Mixed Agency : An Ethical Dilemma

Anything that can impact military readiness can be reported to a member’s commanding officer. A sad result this as caused many a service member to become very distrustful of both mental health and family support personnel. Many civilian counselors have resorted to promising service members that requests for treatment will not be reported to their supervisors. Fortunately while the stigma still exists some progress has been made about shifting attitudes up and down the ranks towards getting the necessary help. (Hall, 2008) This attitude often stems from the fact that if a member, especially one in command of other service members, makes a bad judgment call due to having a mental health issue it could very well lead to a significant loss of both life and government property. Many view or used to view seeking the help of a mental health expert as showing the inability of making sound calls in the field. (Schreiber & McEnay,

There is concern about military service members receiving stigma about getting or needing treatment in the area of mental health. Stigma occurs when individuals view others negatively because they have been labeled or identified as having a deviant behavior against societal norms; deviant behaviors such as mental illnesses or diagnoses uncommon or harmful to others. How does that impact the military? Military men and women alike are termed heroes, warriors, and survivors; this is quite the reputation to keep up. Military members go to war or deploy to hostile combat environments, which many come back with severe mental illnesses and diagnosis that need immediate care. At this point they may not feel like a hero. The terms psychological, mentally ill, PTSD, and behavioral health has gained a reputation as having or being a problem. Being labeled a problem is not what service members want. Many studies are trying to pinpoint the problem and resolve the stereotypes associated with getting treatment. Consequently, an individual’s attitude toward mental health treatment is thought to be affected by other people’s views on mental health care (Held & Owens, 2012).

The Air Force lost 38 airmen to suicide in 2008, a rate of 11.5 suicides per 100,000 airmen. The average over the past five years — since the start of Operation Iraqi Freedom — was 11 deaths per 100,000 annually. Of the airmen lost in 2008, 95 percent were men and 89 percent were enlisted. Young enlisted men with a rank of E1 to E4 and between the ages of 21 and 25 have the highest risk of suicide. Recently released data indicates that active duty males carry, for the first time in known history, a suicide risk greater than that of comparable males in the general population (Psychotherapy Brown Bag, 2009). This is particularly noteworthy considering that the military entrance process screens out serious mental illness prior to entry onto active duty, and that the rate of suicide in military males has historically been significantly lower than comparable civilian populations. To help

Psychological support for troops has emerged as a necessity because this kind of work can deal, to a considerable extent, with a set of specific psychological problems arising within disciplinary systems at all levels, not the lower echelons alone, as is often believed. Occasionally it is just the matter of an enlistee being unprepared for discipline-abiding lifestyle (ignorance of army regulations, orders and regulatory documents). Sometimes, however, psychological problems stem from clearly expressed anti-disciplinary attitudes in some or other serviceman, which attitudes tend to disorganize military activities, mixing, and off-duty routine.

There is a common belief that many combat veterans are suffering; many from invisible wounds that affect them in many ways. The challenge that the VA and other government agencies face is determining which veterans need help, there are several factors that affect this, from the individual’s desire to accept help, to the stigma that most veterans have accepted, which is “if they ask for help, they are weak.” During separation from the military it is a critical time for all soldiers, this time provides an opportunity for the military, the VA and our government to intercede and work with men and women while they are still soldiers. Veteran suicide is an epidemic, the number of veterans taking their life daily has been steadily growing, the statistic published by the VA is that twenty-two veterans end their lives every day (Suicide Data Report, 2012); steps have been taken to curb this number but the efforts have been woefully inadequate.

Rates of trauma and mental illness are reported to be disproportionately higher among American veterans, especially those of the recent wars in Iraq and Afghanistan. The barriers to care after civilian reentry further disadvantage this already vulnerable population. The wars in Iraq and Afghanistan have been the longest sustained US military operations since the Vietnam era, sending more than 2.2 million troops into battle and resulting in more than 6,600 deaths and 48,000 injuries. Veterans are at risk mental health challenges, as well as family instability, elevated rates of homelessness, and joblessness. Veterans have disproportionate rates of mental illness, particularly posttraumatic stress disorder (PTSD), substance abuse disorders, depression, anxiety, and military sexual trauma.

