29 Oct 2015

US Soldier Secretly Records Therapy Session- Therapists Can Be Heard Berating Him for Suggesting He Has Serious Mental Health Problems. Soldiers With Mental Health Issues Dismissed For 'Misconduct' Rather Than Provide The Treatment They Need.

Staff Sgt. Eric James, an Army sniper who served two tours in Iraq, paused before he walked into a psychiatrist's office at Fort Carson, Colo. It was April 3, 2014. James clicked record on his smartphone, and then tucked the phone and his car keys inside his cap as he walked through the door to the chair by the therapist's desk.
As he sat there sharing his fears and telling the therapist he'd been thinking about suicide — all while secretly recording the entire session — James was inadvertently helping to bring a problem within the Army to light: As it tries to deal with thousands of soldiers who misbehave after returning from Iraq and Afghanistan and then being diagnosed with mental health disorders and traumatic brain injuries, the military sometimes moves to kick them out of the service rather than provide the treatment they need.
The Army tried to dismiss James in 2013, because he had been stopped for drunken driving two years earlier. This despite pledges by Army commanders and a 2009 congressional edict to make sure such misconduct is not the result of mental issues brought home from the wars.
Saying he wanted evidence to protect himself, James made secret recordings of more than 20 hours of sessions with therapists and officers at Fort Carson. In the recordings, counselors can be heard berating him for suggesting he has serious mental health problems. They try to convince him his experiences in Iraq were not too traumatic — and even seem to ignore him when he talks about wanting to commit suicide. 
When Army leaders heard about the recordings, they ordered an investigation. It concluded that James had been mistreated, and two of his therapists were subsequently reprimanded.
But the general who runs the Army's medical system said the investigation also reached another conclusion: The mistreatment of soldiers at Fort Carson was "not systemic."
NPR and Colorado Public Radio also conducted an investigation, based on hours of secret recordings from James, hundreds of pages of confidential documents from Fort Carson, and interviews with dozens of sources both inside and outside the base. And that evidence suggests the Army failed to pursue key evidence in its investigation, ruling out claims of mistreatment from nine other war veterans without ever interviewing or even contacting the men.
And according to figures acquired by NPR and CPR under the Freedom of Information Act, the Army has been pushing out soldiers diagnosed with mental health problems not just at Fort Carson but at bases across the country.
The figures show that since January 2009, the Army has "separated" 22,000 soldiers for "misconduct" after they came back from Iraq and Afghanistan and were diagnosed with mental health problems or TBI. As a result, many of the dismissed soldiers have not received crucial retirement and health care benefits that soldiers receive with an honorable discharge.
The cases of the 10 soldiers we investigated raise a question: Why would commanders kick out soldiers for misconduct, instead of giving them more intensive treatment or a medical retirement on the grounds that they have persistent mental health problems? Sources both inside and outside Fort Carson suggested one possible answer: It takes less time and money to get rid of problem soldiers on the grounds of misconduct.
One of the Army's top officials who oversees mental health, Lt. Col. Chris Ivany, tells NPR and CPR that the Army is not violating the spirit of the 2009 law by dismissing tens of thousands of soldiers for misconduct after they came back from the wars, even though they were diagnosed with TBI or mental health disorders.
For instance, he says the soldiers' "functional impairment was not severe" enough in some cases to affect their judgment. In other cases, the soldiers' disorders might have been serious when they were diagnosed, but their "condition subsequently improved" before they committed misconduct — so they can't blame the war for causing them to misbehave.
And in other cases, Ivany says, soldiers' medical records show they were diagnosed with a mental health disorder — but only because a medical worker wrote it down as "a preliminary best estimate, but on further evaluation, the diagnosis was clarified" and perhaps dropped. All this "clearly shows that there is no systemic attempt" to dismiss soldiers with mental problems on the grounds of misconduct, Ivany says.
Army officials would not discuss any of the current and former soldiers' cases, on the grounds that they're protecting the men's privacy.
James says he never set out to "expose" Fort Carson or embarrass anybody. He says he started recording his meetings with officers and mental health staff to keep an accurate record of the conversations.
