PTSD Brain Scans Fall Short for Diagnosis

PTSD Brain Scans Fall Short for Diagnosis

What Do Brain Scans Tell Us About PTSD?

Although researchers do not use brain scans to diagnose PTSD in the clinic, they use them to understand what happens in the PTSD brain.

There is abundant evidence for changes in the structure and function of different areas of brain involved in fear response and anxiety, regulation of emotions, cognitive processing and memory.

For example, there is consistent evidence for reduced volume in the brain region called the hippocampus, which is involved in memory and context processing. This leads to difficulties differentiating cues that resemble trauma, such as the slamming of a door, from the trauma cue itself, such as a gunshot.

What are brain scans?

A brain scan is a general term that covers a diverse group of methods for imaging the brain. In psychiatric clinical practice, brain scans are mostly used to rule out visible brain lesions that may be causing psychiatric symptoms.

However, in research we use them to learn about the pathologies of the brain in mental illness. A common method is magnetic resonance imaging (MRI) that allows us to look at the changes in the volume and structure of different areas of the brain, and integrity of the pathways connecting them.

Then there is functional MRI (fMRI). This method examines blood flow in different areas of the brain as a measure of their dynamic function, mostly in response to a task or event, such as thinking about trauma or viewing of a trauma-related image. I use fMRI in my research to look at the brain circuitry involved in how people can be instructed to learn fear and safety. Positron emission tomography, or PET, and single photon emission CT, or SPECT, are also used in looking at brain function.

At the current stage of the technology and research, psychiatrists, psychologists and neuroscientists only use these methods for researching the brain changes in mental illness, and not for making diagnoses.

In other words, researchers have to combine data from tens of people with a mental illness to determine how, on average, different areas of their brain may differ in volume or function from others. 

 

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How do we diagnose PTSD?

Like most other psychiatric conditions, PTSD is a clinical diagnosis. That means psychiatrists diagnose PTSD by the symptoms presented by the patient. Clinicians look for a constellation of symptoms for a diagnosis:

    • history of exposure to trauma
    • intrusive symptoms such as frequent flashbacks, nightmares, intrusive memories
    • avoiding any reminder of trauma (for example, a veteran avoiding watching the movie “Saving Private Ryan”) and its memories
    • hyperarousal, or being overly vigilant, having sleep disturbances, being easily startled negative thoughts or feelings
      significant distress or dysfunction.

When enough number of the above criteria is met, a clinician makes a diagnosis of PTSD.

Clinicians and researchers use the above criteria for consistency in research. They want to be sure that what they call PTSD across different studies passes the threshold of a certain severity and diversity of symptoms.

However, effects of trauma may not reach the “diagnostic threshold” forPTSD, but can still be very stressing. A traumatized person who has frequent nightmares and flashbacks and avoids leaving their house out of fear, is seriously stressed even though they may not meet the required number of “negative symptoms” per the diagnostic manual. From a clinical perspective, we still address their symptoms and treat them. In other words, what matters in clinical practice is helping with the symptoms that are distressing and cause dysfunction.

Population of U.S. Suffering PTSD

PTSD is common, affecting 8% of the U.S. population, up to 30% of the combat exposed veterans, and 30%-80% of refugees and victims of torture.

This Once a Soldier blog/advocacy post was reprinted in part with permission from and can be found here. 

VA Needs Greater Accountability for Parking Lot Suicides

VA Needs Greater Accountability for Parking Lot Suicides

Motivation Behind Back-to-Back Georgia Suicides Falls at the feet of the VA. This is unacceptable period.

The practice of veterans committing suicide reached what was thought to be a high point last year when a Georgia veteran lit himself on fire in front of the Georgia Capital building. 

The crisis reached a new high over this past weekend in two separate Georgia Veterans Administration facilities where Veterans killed themselves in a final act of heroism. With their last breath, they are hoping to send this message that I carry for them: HELP THEM AND HELP THEIR FAMILIES NOW.

Mr. Barbush offered a multi-dimensional approach to the crisis. One that will cover the funeral expenses and one that will make the latest Ketamine therapy free for those who qualify. 

