May 20th, 2008 by Dr. Val Jones in Expert Interviews
Tags: Hospitals, Psychiatry, PTSD, Veterans Affairs
3 Comments »
I met Dr. Harding at a press conference announcing the expansion of the Give an Hour initiative and really enjoyed our candid conversation about the unmet mental health needs of veterans of the war in Iraq and Afghanistan. It is sobering to know that many hundreds of thousands of soldiers are returning to the U.S. with traumatic brain injuries and post traumatic stress disorder. They volunteered to give up their lives for us, will we volunteer to care for them?
An interview with Richard K. Harding, M.D., professor and chair of the Department of Neuropsychiatry and Behavioral Science and an adjunct professor of pediatrics at the University of South Carolina School of Medicine.
Dr. Val: You mentioned that this quote means a lot to you: “One does not escape war by leaving the war zone.” Can you explain what you mean by that?
Dr. Harding: I was referring to my own experience with children rescued from Vietnam and transported to the U.S. Here, 6000 miles away and in a perfectly safe place with lots of support and food, they were still dealing with the trauma of the war zone. And I’ve seen this all along in my career, especially taking care of the National Guard folks in South Carolina. I’ve seen people become depressed and anxious and use substances to try to deal with the recurring thoughts provoked by combat experiences. They have profound changes in how they see the world. These are healthy people who were doing well in their jobs and family life. And then when they come back, they have a considerable amount of anxiety and worry and a loss of optimism about the future. In a way, the war follows them home.
Dr. Val: How do you help your patients to gain maximal recovery?
Dr. Harding: The best treatment begins with an accurate diagnosis and good access to care. There have been some major road blocks in terms of dependents trying to use TRICARE insurance, so access has been limited for family members who need services.
A good diagnostic workup by someone who knows what he’s doing is really important. Military personnel need to see a therapist who has had experience with PTSD [post-traumatic stress disorder] and other combat-related mental health issues.And they also need to get into a good treatment program that is tailored to their needs. Some people need psychotherapy, and others need psychotherapy plus medications. Some may be so severely depressed that they need to be in the hospital temporarily.
Dr. Val: There have been reports of different rates of mental health disorders in different arms of the military. For example, 50 percent of National Guard personnel report mental health issues, whereas only a third of Marines report the same. What’s that about?
Dr. Harding: Well we don’t know why, but I can speculate. If you are a trained military infantry combat soldier, you’ve been through a lot of training. You are camping out in the woods, you’ve been shot at, you’ve been through all kinds of simulations. You also belong to a tight group of individuals with whom you’ve been working for a long time, and your family has support at the military base in which you live.
That’s a lot different than a National Guard outfit composed of citizen soldiers. They’re suddenly asked to come in — not just one or two weeks out of the year — but to deploy to Afghanistan for 15 months. These people are lawyers, doctors and so forth, but they are often put on frontline assignments as soldiers. Unfortunately, they don’t have the same training and experience as the professional soldiers, so they’re more subject to emotional trauma. In addition, their families back home are scattered all over the state and don’t have the same backup and support that a family on a base would have. Spouses are often isolated when their partner is deployed.
Finally, the stigma associated with mental illness makes the military personnel less likely to get help early on because they’re worried that it will limit their opportunity for promotion.
Dr. Val: I heard that the question about mental health treatment was recently removed from the security clearance questionnaire. Is that evidence of the Army’s attempt to embrace and normalize mental health treatment?
Dr. Harding: It’s a very important symbolic victory. There is still a problem with stigma, but the Army is responding to this concern. There’s a tendency to think of mental health issues as a sign of weakness. Tough Army guys aren’t supposed to have emotional problems. They feel that they’re letting down other people if they admit to problems. You’re supposed to be able to pull yourself up by the proverbial “bootstraps.”
Dr. Val: It strikes me as somewhat adaptive, though, to choose that kind of attitude in a combat situation.