James' two tours in Iraq occurred during some of the bloodiest fighting. He watched through his sniper scope as his targets died and he saw his buddies die, too. He suffered a traumatic brain injury when his Humvee flipped upside down, according to Army records.
James' parents say he began to unravel after he returned to Fort Carson in 2009.
"It's pretty hard as a parent to see your kid go the way he did," says his father, Robert James. "He was happy-go-lucky. Now he's depressed, and he's always down and out."
"This isn't the boy, the young man, I raised," says his mother, Beverly Morris. "He is totally a whole different person."
James says after he came home from his last deployment, his life was in shambles.
"I was angry; I was getting in fights. I drank at least 12 beers every night, so I could pass out — that was the only way I could get any sleep. It's like my mom said, she was the person I'd always call, and I would call her, you know, after I'd been drinking so much and it's late at night and I'd tell her, 'Mom, look, I need help. Every day I wish I was dead,' " James says.
Then one night in 2011, local police pulled James over for drunken driving in Colorado Springs. Two years later, officers at Fort Carson told him they were going to "chapter" him out of the Army for misconduct, as a result of that DUI. James says he knew that meant he might never get the retirement pay or health insurance that the Army promised when he enlisted. Getting forced to leave without an honorable discharge could also mean that he could have trouble finding a decent job.
We first reported in 2006 that Fort Carson was kicking out some soldiers who had mental health problems and committed "misconduct," instead of helping them. Less than three years later, Congress passed the law to help stop the practice.
The law does not forbid the Army to dismiss troops with mental disorders who commit misconduct, but a spokesman for one of the key congressional committees that drafted the language says members of Congress "wanted to make sure the military was not putting people out that have service-related medical issues because the services have a responsibility to get them the care they need."
Secret Recordings Lead To Investigation
James' recordings veer from mundane conversations about scheduling appointments to sessions in which James despairs about his life.
In one, James tells a therapist that he feels angry and miserable most of the time. He doesn't trust anybody, and he isolates himself.
"Like, remember I told you I'm like, I feel like I'm coming into a combat zone when I drive on the base," he asks the counselor. And then he starts trying to talk about some of his scariest experiences in Iraq. "In, like, one month, there was over 1,000 IEDs and multiple ambushes." 
Standard therapy textbooks say that counselors can help patients best when they are supportive, build trust and are empathetic. When patients feel safe enough to share their deepest fears, a therapist can then help them understand their problems and start to get better.
The therapist responds, interrupting him: "Yeah, it was a suck fest ... big time. ... But it was not an emotionally crippling experience," she declares. "Because for the last six years, you've been able to get up and come to work. Have you had things that lingered and it affected you? Yes. But you're not emotionally crippled. You're not a in a corner rocking back and forth and drooling."
In another session, James meets with one of the Army's chief psychiatrists at Fort Carson. A few weeks before, James had filled out a survey used to help diagnose PTSD. James ranked many of his symptoms as "5s," the most extreme symptoms, which potentially signals that the person is in crisis. But the Army psychiatrist doesn't try to get James to open up and explain his answers. Instead, the psychiatrist challenges him.
"When I see 'extreme,' you should be in a hospital," the psychiatrist says in a confrontational tone. "People that put that down, all those 5s, most of those people need to be in a hospital to be stabilized."
The psychiatrist suggests that since James is able to report for duty at Fort Carson, he must be exaggerating his symptoms.
"Because right now, you shouldn't be walking around, if that's how bad you're doing," the psychiatrist says gruffly, after scolding James and repeatedly interrupting him.
In yet another session, with another Army psychiatrist at Fort Carson, James sounds like he's close to the breaking point. He cries audibly as he tells the psychiatrist that he wanted to kill himself hours before.
"I can't do it, Sir, I'm ... losing my mind," James says. "Like, last night I just wanted to ... take all my pills and," James pauses, his voice shaking, "couldn't do it sir. This is killing me, physically and mentally."
As James continues sniffling, the psychiatrist changes the topic. He speaks in a soothing voice, but he never asks James what he is feeling about committing suicide.
"I spent almost a week listening to all of Eric James' recordings," says Andrew Pogany, CEO of Uniformed Services Justice and Advocacy Group, a legal services nonprofit that Pogany and a colleague created to help soldiers in trouble. "It painted a picture that was mortifying. And horrifying." 
