Gaps Persist in Mental Health Care for Ft. Carson Soldiers Who Served in Iraq War

National Public Radio

Corey Davis was a machine gunner in Iraq; he was featured in NPR’s December 2006 investigation on mental health care at Fort Carson. He told NPR that he began “freaking out” after he returned to the base; when he sought help at the base hospital one day, he says he was told he’d have to wait more than a month to be seen.

   * General Robert Mixon says the Army will take disciplinary action against supervisors who mistreat soldiers with mental health problems. Mixon: Army will Take ‘Disciplinary Action’ Against Leaders Who Show Bias Against Mentally Anguished Soldiers

   * Command Sgt. Maj. Terrence McWilliams at Fort Carson says he has verbally reprimanded a few supervisors for improperly treating soldiers with mental health issues.  Williams: Soldiers’ War Experiences Can’t Be ‘Justification for Breaking Law’
All Things Considered, May 24, 2007

Six months ago, an NPR investigation found that leaders at Fort Carson, Colo., were punishing some soldiers who returned from war with serious mental health problems — and preventing them from getting the treatment they need. In some cases, officers kicked them out of the Army.

Those stories sparked on-going investigations of the base, including one by a bipartisan group of U.S. senators and another by Pentagon officials.

Early this year, commanders at Fort Carson responded by launching what they described as an important new program: They required every leader, from sergeant up to generals, to attend a training course on how to spot and help soldiers who potentially have post-traumatic stress disorder. Officials say more than 2,200 leaders have taken the course so far, most of them early this year.

But when I returned to Fort Carson recently to see whether conditions for troubled soldiers have improved, the evidence suggested that the most significant changes are rhetorical.

More troubling, independent mental health specialists who work with troops told NPR that Fort Carson’s heralded new training course might even make things worse. And evidence suggests that the commanders’ stated goal of helping every soldier conflicts with the military’s demand for discipline.

Officials at the base say they’ve been trying to teach leaders about the importance of mental health problems linked to combat since the United States invaded Iraq, but the new workshop is the most important new strategy designed to make sure that every leader gets the message.

Treat Troubled Soldiers, or Discipline Them?

On the face of it, the training program seems like a good step.

“One of the things that’s extremely important in our jobs is minimizing the stigma associated with PTSD,” the director of Fort Carson’s medical center, Dr. John Cho, told dozens of supervisors at a recent session.

He told them that NPR’s reports had taught the base that there were “a number of sergeants” who “did not allow their soldiers come to our hospital,” to get proper psychiatric treatment.

In fact, during my previous visit, I met half a dozen sergeants at the base who expressed contempt for soldiers with PTSD. They said those soldiers were “weak,” called them “s—-bags,” and said they didn’t belong in the Army.

Over roughly 40 minutes, a psychiatric nurse, Laurel Anderson, led the audience through a slideshow designed to get leaders with those types of views to change.

“Combat stress should be viewed as a combat injury,” she told them, clicking through slides. PTSD is “a bona fide psychiatric disorder.”

But as she progressed through the slides, Anderson seemed to give the group mixed messages about how they should treat soldiers with PTSD. On the one hand, she told them several times that “admitting to a mental health problem is not a character flaw,” and that “it’s not OK” if soldiers who have mental health problems don’t get proper help. As leaders, she told them, “Do not ignore the warning signs — excessive drinking, marital problems, domestic abuse, suspected drug use, declining work performance. Make sure you are aware of those signs and symptoms. They are often the first ones.”

In fact, studies from past wars predict that 20 percent to 25 percent of troops with PTSD might be abusing alcohol or drugs, and that significant numbers might commit domestic violence and other destructive behaviors. But as she continued her lecture, Anderson seemed to minimize that problem.

“The fact is,” she declared, in a dismissive voice, “most soldiers who have PTSD do not beat up their families, they do not take drugs, they just don’t do that. The Army is always going to be a disciplined organization with no room for that kind of conduct. The truth is, the Army has one mission: Kill the enemy. Its mission is not long-term care.”

Reinforcing Negative Views of PTSD?

NPR sent the audio and slides from the entire training workshop to four mental health specialists who work with troops and their families; they all denounced the program. At best, they said, it’s so boring and dry that it’s unlikely to change anybody’s mind.

