HHD and Partners Work to Prevent and Address Mental Health Problems in the Military

Many active service members and armed service veterans grapple with mental health issues, including depression, post-traumatic stress disorder (PTSD), and suicidality.  These soldiers may be unsure of where to find help or, if they do seek help, may face services that are fragmented or ineffective.

HHD is working with military and community partners to change this by building the capacity of clinicians and military systems, providing research and evaluation, training and technical assistance on evidence-based practices and developing curricula and other materials.

Two current HHD projects are working to improve the PTSD and suicide prevention services available to the military. They are Disseminating Cognitive Processing Therapy to VA Clinicians and the Air Force Clinical Training Project.

Disseminating Cognitive Processing Therapy to VA Clinicians

While all service members face readjustment issues returning home from active duty, these feelings fade for many vets. Others find themselves in a constant state of stress: unable to sleep, suffering from flashbacks, detached from family, and wondering why they cannot simply resume their “normal” life back at home.  These symptoms describe half a million vets in this country who are suffering from PTSD.

While the U.S. Departments of Defense (DOD) and Veteran’s Affairs (VA) provide mental health services for veterans, many in need may feel there is a stigma associated with mental illness and will not seek treatment.  Even if they do seek treatment, services may be isolated, clinicians’ training is varied, and until recently there have been few evidence-based therapies for treating PTSD. 

Through a new collaboration with the U.S. Veterans Administration, HHD is lending its expertise to VA clinicians who are utilizing a proven therapy to treat PTSD.  In the Disseminating Cognitive Processing Therapy to VA Clinicians project, funded by the VA Boston Healthcare System, HHD is working with researchers and clinicians who teach mental health practitioners to use cognitive processing therapy (CPT) to treat PTSD among vets. This project is the first VA system-wide dissemination of an evidence-based treatment for PTSD.   

“Professional services providers should be engaged in ongoing clinical training to develop the skills necessary to assess and treat veterans who are at risk for mental health problems and to combat stress,” says Rebecca Stoeckle, HHD Project Director.

The project teaches CPT, a 12-session, trauma-focused therapy for PTSD that can be used with either individuals or groups suffering from PTSD.  Research conducted by the VA shows that CPT truly works to alleviate PTSD in vets.  For instance, Candice Monson of the VA Boston Healthcare System studied the effect of CPT on veterans and found that 40 percent of participants actually experienced remission of PTSD.

In January, experts in PTSD treatment held the first CPT training in Dallas for a group of VA clinicians. HHD created the materials, including manuals and videos, used in the training.  Building on the success of this training, HHD and the VA plan to refine the training and materials and train another 600 therapists across the country.  They will also provide ongoing technical support for the VA clinicians, conduct outcome assessments to study the impact of their work, and develop additional trainings to sustain the new skills they’re teaching.

For more information about the Disseminating Cognitive Therapy to Clinicians project, please contact Rebecca Jackson Stoeckle at rstoeckle@edc.org or 617-618-2481.

Air Force Clinical Training Project

Those still actively serving in the military may likewise suffer from PTSD, depression, and other mental health problems. This is especially true for soldiers serving their country in wartime.  These problems combined with personal histories of loss, trauma, and legal or financial crises leave some military members in a state of hopelessness and despair.  They may see suicide as the only option of escape.  While the rates of suicide in military are lower than for similar civilian populations, the statistics on suicide among active military are still surprising; for instance, suicide is the second leading cause of death for active-duty Air Force personnel.

Many people are aware of the highly-regarded work the Air Force undertook in the 1990’s to prevent suicide, utilizing a comprehensive public health approach. This program is the largest and longest-sustained suicide prevention effort in history to be associated with significant reductions in suicide over time.

During the course of this critical suicide prevention work, the Air Force recognized that their 1200 mental health providers, scattered across the world in 79 different locations, needed more training specific to suicide prevention to provide adequate services to its 347,000 active duty members.  To address this gap, the Air Force contacted David Litts, Associate Director of the Suicide Prevention Resource Center (SPRC) in HHD, to deliver suicide prevention training to Air Force clinicians.  Litts previously worked as the first Executive Director of the Air Force's acclaimed suicide prevention program.

Heeding this call to action, Litts began to deliver the one-day workshop curriculum called Assessing and Managing Suicide Risk: Core Competencies for Mental Health Professionals (AMSR) with funding from the Air Force.  The curriculum, created by the SPRC in collaboration with national experts and with funding from the Substance Abuse and Mental Health Services Administration, focuses on increasing the capacity of mental health professionals by training them in essential skills for assessing and managing suicide risk.  The trainers are doctoral-level clinicians with at least 10 years in practice and at least two years’ experience teaching in clinical training programs.

“Suicide risk assessment is an essential skill for Air Force mental health personnel,” according to Lt. Col. Steven Pflanz, the Air Force Suicide Prevention Program Manager.  “The Air Force will benefit greatly by providing additional in-depth training on this critical skill set.”

Litts and colleagues anticipate delivering the AMSR workshop to a total of 45 Air Force bases internationally within the next year. “We are not aware of any system-wide training effort focused on improving clinical management of suicidal clients that compares with that of the Air Force initiative in magnitude,” Litts said. “We hope successes in this program will encourage other large health care systems to do the same.”

Litts and his colleagues in the SPRC plan to continue and expand this important suicide prevention work among military personnel.  They are seeking to identify other unmet mental health needs among the military and finding ways HHD can help fill the gaps, all while continuing to explore additional partners and service providers.

“Military personnel are patriotic volunteers who risk their lives to serve our country,” says Litts.  “It is a very high stress situation, and it is our duty to help ensure they have access to the best mental health services possible.”

For more information about the Air Force Clinical Training Project, please contact Dr. David Litts at dlitts@edc.org or 202-572-3730.

March 12, 2007