Dr. Harding: Yes, it may be. Seventy-five percent of military personnel make it through without mental health problems. They show amazing resiliency when you think about it. I’d like to think that I’d have that kind of resiliency too, but I don’t know. You don’t know until you’re in the situation. When good people try to do tough things, some will inevitably fall into the injury category. What we have to do is get recovery going and the “physical therapy” in the mental sense started as early as possible to help them get back to full capacity.
Dr. Val: What’s the most important message that you’d like to relay to a general public audience about mental health services and veterans returning from Iraq and Afghanistan?
Dr. Harding: Services are available, but you have to ask for them. You have to raise your hand and admit that you have difficulties and need help. It’s also important to do this early on before you leave military service because you won’t necessarily get the same amount of care once you’re back in the workforce.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 20th, 2008 by Dr. Val Jones in Expert Interviews
Tags: News, Psychiatry, PTSD, Veterans Affairs
No Comments »
I had the chance to attend a recent press conference announcing the expansion of a nationwide effort to help U.S. veterans. The American Psychiatric Foundation, the Lilly Foundation, and Give an Hour Foundation joined forces to provide free mental health care for Iraq and Afghanistan war veterans and their families.
This innovative program allows mental health professionals to donate at least one hour a week of their professional time to serve the needs of the military. Collectively, this donated time adds up to a large improvement in access to services beyond the current reach for many of our nation’s heroes.
I am also hoping that the Give an Hour Foundation will join forces with Revolution Health to provide a therapeutic online community for military personnel and families who need support.
An interview with Barbara V. Romberg, Ph.D., founder and president of the Give an Hour Foundation
Dr. Val: Tell me about the Give an Hour initiative. Who came up with the idea, what does it involve, and how is the concept being promoted?
Dr. Romberg: I grew up in the post-Vietnam era and watched my brother’s friends go to war — and they either never came back or they returned as completely different people. So about three years ago, I was watching the Iraq war unfold and I became more and more aware that people were returning home with some very significant mental health issues. I began worrying about whether there were enough mental health services available to meet their needs, and I wondered if we in the mental health community should step up to provide additional services.
The thing that really pushed me to do something about this, as a busy private practitioner, was when I was driving in Bethesda [Md.] with my 9-year-old daughter. We passed a homeless veteran on the street and she said to me, “Mom, how can we?” It was the use of the word “we” that touched me. “How can we let this happen to these men and women who serve our country?”
And I thought, I can’t let her grow up and look to me and say, “Why didn’t your profession do something?” So I said, “OK, I’ve got to do this.” And that was the beginning of the Give an Hour initiative.
The Give an Hour initiative is a national network of mental health professionals — psychiatrists, psychologists, social workers, licensed counselors and therapists — who volunteer an hour of their time per week to serve the needs of the military. Participants are collected in an online database. Military personnel can come to our website at www.giveanhour.org, and enter their ZIP code and the services they seek, and we’ll return a list of providers available in their area. If there is no one listed in the database in the search area, we offer phone support.
Dr. Val: In your opinion, how is the health care system failing Iraq and Afghanistan war veterans who need mental health services?
Dr. Romberg: I’m not sure that it’s failing so much as it’s just being overwhelmed. The Department of Defense and the VA [Veterans Administration] are working really hard, but they’re just overwhelmed. It’s our duty, honor and opportunity to step up as mental health professionals and give back to the military. Regardless of what you think of the war, it’s a wonderful opportunity for our country to heal. The work is also therapeutic for the therapist.
Dr. Val: In terms of access to mental health services, where are the largest shortcomings: 1. Access to psychiatrists? 2. Access to psychologists? 3. Access to affordable therapies? 4. Community support?
Dr. Romberg: Yes. [Laughing.] All of the above. Many of the National Guard and Army Reserves staff return to rural communities after their tours of duty. There often aren’t providers who accept TRICARE [military health care insurance] in rural communities, so access to mental health services is limited. The VA is doing a lot of good work, but there are long waits and not enough therapists for regular ongoing visits. Continuity of care really suffers.