“The families can’t wait for a political solution, even one that allows them to access private health care. That new law is better than the status quo, but it will still prove flawed for this kind of crisis. Anyone using private health care knows that calling that the solution is like calling an aspirin a cure of cancer.”

In 2013, the Veterans Affairs Department disclosed that two of its officials had retired, three had been reprimanded and others were facing unspecified “actions” after reports of rampant mismanagement and patient deaths at the Atlanta VA Medical Center in Decatur. Federal inspectors issued scathing audits that linked mismanagement to the deaths of three veterans there. The Atlanta hospital drew attention again the following year after the murder-suicide of Marine veteran Kisha Holmes. She killed her three children and then herself at the family’s Cobb County apartment. VA officials knew she was in distress and had identified her as a suicide risk.

This story broke on April 08, 2019 by Jeremy Redmon of the Atlanta Journal-Constitution. You can find the original article here, or read on as we have it below: 

Two Deaths in Two Georgia Veterans Administration Parking Lots

The first death happened Friday in a parking lot at the Carl Vinson VA Medical Center in Dublin, according to U.S. Sen. Johnny Isakson’s office. The second occurred Saturday outside the main entrance to the Atlanta VA Medical Center in Decatur on Clairmont Road. The VA declined to identify the victims or describe the circumstances of their deaths, citing privacy concerns.An email the VA sent the Georgia Department of Veterans Service Monday about the Atlanta incident said VA clinical staff provided immediate aid to the male victim and called 911. The veteran was taken to Grady Memorial Hospital where he was pronounced dead.“This incident remains under investigation and we are working with the local investigating authorities,” the email continued. “The family has been contacted and offered support.”The victim in Atlanta was 68 years old and shot himself, according to a person familiar with the investigation who was not authorized to speak publicly about the matter.

In 2013, the VA disclosed that two of its officials had retired, three had been reprimanded and others were facing unspecified “actions” after reports of rampant mismanagement and patient deaths at the VA hospital in Decatur. Federal inspectors issued scathing audits that linked mismanagement to the deaths of three veterans there.In one case, a man who was trying to see a VA psychiatrist who was unavailable was told by hospital workers to take public transportation to an emergency room. He never did and died by suicide the next day. Another man died of an apparent drug overdose after providers failed to connect him with a psychiatrist. And a third patient died of an overdose of drugs given to him by another patient. The death of a fourth veteran, who killed himself in a hospital bathroom, later came to light.

In 2014, the Atlanta center drew attention again after the murder-suicide of Marine veteran Kisha Holmes. She killed her three children and then herself at the family’s Cobb County apartment. VA officials knew she was in distress and had identified her as a suicide risk.

And in November, the Government Accountability Office released a report saying the Veterans Health Administration had spent only $57,000 of the $6.2 million budgeted for fiscal year 2018 for suicide prevention media outreach because of leadership turnover and reorganization within the agency.“ By not assigning key leadership responsibilities and clear lines of reporting, VHA’s ability to oversee the suicide prevention media outreach activities was hindered and these outreach activities decreased,” the report said.

The VA said Monday it was reviewing its policies and procedures to see if changes are needed, adding all of its facilities provide “same-day urgent primary and mental health care services.” The agency also highlighted its Veterans Crisis Line at 1-800-273-8255 and www.veteranscrisisline.net“Suicide prevention is VA’s highest clinical priority,” the VA said in a prepared statement.

“We are working alongside dozens of partners, including [the Department of Defense], to deploy suicide prevention programming that supports all current and former service members — even those who do not come to VA for care.” Isakson, chairman of the Senate Veterans’ Affairs Committee, released a statement Monday, saying he was in touch with the VA about its investigations of last weekend’s suicides, calling them “tragedies that we hear about far too often.”

“While we have taken a number of steps to address and prevent veteran suicide, this weekend’s tragic deaths clearly indicate that we must do better,” he said. “We will redouble our efforts on behalf of our veterans and their loved ones, including our efforts to reduce the stigma of seeking treatment for mental health issues.”

