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

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'Horrific outburst of violence'

An Army psychiatrist allegedly opened fire Thursday in a crowded medical building at Fort Hood, Tex., killing at least 13 people and wounding others.

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Pentagon press secretary Geoff Morrell said the administration "is actively looking for the appropriate people to man the health-affairs staff," but that health care for soldiers is not suffering in the meantime because the interim staff is competent and the military services "have been doing a heck of a job."

"Are they perfect? Absolutely not . . . but we are offering more for soldiers than ever before." He said many soldiers simply do not understand all that is available to them. "There is clearly a disconnect between all we now do and people availing themselves of it."

Some 34,000 soldiers have been diagnosed with post-traumatic stress disorder since 2003, according to the Army surgeon general's office. In the wake of the Walter Reed scandal, soldiers receive increased health screening once they deploy, once they return and months after they are back home, according to a surgeon general's office fact sheet. In 2006, the Army also began a more intensive training program, which it says helps mitigate combat-related mental-health problems. On average, 200 behavioral-health personnel are deployed in Iraq and 30 in Afghanistan.

The military has also hired 250 additional behavioral-health providers and more than 40 marriage and family therapists in recent months. The Army currently has 408 psychiatrists for its force of 545,000 people.

At Walter Reed, the Army has added six psychiatrists, seven psychologists, 11 social workers and eight clinical nurse specialists since 2007 for a total of 124 mental-health providers, an increase of 35 percent, according to figures provided by Walter Reed.

Sixty-five psychiatric residents are also included -- one of whom was Hasan.

Since the shooting, officials have been looking for warning signs in Hasan's career that could have tipped them off to his potential to carry out the attack. Some of his Walter Reed colleagues said patients complained that Hasan seemed uncomfortable talking about soldiers' emotional needs and was himself a loner. He was also not very productive but was gentle in nature and showed no signs of potential for violence, they said.

A former Walter Reed social worker, Joe Wilson, said problems in the mental-health department were usually not discussed openly. "Of course you miss the red flags, you can't talk openly about mental health," Wilson said. "You complain about it to each other, but not to anyone else." The opinion was shared by another mental-health worker who asked not to be named.

Switching a soldier who is unhappy with his psychiatrist to another doctor can backfire and delay the medical board process that determines whether the soldier remains in the service. "It's a complete disincentive to complain" about any particular health-care provider, Wilson said.

At Walter Reed, some soldiers and health-care professionals complain that there are not enough mental-health providers, and senior Army officials have acknowledged that finding enough people to work with the military is a persistent problem. They say patients diagnosed with PTSD and other war-related emotional problems are far too likely to be treated with sleeping aids and mood-altering medications. Many still go without regular one-on-one therapy or meaningful group sessions.

The wife of an amputee soldier recovering at Walter Reed with traumatic brain injury and PTSD said that mental-health services are so uncoordinated and ineffective that the couple decided to pay for private psychotherapy sessions with a civilian provider at $130 an hour.

The couple sought private treatment elsewhere after spending a few minutes with a Walter Reed psychiatrist, who then referred the soldier to a social worker for treatment.