"Due to the wars in Iraq and Afghanistan, the unmet medical and psychological needs of military personnel are creating major challenges. Increasingly, active duty military [s942.photobucket.com]personnel are seeking physical and mental health services from civilian professionals. The Civilian Medical Resources Network attempts to address these unmet needs. Participants in the Network include primary care and mental health practitioners in all regions of the country. Network professionals provide independent assessments, clinical interventions in acute situations, and documentation that assists GIs in obtaining reassignment or discharge." Howard Waitzkin MD PhD 1 and Marylou Noble MA 2 from their March 2009 article Caring for Active Duty Military Personnel in the Civilian Sector. [civilianmedicalresources.net]

      According to the Civilian Medical Resources Network, an average of eighteen United States military veterans kill themselves every day. At least a thousand former soldiers under the care of the Department of Veterans Affairs attempt suicide every month. The crisis has grown so urgent that more veterans are killing themselves than are dying in the wars in Iraq and Afghanistan.

       In April 2008 a study by the RAND Corporation reported that 300,000 Iraq and Afghanistan war veterans currently suffer from post traumatic stress disorder and/or major depression. An additional 320,000 soldiers suffer from traumatic brain injury or physical brain damage. Many of these GIs do not receive adequate help from the Pentagon and VA system.

       The Civilian Medical Resources Network began in March 2005, working to address the unmet medical and psychological needs of active-duty U.S. military personnel who contact the GI Rights Hotline (a national effort by 25 religious and peace organizations).

       The Network has grown from three participating professionals to 60 currently, located in all areas of the country. Professionals receive a brief training in the support and documentation that the GIs require. Due to GIs’ limited financial resources and insurance coverage for civilian services, Network professionals generally provide care free or at greatly reduced cost. When possible, GIs visit Network professionals in person; if an in-person visit proves unfeasible due to geographical distance, Network professionals assist GIs by telephone consultations. The volume of new clients that the Network serves has increased from approximately two per month initially to four per week currently. We are expanding our outreach to peace organizations, professional organizations, and especially GIs.

Read the new article by Howard Waitzkin and Marylou Noble [civilianmedicalresources.net] in the journal Social Medicine [journals.sfu.ca] about the Civilian Medical Resources Network. Caring for Active Duty Military Personnel in the Civilian Sector

Howard Waitzkin MD PhD1 and Marylou Noble MA2

       Due to the wars in Iraq and Afghanistan, the unmet medical and psychological needs of military personnel are creating major challenges. Increasingly, active duty military personnel are seeking physical and mental health services from civilian professionals. The Civilian Medical Resources Network attempts to address these unmet needs. Participants in the Network include primary care and mental health practitioners in all regions of the country. Network professionals provide independent assessments, clinical interventions in acute situations, and documentation that assists GIs in obtaining reassignment or discharge. 

       Most clients who use Network services come from low-income backgrounds and manifest psychological rather than physical disorders. Qualitative themes in professional-client encounters have focused on ethical conflicts, the impact of violence without meaning (especially violence against civilians), and perceived problems in military health and mental health policies. Unmet needs of active duty military personnel deserve more concerted attention from medical professionals and policy makers.

       Combat operations in Iraq, Afghanistan, and elsewhere not only take the lives of US service personnel but also damage the physical and mental health of many who survive. Even though military officials may strive to implement high-quality military health-care,1 reports originating both inside and outside the military have called attention to the unmet medical and psychological needs of service personnel.

       Some analysts have projected that physical and emotional injuries sustained by US soldiers will become a public health epidemic that will continue to stress the already over-extended U.S. health and mental health systems.9-11 Several factors may lead active duty GIs* to request independent medical evaluation and treatment outside of the military system. GIs experience a command system and a medical care system where illness and injury may be viewed as obstacles to the military mission, inconveniences to local commands, or malingering.

       GIs may face deployment to combat zones before full evaluation of physical illnesses. Those GIs with mental health problems such as depression or post-traumatic stress disorder may re-enter combat when newly diagnosed or just beginning a trial of medication. In addition, the problem of double agency pervades the provision of health and mental health services in the military. 

       Personnel shortages and pressure to deploy and re-deploy troops rapidly to Iraq and Afghanistan place increasing pressure on military physicians. As they encounter GIs with health and mental health problems, military professionals must consider the goals of maintaining the numbers and readiness of combat forces.

      These military goals tend to contradict the goal of helping the individual patient. The dual role of military professionals raises inherent tensions that increase GIs’ expressed needs for services in the civilian sector.

       The Civilian Medical Resources Network [www.socialmedicine.info] is a small, national network of Mental Health professionals that was established in 2006 to offer GIs an alternative to the military health and mental health care system. The Network consists of professionals in primary care medicine, psychiatry, psychology, social work, and public health who strive to address the needs of active duty US military personnel when they seek medical and psychological care in the civilian sector. 

Related "Progressive" Civilian Medical and Mental Health Resources

Physicians for Social Responsibility
http://www.psr.org/chapters/oregon/news/caring-for-active-duty.html [www.psr.org]

Caring for Active Duty Military Personnel in the Civilian Sector
waitzkin@unm.edu