Common Behavioral Health Diagnoses in Military Treatment Facilities - Research Paper Example

Common Behavioral Health Diagnoses in Military Treatment Facilities Abstract Military servicemembers suffering from post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), and depression, as well as military suicides, continue to be a major concern of the state and society in general. These servicemembers are sent abroad to fight for our interests and liberties; to fight for the general good and they get back broken. This is the risk we have to take on as a nation and with that, the society holds the responsibility of bringing them back to being productive citizens of the country. To do that, one must understand the conditions our servicemembers are undergoing so that we can treat them better and make them productive citizens of our country. Military servicemembers suffering from post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), and depression, as well as military suicides, continue to be a major concern of the state and society in general. Because of this, military treatment facilities are put up to treat military personnel and their dependents. Its mission is to provide health support for the full range of military operations and sustain the health of all who are entrusted to MHS (Military health services) care. MHS’s primary mission is to maintain the health of the servicemembers so that they can carry out their military missions as well as deliver health services during wartimes. The services also include medical testing and screening of recruits, emergency medical treatment of troops involved in hostilities, and the maintenance of physical standards of those in the armed services. The MHS also provides health care to dependents of active duty service members, to retirees and their dependents, and to some former spouses. Such care has been made available since 1966, (with certain limitations and co-payments), through the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS). As such, these military treatment facilities are well-equipped centers for military-related conditions. The most common conditions in these facilities are mostly mental-health related. Investment in the mental health of the active duty military, veterans and their families is integral to the cost of war. Early identification and military informed care, specifically tailored to war experiences, can successfully return those who have served to full civilian life—and prevent escalating long-term costs of untreated mental disorders. Federal and state leaders need to ensure mental health parity for warriors and their families so they can access services when and where they are needed (Zoroya, 2012). While resilience and self-sufficiency are woven through military culture, the weight of repeated deployments has fallen heavily on the estimated three million spouses and children who are left behind. Today’s service members are more likely to have families than veterans from previous times. Over half (56 percent) of today’s active duty military are married, 17 percent are women and 44 percent have children. Care for children is an especially critical concern for 76,000 service members who are active duty single parents and 41,000 who are dual military parents (DOD, 2009). These are all experiences in the facilities that host these servicemen. These facilities are also the best places to learn what the most common conditions of the servicemen, usually after their deployment. These places are rich places of learning. The psychological health of active duty servicemembers has been an issue of significant concern for the government, with particular attention to the links between deployments and psychological health concerns, such as post-traumatic stress disorder (PTSD), which is the most common form of mental health condition after deployment. News stories have emphasized the challenges faced by some servicemembers returning from deployments, but psychological health is a salient issue for the entire active duty force. It should also be pointed out that mental health issues are not unique to servicemembers or military service. Research suggests that an estimated 26.2% of Americans ages 18 and older experience a diagnosable mental disorder in any given year (DOD, 2009). Overall, mental health disorders have significant impacts on servicemember health care utilization, disability, and attrition from service. In 2011, mental disorders accounted for more hospitalizations of servicemembers than any other illness and more outpatient care than all illnesses except musculoskeletal injuries and routine medical care. Between 2001 and 2011, the rate of mental health diagnoses among active duty servicemembers increased approximately 65%. A total of 936,283 servicemembers, or former servicemembers during their period of service, have been diagnosed with at least one mental disorder over this time period. Nearly 49% of these servicemembers were diagnosed with more than one mental disorder. Between 2000 and 2011, diagnoses of adjustment disorders, depression, and anxiety disorders (excluding PTSD) made up 26%, 17%, and 10% of all diagnoses of mental disorder diagnoses. Alcohol abuse and dependence disorders, and substance abuse and dependence disorders made up 13% and 4%, respectively. PTSD represented approximately 6% of mental disorder diagnoses over this time period (DOD, 2009). The rates of specific mental disorders have also changed dramatically between 2000 and 2011. The reported incidence of PTSD has increased approximately 650%, from about 170 diagnoses per 100,000 person