HHD and Partners Address Mental Health Issues in the Military

Many active service members and armed services 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 find services that are fragmented or ineffective.

HHD is working with the U.S. Veterans Administration (VA) and the U.S. Air Force to strengthen the capacity of clinicians and military systems by creating materials and offering training and technical assistance to better meet the needs of men and women in the military. Two current HHD projects are working to improve the PTSD and suicide prevention services available to the military: Disseminating Cognitive Processing Therapy to VA Clinicians and the Air Force Clinical Training Project.

Disseminating Cognitive Processing Therapy to VA Clinicians

Through a new collaboration with the VA and 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% 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.

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, where they may see suicide as the only option of escape. While the rates of suicide in the 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.

The Air Force recognized that their 1,200 mental health providers, scattered across the world in 79 different locations, needed more training specific to suicide prevention to provide adequate services to their 347,000 active duty members. To address this gap, the Air Force contacted David Litts, associate director of SAMHSA’s 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, and with funding from the Air Force, Litts began to deliver a one-day workshop curriculum called Assessing and Managing Suicide Risk: Core Competencies for Mental Health Professionals (AMSR). The curriculum, created by the SPRC in collaboration with national experts and with funding from SAMHSA, 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 2 years’ experience teaching in clinical training programs.

“Suicide risk assessment is an essential skill for Air Force mental health personnel,” says 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 says. “We hope that 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 to 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 that 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 that they have access to the best mental health services possible.”