Mike Roby, commissioner of the Georgia Department of Veterans Service, said he also is keeping in touch with the VA about what happened.“ I and my senior staff will stay in close contact with both medical directors and their staff as they work with the federal authorities through the investigations,” he said by email. “Our field service officers located at both medical centers remain ready to assist and support veterans and their families.”

ABOUT ONCE A SOLDIER

We are on a mission to offer financial aid to the families of veteran suicide. We have our Silver Lining Project and our Silver Lining Memorials. Both are designed to help the veteran families get back on their feet. If you care like we do, give here. 

 

Vietnam Veterans Association 1046 Meets Once a Soldier

Vietnam Veterans Association 1046 Meets Once a Soldier

Vietnam Veterans Association 1046 Hosts Soldier Suicide Discussion

VVA Also Awarded Two Scholarships That Night

 

Jacksonville’s Vietnam Veterans Association 1046 latest meeting saw two very different events taking place. Their Board and Membership awards two $1,000. scholarships to two local Jacksonville high school students heading into college.

Sara Landmark, from Fletcher High School and Kaely Garcia from Mandarin High School were presented checks by the VVA 1046 as presided over by their President Anthony (Tony) D’Aleo.

 

 

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Dave Barbush, CEO of Once a Soldier, Updated Members on Veteran Suicide

With some Veterans in attendance who were personally touched by veteran suicide in their lives.

“As always, it was a humbling experience to speak in front of a group like VVA #1046. And as always, I get more than I give by listening to their stories and understanding more about the life of a Veteran and their families.” said Mr. Barbush.

 

More on the VVA #1046 Scholarship Program

These ladies were chosen from applications sent to our committee of which Albert Long is the chairman. The senior student must complete the application form and return it to me at the VVA #1046.

According to Mr. Long, “Upon receiving the application, I will screen the application to see that all information is there and I will certify that they are eligible. I will then take all applications to my committee, and we decide on a winner.”

“I must admit this is the hardest part of the job, as we have always received great applicants.”

“As to how we attract applicants, we make known that we will allow relatives of veterans to apply. This is basically by word of mouth. The second solution we employ is to contact the leader of the JROTC of Duval County. He then sends the information to all his various leaders. These leaders then encourage the students to apply.

This my sixth year, and we have found great applicants for our scholarships. We have also been able to increase these scholarships over the years. We started with one $500.00 and now we have given two $1000.”

ABOUT ONCE A SOLDIER

Our Veterans are killing themselves in record numbers mostly due to PTSD. An overmatched VA can’t take care of them or their families. We will.

Soldier suicide leaves Veteran families with thousands of dollars of bills unpaid, mostly bank loans.

We are the only nonprofit standing with the families after a veteran suicide. Stand with us.

Our Mission: Become the preferred channel for donors, advocates and volunteers who care about veteran families left behind after a soldier suicide.

 

Soldier Suicide

ABOUT ONCE A SOLDIER

Our Veterans are killing themselves in record numbers mostly due to PTSD. An overmatched VA can’t take care of them or their families. We will.

Soldier suicide leaves Veteran families with thousands of dollars of bills unpaid, mostly bank loans.

We are the only nonprofit standing with the families after a veteran suicide. Stand with us.

Our Mission: Become the preferred channel for donors, advocates and volunteers who care about veteran families left behind after a soldier suicide.

 

Cellphone Jamming Legislation Needed

Cellphone Jamming Legislation Needed

Convicts Harassing Veterans Via Cellphone Leads to the Soldier Suicide of Our Board Member’s Son

Cellphone Jamming Looks to End This Deadly Blackmail Scheme

 

Jared Johns was once a twin brother, once a father, once a great son, and once a soldier. PTSD took his life this past 9/11. He left a message saying it would be best for everyone involved. But that wasn’t the end of his story.

A few months after his memorial service, information came to light that Jarod was the victim of a sexploitation scheme run from inside a South Carolina prison. Inmates got possession of veteran cell phone numbers and began a devious plot to blackmail them from behind bars. 

One victim was the son of our February gift family, the Johns. Kevin is now on our Board and we support him in his efforts to get #justiceforjard.