years in 2000, to approximately 1,110 diagnoses per 100,000 person years in 2011. The incidence of anxiety, adjustment disorders, and depression diagnoses has also increased. By contrast, the incidence of alcohol abuse/dependence, schizophrenia, and personality disorders fell. Among the services, the Army, followed by the Marine Corps, has consistently had the highest incidence rates for PTSD, major depression, alcohol dependence, and substance dependence between 2007 and 2010, followed by the Navy and the Air Force. Hospitalizations for mental health mental disorders were steady between 2000 and 2006, before increasing more than 50% from 2006 through 2009, from 10,262 to 15,328. This increase in hospitalizations was driven by sharp increases in hospitalization for PTSD, depression, and substance abuse. Calculated by lost duty time, the Army has been the service most affected by hospitalizations of active duty servicemembers for mental disorders, followed by the Marine Corps. PTSD or Post Traumatic Stress Disorder is the most common traumatic disorder. According to current diagnostic criteria45 for PTSD (see text box, below), a person must experience a traumatic event involving death or serious injury, or a threat to the physical integrity of self or others, and react to the trauma with intense horror, fear, or helplessness. Sometime after that trauma, the person must also develop symptoms that cause clinically significant distress or impairment lasting for more than one month. Those symptoms must include symptoms from each of the following three symptom clusters: • Reexperiencing the traumatic event, such as having recurring and distressing recollections or nightmares; • Avoidance of stimuli associated with the trauma, such as thoughts, feelings, and conversations, along with diminished responsiveness and loss of interest in activities; and • Hyperarousal, such as irritability, anger, hypervigilance, insomnia, or difficulty with concentration. In 2010, 5,959 cases of PTSD were diagnosed in active duty servicemembers, a rate of approximately 8.4 new cases per 1,000 servicemembers. Overall, 2% of active duty servicemembers had ever received a PTSD diagnosis. However, the rates of PTSD diagnoses in the Army and Marine Corps were much higher than for servicemembers in the Air Force and the Navy. In 2010, the incidence rates of new diagnoses of PTSD in the active duty Army and Marine Corps were 14.3 per 1,000 and 9.7 per 1,000, respectively, compared to incidence rates of 3.7 per 1,000 for the Navy and 3.4 per 1,000 for the Air Force. Traumatic brain injury or TBI has been considered a “signature injury” of the conflicts in Iraq and Afghanistan. However, approximately 80% of servicemember TBIs occur in a non-deployed setting. Common causes of TBI include vehicle crashes, falls, sports and recreation activities, and military training. Since 2001, it is reported that servicemembers have experienced about 255,852 TBIs, including approximately 212,741 incidences of mild TBI, approximately 20,168 incidences of moderate TBI, approximately 6,472 incidences of severe TBI/penetrating head injuries, and 16,471 unclassifiable TBIs. Incidents of mild TBI rose sharply between 2005 and 2007, due in part to more aggressive screening measures for mild TBI instituted in 2006. Diagnoses of TBI in deployed settings nearly doubled between 2010 and 2011, due in part to a greater focus on identifying and treating TBIs among deployed servicemembers. Beginning in 2010, suicide has been the second-leading cause of death for active duty servicemembers, behind only war injuries. Researchers have suggested that, similar to suicides among civilians, suicides by servicemembers are often impulsive acts triggered by various stressors, including relationship problems and financial or legal problems. Suicides among the active duty forces have increased between 1998 and 2012, rising from approximately 200 deaths by suicide in 1998 to 349 in 2012. Between 1998 and 2011, the incidence rate of deaths by suicide for active duty servicemembers overall was approximately 14 per 100,000 person years. Most of the increase in suicide rates between 2000 and 2011 has been concentrated in the Army and Marine Corps. Between 2005 and 2009, the incidence of suicide has nearly doubled for Army and Marine personnel, while remaining approximately level for Navy and Air Force personnel. In 2011, the suicide rate for Army personnel was approximately 23 per 100,000, while the rates for the Navy and Marine Corps were approximately 15 per 100,000 and the rate for the Air Force was approximately 13 per 100,000 (Marchione, 2012). While the rates of suicide in the Armed Forces overall have increased between 1998 and 2011 (Mansfeld, 2010), the rates for active duty servicemembers overall remain lower than for comparable civilian populations. Lower suicide rates among the Armed Forces have been attributed to a variety of factors, including the servicemember’s full-time employment; “healthy-worker” effects, including a sense of belonging and purpose among active duty servicemembers; and universal access to health care among the military population (Swofford, 2010). Treatment of servicemembers is generally provided by either civilian or military mental health care providers working in a military treatment facility. Their treatment decisions typically are made following clinical practice guidelines (Godleski, 2012). Within the active duty forces, psychological health issues include diagnosed mental disorders, such as depression or PTSD, as well as other mental health problems, such as problems with