need to be adequately disseminated.

(Shannon, 2007) The reliance is exclusively on the local providers particularly for the families. These programs are also not available with ease, coherent and suffer from poor quality. What is more alarming is that the report indicates that there is a singular lack of central oversight in the military for such programs, thus indicating that this is a serious institutional problem and will take some time for remedy. (Shannon, 2007) Delivery Systems It is assessed by scholars that military social support systems can be professional, institutional, direct exchange relations or can be based on generalized reciprocity.

In most militaries around the world social support systems are institutionalized. Networks are embedded in traditional military norms and values, such as the value that is placed on community. This type of network is likely to occur in the ‘institution’ model where communitarianism is strong and the individual is dependent on the military community for social support. Support is based on a contribution-retribution basis towards the whole community. There is no strict accounting of given or gotten support.

Often the military community is – to a certain degree – isolated from civilian society (it’s a closed inner directed community). This community is characterized by strong social control, a high commitment to community from its members and hierarchic relationships. Social control takes care of people who tend to behave as free riders. The military community serves as a surrogate family of the extended form. (Moelker, 2006). In recent years, the US Congress has acted to increase the bonuses and benefits that can be offered for both recruitment and retention.

The 2006 National Defense Authorization Act includes an even wider variety of incentives, from higher cash bonuses to education benefits to down payment assistance for first homes to referral bonuses for serving soldiers who bring in new recruits. As such the delivery systems for social support services are based on a governmental, departmental system. This means that bureaucracy does have a role to play and it tends to push for greater institutionalization of social support systems. Non-Governmental or even private social support is a possibility and it is being practiced in the US in parts.

The world over, militaries have put in place support systems that will look after their soldiers in peace and war, at home and during overseas deployment. For instance, in 1996, the French Army created the recruitment retraining and quality of life departments (BRRCP), which constitutes proximity support for the families of soldiers. The French Army wants to improve the efficiency of the set up by developing the aid to parents and couples. This support set up comes within the scope of an approach aimed at establishing a contract between the institution, the military and his/her family.

The objective of the command is to define the nature of the provided support and to be able to carry out its engagement. (Bouillaud, 2006). In Germany the Bundeswer has a Family Support Organization. Like in the United States, such German organizations have legal and constitutional foundations too. Section 31 of the Legal Status of Military Personnel Act (“Soldatengesetz”) regulates the duty of the employer (read the State) to provide care and welfare services. In the context of the service-loyalty relationship, the State is obliged to look after the welfare of its military personnel, civil servants, and their families.

This also applies to the period after retirement. Active servicemen and women as well as reservists, along with their families, potentially benefit from such measures as a result. To fulfill this obligation, the employer can have the armed forces provide morale, welfare and recreation support. (Kreim, 2006). The stresses and strains that the military profession places on the spouses or partners and families of servicemen and women have taken on a new dimension through the increasing frequency of Bundeswehr missions abroad and the parallel reorganization of the armed forces.

To be able to meet these diverse challenges better, family support, which for years has been looked on as a secondary task, has been reconceptualised and reformed. Therefore, the world over there appears to be an effort to not only improve on existing social support services, given the increasing impact of military/war/active duty on combat troops. This relates to both the war on terror, led by the US and in other places where insurgency and other forms of violent conflict are rampant.

With increase in active duty, so does the impact on personnel and their families. For this governments have to start thinking of the ways and means to improve contact with soldiers. What should be aimed at is to develop simultaneously all types of support relations. For some military personnel the traditional military family is a life world that is a reality. For others the friendship circle constitutes the reality. This means that the armed forces have to facilitate all types of support relations.

It will be difficult for the armed forces to supply the diversified array of supportive activities towards the support relations. The secret of matching support to the support relations is that support delivered by the armed forces has to be appropriate. One cannot force a group of individuals that function as a friendship circle to consume the kind of support that is appropriate for the isolated military family. Professional support would in this example be contra productive and arouse feelings of aversion.

To be able to match the right kind of support to the right support relation armed forces have to be able to provide all kinds of support. Finding the right balance constitutes what will make a fighting force mental and physically strong in the next century. There is a need for regular audit of the human services as much as it is towards other need provisions in the military. Such audits will keep the staff alive to the needs of the military families and undertake care based on evidence rather than hearsay.

( Zemke, 2001) Amongst the remedial measures suggested by the APA for overcoming the deficiencies in military behavioral health services for families are the need for centralized leadership for deliverance and accountability. (Shannon, 2007) This has to be followed by increased education of military leadership and generate awareness amongst military personnel by better information on importance of maintaining mental health. The APA has also recommended specifically that behavioral health services should be provided to the families as these make a direct impact on the capabilities of service members.

(Shannon, 2007). The APA has also recommended additional budgetary support for such measures as well as the need for providing better facilities, training of staff in behavioral health practices and their continued monitoring. There is no doubt that these measures are critical and will add to removal of the serious deficiency in the delivery of behavioral health services in the American army. Conclusion The United States military is a unique institution which has been at the fore front of America’s leadership of the World order throughout American history.

The military has been derived from American society and as such represents the social matrix from which it comes. The military is a unique institution and thus there are special needs to support the soldiers, sailors, airmen and marines when they go to war or even when they are preparing for the war ahead. The American military through out its long history of over two centuries has constantly strived to provide the best social structure to the military in terms of support services. This has resulted in high morale and excellent fighting qualities of the men in trying times.

However the military cannot rest on these laurels of the past and there is a constant need for transforming by providing better delivery systems keeping in view the changing social norms. With this greater awareness, understanding the military as a system and applying the same in the context of the rising aspirations, psychological and moral needs of soldiers and their families should enable providing better social services in time to come. For this other models as examined in the Paper could well be applied in the American context.


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