 

Kevin Johns is Fighting to End This Crime for His Son and Others 

 

From Mr. Johns’ letter to Lindsey Graham posted on his Facebook page:

Mr. Graham, we are writing you in support of your joint legislation, with Sen. Tom Cotton, on cellphone jamming in state prisons. Our son Jared R. Johns, an army veteran, was a victim of a sex-tortion scheme carried out by prisoners in Lee correctional institution in Lee county, SC.

Jarod received several phone calls, from different numbers, trying to extort money from him. He was bullied into taking his own life on September 11th 2018, out of fear, because they had convinced him he received an illicit picture from a 17 year old girl.

Greenville city police, along with the Army criminal investigation division are currently working a case against the prisoners responsible for trying to extort, not only my son, but hundreds, if not thousands, of veterans and active duty soldiers.

My family and I have been very vocal about the atrocities carried out by inmates with cellphones from inside our state prisons. We now live in fear of retaliation from the same criminals that nearly killed Robert Johnson, a former South Carolina corrections officer in a hit orchestrated by an inmate using an illegal phone. These prisoners have got to be stopped. The South Carolina corrections department has spent more than $8 million installing golf course-like netting around 8 high security prisons after gangs fought over cellphones in April 2018 and left 7 inmates dead.

Our son was killed several months after these nets were installed and contraband sweeps were made. These phones are being brought in by visitors, correction officers and prison workers. The only way to truly stop the use of cellphones in prisons, is to make them inoperable. We thank you for proposing this bill and look forward in its passing.

Signed,

Kevin Johns and Kathy Payne Bowling, the parents of Spc. Jared Johns

What You Can Do

Please help our family by contacting your US Congressman and Senators and tell them you want #justiceforjared by them supporting The Cellphone Jamming Reform Act.

Lindsey Graham
Washington Office
290 Russell Senate Office Building, Washington, DC 20510
(202) 224-5972
https://www.lgraham.senate.gov/public/index.cfm…

Tim Scott
Washington Office
167 Russell Senate Office Building, Washington, DC 20510
(202) 224-6121
https://www.scott.senate.gov/contact/email-me

Jeff Duncan
Washington Office
116 Cannon HOB, Washington, DC 20515
(202) 225-5301
https://jeffduncan.house.gov/contact-me/email-me

William Timmons
Washington Office
313 Cannon HOB, Washington, DC 20515
(202) 225-6030
https://timmons.house.gov/contact/email-me

ABOUT ONCE A SOLDIER

Our Veterans are killing themselves in record numbers mostly due to PTSD. An overmatched VA can’t take care of them or their families. We will.

Soldier suicide leaves Veteran families with thousands of dollars of bills unpaid, mostly bank loans.

We are the only nonprofit standing with the families after a veteran suicide. Stand with us.

Our Mission: Become the preferred channel for donors, advocates and volunteers who care about veteran families left behind after a soldier suicide.

 

Stopping Soldier Suicide the Navy Way

Stopping Soldier Suicide the Navy Way

The following content is all property of the US Navy as posted on their Reddit.com subreddit. It is so useful that I’ve copied the entire page and reproduced it here in an effort to get it in front of more readers.

PLEASE GO GET HELP.

THE NAVY, AND ALL OF YOUR SHIPMATES, WANT YOU TO BE THE BEST POSSIBLE FUNCTIONING YOU. THE NAVY WILL DO EVERYTHING IN THEIR POWER TO GET YOU TO 100%.

GOING TO TALK TO MENTAL HEALTH DOES NOT MEAN YOU’LL BE KICKED OUT OF THE NAVY.

Please. Go get help!

Chief Khan’s message to you about getting help!

Myths and Facts About Mental Health

MYTH: Admitting you have considered suicide or seeking help for medical attention will ruin your career.

FACT: This is the most untrue statement ever. PRC(AW/IDW/EXW) Jeromy Kelsey is a great example of how you can progress after mental health treatment. Watch his interview here (trigger warning: he speaks of traumatic sexual abuse in his early life). If you commit suicide, your career is absolutely over—because you won’t be around to have a career. If you go get help, you can go on to have a fantastic career. Please don’t end your life, and your career, to suicide.

