Politics & Government

Embedded therapists protect Guard soldiers' mental health

Family counselor, Roger S. Duke of Modesto, Calif. Duke works for TriWest Healthcare Alliance to help soldiers with mental health.
Family counselor, Roger S. Duke of Modesto, Calif. Duke works for TriWest Healthcare Alliance to help soldiers with mental health. MCT

WASHINGTON — Roger Duke is a Vietnam veteran, a retired Marine lieutenant colonel and a licensed marriage and family therapist. Since 2006, he's spent at least one weekend a month embedded with a California National Guard unit.

Duke, 57, wasn't deployed with the unit's soldiers in Iraq and Kosovo, but he's a trusted face whom the soldiers confide in before and after their deployments.

"Some of the best conversations I have with them are at one in the morning in a Humvee during a training exercise," said Duke, who's part of a California program designed to help returning Guard and Reserve members by attaching mental health counselors to their units.

California National Guard officials said they're pleased with the results.

"It's been a great tool in my toolkit," said Lt. Col. Jon Siepmann, the commander of the 1st Battalion 184th Infantry California Army National Guard, based in Modesto.

Duke, a private contractor, works with the battalion's Delta Company. The company was "battle scarred," having seeing significant action, he said.

"I found a tight, proud infantry unit that had suffered," Duke said.

The soldiers want to talk about everything, from the trauma they suffered in losing friends to family, job, finances and other post-deployment adjustment problems. He refers those with serious problems, such as post-traumatic stress disorder, for further help.

The program has been so successful that two Senate Democrats, Patty Murray of Washington and Claire McCaskill of Missouri, want to take it nationwide.

"They face the trauma of war, but they also face all kinds of trauma when they come home," Murray said. "Sometimes they need a friendly ear."

Murray and McCaskill have introduced legislation that would require the Pentagon to provide National Guard and Reserve units with embedded mental health counselors.

Returning Guard and Reserve members often have less access to the care they need than their regular Army counterparts do, McCaskill said.

"This bill is all about making sure the heroic men of our Guard have better access to mental health care, especially as mental health-related illnesses are plaguing our veterans in increasing numbers," McCaskill said.

Rather than the current system, in which troubled Guard and Reserve members sometimes slip through the cracks, a counselor would be assigned to each unit in an effort to earn the trust of soldiers who often are reluctant and sometimes stigmatized for seeking mental health care. The counselors would have access to weekend drills and other training exercises and also work with the families of soldiers.

National Guardsmen returning from overseas deployments are medically covered for 180 days, but negotiating for mental health care is very complex.

The national program would be based on the California National Guard pilot program, which has 27 licensed mental health care professionals embedded with 42 different units. The California program costs about $820,000 a year.

Data from the California program suggest that easily available, early intervention can help stem the need for more serious treatment in the long run, Murray said. About a third of the cases seen by the embedded counselors were "self-initiated" by soldiers when the program began in 2006, and the remaining were a result of outreach by the counselors or intervention by commanders. That's now been reversed, with 57 percent of those seeking help taking the first step on their own.

That suggests "time, trust and familiarity" have reduced the anxiety and stigma of approaching a mental health care counselor for help, Murray said.

"Sometimes they just want to talk," Duke said. "They know me. I make it safe for them to bring up issues they otherwise wouldn't. I wish we could be in every armory."

Since 2006, Catherine Butler, a San Diego family therapist, has worked with a National Guard unit in southern California's Imperial Valley that recently returned from Kosovo.

"In the beginning, they were like, 'I'm not going to talk with you, I don't know you,'" she said. "That has changed."

Butler talked of one guardsman she helped who was a federal law enforcement officer. A month or so after returning from a deployment, the man dove under a bench when he heard gunfire as he entered a shooting range connected to his law enforcement job.

Because of the incident, the man lost his job. He suffered from PTSD, sleeplessness and irritability, Butler said.

"He looked like death warmed over when he came to me," she said. "He told me he didn't know what to do. I made some referrals for him. I was a little bit of a cheerleader and a friendly voice."

Most Guard members didn't join thinking they'd be deployed to Iraq, Afghanistan or elsewhere, and they don't have the support system that regular Army soldiers have when they get back, Butler said.

"A 100 percent of those who come back are changed," she said. "To what extent differs. But if we are willing to send them to war, we need to take care of them when they get home."

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