Psychiatric Research in a Military Setting: Evolution of a Study on Inpatient Group Psychotherapy (original) (raw)
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Military Medicine, 2011
Objective: To evaluate critically whether treatment models existed in the literature to treat a soldier with multiple psychiatric and other comorbidities and propose a mental health model consisting of an integrated multidisciplinary treatment team for use in military outpatient settings. Method: A case example was described to demonstrate the complexity of presentation including depression, anxiety, insomnia, post-traumatic stress disorder, chronic pain, substance abuse, relationship problems, and suicide attempts. Literature search was conducted for the period 2004-2009. Articles that referred to collaborative/integrated care were examined in detail. Results: Seven articles described collaborative care. Of these, fi ve described collaboration with only primary care and 2 with other specialties including pain, substance abuse, and vocational rehabilitation services. Most articles gave a broader description of the collaborative model. Some postulated a theoretical framework. One described collaborative care in detail but was coordinated by only one professional. None described integration of providers involved in the patient's care. The process of implementation was not suffi ciently described. Conclusion: Because of limitations in the published literature, a mental health model consisting of a multidisciplinary integrated treatment team is proposed to treat the soldiers in the military outpatient setting.
Priorities for Psychiatric Research in the U.S. Military: An Epidemiological Approach
Military Medicine, 2003
Among the 1.4 million active duty U.S. military service members, 6% receive outpatient treatment for a mental disorder each year. Over 25% of these service members leave military service within 6 months, a rate that is more than two times higher than the rate following treatment for any other illness category. There is clearly a need to define psychiatric research priorities and an unprecedented opportunity to enhance the field of psychiatric research in general using the well-characterized military population. The first priority is to better define the burden of mental disorders in terms of incidence, prevalence, severity, risk factors, and health care use. The impact of mental disorders on occupational functioning, particularly among new recruits, needs to be better characterized. Suicide research should include efforts to validate mortality data, define the normal level of rate variability, and establish surveillance for clusters. The highly structured occupational environment of the military lends itself to studies of preventive interventions designed to reduce disability or occupational attrition resulting from mentallbehavioral problems.
Psychiatry in the Army: A Brief Historical Perspective and Current Developments
Psychiatric Services, 1991
fight with bows and arrows or with hydrogen bombs, involves such items as leadership, courage, morale, motivation, perseverance, derelic tion, malingering, and the age-old problems ofdnink and breach of dis cipline. Psychiatry in the military setting finds itself inexorably drawn into consideration of these eternal verities ofmilitany life.― World War I brought the â€oe¿ eternal verities― ofmilitary life into sharp focus, which helped psychiatrists to evolve the basic tenets of military psychiatry. These principles were refined, redefined, and sometimes obscured during World War II and the wars in Korea and Vietnam, as well as in more recent military opera tions. This paper briefly reviews the history ofpsychiatry in the United States Army in the 20th century and outlines the evolution of its prin ciples. The structure of psychiatric practice in the United States Army and its current areas of interest, in cluding combat and crisis strategies and community and family psychia try, are examined. Military psychia try's effects on and contributions to general civilian psychiatry are also emphasized. Historical overview The battles in Europe during World War I resulted in a large number of patients presenting to physicians with a syndrome called ‘¿ ‘¿ battle shock. â€oe¿ Symptoms of dizziness, blindness, deafness, muteness, shaki ness, crying, and general inability to perform were considered to have a neurological origin and to be caused by artillery blasts (2). When the United States entered the war, the psychiatric consultant to the Army Surgeon General assigned Major Thomas Salmon to direct the Army's psychiatric program in Northern Europe (1â€"3). Salmon noted that the British evacuated their battle shock casual tics to neuropsychiatric wards in civilian hospitals, often at home in England. These practices resulted in a low percentage of casualties being returned to duty and a high percent age of entrenched, chronic symp toms. The French, on the other hand, instituted treatment of psychiatric casualties near the battle front, rarely evacuating soldiers to the rear or dis charging them from military service. The French military psychiatrists were sensitive to the concept of 5cc ondary gain from â€oe¿ battle shock.― They understood that soldiers could use these symptoms as a means of separation from the front line, from the unit, or from military service at together. The French military psy chiatnists instituted aversive tech niques, including loss of privileges, for nonpsychotic psychiatric casual ties. These interventions seemed to communicate to the servicemen that they were expected to become func tional again and were to remain on active duty. Salmon sought to create a pro gram for United States troops that would incorporate the compassion of the British but would also provide for the successful retention and rein tegration ofpsychiatnic casualties, as he had seen in France. He initiated the concepts of proximity, imme diacy, and expectancy. Psychiatric casuaLties were to be treated as near to the battle front as possible (prox imity), in as short a time as possible (immediacy), and with the belief that many, if not all, would be able to return to the front to support their â€oe¿ buddies― after a briefrest (cxpectan cy). Treatment interventions were
Military Culture and Psychotherapy: Strange Bedfellows
Black Sea Journal of Psychology, 2021
The military represents a distinct and overlooked cultural group. Because culture is germane to any effort to understand and treat disordered functioning, psychologists who work with service members or who plan on doing so should acquire the competencies needed to situate psychological treatment in the context of the needs and realities of military personnel. Psychologists must also remain aware of the many circumstances in military settings that pose ethical dilemmas in the provision of appropriate and effective mental health care. In this article, we describe military values and beliefs, military customs and courtesies, barriers to seeking psychological treatment in the military, and pathways for increasing psychologists' competence in providing culturally informed treatment to military personnel. We offer suggestions to guide future research on this neglected topic.
