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San Diego Conference Focuses On Veterans Mental Health Issues

April 25, 2012 1:08 p.m.


Barry McCaffrey is a retired 4-star Army General and former US Drug Czar.

Andy Eckert is CEO, of CRC Health Group.

Related Story: SD Conference Focuses On Veterans Mental Health Issues


This is a rush transcript created by a contractor for KPBS to improve accessibility for the deaf and hard-of-hearing. Please refer to the media file as the formal record of this interview. Opinions expressed by guests during interviews reflect the guest’s individual views and do not necessarily represent those of KPBS staff, members or its sponsors.

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CAVANAUGH: Today's returning veterans have been called members of the most professional and combat-hardened battle force in the nation's history. That has not protected them from the mental and emotional scars of war. San Diego is home to the largest number of veterans from the Iraq and Afghanistan wars. Will so it's fitting that a conference on veterans' mental health issues that gathers professionals from across the country should take place here. Joining me is my guest, retired 4-star army general, and former U.S. drug czar, Barry McCaffrey. General McCaffrey, welcome to the show.

MCCAFFREY: Good to be with you want

CAVANAUGH: Also joining us is Andy Eckert, CEO of CRC health group. Hello and welcome.

ECKERT: Thank you very much for having me.

CAVANAUGH: We do have the largest number of Iraq and Afghanistan vets here in San Diego, and some veterans are really hurting these days. General, what are some of the statistics on PTSD and mental health problems among returning veterans?

MCCAFFREY: Well, it's a serious issue. Two million of our young men and women have served in Iraq or Afghanistan, many of them with repetitive tours. 53,000 killed. There's a really war going on over there. And when they come home, the majority of them are doing quite well. But when they do come home, they have other challenges, maybe 11-20% of them are probably affected by post traumatic stress disorder: Probably 30% of the Vietnam veterans are affected by PTSD. They come home, there's also new signature injury, traumatic brain injury, thousands of IEDs a month in Iraq. Some of these kids come home with severe organic brain damage. So the worst of them, the ones that have multiple amputations, PTSD, and other issues are being pretty well supported. But I think we've lacked the capacity, and it's taken us a long time to get energized to understand the nature of the problem. That's why we had this conference. Brought professionals from all over the country. We respect the VA, thank God for the VA. It's the second biggest department in our government. But we got a bill capacity that has to be science-based treatment. And that's what CRC health group tried to do.

CAVANAUGH: General, can you remind us what PTSD is?

MCCAFFREY: Well, you know, if it was World War I, we would have called it shell shock. If it was World War II, we might have called it combat fatigue. We've known for -- from the civil war on that soldiers placed under immense stress end up being affected by it. Probably just for ray short period of time if you really took a mental divous, we'd get you out of the line, gave you a hot shower, a good meal, put you to sleep for eight hours, and push you back into combat. You would regain your footing. But I think what we're also encountering now is that these symptoms of hyper arousal and irritability, and insomnia, and a sense of being disassociated from those who haven't encountered what you did, a lot of those surface more when they're out of combat than in.

CAVANAUGH: How do repeated tours play into this?

MCCAFFREY: Well, we think it's an impact. We had some veteran at a conference I addressed in Colorado, had ten combat tours, and been wounded twice. Over time, these are cumulative demands on the person's personality and psyche. And by the way, this didn't just start in combat. It's where you were earlier in life, have you had a history of alcohol and drug abuse, mental problems, all these factors combine. But all of us have our limit. And at some point, you know, the stresses have to be dealt with, whether it's in combat where we're pretty good at it, dealing with acute cases of combat psychosis, back to the Vietnam generation who are hitting their late 60s, and suddenly trying to resolve some of these issues.

CAVANAUGH: How does the military screen for people either before they're deployed to see whether or not they do have some of these underlying issues that might develop into a mental health issue during combat or after deployment?

MCCAFFREY: Well, they've devised a fairly elaborate system of trying to get a baseline of your health condition, not just for mental health, but also for yes, sir condition. We learned a lot of this during desert storm. There is a baseline assessment. Some staff sergeants major in the Marines or the army, is a professional, a volunteer, has a career, has responsibilities to a family. This is a paycheck they're getting. So understandably, it's difficult easily getting at the nature of the problem or the magnitude of it. But again, I think it's working a lot better now than it was eight, nine years ago. And decade-long war, the smallest army since 1939 when my dad was sworn in as an infantry lieutenant, we put them under tremendous stress. Now they deserve better support than they have been getting of the

CAVANAUGH: I'd like to bring in Andy Eckert, CEO of CRC health group. I think that the general McCaffrey mentioned this, but can you elaborate? Doesn't the VA take the lead role in helping veterans deal with these mental health issues?