Dr. Val: What’s the most important message that you’d like to relay to a general public audience about mental health services and veterans returning from Iraq and Afghanistan?
Dr. Romberg: These men and women are put in situations that are sometimes horrific and excruciatingly stressful for long periods of time. If you put any of us into those situations, it would affect how we experience ourselves and the world. What we want to do is educate the public so that they understand this and know how to talk to their neighbors and co-workers. When people don’t understand an illness, they can become uncomfortable and fearful that they may say the wrong thing. But by normalizing mental health issues through public education efforts, we can reduce the associated stigma of mental illness.
Military personnel need to be comfortable in accessing services when they need them. For starters, they can visit the Give an Hour website. We’re also affiliated with many other Veterans Affairs associations like the Wounded Warriors program, National Military Family Association, and TAPS. These organizations can offer assistance or put people in touch with us as needed.
*See a continuation of this conference reporting here.*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 28th, 2008 by Dr. Val Jones in Expert Interviews, Health Policy
Tags: Chronic Disease, Finance
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In my quest to bring the best possible health advice to the Revolution Health community I am actively pursuing interviews with credible sources. At the top of the list is America’s #1 doctor, the Surgeon General. I recently had the opportunity to sit down with Vice Admiral Richard H. Carmona, M.D., who served as Surgeon General from August 2002 to August 2006. He addressed a range of health issues facing Americans today. I am posting the interview in segments; the following post is part of that series.
Dr. Val: What is the most important message that Americans need to hear about chronic disease?
Dr. Carmona: The public needs to realize that we are spending more than 16% of our gross national product on healthcare, which amounts to over 2 trillion dollars per year. If you follow the curves out, and don’t do anything to change them, within the next decade we’ll be spending 20% of our GNP, or 4.1 trillion dollars per year. So the legacy we will leave our children in both disease burden and economic burden is unsustainable.
On top of that, 75 cents of every dollar we spend on healthcare is on chronic disease, most of which can at least be mitigated if not prevented. The Partnership to Fight Chronic Disease recognizes this and has put together a coalition of academic and business organizations and advocacy groups to get the word out to the American public that fighting chronic disease is one of the best ways to begin to transform from a “sick-care system” to a “healthcare system.” The PFCD now has 110 partners and growing, because so many people recognize what we recognize – prevention of chronic disease is cost-effective and saves lives.
We need to do everything we can to prevent these chronic diseases, and we hope that more communities, employers, and patient groups will join us. We’re a non-partisan, non-profit organization, and all of us are trying to make the health of the nation better through the most cost-effective preventive strategies. Eliminating chronic disease is one of those main goals.
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The Surgeon General series: see what else Dr. Carmona has to say about…
Cost Savings Associated with Preventive Health
Obesity is America’s #1 Health Concern
Consumer Directed Healthcare and Health Literacy
Complementary and Alternative MedicineThis post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 26th, 2008 by Dr. Val Jones in Expert Interviews
Tags: Consumer Directed Healthcare, News, Technology
2 Comments »
In my quest to bring the best possible health advice to the Revolution Health community I am actively pursuing interviews with credible sources. At the top of the list is America’s #1 doctor, the Surgeon General. I recently had the opportunity to sit down with Vice Admiral Richard H. Carmona, M.D., who served as Surgeon General from August 2002 to August 2006. He addressed a range of health issues facing Americans today. I am posting the interview in segments; the following post is part of that series.
Dr. Val: What role could consumer-directed healthcare initiatives play in helping to reduce healthcare costs associated with chronic disease? Is the government doing enough to support this movement?
Dr. Carmona: I think the consumer-driven initiatives struggle for a number of reasons, and the most important one is that we’re a health illiterate nation. Studies show that about one third of our population doesn’t understand the connection between their lifestyle and their health outcomes. Consumer-driven initiatives are predicated on the assumption that the consumer can understand the issue and take appropriate action to change behavior.