Pogany used to be a soldier himself at Fort Carson. He fought back against the Army for mistreating him, and won. Pogany and his co-director, Robert Alvarez, sent some of James' recordings to Charles Hoge, a psychiatrist and retired colonel who advises Lt. Gen. Patricia Horoho, the Army's surgeon general.
"What no one fully appreciates is the serious nature of what transpired during clinical encounters with at least two mental health providers at Fort Carson," Hoge warned one of the general's top aides in an internal email. He wrote that some of what he heard "demonstrates unprofessionalism, hostility, and lack of empathy" and "potential for negligence leading to significant potential harm."
Less than one month later, Horoho ordered an investigation of Fort Carson. She announced the results at a press conference in February.
"The investigation concluded that we had two providers that actually showed a lack of dignity and respect to one soldier," Horoho told reporters. In other words, the investigation found that James was the only soldier at Fort Carson who had been mistreated.
"I thought the investigation was a very thorough investigation. I believed it gave the facts and certified that there wasn't a systemic problem," she said. 
Also, according to Horoho, two of the therapists who worked with James had been reprimanded.
Meanwhile, commanders at Fort Carson did a dramatic about-face: Instead of dismissing James from the Army, they sent him for treatment at the National Intrepid Center of Excellence in Bethesda, Md., the nation's top military center for TBI and PTSD. The Army also gave James a medical retirement, with honor and full benefits.
Horoho also ordered staff at Fort Carson to get special training. According to an Army document, mental health employees took a few hours off work to discuss issues such as "dignity and respect during patient encounters." The Army also made it easier for soldiers to appeal if they feel they have been mistreated.
But Horoho stressed the takeaway conclusion two more times at the press conference: "I have not seen anything that's systemic in the way that our behavior health providers treat our patients," she added.
Here's what's curious about Horoho's declarations: Documents show that the Uniformed Services Justice and Advocacy Group told investigators under oath that commanders and mental health staff at Fort Carson have mistreated many soldiers — and thrown many out of the Army for misconduct after they came home from the wars with mental health problems. The advocates told investigators about nine current and former soldiers, in addition to James, who they said were typical cases.
NPR and CPR contacted all of those soldiers. They told us that Horoho's investigators never contacted them.
"Every case has a slightly different flavor, there's slightly different facts to it," says Pogany. "But when you take a step back, it is all the same stuff. If [Army officials] honestly want to fix this problem, they need to understand what's going on here and they need to admit that this is going on across the board."
The Case Of Jason Holmer
Consider the case of Jason Holmer — one of the names on the list that investigators never called. Holmer deployed three times to Afghanistan and Iraq. The Army awarded him the Bronze Star, one of the service's most prestigious medals.
One night, Holmer and his unit were ambushed. A mortar round landed about 10 meters from him "and it lifted us up off the ground," Holmer says.
That was the first possible TBI documented in Holmer's medical records.
The story of what happened after he came home echoes James' transformation. Holmer says his wife told him he was a different person — and they divorced. His medical records show he suffered "major depression" and "feelings of hopelessness" and "high irritability." He had trouble remembering things — a common TBI symptom — and he couldn't sleep.
"I had one doctor saying, 'Oh, you just got some anxiety, here's some sleeping medication and antidepressants. You'll be fine,' " Holmer says.
Instead, Holmer started drinking a lot. Then one night in 2012, police found him sleeping in his blue Dodge Ram pickup truck, parked along the side of the road. They charged him with driving under the influence. And three days later, the Army started the process of dismissing him for misconduct.
Commanders sent Holmer to a therapist at Fort Carson, in line with the 2009 law, to evaluate whether PTSD or TBI might have played a role in causing his behavior. His medical records show he had some classic symptoms.
But soon, Holmer received a curious email written by the therapist. The therapist had not intended Holmer to see it, but she sent her email to an officer who accidentally forwarded it to Holmer.
"At this time, while [Holmer] may have a significant [behavioral health] condition, I'll be able to clear him," the therapist wrote. "I believe it would be in our best interest to assist in expediting the process." In military language, that means it would be in their best interest to kick Holmer out for misconduct.
The therapist signed her email with a smiley face.

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