Defense bill mandates yearly mental health checkups for troops

Navy Times — Thu, 11 Dec 2014 10:17:34 -0500

From: Navy Times

The defense policy bill passed by the House last week and now pending in the Senate will change how often troops get mental health exams, where they fill some prescriptions and how long they stay in a hospital for mental health treatment.

The bill, which authorizes $30.7 billion for the defense health program, rejected Pentagon proposals to consolidate Tricare into a single plan — an idea that would have altered the medical program for nearly all Tricare beneficiaries except active-duty troops — but still makes significant changes.

Among the largest is a requirement that all active-duty and Selected Reserve troops receive one-on-one mental health screenings once a year.

The assessments can coincide with annual physical exams or pre- or post-deployment assessments, but they must be face-to-face, according to the defense policy legislation. In addition, deployed troops also must have an in-person mental health exam once every 180 days of deployment.

Sens. Joe Donnelly, D-Ind., and Roger Wicker, R-Miss., who proposed the new requirements, said they are needed to help break down the stigma of seeking help for mental health issues.

Donnelly named his original bill for Jacob Sexton, a 21-year-old National Guardsmen who fatally shot himself while home on leave from Afghanistan in 2009. As a Guard member, he had access to online assessments but was required to have a face-to-face exam only once every five years.

The legislation, which also requires the Defense Department to provide a report to Congress on in-person mental health assessments, is intended to fill gaps in current requirements, the lawmakers said.

Donnelly called suicide a "service-wide problem," adding: "Beating this scourge is a critical component of military readiness."

Another change included in the legislation that is sure to have an impact on most Tricare beneficiaries is a requirement that Tricare patients who take name-brand medications for chronic conditions fill them at a military pharmacy or with the Tricare home delivery program starting Oct. 1.

Details have yet to be released by DoD, but the bill essentially forces Tricare beneficiaries to use military pharmacies or mail order for prescriptions for long-term medical conditions unless they use generic brands.

The new requirement will save the Pentagon money: Last year, DoD's efforts to move retail prescriptions to mail or military facilities, including a program requiring Tricare For LIfe beneficiaries to use the mail or military pharmacies, saved $74.8 million, according to DoD.

But the move also will save Tricare patients cash as well. With prescription copayments included in the new legislation, the cost of a 30-day prescription at a retail pharmacy for name-brand medications will rise to $20 under the new legislation, while the same prescription is provided at no-charge at military treatment facilities. Moreover, a 90-day mail prescription will cost just $16.

Beneficiaries still will be able to fill prescriptions for name-brand drugs for acute illnesses at Tricare network retail pharmacies as well as prescriptions for generic brands, which will cost $8 for a 30-day prescription.

Another significant change in the bill will greatly benefit military family members and troops struggling with severe mental health conditions: The new legislation lifts limits on the number of days Tricare covers inpatient psychiatric care, currently 30 total days per fiscal years for patients 19 and older and 45 days for patients 18 and younger.

The change "removes a potential barrier to receipt of mental health care that does not exist for other medical or surgical care," lawmakers wrote in the explanatory report accompanying the bill.

A provision offered by Sen. Claire McCaskill, D-Mo., to require Tricare to cover the cost of breast-feeding equipment, support and counseling for moms who want to nurse their infants also made it into the final version of the bill.

That change aligns Tricare with the requirements of the Affordable Care Act, which mandates that health insurers cover lactation equipment, counseling and support.

Other requirements in the bill include mandating DoD to provide reports to Congress on issues, including:

*The reduction of Tricare Prime service areas.

*The use of burn pits in deployed settings.

*Fertility treatments for injured service members.

*Service resiliency programs and transition care for troops diagnosed with post-traumatic stress disorder.

http://www.navytimes.com/story/military/capitol-hill/2014/12/11/defense-bill-tricare-troops-health/20147081/

Response by SSG Jason Cherry made Dec 11 at 2014 10:21 AM

SSG Jason Cherry — Thu, 11 Dec 2014 10:21:51 -0500

I think most services already have something like this in place. The Army certainly does... but the fact it would be law I think would cement it further. I just hope that it is for the Service Members benefit, and not some sort of factor in exclusion from service.

The only problem I see right off the bat is the amount of providers to Service Members is already low, so unless they are planning on hiring a lot more, this will put more burden on an already overburdened system.