ECKERT: Well, the VA certainly has a broad network of treatment facilities. We're very active with what's known as Tricare, Tricare is the agency vested with responsibility for active military personnel as well as their families. And the Tricare certification process for a treatment facility is very rigorous. I would argue probably more rigorous than almost any other certification in which we live in this regulated world which is great news. We have four programs, one in Texas, one in North Carolina, Virginia, and Florida. That serve Tricare participants. And we've treated over seven thousand people over the last 15 years, which unfortunately is just a tip of the iceberg of this particular problem. So this type of conference and having general McCaffrey here certainly raises the visibility of the issue. These types of interviews because we're trying to get the word out there that help is available.

CAVANAUGH: One of the things this conference is doing is drawing in healthcare, mental healthcare providers and professionals from across the nation. I'm wondering what role do perhaps private mental health providers play in providing services to veterans?

ECKERT: We're a private organization. And certainly this is a marketplace that has a healthy mix of nonprofits, local institutions, big national name brand nonprofit institutions, such as Hazelton or Betty Ford, and companies such as our the. We're the largest behavioral health company in the country. We have about 140 facilities all over the place, treating 30,000 people a day. And the military is an incredibly important part of our daily operation.

CAVANAUGH: And do your protocols are treatment, are they similar to what the VA provides or different?

ECKERT: I'm not other than entirely sure what the VA provide. I would suspect they're very similar. We have developed over time based upon our experience some specialized tracks for folks that suffer from PTSD, and other combat-related challenges. So we have a whole battery of assessments that we do on the front end to tailor programs to the individual's situation. We'll then monitor their medication. Cognitive behavioral therapy, a lot of trauma work, EMKR, which is a rapid eye therapy. So some pretty cutting-edge things. Most importantly, we've hired a bunch of exmilitary clinicians. These are folks we believe will strike a more healthy and productive relationship with the patient. One of the primary drivers of successful behavioral therapy is the relationship between the therapist and the patient. And how productive that is. And so we have a bunch of pilots under way at our company to measure that on a real-time bases. If we is can have ex-military folks working with active military folks and their families, we're one step ahead in terms of driving a more positive and productive therapeutic line.

CAVANAUGH: General, mental health issues like PTSD can affect a veteran's life for years, you point out. I'm wondering also though, if you could describe to us what kind of a toll those types of mental health issues take on families and the larger community.

MCCAFFREY: Yeah, well you go right to the heart of the matter because none of this happens in isolation. We see the same thing in drug and alcohol abuse. You don't suffer from isolation. Your community is affected by it, your family, your employers, etc. So that's another follow-on requirement. And I hope CRC can also deal with it, but one of our lecturers this morning talked about the requirement to reach out to the spouses of Iraq and Afghanistan veterans and deal with their problems. They face deployment. They agonize over it. One of the women in the conference this morning told me that one of the girlfriends she was treating said she talked to her deployed soldier, and would hear incoming rounds over the iPhone that he was talking on. So this is a different wired world now, and these families are right there on the front line. We we sergeants that are doing their homework with their sons at night, the son being in Italy, in the 173rd airborne, and dad's in Iraq, over video cam. So they're connected. And it's a challenge we're going to have to face up to.

CAVANAUGH: And everybody is involved in this war, perhaps in a way that they weren't in previous combat situations. Let me speak to you, general, if I may, just a couple of questions about what's going on in Afghanistan. We've recently seen some terrible pictures coming out of Afghanistan. Our troops posing with dead Afghan bodies. This is not the first time we've heard about incidents like this. And I'm wondering from your perspective as a former commander in the gulf war, do you see this as a problem of command and discipline in the ranks in Afghanistan?

MCCAFFREY: Look, the only reason these troops can go into combat and not turn into animals and because they come from nice families. We recruit from the top 15% of American society, no felony arrest, high school graduate, physically and mentally okay. We put them through extensive training. But at the end of the day, what keeps this system straight is there's an older platoon sergeant in every group of 40 soldiers, there's a nice boy or girl lieutenant, college graduate, nice family, and then over them is a captain company commander, and a first sergeant. That's where the discipline of the Marines, the army, Airforce, Navy exists. And sometimes it fails. So I think -- and by the way, there's different incidents with different importance. Abu garrab was a failure of government policy. I think we ended up with a criminal policy in violation of U.S. domestic law, international law. That was a big deal. 1282nd airborne paratroopers mugging for the camera. From their point of which is some Jihadist adult who blew himself up by accident, they were amused. It's in bad taste, but it's bad taste now with an iPhone. So suddenly you've got pictures of this floating all over the world. Other incidents are more serious. This staff sergeant bails --

CAVANAUGH: In Kandahar.

