THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Tuesday, June 11, 1996 TAG: 9606110302
SECTION: FRONT PAGE: A1 EDITION: FINAL
SOURCE: BY DEBRA GORDON, STAFF WRITER
LENGTH: 152 lines
Career breaker. Stigma. Damaging.
These are the words that many members of the military use when talking about seeking help for mental-health problems.
In recent years, high-ranking officials in all branches of the military have sought to dispel those perceptions, telling members to seek help if they need it - and assuring them that there will be no repercussions if they do so.
Navy Adm. Jeremy ``Mike'' Boorda was a leader in this effort to raise awareness. Just three weeks before his death, he referred to suicide in a talk at the Naval Academy, asking: ``Can the sailor commit suicide and not have the leader know that he or she was in distress? No.''
Then Boorda committed suicide, stunning even those closest to him. His death has refocused attention on a persistent perception in the Navy - that seeking psychiatric help can derail a career.
``The policy in the Navy is very clear,'' said Rear Adm. Donald Muchow, the Navy's chief of chaplains. ``Being helped for depression or alcohol abuse or those sort of things is not a ball and chain around one's career.
``Now, do I think everybody knows that and believes it?
``Unfortunately, I don't think so.''
The stigma surrounding mental illness is slowly disappearing in the civilian world. During a recent Senate debate about including mental-health benefits in a health-care reform bill, several senators stood and admitted to their own mental-health problems.
Even Colin Powell, the retired chairman of the Joint Chiefs of Staff, was open about his wife's battle with depression last year when he considered running for president.
But openness in discussing mental-health issues has yet to come to the Navy and other branches of the military, said Robert Resnick, past president of the American Psychological Association. Resnick, who chairs the division of clinical psychology at Virginia Commonwealth University in Richmond, has spent the past five years working with the Army on mental-health issues.
While top-level military officials urge active-duty members not to fear asking for help, few have acknowledged any psychological problems they may have battled themselves, he said. This perpetuates the myth that seeking help will damage your career, he said.
And myth it may well be. A 1994 study published in the journal Military Medicine in which 138 Navy and Marine commanding officers were polled on their attitudes toward mental-health assistance found it ``highly unlikely that having received mental-health services alone will close the door on a member's career.''
But the diagnosis may.
It is a commander's responsibility to ensure that his people are physically - and mentally - ready for action.
So if someone is unable to do his job - whether because of a broken leg or a broken psyche - the patient's commanding officer has to be notified, said Navy Cmdr. James R. DeVoll, flight surgeon for the aircraft carrier Enterprise.
And that's what often stops service members from asking for help: concern about the confidentiality of their problems, said Jesse Harris, former chief of social work for the Walter Reed Army Medical Center and now a professor at the University of Maryland-Baltimore.
The civilian world's patient/physician privilege doesn't exist in uniform, said Navy Capt. John Mateczson, principal director of clinical services at the Department of Defense.
What an active-duty military member tells a doctor, therapist or social worker could be passed on - creating a tension between a person's right to privacy and the military's need for combat readiness.
``Fitness of duty is the main interest of the command,'' said Cmdr. Michael Knowlan, acting director of Portsmouth Naval Hospital's psychiatry department. ``Beyond that, (commanders) are not interested in any specifics the clinical situation may entail.''
Even a commanding officer's personal bias against mental-health therapy and service members who seek it should not affect someone's career - as long as doctors agree that the service members are still fit to do their jobs, said Navy Cmdr. Nancy Bakalar, a senior policy analyst with the Department of Defense.
``The commanding officer can have a bias, but there are service policies that are what the commander must follow,'' she said.
It's rare that a commanding officer would even see details of a service member's mental-health visit, said Navy officials.
``I've never had a (commanding officer) actually ask to look at the record,'' said Cmdr. Peter True, a Navy psychiatrist. ``I call the C.O. and tell him, `This is the scoop. I think the guy's good to go' or `not good to go.' Or, `good to go, but he has to be on this medication.' So he has this basic knowledge. . . . They say, `That's good enough for me, doc.' ''
Dr. Priscilla Hankins, now a staff psychiatrist with the Veterans Affairs Medical Center in Hampton, remembers that during her seven years as a Navy psychiatrist, ``confidentiality was certainly a top priority. But in the military setting, there are some circumstances under which it would have to be broken.''
One such instance: The person is a danger to himself or others - the same circumstances under which confidentiality would be broken in the civilian world.
At times, a Navy mental-health provider may be ordered to release information that he feels he should not.
``It's a tough call, and military psychologists and psychiatrists struggle with this thing all the time,'' said VCU's Resnick. ``They have to march to two different masters: their military chain of command and their professional ethics.''
Sometimes the two collide.
A 1995 article in the medical journal Professional Psychology described two conflicting cases. In the first case, a military psychologist was sanctioned by the American Psychological Association for failing to maintain the confidentiality of a service member's record. In the second case, the psychologist, adhering to the principle of confidentiality, was sanctioned by his commanding officer for failing to reveal information about a patient.
The article also noted that a study of Army psychiatrists found that one in four admitted to having been ordered to reveal confidential information.
When a sailor's mental-health records are revealed to those higher up in the command, it doesn't necessarily hurt that sailor's career, Navy officials said. These days, there are even people taking anti-depressants such as Prozac while serving aboard Navy ships.
``Getting care often improves careers because work performance gets better as they get better,'' True said.
Hiding mental-health problems and hoping they'll go away may hurt a sailor's career more by affecting his job performance, Navy officials said.
If the problem is so bad that it results in medical discharge, seeking help will at least ensure the sailor's eligibility for future benefits, said the Defense Department's Mateczson.
But Navy brass face a formidable challenge in convincing sailors that asking for help isn't a sign of weakness.
``If there are ways that we can assist you in living life more fully, being more effective in the job or in achieving your own goals and happiness, then you're going to be a better sailor,'' said DeVoll, the Enterprise doctor.
``That is much more valuable than trying to `poo-poo' a problem, or shove it down or ignore it.''
In the past eight years, the Navy has pushed that message. Navy psychiatrists and psychologists spend time in the field, visiting ships, talking to skippers, encouraging sailors to seek help when needed. Commanding officers receive extensive training in suicide prevention. And the Navy's crisis-intervention team is readily available.
``I think the Navy and other services are doing some innovative things in educating commanders to recognize problems that go beyond whether or not the vehicle or ship is running, to `How is this human that's working for me functioning, and is there a way I can help?' '' said chief of chaplains Muchow.
They are efforts that, in the aftermath of Boorda's suicide, may be even more important.
``The take-home lesson in Adm. Boorda's suicide,'' said the Enterprise's DeVoll, ``is that mental-health problems which may lead to risk of suicide are no respecter of age, gender, ethnic background, experience. It's very democratic.'' ILLUSTRATION: CHRISTOPHER REDDICK
The Virginian-Pilot
``If there are ways that we can assist you . . . then you're going
to be a better sailor,'' says Navy Cmdr. James R. DeVoll, flight
surgeon for the carrier Enterprise.
KEYWORDS: MENTAL HEALTH MILITARY by CNB