DoD spent nearly $363 million on weight-loss surgeries in past decade
Filed under: Health data, Health journalism, Hot Health Headline, Public records
Reporting for KIRO-Seattle, Chris Halsne used FOIA requests to find out how much the military’s TriCare plan is paying for weight-loss surgeries for soldiers and their dependents. Including post-surgery tummy tucks, Halsne calculates (PDF) that the government was on the hook for at least $362,971,831 for such procedures over the past decade.
The military defends the expenditures by pointing to the long-term savings of having healthier TriCare enrollees, though Halsne found those savings difficult to prove, as 86 percent of soldiers and their families leave the plan before they qualify for lifetime benefits.
Halsne found that even some active-duty personnel are getting bariatric procedures, which are officially off limits to them as they are required to stay fit through diet and exercise to remain in the military.
While analyzing Defense Department records on health-related costs, KIRO Team 7 Investigators also discovered the military continues to pay for some weight loss surgery for active duty personnel. Records show $2,400,000 worth since 2001. The military banned bariatric procedures for active duty soldiers and sailors in 2007, yet it appears they approved around 57 of them after that.
Tricare, the military’s health insurance program funded by federal taxpayers, declined KIRO’s repeated questions for an interview.
Stories focus on suicides of doctors, soldiers
New York Times columnist Pauline Chen, M.D., serves up a reminder that suicide prevention isn’t just a matter of access to counseling and resources, in the form of a story about high physician suicide rates. If there’s any sector of the population that should be able to recognize that they are suffering from mental illness, and that the condition is treatable, it should be doctors, Chen writes. Yet still they kill themselves at a rate above the American average.
For several decades now, studies have consistently shown that physicians have higher rates of suicide than the general population — 40 percent higher for male doctors and a staggering 130 percent higher for female doctors. While research has traced the beginning of this tragic difference to the years spent in medical school, the contributing factors remain murky. Students enter medical school with mental health profiles similar to those of their peers but end up experiencing depression, burnout and other mental illnesses at higher rates. Despite better access to health care, they are more likely to cope by resorting to dysfunctional behaviors like excessive drinking and are less likely to receive the right care or even recognize that they need some kind of intervention.
Chen mentions two recent studies published in the Journal of the American Medical Association that shed more light on the issue, one showing that in medical school depression and burnout are separate entities, and the other showing that depressed students believe others view them as incompetent. In the end, she calls for further long-term research, but does not take the next logical step and investigate comparative research and statistics. Is it just American medical students who are depressed? Do countries with low-cost, low-pressure med schools produce doctors with better mental health? There’s a lot of room for investigation.
Suicides in another high-access group
Chen’s New York Times colleague, James McKinley, writes that as many as 20 soldiers connected with the Army base at Ft. Hood have killed themselves this year, despite the Army’s suicide prevention efforts.
The spate of suicides in Texas reflects a chilling reality: nearly 20 months after the Army began strengthening its suicide prevention program and working to remove the stigma attached to seeking psychological counseling, the suicide rate among active service members remains high and shows little sign of improvement. Through August, at least 125 active members of the Army had ended their own lives, exceeding the morbid pace of last year, when there were a record 162 suicides.
As of July, the Army requires all returning soldiers to be evaluated by a mental health specialist, though veteran advocates still point to a shortage of psychiatrists and an emphasis on treatment through medication rather than through therapy. The system is taxed by record numbers of soldiers seeking help for psychological problems, and mental health was the leading reason for hospitalization in the Army last year, McKinley writes.
Each suicide is unique, McKinley writes, and it’s hard to find patterns.
PTSD or personality disorder? It matters to soldiers
Filed under: Government, Health journalism, Health policy, Studies
The AP’s Anne Flaherty has put together a story that illuminates the Army’s refusal to admit that it could have misdiagnosed (and discharged) hundreds of soldiers who may have had PTSD or traumatic brain injury instead of a personality disorder. Keep in mind that a discharge for “personality disorder” means no veterans’ benefits and a lifetime of stigma. A diagnosis of PTSD or injury, on the other hand, means treatment will be covered by the government.
Photo by isafmedia via FlickrThe Army, for its part, has decided there’s nothing unusual about the following chain of events (taken from Flaherty’s story):
- The Army “discharged about a 1,000 soldiers a year between 2005 and 2007 for having a personality disorder.”
- In 2007, The Nation’s Joshua Kors writes a cover story exposing the Army’s apparent habit of diagnosing soldiers with a personality disorder instead of considering the possibility of PTSD or traumatic brain injury.
- Soon after, “the Defense Department changed its policy and began requiring a top-level review of each case to ensure post-traumatic stress or a brain injury wasn’t the underlying cause.”
