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Furloughs to affect Army's behavioral health care

By C. Todd Lopez

WASHINGTON (March 13, 2013) -- Upcoming furloughs for Army civilians, along with budget cuts, will affect the Army's ability to provide behavioral health care to Soldiers, an official said.

More than half of the Army's behavioral health providers are either government civilians or contractors, said Col. Rebecca Porter, the chief of Army behavioral health care, speaking at a Defense Writer's Group breakfast Tuesday.

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"The plan is that our Department of the Army civilians who are employed with us would be impacted across the board," Porter said.

The Army's medical community is about 60 percent civilian, overall, she said. Within the behavioral health specialty, which includes about 4,500 providers, more than half are civilian.

With the Army surgeon general's priorities for medical care during the sequestration being warrior care, primary care, behavioral health and the Integrated Disability Evaluation System, Porter said the Army is looking at possibly exempting some of those Army civilians from furlough.

Another option, she said, is to have Soldier-providers, that is medical providers who are in uniform, backfill where care is most needed.

"In the areas that we anticipate that furloughs or sequestration could have greater impact on the availability of care for Soldiers," she said, the Army is looking at "moving, especially uniformed people, there on a temporary basis to assist."

Due to both Operation Iraqi Freedom and Operation Enduring Freedom, there has been a greater need in the Army for behavioral health providers, Porter said. And the Army has worked to bring those medical professionals on board, despite there being a nationwide shortage in the civilian community as well. With furloughs and sequestration, lack of stability as a behavioral health provider within the Army may draw some of those professionals back to the private sector.

"There is a national shortage of behavioral health providers," Porter said. "We've worked for several years, since 2007, we've more than doubled the number of behavioral health providers that we have in the Army. To see them now looking elsewhere because they don't have the job security that they thought they were going to have, and they don't know how much the organization or the institution supports them in what they are trying to do, it is a morale issue."

She said in behavioral health, when contracts or term positions come up for expiration or renewal, they will go through her office "so we can look, kind of corporately, at what do we have as far as resources in the personnel realm. We value those individuals greatly. Particularly for providers, we are looking to retain them."

Porter said the Army has seen success with embedded behavioral health teams, or EBHT, where behavioral health providers are taken out of the hospitals and instead aligned with specific brigades. The pilot installation for that effort was at Fort Carson, Colo., and she said success with the program has meant an expansion of the program to brigade-sized elements across the Army by the end of fiscal year 2016.

An evaluation of the EBHT program at Fort Carson, she said, has shown "a decrease in incidents of psychiatric hospitalizations, decreased incidents of suicides, of suicide attempts and even things like alcohol-related incidents."

The success of the EBHT program, and cause for its expansion across the force, stems largely from the benefits of creating familiarity between providers and unit commanders.

"Co-locating them with the unit and with the commanders, I think, helps the behavioral health provider be more in tune with what are the needs of the command," Porter said. "But it also, in our experience, makes the commander, and the Soldiers, more trusting of the behavioral health providers."

Early in her career, she said, as a captain she was in a position to make a recommendation to a commander that he not take a Soldier on deployment, due to post-traumatic stress disorder, known as PTSD. She said that commander thanked her for her input, but took the Soldier on deployment anyway. Later, she said, problems surfaced and the commander had to send the Soldier home.

"Today, I think if I made the same recommendation to a commander, I think they would heed a behavioral health professional's input a lot more than they did 16 or 17 years ago," she said. "It's a different environment. Vastly different than it was back then."

Part of the increased trust commanders have in behavioral health providers stems from increased awareness of issues like PTSD, Porter said. But she believes that the relationships that can be built through the use of EBHTs will only further commander trust.

The EBHTs are made up of civilian behavioral health providers, she said. Downrange, units have two organic behavioral health providers, and two behavioral health technicians. There are also combat stress control teams that function in a general area and go where commanders think additional help is needed.

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