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Military leads mental health care transformation

WASHINGTON (AFNS) -- The United States is in the middle of a "cultural transformation" in mental health treatment led by the Defense Department and the military services, the department's top mental health expert told a congressional panel Feb. 24 here.

Mental health resilience "is fundamentally underlying everything we do," Army Brig. Gen. (Dr.) Loree K. Sutton told the House Veterans Affairs Committee.

Doctor Sutton, director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, testified along with Dr. Ira Katz, chief of the Veterans Affairs Department's mental health services, during a committee hearing on suicide prevention.
In 2009, there were 312 confirmed suicides among servicemembers, of which 26 were in the Reserve components, according to the Armed Forces Medical Examiner System, Doctor Sutton said in testimony submitted to the committee. The data shows those particularly at risk were white men younger than 25, with a rank at or below E-4 who were divorced and had not graduated from high school. Other common factors, as mirrored in the private sector, included substance abuse, relationships, legal or financial problems.

While the impact of deployment is under investigation, Doctor Sutton said, only 16 percent of the suicides occurred in Iraq or Afghanistan. Still, the counterinsurgency and asymmetric warfare that servicemembers have battled since 9/11 "continues to place a great amount of strain" on troops, she said, adding that "the invisible wounds of war can be most deadly of all."

Defense Department data shows that 30 percent of servicemembers who died by suicide communicated their potential self-harm, 49 percent had been in treatment within 30 days of their suicide, and 26 percent had sought mental health resources.

The department's core message to servicemembers and their families, Doctor Sutton said, is:
-- You are not alone;
-- Treatment works;
-- The earlier the intervention, the better; and
-- Reaching out is an act of courage and strength.

"Suicide has a multitude of causes and no simple solutions," Doctor Sutton said, adding that each suicide is as unique as each victim.

Because of that, it is difficult to pinpoint an outreach or treatment approach, she said. The department and the services are using a multipronged, holistic approach to tackle prevention education, research and outreach, she told the legislators.

"We are in the middle of a cultural transformation -- one in which the (DOD) and the services are leading the country," Doctor Sutton said. "'Suck it up and drive on' led us for years, but that is no longer adequate" as an attitude toward mental health problems.

"A new public health model is being led by (Defense) leaders at all levels, starting with the secretary of Defense," she added.

While the medical field is undergoing a "revolution" in neuroscience, it is a complex discipline, and "the human brain is not subject to command and control," Doctor Sutton said. So DOD is leading the way in partnering with other departments and nonprofit groups to better understand and prevent suicide.

For example, the Army began a partnership with the National Institute of Mental Health last fall to conduct the largest study ever of suicide and mental health among U.S. servicemembers. Data collection is to begin in March to assess hundreds of thousands of Soldiers over five years.

Other DOD initiatives that should help in suicide prevention, Doctor Sutton said, include the ongoing effort with VA to have interoperability of electronic medical records, a pilot program for mandatory protocol for treating concussions in the field, and partnerships with VA, the USO and the Red Cross for treatment outreach.

"We are working this at all levels," Doctor Sutton said. "We understand we are in unchartered territory. Never in the history of our republic have we placed so much (burden of war) on so few for so long."