>> Murdering children and women and he leaves a combat base probably drunk and he moves alone through the dark for a mile to murder people? That's a different story. That's really not a tale of indiscipline or war crimes. That's a tale of alcohol abuse and psychiatric breakdown.

CAVANAUGH: Right. I was going to ask you, is this perhaps an issue of a mental health issue not being recognized by the military?

MCCAFFREY: Of course. But you know, there's 2.4 million men and women in the Department of Defense, and there's a war on; so we're using the assets we got. Overwhelmingly, and I've been in and out of Iraq and office since the start of the war. I see them all the time. My son just came back from his latest tour in Afghanistan. My daughter was in the forces. They're the best force we've ever had. But they have been under stress, they're overloaded, they're coming out of combat, and we're going to have to make sure we're sorting the situation out and taking care of them.

CAVANAUGH: What has your son told you about the stresses facing his soldiers in Afghanistan?

MCCAFFREY: Well, you know, two assignments ago, he was a deputy commander of a pair trooper brigade fighting in the northeastern part of Afghanistan, they were in some pretty heavy contact. And that's one situation. To a large extent, I remind people, this is the best-supported military force we ever had. If you're a national guard, military police unit or marine combat battalion in Helmand province, the tenth mountain division up in the north, some of these troops are in daily combat. And some of them are on their third or fourth combat tour. In a general sense though, these troops when we deploy them now get two weeks on leave, we feed them properly, they live in air-conditioned Orris heated quarters. That's not the case with the infantry and rifle company in the mountains. But we take pretty good care of them. So it depends on where you 7ed and what year it was.

CAVANAUGH: Let me get back to the mental health issues surrounding veterans returning from combat. One of the big issues is for those veterans who want to stay in the service. They've done their deployment, but they want to stay in the service. And they are feeling that they have some issues that they want to contend with, but they fear that seeking help for mental health issues is going to affect their military careers. What's your take on that, general?

MCCAFFREY: Well, I think it's a problem. Certainly more so in the army than the Marines maybe, and special ops and other units. If you're got severe PTSD, it's hard for me to imagine we're going to keep you in a unit that's gone deploy back. We interview them and put them in the army/Navy times, and I think it's changed for the better significantly. The bigger problem to be blunt, I think is you get a troop home in its second combat deployment, are he's got $60,000, one out of four end up with alcohol abuse problem, which CRC is intentionally aware of. And suddenly they've got $60,000, a three thousand cc motorcycle, and they're having a fight with their 20 year-old wife. It's adjustment problems that primarily they were dealing with, exacerbated by alcohol abuse. The chain of command has got to get involved. We have to recognize that PTSD may well be part of it. And as many as twenty% might be affected. Mostly a year later, they're okay.

CAVANAUGH: Andy, let me ask you a question. As you gather together all of these mental healthcare providers, and talk to them about these issues of recovery, and as we heard the general say, this is an issue that's going to follow us through the years, are there enough providers who are aware of this situation and are able to provide the advocate services to our returning veterans?

ECKERT: I think the capacity is never enough. The trained therapists, certainly never enough. Particularly as we've grown and learned more about the challenge itself, this is not an episodic disease, typically, or incident. This is typically chronic stuff, particularly drug and alcohol abuse. So we've banished the phrase after-care in our programs. We now call it continuing care. Of and to your point, that adds an extra stress on the system, in that we need to find great programs, support groups, 12-step, NA, AA groups in their communities when they return. So it might be a 20-day to 45-day residential stay on the front end. Quite a bit of intense detoxification if necessary, and then very intense private and group counseling during the balance of that residential stay. Leading then to more community-based treatment when the person returns back to their home. So the stresses there, I will say the awareness of the challenge, the awareness of the issue is I think growing by the day. This type of conference, I don't believe, is being held in this way, you know, perhaps five or ten years ago. So a great degree of sensitivity, great leadership and advocacy by folks like general McCaffrey. So all is heading in the right direction.

CAVANAUGH: I want to thank you both for speaking with us very much.

MCCAFFREY: Good to be with you.

ECKERT: Thank you.