personal relationships or family circumstances. Other mental health issues facing the Armed Forces include traumatic brain injuries (TBI) and the suicides of servicemembers. Mental health issues in the active duty force have an impact not only on the individual servicemembers and their families, but also on the services as a whole. Connections of Behavior to Theory There are many theories that support this trend in the military health programs. Most are genetically predisposed, and there are screening methods to choose the least predisposed candidate in the service (Harell, 2011). History, Diagnostic Criteria, and Epidemiology—Servicemembers that served in OEF/OIF/OND appear to have a 13%-20% lifetime prevalence of PTSD. In contrast, the unadjusted general population lifetime prevalence of PTSD in adults appears to be 8% Neurobiology – Further research is needed to identify biomarkers of PTSD like in brain imaging models and pharmacologic agents. One has to realize that being in the military is stressful. These stressful environment with life threatening scenarios do a lot of trauma to the mind and health. Hence, the need for more studies and practice (Tanielen, 2012). Benefits: The benefits of the internships are immense. As professionals, interns have seen the scenario first hand: what happens inside a military facility, what cases are there, what the common behavior, what certain diseases are treated there. The services rendered inside the facility are also quite educational for an intern who will have to undergo that specific career track. It is a very different facility as compared to a private facility, but especially comparable. True, the cases inside a military health facility is different as compared to a civilian hospital’s but it is definitely more interesting and you know that you are helping a fellow countryman (and the country) by serving in this facility. All health facilities are the same in terms of environment: one has to be hygienic, fast, alert, etc. However, in times of war, one’s alertness level should up and running. It is after all, a war zone as well inside the facility. One has to be professional at all times, has to work under pressure and be committed. Recommendations: It should be recommended that future interns should be prepared for all scenarios all the time. Even if it is not wartime, the cases delivered inside the military facility are as varied as the cases in hospitals everywhere. It should also be noted that the common cases in military facility are mostly mental-health related. It is recommended that the intern should be geared towards a mental-health career track as it would boost his career immensely. As most internships go, one is expected to learn more in this kind of environment. It is quite unique and hands-on, and should append the school learnings. Also, many people should note that a military facility environment is a government facility. It is serving the people. As one should learn, he should also serve the people and country and maintain integrity and honor at the same time. Personal Growth: As an intern, I have begun to appreciate our military personnel as I am working with them everyday. The sacrifices they take for our country, for serving the world in general and seeing them suffer takes a lot of courage, and seeing that everyday has a lot of impact on me. As a medical professional, being in a medical military facility is a big break for me. I know the statuses of our servicemen, I am in the zone and I know the real deal. I know what the truth of the matter is, how they suffer, and with that I know I can voice out their needs. It also exposed me to the real world of medicine, especially mental health. There is a real threat out there, and yes it is the war and the people’s stigma towards mental health. As for experience, it is priceless. They say that experience is the best teacher and I believe so. All the learning I had in school seemed to be too tame when compared to what I actually had to do onsite, and I know that is just the tip of the iceberg as I know I am only an intern! References: Department of Defense. (Dec. 2009) 2008 survey of health related behaviors among active-duty military personnel. Retrieved from www.military.com/military-report/dod-health-survey-results-released Godleski, L., Darkins, A., & Peters, J. (Apr. 2012) 98,609 U.S. Department of Veterans Affairs patients enrolled in telemental health services, 2006–2010. Psychiatric Services, 63(4). Retrieved from http://ps.psychiatryonline.org/article.aspx?articleid=1090305 Harrell, M.C., & Berglass, N. (Oct. 2011) Losing the battle: The challenge of military suicide, Center for a New American Security. Retrieved from www.cnas.org/files/documents/publications/CNAS_LosingTheBattle_HarrellBerglass.pdf Marchione, M. (June 2012) U.S. vets’ disability filings reach historic rate. Associated Press. Retrieved from: www.usatoday.com/news/health/story/2012-05-28/veteran-disability/55250092/1# Mansfield, A., et al. (Jan. 2010) Deployment and use of mental health services among US Army wives. New England Journal of Medicine Swofford, A. (May 2012) The epidemic of military suicides. Newsweek. Retrieved from www.thedailybeast.com/newsweek/2012/05/20/anthony-swofford-on-the-epidemic-of-military-suicides.html Tanielian, T., & Jaycox, L.H. (2008) Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. Retrieved from www.rand.org/pubs/monographs/2008/RAND_MG720.pdf Zoroya, G. (Jan. 2011) More Army Guard, Reserve soldiers committing suicide. USA Today. Retrieved from www.usatoday.com/news/military/2011-01-20-suicides20_ST_N.htm Read More