Furloughs Could Affect Army's Behavioral Health Care
By C. Todd Lopez
Army News Service
WASHINGTON, March 14, 2013 Upcoming furloughs for Army civilians, along with budget cuts, will affect the Army's ability to provide behavioral health care to soldiers, the service’s chief of behavioral health care said here this week.
More than half of the Army's behavioral health providers are either government civilians or contractors, Col. Rebecca Porter said at a Defense Writers Group breakfast March 12.
"The plan is that our Department of the Army civilians who are employed with us would be impacted across the board," Porter said.
The Army's medical community is about 60 percent civilian, overall, she said. Within the behavioral health specialty, which includes about 4,500 providers, more than half are civilian. The Army surgeon general's priorities for medical care in coping with spending cuts for the rest of the fiscal year mandated by the sequestration provision in budget law are warrior care, primary care, behavioral health and the Integrated Disability Evaluation System, Porter said. Army officials are looking at possibly exempting some of those Army civilians from furlough, she added.
Another option, she said, is to have medical providers in uniform, backfill where care is most needed.
The wars in Iraq and Afghanistan created a greater need in the Army for behavioral health providers, Porter said, and the Army has worked to bring those medical professionals on board. With furloughs and sequestration, lack of stability as a behavioral health provider within the Army may drive some of those professionals back to the private sector, she added.
"There is a national shortage of behavioral health providers. … Since 2007, we've more than doubled the number of behavioral health providers that we have in the Army,” Porter said. “To see them now looking elsewhere because they don't have the job security that they thought they were going to have, and they don't know how much the organization or the institution supports them in what they are trying to do, it is a morale issue."
When contracts or term behavioral health positions come up for expiration or renewal, providers go through her office "so we can look, kind of corporately, at what do we have as far as resources in the personnel realm,” Porter said.
“We value those individuals greatly,” she added. “Particularly for providers, we are looking to retain them."
Porter said the Army has seen success with embedded behavioral health teams, or EBHTs, where behavioral health providers are taken out of the hospitals and are aligned with specific brigades. The pilot installation for that effort was Fort Carson, Colo., and success with the program has meant an expansion to brigade-sized elements across the Army by the end of fiscal year 2016, she said.
An evaluation of the EBHT program at Fort Carson, she said, has shown "a decrease in incidents of psychiatric hospitalizations, decreased incidents of suicides, of suicide attempts and even things like alcohol-related incidents."
The success of the EBHT program, and cause for its expansion across the force, stems largely from the benefits of creating familiarity between providers and unit commanders.
"Co-locating them with the unit and with the commanders, I think, helps the behavioral health provider be more in tune with what are the needs of the command," Porter said. "But it also, in our experience, makes the commander, and the soldiers, more trusting of the behavioral health providers."
Early in her career, Porter said, she was in a position to recommend to a commander that he not take a soldier on deployment, due to post-traumatic stress disorder. She said that commander thanked her for her input, but took the soldier on deployment anyway. Later, she said, problems surfaced and the commander had to send the soldier home.
"Today, I think if I made the same recommendation to a commander, I think they would heed a behavioral health professional's input a lot more than they did 16 or 17 years ago," she said. "It's a different environment -- vastly different than it was back then."
Part of the increased trust commanders have in behavioral health providers stems from increased awareness of issues such as PTSD, Porter said. But she added that she believes the relationships that can be built through the use of EBHTs will only further commander trust.
The EBHTs are made up of civilian behavioral health providers, she said. Downrange, units have two organic behavioral health providers and two behavioral health technicians. In addition, combat stress control teams function in a general area and go where commanders think additional help is needed.