Are we doing enough? No. The government could pour all of its budget into patient education, but if the people don’t receive a message that they can understand and act upon, we’re wasting our time. The real challenge for consumer-directed initiatives is to deliver health literate, culturally competent messages that resonate with diverse populations. If I sent a bunch of posters to certain communities with a picture of the Surgeon General saying, “eat less and exercise more” would that change behaviors in that community? No. What we need to do is partner with community leaders, whether it be a priest or a rabbi or a grandmother or a block neighborhood captain – someone who has credibility in that community and work with them and spend the time necessary to change the culture.
The American public wants the best of everything, they want it yesterday, and they don’t want to pay for it. That pretty much characterizes the problem that we have. We see health as a right, we want somebody to give us a card, and if we want to smoke, that’s our right too. There’s this attitude that if we want to drink excessively, that’s our right, and if we want to ride a motorcycle without a helmet, that’s our right (“you can’t tell us what to do”). However, when I crash my motorcycle and I have a head injury and I’m disabled for life, I also expect society to pay for that.
We have to do a better job of improving health literacy so that American people of all socio-economic strata can understand the consequences of the choices that are deleterious to their health and help them to adopt appropriate behaviors that optimize health and wellness. Health literacy is the currency of success for everything we need to do to improve the health, safety, and security of our nation. It’s part of what we include in every project we do at Canyon Ranch Institute, with all our partners.
Dr. Val: And how do we get the message across to them, then?
Dr. Carmona: Boy, people have written books on that one. I’ve been plagued by this question, Val, ever since I came into the office of Surgeon General. I remember one day sitting down with my staff and taking a look at the previous Surgeon General reports. I thought they made pretty good book ends and looked nice in my office, but I wanted to know what we used them for. One staff member said, “Well sir, these have been developed to define the base of knowledge on a given topic and it helps our peers decide what needs to be done. It has a long bibliography and it’s based on science.”
But then other staff told me, “Really these are written for the public, so they’ll understand the information.”
And I thought to myself “I don’t know that any of the ‘public’ that I grew up with could read this.”
So I started a program to help communicate health messages to the American public. The goal was to develop resonant messages that would result in maximal behavior change over time. My advisors told me that the messages had to be written at a sixth grade level. So what we did with every Surgeon General’s Report and every Surgeon General’s Call to Action and other publication – we published the “Peoples’ Piece” to go along with it. It was full of pictures and written like a comic book to facilitate parent-child dialog about health. We also wrote them with cultural sensitivities in mind. The science behind our recommendations doesn’t change, but you have to send out thousands of messages to resonate with people from different cultures and languages – who are all Americans – in order to change their behaviors. So that’s what makes this so difficult.
Dr. Val: How do you get the ‘Peoples’ Piece’ to the people? Do you use the Internet or new media approaches?
Dr. Carmona: Unfortunately it’s often the case that the people who need the information the most don’t have Internet access. But the Internet can be incredibly powerful. For example, Dr. Francis Collins (the head of the human genome project at NIH) helped me with the U.S. Surgeon General’s Family History Initiative. We put our heads together to help people understand the significance of family health history.
We put it on the Internet and also distributed it to libraries, post offices, community centers, and schools. It helped people to create a family health tree to use as a talking point with their doctors. They could remind their doctors that, for example, their aunt and grandmother had breast cancer and then ask if they should be monitored more closely. Or they could discuss the fact that their uncles and cousins all had heart attacks before age 50. This tool helped people to begin identifying their risks based on a good family history – which busy docs don’t pay enough attention to anymore. When you know your history, genomics becomes valuable. If we can characterize disease, then we can search for potential genetic loci to help explain what’s going on and take a preventive approach to modifying the person’s environment to mitigate risk.
This concept is extraordinarily hard to communicate, but the Family History Initiative helped to make it accessible to people. We released the project at Thanksgiving time – when we knew that families would be together and could discuss their health histories, and it was a resounding success. Within a week or two we had hundreds and thousands of hits, with people asking for more information.
