On the Front Lines of Military Mental-Health Issues

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Class of ’05 | In 1991, Keynan Hobbs Nu’05 GNu’06 Gr’06 returned from deployment with the 101st Airborne Division in Iraq determined to re-enter civilian life.

“There were a lot of years that followed when I continued to do the things that I thought ordinary people did, although I never felt ordinary,” he explains. “Going to college, getting a job, getting married. I did all that stuff with some amount of emotional distance from it. I never felt really connected to what I was doing but just felt I would do it anyway.”

Hobbs finally went to speak with a counselor. “I’m so angry all the time that I notice it if I’m not angry and anxious,” he remembers saying. “I’m at risk of losing my marriage and my home and everything else if I don’t do something about it.” That was the first time he was diagnosed with Post Traumatic Stress Disorder, or PTSD.

Back then PTSD was a relatively new diagnosis, only officially recognized since 1980. “There was a Vietnam veteran persona, a WWI veteran persona, an archetype of these psychologically wounded veterans,” explains Hobbs, but little scientific data for both the diagnostic and treatment ends. Hobbs was fortunate to be referred to a psychiatric nurse at a Veterans Affairs hospital for therapy that would allow him to turn his life around. He changed his career path from art to nursing, wanting to help other people going through what he had been through.

Today, as a clinical nurse specialist at the VA’s Mission Valley Outpatient Clinic in San Diego, Hobbs is treating veterans for PTSD and other mental-health concerns. While 25 percent of returning veterans meet the full diagnostic criteria for PTSD, he says, a much higher number—at least three out of four, he estimates—have some symptoms and could benefit from treatment.

The good news is that more and more veterans and soldiers still on active duty are seeking treatment. Lieutenant Commander Pamela Wall GNu’05 Gr’15 of the US Navy, a psychiatric nurse practitioner stationed with the Second Marine Corps Division at Camp Lejeune, says that while military personnel with mental-health issues used to fear being stigmatized, that has begun to change.

In addition to regular medical screenings, “every service member is screened when they get back, and again six months later,” she explains. These screenings are “part of that aggressive campaign to help de-stigmatize mental-health issues. If everyone’s being screened, there is no stigma.” Even seemingly mundane stressors such as new babies or other adjustment issues are identified for possible intervention before problems escalate.

Neither Hobbs nor Wall is claiming that the mental-health stigma has completely disappeared. In Wall’s view, the pop-culture image of the stoic soldier contributes to the problem.

“You never see Thor or Tony Stark or Sly Stallone lying on a therapist’s couch getting help,” she points out. Yet Wall and Hobbs both see tremendous strides, and Hobbs thinks part of the reason is that there are now ways to treat even severe PTSD.

“Being able to screen for it and know that you’ve got evidence-based interventions to back up a positive result is a big deal,” he says. “That’s worth disseminating. That’s when you really get the stuff out and you start building programs around these available treatments.” He points to cognitive-processing therapy and prolonged-exposure therapy, both evidence-based treatments included in the VA’s most recent protocol rollout.

The whole concept of brief therapy—a model that focuses mostly on the present and future instead of the past, thus significantly reducing the number of sessions—is an important development, Hobbs explains. “People used to think that once you’re a wounded vet, you’re going to be a wounded vet forever. You’re going to have to be in therapy for the rest of your life. It’s a real paradigm shift to be going to [just] 12 sessions,” using a framework that has a proven track record.

There is still a need for continued research, of course. At Penn, Edna Foa, professor of clinical psychology in psychiatry and director of the Center for the Treatment and Study of Anxiety, recently received a grant from the Department of Defense to study the most effective way to implement prolonged-exposure (PE) therapy. At the VA clinic in San Diego, Hobbs is working on a study of PE in which patients use video links.

Wall, who is still working on her doctorate at Penn, has somewhat different research interests, which were sparked by her work with a dog named Laura Lee at the National Naval Medical Center in Bethesda. Laura Lee opened up wounded soldiers in ways no human therapist could, says Wall. She hopes to conduct biomarker studies on pet therapy.

Wall and Hobbs are also using their experience to teach others about military mental-health issues. Both appeared on an episode of PBS’s Need to Know that dealt with the mental-health needs of returning veterans. Both also share their experiences as panelists for the Jonas Veterans Healthcare Program, an initiative with the New York-based Jonas Center for Nursing Excellence, which provides support and funding for nurses who work with veterans.

And, Wall points out, military medical personnel are often the ones who need the most mental-health support.

“The medical providers are seeing these injuries all day, every day, and it is their job to save life and limb,” she says. “Some days that’s not possible”—so they return from their deployments mired in guilt.

Having been deployed as a nurse herself, Wall knows how critical it is to reach out to those providers. A lot of medical personnel are deployed through Bethesda, so when she was stationed there, Wall helped develop a breakfast program in which the returning nurses would meet psychiatric nurses who had previously been deployed.

That kind of ready accessibility is crucial, which is why there are mental-health professionals embedded right into units, she says.

On the whole, the military’s stepped-up focus on meeting mental-health needs seems to be making progress.

“I have a friend who has been in the Marine Corps for 12 years,” says Hobbs. “He’s got a complex picture of physical and mental-health issues from his deployments. He knows what his symptoms of PTSD are and he’s able to talk about them in a way I never could have so soon—especially not while I was still in the military, but even six or seven years afterward. He’s got an awareness way ahead of where I did. I think most of our military are like that now.”

—Emily Rosenbaum C’95 GEd’96

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