MYTH: Talking to a mental health professional will automatically get back to your chain of command.

FACT: If you are just going in to talk to mental health for a routine mental health visit, your chain of command is only required to know that you have a medical appointment. HIPAA and Privacy Act still applies. All your command gets to know is you have an appointment and if you’re fit for full duty.

DODI 6490.8 directs that providers shall only notify the line commander when one of the following conditions is met

  1. Harm to self–serious risk of self-harm as a result of the condition or medical treatment of the condition
  2. Harm to others–serious risk of self-harm as a result of the condition or medical treatment of the condition
  3. Harm to mission–Serious risk of harm to a specific military operational mission such as risks that impact judgment
  4. Special personnel–service member is in the PRP or in some other position that has been pre-identified as having mission responsibilities
  5. Admitted to or discharged from any In-Patient Care
  6. Acute Medication Conditions that will interfere with duty (medicine that might make it unsuitable for you to stand an armed watch or operate heavy machinery)
  7. Admitted to or discharged from any Substance Abuse Treatment Program
  8. Command-directed mental health evaluation
  9. Other special circumstances–this is determined by a health care provider and CO at the O6 and above level.

DODI 6490.8 further clarifies that ”’only the minimally necessary information may be disclosed”’:

  1. Diagnosis
  2. Any recommended duty restrictions
  3. Treatment plan
  4. How the command is expected to support the service member’s treatment

MYTH: Mental health complications can get your security clearance revoked.

FACTNot usually, but in rare cases. If you are diagnosed with a mental health disorder that can’t be treated and/or you are diagnosed with a mental health disorder and refuse treatment (you stop taking prescribed medication for example), this puts you at great risk of losing your clearance. An example of this is if you are diagnosed with Alcohol Use Disorder and refuse to follow the treatment plan—that could put you at risk of losing your clearance.

‘Executive Order 12968, dated August 4, 1995, states that “no negative inference concerning eligibility for access to classified information may be made solely on the basis of mental health counseling.” …When self-initiated, treatment is often a favorable indication that the subject recognizes the problem and is taking care of it….When investigative results are reviewed to make a security clearance decision, the fact that the individual voluntarily sought professional help is a significant positive factor in the decision.”

Less than 1% of security clearances are revoked due to mental health reasons.

DONCAF’s manual for adjudicating security clearances.

MYTH: I will not be allowed to stand armed watches.

FACT: Sometimes. This is almost always when the medication you’re on could potentially put you or others at risk. However, this is a temporary situation until your treatment plan is finalized and you make a recovery. According to the OPNAVINST 3591.1F, Chapter 6: Disqualifications: Psychiatric Illnesses, once your treatment is finished (or in the cases where you might be taking medication for a long period of time, once your treatment is stabilized), or once you get a doctor’s recommendation, you’ll be allowed to stand all the armed watches you want.

MYTH: People go to mental health to get out of work or because they’re weak.

FACT: Only the strongest people recognize they need help and go get it.

“I’m feeling depressed, now what?” A heartfelt letter to you from a seasoned Corpsman

“What if I’m feeling depressed?” by HM1(FMF) u/DocMichaels

OK. My Name is HM1(FMF) Michaels. I am a Surface Force Independent Duty Corpsman. I have been in, as of April 2017 for almost 15 years, four combat deployments: one to OIF, two to OEF, and I was the senior medical asset/provider on the ground when we evacuated the US Embassy in Tripoli, Libya in 2014. I have dealt with primary care mental health and behavioral health issues for a number of years, but by no means am I a specialist. I can not diagnose you via r/Navy, and I will not.

The first, and most important thing is you recognize that something isn’t right.

You’re reading this because you’re feeling depressed, down, frustrated, or chronically unhappy, and you’re unsure of what the next, or even best option is. This information essay, in part, is to help you make the best choice(s) for you, so that you can either:

A) Return to full duty

B) Get the in-depth care you need

C) Out-process from the Navy.