***
The Surgeon General series: see what else Dr. Carmona has to say about…
Cost Savings Associated with Preventive Health
Obesity is America’s #1 Health Concern
Complementary and Alternative Medicine
Preventing Chronic DiseaseThis post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 25th, 2008 by Dr. Val Jones in Expert Interviews
Tags: Cancer, Chronic Disease, Fitness, Food and Nutrition, Parenting, Relationships, Weight Loss
5 Comments »
In my quest to bring the best possible health advice to the Revolution Health community I am actively pursuing interviews with credible sources. At the top of the list is America’s #1 doctor, the Surgeon General. I recently had the opportunity to sit down with Vice Admiral Richard H. Carmona, M.D., who served as Surgeon General from August 2002 to August 2006. He addressed a range of health issues facing Americans today. I am posting the interview in segments; the following post is part of that series.
Dr. Val: Obesity rates continue to rise each year. Does obesity lie at the core of the chronic disease crisis and if so, what can America do to reverse this trend?
Dr. Carmona: Obesity is absolutely at the core of the chronic disease crisis. When we look at the relationship of obesity to other diseases that plague society today (such as asthma, cancer, cardiovascular disease, and diabetes) obesity increases the incidence of each of them, and can even accelerate some of them. Losing weight is not about trying to emulate models in fashion magazines, it’s about being healthy.
If we could only address one major public health issue as a nation, I would focus on the obesity crisis. Weight loss could have the greatest impact in decreasing the chronic disease burden in America.
Dr. Val: So what can we do about obesity?
Dr. Carmona: That question is simple on the surface but incredibly complex when you begin to analyze it carefully. First of all we have to identify the variables that contribute to this problem, because it’s a multi-factorial issue. The socio-economic determinants of heath are inextricable from the health status of individuals and communities. That means that if you’re poor and have less education, you’re going to experience health disparities. You can’t afford to buy healthy food, you don’t live in a neighborhood where you can walk at night and get exercise, and so on. So understanding all the determinants of health to address obesity is important.
Let me describe just one significant variable contributing to the obesity epidemic: the sedentary lifestyles of children. Thirty years ago it was commonly believed that physical education in school was not important, because kids played during all the hours that they are out of school. Parents reasoned: ‘Why should I pay a teacher to have my kids play ball at recess? I’d rather have her teach them math and science.’ So there was a sweeping trend to discontinue physical education at school. Now, however, kids spend too much time on playstations rather than on play grounds – or they watch over 4 hours of TV a day. They’re sedentary at school and at home.
Other variables that influence obesity rates in kids include the accessibility to fast food, the increased rate of single parenthood, and the change in cultural traditions around meal time. For wealthier families, easy access to large volumes of food of every possible kind can create an environment where people overeat.
The solution to the obesity crisis is not “one-size fits all.” The approach to obesity must be tailored to the cultural and socio-economic sensitivities of the sub-population that you’re trying to reach.
Ultimately we need to change behavior – walk a little more, eat a little less, buy some healthy foods. But targeted interventions must be culturally sensitive and socio-economically relevant. For example, the government is funding programs to make healthy foods more accessible to underserved areas, and physical activity programs are being reinstated in schools. But the effects of these programs are not going to be seen for many years because it takes time for the culture to catch up. Also, the approach must be comprehensive. If we were able to get all of our children enrolled in a daily game of baseball (to increase their physical activity), that would not solve the problem of fast food and video games.
There needs to be a community approach, so that no matter where the child turns they’re getting positive reinforcement of healthy behaviors. That’s part of what I’m doing with the national non-profit health organization that I’m president of now – Canyon Ranch Institute.
***
The Surgeon General series: see what else Dr. Carmona has to say about…
Cost Savings Associated with Preventive Health
Consumer Directed Healthcare and Health Literacy
Complementary and Alternative Medicine
Preventing Chronic DiseaseThis post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
