WASHINGTON, DC—The ancient Greeks called it fear-shedding. In the Civil War it was known as Soldier’s Heart. In the first World War, it was shell-shock. After Vietnam, it was combat fatigue. And after the Gulf War, it was known first as post-traumatic stress syndrome, and then PTSD, explained Secretary of Defense Robert Gates at the kick-off to the joint VA/DoD mental health summit held here last month.

“In the past, unseen injuries such as PTSD and TBI were not accorded the full attention they deserved, but these kinds of ailments in one

form or another have been around since war itself.”

The summit—a week of workshops for VA and DoD mental health leaders and providers—was kicked off with appearances by a number of federal health leaders. It was, officials said, a statement that psychological and spiritual injuries were being placed on a par with physical ones.

Funding Present, Physicians Absent

According to Gates, the military health system has come a long way in recent years in terms of treating such injuries with seriousness and respect. DoD’s program budget for psychological health and traumatic brain injury nearly doubled to $1.2 billion from last year, including $400 million for research and development, Gates said. “And beginning in 2010, many of the psychological health programs that have been funded through supplemental appropriations will become part of the department’s base budget.”

But an increase in funding is not a cure-all, he noted. There is a significant lag between obtaining resources for new mental health services positions and actually filling those positions. “There is a chronic problem finding qualified mental health providers near the military’s largest installations, many of which are in rural areas,” Gates declared.

For example, the Army had added 900 behavioral health provider positions since 2007, but they still face a shortfall of about 330 specialists—a gap that will grow to 500 if the Army follows through with putting behavioral health providers with every brigade.

Spreading Information, Changing the Culture

Military health leaders are also concerned that servicemembers’ families are not getting the care they need to help with reintegration of returning servicemembers. “Soldiers have evolved and changed and are reunited with families that have also evolved and changed,” Gates explained. Stress that all members of the family have been feeling while the one family member was deployed does not disappear, but just gets moved to another part of their lives.

There is a serious disconnect between the programs that exist to help these families and the awareness of the rank and file that they exist. “We must do a better job of understanding these dynamics, addressing them, and making sure our people take advantage of what’s available to them,” Gates declared.

It is up to local leaders to identify what resources are available locally and make sure that information gets to servicemembers and families. He asked summit attendees to consider the problem in their working groups and promised that he would help in whatever way to solve the problem, whether through new funding, new authority, or cutting through bureaucratic barriers.

As for what might be the biggest barrier between servicemembers and care, that might be the stigma still attached to seeking mental health care, Gates noted. Projects such as the Real Warriors Campaign, which disseminates stories of real servicemembers who have sought treatment, are the best weapon to combat the problem. “There is no greatest ally than the soldiers, from the highest rank to the lowest,” Gates said. “Spreading the message [that there] is no weakness in asking for help.”

“Completely removing the stigma may very well be the work of generations, but we will do everything possible to chip away at it,” he said.

Gates took the opportunity to point out that the war in Afghanistan had surpassed the Revolutionary War as the longest war fought with an all-volunteer force, and the effects of such a campaign on servicemembers was unknown and unprecedented.

“We are in uncharted territory,” Gates declared.

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