Response by CPT Zachary Brooks made Dec 11 at 2014 10:33 AM

CPT Zachary Brooks — Thu, 11 Dec 2014 10:33:12 -0500

While I think this is a good thing as it helps keep the force healthy, my real question is, why do we continue to spend more and more money without fixing many of the issues that cause this spending?

The military is becoming another big government program.

Response by SGM Erik Marquez made Dec 11 at 2014 10:39 AM

SGM Erik Marquez — Thu, 11 Dec 2014 10:39:16 -0500

Anything that is mandatory and routine without adding personnel specifcally to serve the need.. Will become routine , minimized, rushed and dealt with as an additional burden. The service provided (or not) will reflect that.

This will prove to be another check the block task for overburdened physicians, PA, Combat Stress folks... who will now be forced to do routine health checks vice focused help to those in actual need.

Response by PO2 Jonathan Scharff made Dec 11 at 2014 10:46 AM

PO2 Jonathan Scharff — Thu, 11 Dec 2014 10:46:33 -0500

Always nice to see us doing the right thing for service members. Too bad they couldn't incorporate some limitations on how this information could or could not be used against service members. No one wants to access health care if it is going to be held against them.

Response by LTC Paul Labrador made Dec 11 at 2014 11:18 AM

LTC Paul Labrador — Thu, 11 Dec 2014 11:18:38 -0500

I see this as being just as effective as the BH screening troops get in their initial PDHA.....meaning not at all. These types of screenings require the patient to be candid and honest. Sure some will be, but I can almost gaurantee you that most people will not.

Response by MAJ Private RallyPoint Member made Dec 11 at 2014 11:18 AM

MAJ Private RallyPoint Member — Thu, 11 Dec 2014 11:18:16 -0500

The psychiatric community has established that there are three outcomes from those people whom have experienced a traumatic event. One, the experience makes you stronger. Two, the event will have negligible effect. Or three, the event will completely destroy the individual's psyche.

What I would be interested to see is the number of mental health issues we currently have categorized by number related to service in combat and number that were preexisting conditions prior to entering military service.

From my perspective, I think that what we have not adequately addressed is providing a thorough psychiatric evaluation to candidates prior to entering military service.

References that I am familiar with:

"The Dark Side of Comprehensive Soldier Fitness" (This article discusses the Army's Comprehensive Soldier Fitness Program and address such topics as CSF, PTSD, and the GAT.)

American Psychologist, Volume 66, Issue, published January 2011 (Entire journal is dedicated to CSF, GAT, PTSD, and other associated topics).

Response by CPT Aaron Kletzing made Dec 11 at 2014 11:23 AM

CPT Aaron Kletzing — Thu, 11 Dec 2014 11:23:03 -0500

I appreciate the intent of this initiative. My one concern is that this unit-level task will turn into an administrative check-the-box exercise in the way it is administered across the force. Some units will do this well and give it the appropriate patience. Others will unfortunately rush troops through it. I wish only the best for this.

Response by SGT Bryon Sergent made Dec 11 at 2014 11:25 AM

SGT Bryon Sergent — Thu, 11 Dec 2014 11:25:40 -0500

In my opinion there are many things going on with this. If I tell the doc(wizard) that I am not doing good and then get the eval, and it shows some PTSD at what ever stage. Fine then I get treated. Along with that is the government report to the top. Which then wants to know if I have a POW(personally owned weapon) I now have a eval out there that says what ever and that I shouldn't have a gun. Now because large crowds (example) make me anxious, NOT CRAZY, they are going to say that I can no longer have a weapon. Or if me and my wife are angry and fighting, NO ABUSE, that I am unstable and can no longer poses a weapon!

Of coarse soldiers are going to lie. Might it help some. Yes, but the ones that are the bad ones are going to lie or beat the test and get passed over. I know I'm not going to tell the doc somethings like owning a weapon. Far as that goes I have been asked to leave a DR office for refusing to tell them on a questionnaire if I own a gun or not. None of anyone's business!!!!

Response by PO1 Donald Hammond made Dec 11 at 2014 12:13 PM

PO1 Donald Hammond — Thu, 11 Dec 2014 12:13:41 -0500

Oh geez. Better not check submariners while underwater.