These words left the pen of judge Stephen Reinhardt two years ago from the 9th circuit court of appeals on a case of veterans against the Department of Veterans Affairs (VA); The dispute for a veterans right to healthcare is still raging. The United States is facing a larger population of veterans every year, who suffer from a number of debilitating ailments, and finding itself with less means to take care of them. The VA is allowing health assessments go unnoticed for years due to lack of funding. Without this necessary treatment veterans who suffer from mental disorders like depression, anxiety or Post Traumatic Stress Disorder (PTSD) will build up tension and develop a risk for breakdowns which can cause not only mental, but physical damage to themselves and their community. These valiant men and women deserve proper treatment by means of formal evaluation, cognitive therapy, and monitored medication. Our service members have been promised treatment and it is our obligation as a country is to ensure it is

Both articles identify the issue of providing mental health services for veterans with an extra emphasis on those that served in Afghanistan and Iraq (OEF/OIF veterans). It is no surprise that returning veterans suffer from both visible/invisible (physical and mental) wounds. Most veterans have this “high” expectation that they are going to receive quality care from both the DoD and VA. Unfortunately reality steps in where veterans are slapped in the face because they are receiving a lack of poor quality care all while jumping through Beuracractic hoops. The challenges faced to access these services include resistance, stigma, lack of professionalism, and geographic and/or regional disparities in the distribution of services resources and/or benefits, and the system simply refusing to change.

Studies have found that fewer than 50% of officers suffering from PTSD, depression, or alcohol abuse sough mental health services. The reasons cited for not seeking help included a doubt in the confidentiality of the service offering the services, a potential negative impact on the officer’s careers, and the stigma associated with needing mental health services (Fox et al., 2012).

According to a study constructed by JAMA Psychiatry, a medical journal published by the American Medical Association, explained that one out of five soldiers, who have enlisted into the military have suffered from a mental disorder (Hastings). With this statistic, there are doubts regarding the military’s assessments of the enlisted. Matthew Nock, a Harvard University psychologist, led a study on mental disorders in the military, and concluded that

Chris is a 38 year old, heterosexual, masculine, Caucasian male. Chris has just recently returned home from Iraq after serving four tours. He claims to be having trouble adjusting to civilian life and reports his weakness for giving up and choosing to quit while his “brothers” are still overseas. Chris is married with two children and desires to fulfill his roles as being a husband, father, soldier, brother, son, etc. Chris believes that this is his life’s duties and God’s plan for him. Due to feelings of anger, aggression, guilt, shame, loss, anxiousness, hopelessness, and depression, a VA physician advised Chris to utilize the VA Healthcare System in order to seek appropriate treatment.

Many challenges still remain as Iraq and Afghanistan veterans seek available access to mental health care. These challenges include the resistance and stigma to seek care, lack of

As the small group grew larger, I achieved great satisfaction in the effects that it had on the participating soldiers. This confirmed my thoughts that I had found my true calling. The second event that affected my decision was when I returned from my second combat deployment in Bagram, Afghanistan. Upon returning there were hundreds of soldiers who requested to seek mental health treatment for a variety of reasons, including loss of a loved one, night terrors, and suicidal thoughts. Although every soldier that requested mental health treatment was able to meet with a mental health professional, such as a licensed clinical mental health counselor (LCMHC), a licensed marriage and family therapist (LMFT), and a licensed professional counselor (LPC), there were still dozens of soldiers that weren’t diagnosed for months because of the lack of clinical psychologists who was required for specific testing. Understanding that there was a need for something that I was passionate about ultimately made me decide to pursue a doctorate because I plan to conduct research during the program and after licensure. A Ph.D. is a research degree that requires conceptual and theoretical knowledge; it is not enough to regurgitate

A service member’s emotional and psychological issues are not like malfunctions of a piece of equipment and must not be treated as a troubleshooting problem in a technical manual. And yet this seems to be the only way the military, as a whole, knows how to address the issue of a service members mental health. It requires a holistic approach that is not currently embraced by the military. Historically, the military has been ill-equipped to handle the shifting nature of the psychological issues created by introducing a service member to the battlefield.

This case analysis is about Dr. McHale, a psychiatrist in the United States Army. Dr. McHale is also a commissioned officer who