At Walter Reed, a palpable strain on mental-health system

As investigations into the the Nov. 5 massacre at the Fort Hood, Tex. army base ensue, the military community deals with the realities of violence at home and abroad.
By Anne Hull and Dana Priest
Saturday, November 7, 2009

The instructions were simple: Talk about your feelings on the morning after learning that an Army major in Texas was believed to have gunned down 13 people and wounded another 38 at Fort Hood.

But here at Walter Reed Army Medical Center, in a group-therapy session for combat-stressed soldiers in the hospital's outpatient psychiatry unit, frustrations soon boiled over and Pfc. Sophia Taylor was out the door.

"You people don't listen," the Iraqi war vet said, as two clinicians followed her down the hall to the elevators.

"Sophia," one of them said.

Taylor was trembling and wiping tears from her face.

"Stop talking to me," she said. "This ward ain't gonna change until everyone else in the freakin' Army dies. You people don't listen to me. I'm tired of talking."

This scene at Walter Reed on Friday underscores the ongoing tensions, frustrations and problems in the military health-care system for troops returning from Iraq and Afghanistan with psychiatric problems.

More than two years after the nation's political and military leaders pledged to improve mental-health care, their promises have fallen short at military hospitals around the country, according to mental-health professionals, Army officials, and wounded soldiers and their families. Those hospitals include Walter Reed, where the man accused of the Fort Hood shootings, Nidal M. Hasan, spent four years as a psychiatric intern, resident and fellow.

What may have happened to Hasan during those four years is one of the things being investigated. But it isn't only Walter Reed that is under fresh scrutiny: Evidence of an undermanned, overworked health-care system stretches all the way to the Pentagon, where all of the top health-policy positions remain unfilled, leaving a void on an issue long fraught with inefficiencies and entrenched bureaucracies.

The top civilian health position of assistant secretary of defense for health affairs is vacant and is being temporarily filled by Ellen Embrey, a hard-working career administrator who colleagues say lacks the authority of a political appointee to push the military services and the health-care bureaucracy in the right direction.

Three other top positions -- the principal deputy, the deputy for clinical programs and policy, and the chief financial officer post -- are also unfilled.

The vacancies occur as the Army in particular struggles with a soaring suicide rate. In 2009 so far, 117 active-duty Army soldiers were reported to have committed suicide, with 81 of those cases confirmed -- up from 103 suicides a year earlier.

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