Response by SSG(P) Private RallyPoint Member made Dec 11 at 2014 12:44 PM

SSG(P) Private RallyPoint Member — Thu, 11 Dec 2014 12:44:44 -0500

Unfortunately a year to year exam may still be too late...or not enough. Most men won't reveal things that are going wrong in their life, like failed relationships, counseling statements, divorce, cheating spouse, they usually are the tough guys and want to 'try and work things out' by themselves, I know, I've been there. Many that do reveal their weaknesses or demonstrate that their personal life is falling apart are fearful it may impact their professional life. I believe that this is a command - down failure...every CO should get to know the troops, maybe not man to man, but needs to have weekly talks with the SMs in his or her unit. They need to reiterate open door policy, that also goes for PSG, 1SG, CSM, and SM. This is getting out of hand...all these suicides. Even the Army itself needs to warn soldiers that many relationships cannot withstand more than a 12 month deployment. The Marines learn from some of their mistakes, and a 6 month deployment is commonplace....troops should start a grassroots movement to experiment with shorter deployments first. Failed relationships is probably the most common cause of suicides if I were to guess, knowing something is different about your troop should make you pull them aside....and dig into the cause. I don't think troops need more drugs. They need professional counseling with a marriage counselor or MSW, or LICENSED therapist. We can get through a lot of these failures, we just need an unbiased person to share it with. Mental health drugs are also a common cause for suicides. They make you feel like a different person, and if you miss your meds or run out, guess what, quitting cold turkey, is often enough to make you crazy. Shorter deployments, discouraging marriage before deployments, counseling, and get to know your soldiers. If a troop wants to off themselves, unfortunately besides committing him to a hospital or physically holding them down until the MPs come...is the only other option.

Response by Lt Col Private RallyPoint Member made Dec 11 at 2014 4:37 PM

Lt Col Private RallyPoint Member — Thu, 11 Dec 2014 16:37:47 -0500

Will they continue to ask me if I'm thinking of harming others? I always smile when they ask that question.

Response by PO3 Private RallyPoint Member made Dec 11 at 2014 4:55 PM

PO3 Private RallyPoint Member — Thu, 11 Dec 2014 16:55:05 -0500

I learned not to answer these types of questionnaires honestly when I went through Basic Enlisted Submarine School.

I answered the initial entry survey honestly and got flagged. I was interviewed by mental health and then cleared back to full duty (in fact, our instructor made me the class leader with the introduction "This is Petty Officer Glade and he's your class leader. He failed his psyche exam, so don't piss him off")...

I don't claim to be the smartest guy in the world, but if I could figure out what not to say on these, someone with something to hide would for sure know what not to say...

Response by SSgt Private RallyPoint Member made Dec 11 at 2014 5:29 PM

SSgt Private RallyPoint Member — Thu, 11 Dec 2014 17:29:02 -0500

If this can truly make us a stronger force, I see nothing wrong with the annual mental health checks. The issue will be, what else are they trying to sneak on to this bill? I mean they give us a list at the bottom of the article but what else are they requiring? I am always for a stronger military but it seems any time we have a chance at something to do that, it is slowed or halted by a concession that offsets the trade-off.

Response by SGT Private RallyPoint Member made Dec 11 at 2014 5:53 PM

SGT Private RallyPoint Member — Thu, 11 Dec 2014 17:53:17 -0500

I already receive an annual mental health evaluation, so to me this is no big deal. The one issue I see is something that the I am sure is an issue now, and that is people who have issues are not going to speak up in these sessions in the fear of some sort of action being taken against them. People do not like to be labeled.

Response by SPC John Decker made Dec 13 at 2014 9:43 AM

SPC John Decker — Sat, 13 Dec 2014 09:43:14 -0500

I agree that what is described here seems to be a very good thing. I also know that most bills that go through congress are almost never limited to one topic. I am allowing for the possibility that somewhere else in this bill is wording that might make things worse for our service men and women and their families.

Response by 1LT David Moeglein made Dec 13 at 2014 10:37 AM

1LT David Moeglein — Sat, 13 Dec 2014 10:37:06 -0500

As a provider of mental health services, I am pro mental health. However, let service members do their job without harassment. If they are functioning effectively by objective measures, let them serve. Let them figure out how to pursue their own mental health. If everyone gets a mental health assessment, then there will be no mental health treatment resources for those who need them. We don't need more bureaucracy in our country. What percentage of our defense budget do we really want going to psychopharmaceuticals? I'd rather see it going to good nutritious chow.

Response by SrA Marc Haynes made Dec 13 at 2014 10:58 AM

SrA Marc Haynes — Sat, 13 Dec 2014 10:58:48 -0500

I am for any program that helps troop's & veteran's quality of life. It will be difficult to get an accurate analysis of the true mental health picture with 1 year screenings. I do like the more frequent evals for those deployed in combat.
It will be most dependent on the person being evaluated honestly, I hope and pray that it is administered correctly because saving just one life makes it all worth it.