- Sure enough, “the annual number of personality disorder cases dropped by 75 percent.”
- At the same time, the number of post-traumatic stress disorder cases has soared. By 2008, more than 14,000 soldiers had been diagnosed with PTSD — twice as many as two years before.
- Army officials “reviewed the paperwork of all deployed soldiers dismissed with a personality disorder between 2001 and 2006″ and said they “did not find evidence that soldiers with PTSD had been inappropriately discharged with personality disorder.”
DoD campaigns against stigma of depression, PTSD
The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury’s new Real Warriors campaign is designed to aid soldiers with what they seem to see as the three r’s of military mental health: resilience, recovery and re-integration.
The RealWarriors.net site not only directs soldiers to additional resources, but also shares anecdotes from their peers and provides them with guidelines for good mental health, both in combat and out of it.
The effort, launched in May, even has a Twitter account.
(Hat tip to Arline Kaplan of the Psychiatric Times)
Related:
Bay Area panel on veterans’ health highlights untold stories
Lack of oversight contributes to Army suicides
Filed under: Government, Hot Health Headline, Studies
The Army reported that 143 active duty soldiers killed themselves in the last year, the highest number since the statistics started being kept in 1980. This year’s numbers are on track to break that unfortunate record. Gregg Zoroya of USA Today reports that an Army investigator blames at least part of this rise to a lack of day-to-day oversight by commanders accustomed to leading amidst the intensity of the battlefield rather than the less-obvious perils of the barracks.
The investigator’s solution is simple: commanders need to interact with their troops more, to keep in touch and keep their eyes out for risk factors.
Zoroya also noted another contributing factor to the climbing suicide rate:
Along with soldiers who engage in risky behaviors, McGuire says, the Army has a greater number of troops who entered the service with pre-existing anxiety or depression or who have stopped taking their behavioral medication in order to meet entrance requirements.
Soldiers concerned they may be at risk can try this online mental health self-assessment designed specifically for members of the armed services.
Army works to prevent soldier suicides
Teresa Snow of KRCG-Jefferson City, Mo., took a deeper look at suicides among active-duty military forces. Snow examined the factors that contribute to military suicide, spoke with a veteran who had attempted to take his own life and reviewed a two-hour suicide prevention video prepared by nearby Lincoln University at the Army’s behest.
Snow said the video, mandatory viewing last month for all 1.6 million members of the Army (both active duty and reserves), functions like a “choose-your-own-adventure” novel, with soldiers following along with characters and making decisions for them.
“It’s training on two levels,” says (LTC Gary) Gilmore. “What would I do as an individual when I just say all of these things, I feel like the world is dog piling on me what am I going to do about that? And the other piece is that OK, you’re the buddy who’s watching this happen, are you a real friend if you let him make a little secret with you and say don’t tell anybody? No, you have to say to him, I am being your friend, I’m not going to let this slide.”
Though the eyes of Wayne Dyle, Snow also took a raw firsthand look at the consequences of the Army’s failure to prevent suicides among active-duty forces and veterans.
Army Veteran Wayne Dyle doesn’t blame his time in the service but that last factor, drug and alcohol abuse for his suicide attempt. When he wanted to get off drugs and his wife did not, his third marriage began to break up. The break up and his $1500 a week drug habit were taking a toll. He describes how one day he loaded up, “When I ran out of the beer, the vodka, the meth, the crack, I ran out, I was out of money, said Doyle.”
Then he tried to slit his wrists.
Report exposes failures of Army mental health care
This week on Salon.com, Mark Benjamin and Michael de Yoanna are posting the results of their investigation into climbing “preventable death” rates among American soldiers. The reporters focused on the cases of soldiers in Ft. Collins, Colo., but also included the national implications of their findings. In January, they report, the army suspects more soldiers killed themselves than died in combat in Iraq and Afghanistan combined.
Their findings are being published in a series called Coming Home:
“Salon put together a sample of 25 suicides, prescription overdoses and murders among soldiers at Colorado’s Fort Carson since 2004. Intensive study of 10 of those cases exposed a pattern of preventable deaths, meaning a suicide or murder might have been avoided if the Army had better handled the predictable, well-known symptoms of a malady rampant among combat veterans: combat-related stress and brain injuries.”
According to Benjamin and de Yoanna, many, if not all, of the deaths were preventable. They point to systemic problems with the military culture and the military standard of medical and psychological care as the root cause. The reporters said the Army’s mental health system had failed the soldiers, many of whom had returned from Iraq and suffered classic symptoms of chronic PTSD.
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