Furloughs Threaten Military's Mental Health Ranks

Looming furloughs and funding cuts will force the military to lose many of the highly-valued mental health and behavioral professionals who were hired to cope with soaring rates of Post Traumatic Stress Disorder, top defense medical and personnel officials said Wednesday.

“I do have concerns over the long-term capability to provide mental health care to the force” to counter the effects of PTSD, said Dr. Jonathan Woodson, the assistant secretary of defense for Health Affairs.

More than half of the mental health specialists serving the military are civilians, and “they have options to seek employment elsewhere. I worry about sustaining the workforce,” Woodson said at a hearing held by the House Military Personnel Subcommittee.

Furlough notices were expected to go out next week to more than 800,000 Defense Department civilian workers telling them that once-a-week unpaid furloughs will begin in April and continue for 22 weeks to meet the cost-cutting demands of the Congressional sequestration process.

The military stands to lose $500 billion over the next decade in planned defense spending under sequestration. Pentagon leaders must cut $46 billion from the defense budget before Oct. 1 unless Congress can agree to an alternative deficit reduction plan.

Lt. Gen. Patricia Horoho, the Army’s surgeon general, has lobbied to exempt the mental health specialists from furloughs to retain them for treating PTSD. The Pentagon has said that 20 percent of the civilian workforce will be exempt from furloughs. However, it did not look like the mental health specialists would receive that exemption, said Col. Rebecca Porter, the chief of Behavioral Health in Horoho’s office.

“We value these individuals greatly,” Porter said of the mental health workers. “If they start to go out the door, it’s going to take a lot longer for us to rebuild that” mental health workforce, Porter told a defense writers breakfast Tuesday.

“We have in the past offered retention bonuses, but that’s not specifically on the table now,” said Porter, a former military police officer and now a clinical psychologist whose main task is treating PTSD in the Army.

Her comments echoed those of Gen. Ray Odierno, the Army’s chief of staff, who told a Senate hearing last month that "before sequestration, we allocated the dollars and positions to increase military and civilian mental health providers."

"The problem is there are not enough out there,” Odierno said. “Now what's going to happen is we're going to have to reduce the number we already have."

Despite Horoho’s push for furlough exemptions, "our judgment is that's not a good idea,” said Robert Hale, the Defense Department’s Comptroller. “We made a judgment that consistency and fairness is the right approach" in having the furloughs go across-the-board in the workforce, Hale said Monday at a briefing.

Figures provided by the Defense Department showed that the number of mental health professionals employed by the military rose from 6,590 in 2009 to 9,570 by 2013 to include 2,118 psychologists, 809 psychiatrists, and 2,533 social workers.

Last year, the Department of Veterans Affairs reported that nearly 30 percent of more than 834,000 Iraq and Afghanistan war veterans treated at VA hospitals and clinics have been diagnosed with PTSD.

The Army released a report by its Task Force on Behavioral Health on the diagnosis of PTSD within the service. The report, released March 8, was prompted by charges that hundreds of cases of PTSD were misdiagnosed and soldiers were denied benefits and treatment at the Madigan Army Medical Center at Joint Base Lewis-McChord outside Tacoma, Washington.

At an Army roundtable March 8, Horoho defended the work of Army mental health providers in diagnosing PTSD while noting that diagnosis in the mental health field is both “an art and a science.”

Horoho said the Task Force reviewed more than 154,000 behavioral health cases across the Army, and independent analysts agreed with 88 percent of the PTSD diagnoses.

In the remaining 12 percent of the medical evaluation board records reviewed by the Task Force, the independent analysts disagreed with the original diagnosis, Horoho said.

Porter said that getting the troops to come in to have a diagnosis made was often a bigger problem than the risk of misdiagnosis. There is still the “stigma” among the troops that seeking help is a sign of weakness, she said.

“I think I’d look naïve if I said there’s not still a stigma out there,” Porter said. “We’re still struggling to get to where seeking help is seen as a sign of strength.”