Response by SPC John Decker made Dec 13 at 2014 11:11 AM

SPC John Decker — Sat, 13 Dec 2014 11:11:38 -0500

I've been thinking about this since my first comment. Instead of the assessments, what might be considered is shortening the length of deployment in conjunction with a pre-deployment briefing. The briefing being given by a service member who had previously been deployed to the area in question. While never having experienced combat, I would imagine that circumstances are unique. Rather than just trying to imagine what might happen, having been informed or the reality before getting there might help. Shortening the length of deployment might allow the human mind to heal itself more readily. Post-deployment assignment should be another overseas posting, in a non-combat zone, to perhaps allow a slower adjustment period.

Response by SGT Charles Vernier made Dec 13 at 2014 1:26 PM

SGT Charles Vernier — Sat, 13 Dec 2014 13:26:28 -0500

"The road to hell is paved with good intentions." What are the root causes of the mental health issues? Excessive deployments, TBI, lack of transition to civilian life? Would it be possible to address those issues? Instead of dealing with symptoms why don't we deal with cause? Just some material for debate.

Response by SPC Phillip Ludlow made Dec 14 at 2014 2:06 PM

SPC Phillip Ludlow — Sun, 14 Dec 2014 14:06:10 -0500

i think its a great idea.

Response by SPC David S. made Dec 14 at 2014 2:26 PM

SPC David S. — Sun, 14 Dec 2014 14:26:43 -0500

Our approach in how we address mental health care needs to be reworked in my opinion. Currently if your in crisis only option is to go to the closet emergency room and wait for the appropriate resources to become available. As there is a lack in facilities for mental health care this can be 12 to 24 hours and incurring overpriced transportation cost that typically come out of pocket.
Also current approach in treatment of most mental health issues is via pharmaceuticals with very little therapy. The lack of resources I feel is due to state cut backs as many of state facilities are closing and the private sector taking up the slack. This shortage in available beds only exasperates the shortfalls. The root cause of all of this is money as many of these individuals health care issues are chronic and many of those with them are either homeless, unemployed, or without income or insurance coverage thus many states and hospitals avoid this aspect of health care. Before it becomes a requirement I think it would be wise to evaluate and address any resource needs before making this a requirement as failing to do this will only add more work load to an all ready overloaded system.

Response by PV2 Abbott Shaull made Dec 14 at 2014 4:48 PM

PV2 Abbott Shaull — Sun, 14 Dec 2014 16:48:01 -0500

You know I come from two points. I see clear cut case, where have a baseline developed with all recruits. With that said, I think after that it should be left up to the individual to go seek help, or guided to when it becomes a problem where they can't function.

Not to use it as means to add to ground for Chapter a soldier. It one of those things, when you command element send you to the mental ward, for evaluation, and they diagnose with depression and anxiety that was caused by said Command. The soldier in question already had one existing thing that could be medically review for Medical related discharge, and you hand them another one. Then process the Chapter anyways, because you as Company Commander, and your First Sergeant both screwed up. Well yeah it shouldn't be yearly thing for everyone, unless you have one of the sensitive MOS that does require it. Like I said, when it comes down to it, there really needs to be a standard clearly defined in which personnel in the Command and the level above the Command agree that they need to go. I was performing all my duties at the best of my abilities, I was seeking help from sick call like I was suppose, did what I could. I took all the belittling from several two of the other three Squad Leaders in my Platoon, one went as far as coming into my room at 3:30 in the morning drunk to give me the riot act. Or the First Sergeant going on and on about all his broken bones and sprains over the years. Especially when these people are not medically train professional. I was the not the only one frustrated by all this, my Plt Leader, Plt Sergeant, Squad Leader, and Team Leader all took in stride and I am sure they took a lot of heat too. I received lectures on not to take pain meds all the time.

The point is after I got thrown out, it took me 15 years to go to the VA to start the process. Due to not wanting to deal with the Mental issues, I just put the claim in for my right leg/ankle. Mainly due to the fact that I don't like having that label. My son was diagnose with Asperger's at age 7, he is now 9. Well to make long story short, I went to my family doctor, got referral to see the if I had the same problem, I always had problems with attention span, anxiety more so since I left the military, and always terrible taking test. Well found out that at the age 44 that I have Asperger's, and again Depression, and Anxiety. In fact, the Apserger's was to degree that she would of said I had ADHD too according to my test scores. Remember the time frame I was in School, and in the Military, ADHD and Asperger's were unknown.