Psychiatric consultations in a military general hospital
General Hospital Psychiatry, 1986
Theauthors describe thedemographicand diagnostic characteristics of 2065 medical and surgical inpatients referred for psychiatric consultation ouer a Z-year period at a military medical center. The referral rate was 5.8% of all hospitaladmissions with the percentage of referrals from surgical and neurology serzlices being higher than recent civilian studies. Although the variety and frequency of psychiatric and physical disorders arequite similar to civilian consultation-liaison (C/L) psychiatric services, the authors reported lower rates ofpersonality disorder diagnoses and higher percentages of V code and no-psychiatric-disorder diagnoses.
Military Medicine
Introduction Prolonged exposure therapy is an effective treatment for posttraumatic stress disorder that is underutilized in health systems, including the military health system. Organizational barriers to prolonged exposure implementation have been hypothesized but not systematically examined. This multisite project sought to identify barriers to increasing the use of prolonged exposure across eight military treatment facilities and describe potential solutions to addressing these barriers. Materials and Methods As part of a larger project to increase the use of prolonged exposure therapy in the military health system, we conducted a needs assessment at eight military treatment facilities. The needs assessment included analysis of clinic administrative data and a series of stakeholder interviews with behavioral health clinic providers, leadership, and support staff. Key barriers were matched with potential solutions using a rubric developed for this project. Identified facilitators...
This is the first of a three-part systematic review of the potential benefits and harmful effects of the military's century-old doctrine of frontline psychiatry or combat and operational stress control (COSC). Since the Second World War, psychiatric casualties have outnumbered the combined total of American service members both wounded and killed-inaction. The original, explicit purpose of frontline psychiatry programs established during the First World War was to prevent mass evacuation and attrition of military personnel experiencing acute war stress injuries by emphasizing brief, nonpsychiatric interventions resulting in return to duty (RTD). Although frontline psychiatry continues to evolve, these bed-rock principles of RTD and avoiding psychiatric evacuation remain unchanged. Today, the US military explicitly predicts that over 95% of war stress casualties will be RTD with evacuation limited to those deemed either grossly impaired and/or clear safety risks to self or others. The military justifies its mental health policy by claiming that studies have demonstrated its health benefits to individual service members and their families, as well as findings that medical evacuation and subsequent psychiatric treatment are harmful. However, the only systematic review of the effectiveness of frontline psychiatry was published in 2003, warranting critical examination of the military's claims. Specifically, the actual evidence for or against the military's primary mental health policy has never been fully examined, so that any conclusions are tentative. The sheer complexity and national security implications underlying the military's unchallenged 100-year doctrine required a three-part review. In this study, we frame the debate on the military's frontline psychiatry/COSC by examining its historical origins, ethical-legal controversies, and contemporary program descriptions.
Military medicine, 2006
The integration of mental health treatment with primary care is a U.S. Air Force priority. Unfortunately, manning shortages limit the utility of psychiatry in existing Air Force health care models. In this study, we present efficient and data-driven models for psychiatric involvement with primary care. These models include the use of psychiatrists as clinical consultants and primary care educators. Certain factors are required to implement these models including command support for locating psychiatrists within primary care, data-driven educational approaches, collaborative clinical care, and administrative support.