Please realize, those choices aren’t mutually exclusive, and you might have “some from column A and some from column B”, so to speak.

I AM ASHORE, THE FEELINGS OR THOUGHTS ARE TELLING ME TO HURT MYSELF OR SOMEONE ELSE, OR I JUST DID.

OK. Stop what you are doing, reading this, go to tell your nearest supervisor that you need to go to the ER. Right NOW. Suicidal or Homicidal Ideation (thoughts) or actions are considered an EMERGENCY. Go to the nearest ER, even if it isn’t an MTF. If you are off duty please let someone in the chain of command know you are going to an ER for accountability reasons. Your chain should be afford you the opportunity to tell them, if you so desire, why you are going to an ER.

I AM ASHORE, I HAVE BEEN FEELING DOWN OR DEPRESSED FOR EITHER A SHORT OR A LONG PERIOD OF TIME, WHAT SHOULD I DO?

This is the meat and potatoes of this piece: What options are available to you.

  • Chaplain

These folks are great if you need an ear to listen. They will not judge you for anything you tell them, and the best part is: ABSOLUTELY CONFIDENTIAL. 100%. They cannot, and will not tell anyone in your command what you tell them, no matter what. If you tell them you want to hurt yourself or other people, they can walk with you to medical to get more acute, definitive help. They are not necessarily a requirement to be religious to talk to them, and even if you are X denomination and they are Y, the Chaplain Corps is trained to be very accepting of all faiths and creeds.

The downside to Chaplains being,..well Chaplains, is that you may have something deeper than what discussion can handle. This is where specialist consultation comes in and we will get to that shortly.

  • Medical (Hey! That’s Me!)

Medical is the primary gate way for a lot of the various issues and concerns that you may have. It is, in my opinion, the best, most direct way to get the care you need. When you come see me, an IDC, or a Medical Officer at your command or clinic, the most important thing is to be honest with us. Don’t fluff stuff up and tell us what you think we want to hear. We will “Contract for Safety”. That can be written or verbal, and basically is you “promising” us that you aren’t in a position to hurt others or yourself. Mainly, you’re not an emergency. If you are, that’s ok! We’ll get you over to the nearest ER.

When we sit and talk, I’m going to ask you a bunch of questions about things that may have recently changed. Are you sleeping any differently? How’s your energy level? Can you concentrate on small tasks? Any feelings of guilt? Things like that. While we’re talking, I’m looking for observable things, too.

As an IDC, certain MTFs limit what I can and cannot prescribe, and that is based, not on the AMALs we work with, but the local MTF’s guidelines. Some IDCs can start you on a low level SSRI(See below), while others can only re-fill a past prescription, and even some can’t touch any of them. Additionally, it might be more than we think we can handle, and we will turn over to the Physician Supervisor. Physician Assistants and

Physicians can prescribe many initial intake level SSRIs, but do not necessarily have the training to regulate all of the minutiae associated with the medications.

If we, at medical feel that the issues you are presenting us with are over our scope of care (again, we’re primary care- a gateway), then we have options for consultation:

  • Behavioral Health Clinic: This is what a lot of the smaller MTFs are transitioning to. BH clinics maintain a Psychiatrist or two, a few psychologists, and a number of counselors and social workers. Psychiatrists are physicians who can prescribe medications for you both primary care, and psychotropic. In a nutshell, they will assess if there is a chemical imbalance or receptor imbalances within your brain that are causing your symptoms. Major mental illnesses like Bipolar Disorder, Schizotypal signs, and OCD are treated by Psychiatrists. Psychologists, on the other hand do not prescribe medications. In broad strokes, they want to help you help yourself. They work on coping mechanisms, interpersonal communication techniques, and other non-medication routes that are available (art therapy, for example).
  • Mental Health Clinics are seen at most hospital MTFs, and have more psychiatrists than BH clinics. These facilities can offer inpatient treatments for short courses, and usually this occurs with significant encounters such as Suicidal Attempt and other severe mental instabilities.
  • Anger Management is a clinic that TriCare offers that helps with what it sounds like. It helps with coping mechanisms and reduction in stressors.
  • SSRI Selective Serotonin Re-Uptake Inhibitors. This is just ONE class of medication that is used to treat depression or other mental illnesses. This medication directly affects the chemistry in the brain in order to help you get back to normal. These medications can have a number of side effects (you hear the lengthy side effects on the commercials all of the time). There is a small window of time where you adjust to the medication levels. This window can make a patient feel worse, or even suicidal, and your prescribing provider should discuss with you what you should do (Follow up with them or Go to ER) if you feel that way. The medication can also present a false sense of rehabilitation. You could be on them for a few weeks and start to feel much better. It is not unheard of for patients to self-discontinue the medications for this reason, and have rebound symptoms by going “cold turkey”.