So now, I just seen my VA provider, and I am going to see VA Mental Health worker to work around those issues, so maybe to help with issue with my family. Maybe to be more productive too.

Response by CSM David Heidke made Dec 15 at 2014 9:23 AM

CSM David Heidke — Mon, 15 Dec 2014 09:23:23 -0500

Oh, great... Another annual requirement... Add this to suicide prevention training, periodic health assessments, anti-terrorism training, and brown leather boot training.

Why not give reservists tricare like the active duty? After all, we have the same requirements.

Other Reserve CSMs have said this until we're blue int he face... We have way too many mandatory requirements. We have the same requirements as the active duty, but they have 365 days to do it. We have about 48, and the active duty says they don't have the time either.

How about we learn how to drive a truck for a few hours a year. Instead, Soldiers are poked and prodded by medical professionals more than the Roswell aliens.

Response by John Russell made Dec 15 at 2014 10:41 PM

John Russell — Mon, 15 Dec 2014 22:41:01 -0500

Fruit for thought the idea is good on paper in theory. You can pretty much lie your way out on the questionaire. Doesnt make a difference. It makes it more of an administrative nightmare to go every year. You get more service members sitting around waiting in line at the clinics to see the doctors to get their heads examined (yay or nay) than being there at work making sh*t happen. Those soldiers who have caused mass shootings have in some way shape or form received screenings prior. Regardless, more doc head checks dont fix anything. In reality the only way is if they really want the help and just come forward and volunteer themselves. My .02 cents

Response by LCpl Private RallyPoint Member made Jan 5 at 2015 8:26 AM

LCpl Private RallyPoint Member — Mon, 05 Jan 2015 08:26:16 -0500

With so many of us dying by our own hands every year... fuck it. A rope in the water's a rope, even if it might not be attached to anything. Hopefully it helps.

Response by CW3 Private RallyPoint Member made Jan 5 at 2015 12:57 PM

CW3 Private RallyPoint Member — Mon, 05 Jan 2015 12:57:23 -0500

I just want to know who's expected to pay for the mental health services for Reservists? Too many requirements require us to pay for things the active duty get for free (to the individual soldier)

Response by PV2 Violet Case made Jan 22 at 2015 1:15 AM

PV2 Violet Case — Thu, 22 Jan 2015 01:15:30 -0500

I'm not for sure if this is the right place for this I tried to ask a question and it brought me to this page. While I was being evaluated after leaving the military the VA was asked me to take a test of over 300 questions. Some of the questions were the same just asked differently.
First example: one question said if you were in a store would you be in a hurry to get what you wanted and leave? I said yes. Then the question if you were shopping would you be patient and wait and visit with people in line. I said yes again.
Ok another example : if you were packed and going on a vacation would you be excited and ready to take off in the morning? I said yes. This same question when waking up and knowing you were going on a trip would you be in a hurry and out the door. I said no.
'Ok the doctor told me I had a personality disorder. I said what??? He said to me you can't answer no to one and yes to another or yes to both when it asks the same thing.
I said ok today I went to the store I was in severe pain or I had an appointment I had to get to right away so I would be in a hurry, but on another day I would be shopping not so much pain had no appointments so in no hurry and would be friendly and more patient.
The other question, I was going to go on the trip the weather was good my body feeling pretty good and rested so yes ready to go. But then if I would have woken up to a blizzard and the weather not good and in pain I'm not going to go out and be dumb and drive in a blizzard, how is that a personality disorder? Would you agree with me that many things depend on the circumstances that are happening at the time how you would respond. And can someone please help me understand how I was wrong to think that way? And if the tests they conduct on soldiers for their mental testing would be similar to this how will that help?

Response by Cpl William Domenz made Jan 22 at 2015 10:55 AM

Cpl William Domenz — Thu, 22 Jan 2015 10:55:36 -0500

How can this help when the VA can't even pull the correct teeth out of your head? (I am speaking from experience)
I would love to believe this would help vets from committing suicide or just coping with PTSD and or the transition back into the civilian land. I just can't see this doing anything but putting the individuals they "DEEM" unfit, have a disorder, or whatever the new buzz word is, on some list that will diminish their rights and still not get them any care even if they need it.