“I would be worried that it would turn them off,” says Dr. Stephen Xenakis, a retired brigadier general who used to supervise all the Army’s medical centers in the southeastern United States.

“I would say [the training] is a failure,” another psychiatrist, Dr. Judith Broder, told NPR.

Broder runs a network called The Soldiers Project, which includes more than 100 therapists in California and New York who offer free services to troops and their families. Broder says after listening carefully to the lecturer’s choice of words and tone of voice, and analyzing the slides, she has concluded that the training could actually reinforce sergeants who feel that soldiers with PTSD deserve to be punished.

If the critics heard any “mixed messages,” says Dr. Stephen Knorr, chief of mental health, it was “inadvertent.” And he adds that the training is reaching leaders, no matter how boring it is – because whenever commanders call soldiers into an auditorium and tell them that “‘this is important stuff, we’ve got to take care of our soldiers, we’ve got to take care of each other’ — it has a tremendous impact.”

New Reports of Punishment for Mental Anguish

There are other signs that the climate at Fort Carson hasn’t changed as much as the commanders say they want. During my last visit, I talked with five soldiers who all tell similar, troubling stories: They’ve been falling apart, psychologically, since they came home from the war. Their supervisors have been punishing them, and in some cases, taking steps to kick them out of the Army. The soldiers’ medical and personnel records corroborate their accounts.

Commanders at the base would not talk to NPR about the soldiers, citing medical privacy. Commanders also stressed that it’s unrealistic to expect every leader at Fort Carson to change as a result of the new training on PTSD. Still, the base commander, Gen. Robert Mixon, insisted that he’ll punish leaders who mistreat soldiers in trouble.

“We expect leaders to support soldiers’ getting care and treatment without bias,” Mixon said. “And if we see evidence of bias, we will take disciplinary action against the leaders.” Mixon said the Army has already held some leaders “accountable.”

But Mixon’s right-hand man, Command Sgt. Maj. Terrance McWilliams, told NPR, “No, we have not taken disciplinary actions.”

McWilliams said he has merely “reprimanded” a few leaders “verbally.” As McWilliams explained his approach to running the base, day-to-day, he shed light on the dilemma that seems to be causing so much controversy around Fort Carson. Even though the training sessions on PTSD teach leaders that some of the most common side symptoms include “excessive drinking, marital problems, domestic abuse, suspected drug use, [and] declining work performance,” McWilliams insisted that he’ll punish soldiers who misbehave in those very ways — despite the fact that the Army’s doctors have diagnosed them with disorders like PTSD.

“We have an obligation to maintain good order and discipline,” McWilliams said. “We just can’t…say that ‘my experience in Iraq or Afghanistan is a justification as to why I broke the law'” — including military rules.

But mental health specialists who work with victims of PTSD say that, in effect, Fort Carson’s policy punishes many soldiers for their illness — since a large minority of soldiers with PTSD do act out, in destructive and even illegal ways.

We Can’t Fix Every Soldier’

Still, the chief of Fort Carson’s mental health center, Dr. Steven Knorr, stands by this tough policy — even though it seems to contradict what top officials at the Pentagon have told the public. Assistant Secretary of Defense William Winkenwerder told NPR last year that the military’s goal is to heal every soldier who comes back from the war with emotional problems, or at least heal them enough to return to active duty or live a good life outside the military.

But Knorr has written a memo warning commanders that they’re making a “mistake” by “trying to save every soldier. We can’t fix every soldier,” Knorr’s memo states. “We have to hold soldiers accountable for their behavior. Everyone in life — besides babies, the insane, and the demented and mentally retarded — has to be held accountable for what they do in life.”

Knorr’s memo, which he posted on his office bulletin board, also warns commanders not to make another mistake: “Procrastination on discipline and separation.” Translation: Officers should get rid of troubled soldiers, quickly. “From a commander’s standpoint,” Knorr explained, “a staff sergeant may have 30 officers in his platoon, and he has to get them trained and ready and working on a cohesive team. If he has one or two soldiers who are not showing up for work, showing up intoxicated, using illicit drugs, or going AWOL, that soldier with the misconduct problems is dragging behind the whole platoon — and they don’t have time for that.”

NPR played Knorr’s comments for retired brigadier general Dr. Stephen Xenakis. “It really saddens me,” to hear that policy, Xenakis said. “It’s inhumane.”

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