I AM ON SHORE, BUT DO NOT WANT TO ENGAGE MY UNIT’S MEDICAL DEPARTMENT

Well, ok. That is your prerogative, but not the most engaging one for us and yourself. You have these options in this case:

Military One Source: Offers non-military treatment to you and your family members. It is confidential, and your command will not be notified that you are seeking care with them. They offer psychologists and various types of counselors. The downside is, also, that your command will not be notified. This can affect a slew of other second and third order effect of regular medical care.

TriCare: offers members and family members up to eight covered visits at a network mental health provider. This could be a psychiatrist. If you are prescribed ANY medication, we ask that you let us know what you are taking so that we do not prescribe something to you for another issue that could conflict with any medications you are taking, and create an adverse reaction.

Local Fleet & Family Service Center/ Marine Corps Support Services Centers: also offer numerous counseling for self, family, and marriage needs. These are not medication prescribing entities, and are also not tracked by your unit or medical.

I AM DEPLOYED AND AM HAVING ISSUES

Go to Sick Bay or BAS. If your provider feels that they cannot sustain you until port/re-deployment, then you may need to be seen by a professional mental health practitioner. This could entail going to the Big-Deck or a Role 3 medical facility at the next available time. Do not worry that your team/work center will be upset or hurting. They’ll be more distraught if something happens to you that could have been controlled or fixed!

Big questions often heard

“If I go to medical will if affect my career?” No, and Yes. The big push in recent years is to eliminate the stigma associated with MH/BH care. You cannot, and will not receive direct “punishment” from going and seeking care for YOU. Your job may require certain prerequisites and clearances that psychotropic medications could affect. PRP or the personal reliability program is one of them. TSI/SC in some cases, for certain ratings, could be another. This really shouldn’t be your biggest concerns. You are not your job. If you are hurting, emotionally or mentally, we want to help you. Your well-being should be your biggest interest, not necessarily your career. That can come after you are well.

“Can I be separated for going to Psych?” Also Yes and No. If you can be controlled with or without medication, then normally no. The MANMED Ch 15 details what is NOT allowed for initial service/continued service. Diagnoses such as Schizophrenia are not usually conducive to continued service, whereas major depressive disorder that is controlled by meds WILL allow you to Stay Navy. Suicidal Actions are also not usually conducive to continued service. That doesn’t always mean immediate out-processing, but that you may not be able to re-enlist.

Do I need to tell my chain? Well, it doesn’t hurt to engage with your COC. They shouldn’t be blindsided with a member having to immediately leave, but that can’t always be helped. You don’t have to tell them specifics, but they do need to know that you have appointments scheduled at medical. If they ask “for what?”, you can tell them you are not comfortable saying at that time. Your unit’s Medical should be informed in any event. That way they can brief the CO/XO if something goes squirrely.

The TL:DR is that we are here for you. At Medical we look out for the patient first, the Navy second. We want to ensure you are ok enough to help yourself, do your job, and be an active member of the community. If you have any questions or concerns, please talk to someone or utilize the resources I discussed above. If you have any specific questions, please utilize your Sick Bay, BAS, or local MTF.

Mental Health Resources

Resources if you, or a shipmate, are in a state of crisis.

Suicide Hotline 1 (800) 273-8255

Pros:

  • Free
  • Anonymous
  • Confidential

Cons:

  • Not able to give treatment or medication.
  • One-time conversation: you can call as many times as you need to, but there is no continuity of care so you may have to reexplain yourself if you call a second time and get someone else on the other end of the line.

Can be reached at:

  • 1 (800) 273-8255

Command Chaplain

Pros:

  • According to SECNAVINST 1730.9 everything you say to the Chaplain is absolutely held in confidence. Only you can tell other people what you said to the Chaplain. The Chaplain can’t even be made to testify against you or about what you said, so go ahead and confess to murder if you want.
  • Navy Chaplains, unlike civilian members of various religious groups, do not care about converting you to their religious beliefs. You can be a member of the Church Of The Flying Spaghetti Monster and they will not once try to discuss doctrine or make efforts to convert you. They may ask what you believe, in order to provide you with the best possible service (e.g., if you’re Jewish and talking to a Muslim Chaplain, they may ask if you’d prefer if they go get the Jewish Chaps for you). Talking to Chaps will only be as religious as you want it to be. Think of Chaps as a Professional Best Friend, always ready to listen and understand no matter what your situation is.
  • They’ve heard it all before. It’s very hard to shock a Chaps. Rape, suicide, financial issues, abusive wife, sex addiction, your chief hurt your feelings, you think you’re a failure because you accidentally burned some cookies for the command bake sale, whatever. I promise, Chaps has heard it all before and won’t be scandalized or upset with whatever you need to talk about.

Cons:

  • They cannot offer professional counselling, medication, or treatment.
  • They cannot leave you if they think you’re a danger to yourself or to others–so you may find yourself strongly encouraged to go to medical with them.

Can be reached at:

Fleet and Family Center

Pros:

  • Free
  • Confidential
  • No referral required from your command

Cons:

  • Limited services
  • Not able to prescribe medication

Can be reached at:

Mental Health Counselors on Base

Pros:

  • Medically trained and licensed professionals.
  • Can prescribe medication
  • Will work with you to develop a treatment plan.
  • Fall under BUMED and DODI 6490.08 and HIPAA (Health Insurance Portability and Accountability Act of 1996) laws and are restricted about what they can tell your command
  • Your command must accommodate their directions. You will usually find that your command will be overly solicitous in trying to help you with your recovery program. Nobody at your command is allowed to form any sort or reprisal against you or hinder you from receiving treatment.

Cons:

  • If they think you’re a danger to yourself or others, they are required by law to intervene. This may mean you find yourself getting treatment that you may not want initially.
  • Sometimes getting an appointment can be difficult. If your immediate situation is not life-threatening, they want you to be referred to them from your Primary Medical Care Provider, Ship’s Independent Duty Corpsman or from the counselors at Fleet and Family.

Additional Note:

  • 99% of sailors who go to mental health and seek treatment are returned to their normal job, with normal clearances.

Military Crisis Hotline

Pros:

  • Free
  • Anonymous
  • Confidential

Cons:

  • Not able to give treatment or medication.
  • One-time conversation: you can call as many times as you need to, but there is no continuity of care so you may have to reexplain yourself if you call a second time and get someone else on the other end of the line.

Can be reached at:

  • Dial: 1-800-273-8255 and press one (if you don’t press one, it will route your call to the National Suicide Hotline instead of a Veteran-Specific call center)
  • text 838255
  • online chat
  • In Europe call 00800 1273 8255 or DSN 118 (may not be toll free for all areas or providers)
  • In Korea call 0808 555 118 or DSN 118
  • In Afghanistan call 00 1 800 273 8255 or DSN 111

More Resources

All The Official Navy Resources on Suicide Prevention

OPNAVINST 1720.4A: The official Navy Suicide Prevention Program instruction.

Everyday ways YOU can promote Suicide Prevention Awareness!

What’s In A Word? How we talk about suicide matters. The words we use carry meaning, and it’s important that we do not glamorize suicide or or use judgmental words.

ASSIST! Applied Suicide Intervention Skills Training – This course equips participants to act as “first responders” to a person at risk of suicide.

SAIL: Sailor Assistance and Intercept for Life is a workshop that will give you skills and tools necessary to intervene and help your shipmates!

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