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Fort Carson sees progress in mental health battle as suicides drop

December 23, 2010

The murder rate for Fort Carson troops is dropping. The suicide rate is too. So is the rate of soldiers locked in the local mental hospital for suicidal or homicidal thoughts.

Army officials say it is because changes made in the last few years are finally taking hold.

And when Army brass come to tour Fort Carson looking for the keys to the success, they often stop in the office of a friendly, young psychologist named Captain Katie Kopp.

Kopp, 29, is the behavioral health officer for the 4th Infantry Division’s 4th Brigade Combat Team — basically a combat shrink. When the brigade spent 12 months in the remote mountains of southeastern Afghanistan in 2009 and 2010, she was there with them, helicoptering through war-torn valleys to tend to soldiers at outposts.

In areas too dangerous for helicopters, she jumped supply convoys that often attracted rifle fire and rocket attacks.

“It gives me street cred with the Joes,” she said recently with a slight laugh. But seriously, she added, spending a year in the those valleys enables her to relate to the men she is now counseling for post-traumatic stress and other psychological wounds.

If a patient mentions he was in a certain company, she said, “I know exactly who the guys killed in that company were. I know the dates of those anniversaries, and I know the people who are probably going to need to talk about those anniversaries.”

Deploying a shrink with a brigade is nothing new. What’s new is that Kopp is still with them. In the past, most psychologists showed up just before the deployment and left days after the brigade got home. They weren’t there to help with the often turbulent months after soldiers return.

Kopp will stay with the brigade until it deploys again, and perhaps longer.

That change, and many like it, are designed to address the problems that kept soldiers who needed help from being identified, and kept soldiers who identified themselves from getting help.

At the start of the Iraq war in 2003, Fort Carson had little recent experience dealing with soldiers returning from combat and few mental health professionals. A third of mental health staff positions were unfilled.

As the war escalated, so did the amount of cases. By 2007, the number of soldiers being treated for post-traumatic stress at Fort Carson had jumped more than 700 percent.

Soldiers waited weeks to see a therapist, often only to be handed a drug prescription.

Soldiers caught for drug and alcohol abuse and sent for treatment usually never got it. At the same time, countless soldiers never were identified as needing help at all.

Many saw post-traumatic stress disorder as a weakness, or worse, a made-up excuse for cowards. Some soldiers were berated or punished by their sergeants for trying to seek help. Countless others simply decided to hide their condition to escape public shaming.

Denial of post-traumatic stress reached well beyond the rank and file. The head of psychiatry at Fort Carson sent a memo in 2007 warning that psychotherapy was not the answer for misbehaving soldiers. They were, he said, “dead wood” and needed to be kicked out of the Army.

In 2008, the head chaplain of Fort Carson told the command that the growing number of soldier suicides was likely caused by witches in Manitou Springs casting spells.

Perhaps worst of all, the people most able to recognize soldiers who were struggling — their immediate commanders — were often no longer around.

Standard Army practices called for almost all leadership in combat brigades to change three to six months after returning from a tour, when mental health problems are most likely to appear. Leaders who could recognize changes in their troops were often no longer around.

The results were tragic. The suicide rate at Fort Carson climbed yearly until by 2008, it was four times the national average. The arrest rate for Carson soldiers increased every year. And a shocking number of soldiers were involved in murders.

Most of the murderers had seen brutal combat. Most had inadequate mental health care. And most came from the unit where Capt. Kopp now works — the 4th Brigade.

The turning point came when Gen. Mark Graham took over command of Fort Carson late in 2007. Graham, who had two sons who died as young Army officers — one from a roadside bomb in Iraq, one from suicide — made mental health a priority.

He publicly and repeatedly said that post-traumatic stress disorder is real and could mow down the mightiest warriors. He lobbied for the head of psychiatry to be replaced with someone more compassionate. The psychiatrist was sent to Iraq. Graham did the same to the head chaplain, who was sent to Germany.

The general then commissioned an in-depth study of murder, suicide and the failings of the behavioral health system at Fort Carson. The 127-page report became the foundation of the changes now taking place at the Army post.

“The top thing, the first step, was elimination of the stigma —making sure everyone knew, no matter who you are, coming forward to get help is a sign of strength, not weakness,” said Graham, who is now stationed at Fort McPherson, Georgia.

Graham found an ally in the 4th Brigade’s then new commander, Col. Randy George. They worked together to put new programs in place to help troops deal with deployments.

“I wanted to make sure we learned from the past. Graham supported me in that,” said George, who took over command of the brigade in 2008 and led the unit in Afghanistan in 2009. He is now a fellow at the Council on Foreign Relations in New York.

Before deploying, George put all his soldiers through new “mental toughness training” that taught relaxation techniques to help troops deal with stress in combat. He increased the number of mental health screenings, surveying troops before they left the war zone, as soon as they came back, and then twice more in the months after they came home.

And George radically altered leadership turnover in the brigade, staggering promotions so not all commanders would leave at once. In some cases he even replaced company commanders — young captains intimately familiar with a group of about 120 troops — halfway through the tour so they would stay with their units longer when they returned to Colorado Springs.

“That might be the single most important intervention Col. George did,” Kopp, the psychologist, said. “Anyone can bring a soldier to me for an evaluation, but one of the critical things to know is how a soldier has changed. With the command in place longer, there are people who can tell me that.”

The staggered replacement of commanders is also the key to breaking the mental health screening code of silence, George said.

Instead of relying only on soldiers to self-report ill effects of combat stress, the brigade devised a system that asks sergeants and other immediate commanders about their soldiers, too.

“If a captain knows one of his guys lost a friend or went through something hard, he can refer him for help,” George said.

The colonel also lobbied for the Army to give him a long-term psychologist like Kopp.

The new system is sometimes better in theory than in practice. Many troops are eager to get their next promotion or assignment after a deployment and get special waivers to leave the unit early. Some soldiers now say they are so bombarded with classes about the dangers of ignoring stress that they tend to tune out.

But at least commanders now recognize the value of keeping units together, supporters say, and they are trying to make improvements — something that rarely happened before.

The improvements reach beyond the 4th Brigade. As programs prove effective, more brigades are adopting them. And Fort Carson has enlarged the behavioral health staff. The drug and alcohol abuse counseling and testing center has grown from a staff of seven in 2007 to a staff of 16 today. By 2012 it is expected to grow to 23.

The budget and staff for behavioral health have more than doubled in the same time period, and Fort Carson is building a 26,000-square-foot behavioral health clinic.

In an effort to make all those new psychologists and psychiatrists more effective, Fort Carson moved them out of the main hospital and into the brigades.

The 4th Brigade now has a plain, brown metal building in the middle of its neighborhood of Fort Carson where 11 therapists are within walking distance of the unit’s 3,900 troops.

“This way guys have to spend minimal time away from their units,” Kopp said. “And I can coordinate easily with commanders. If I know there is a big training for three days next week, I will make sure to schedule appointments around it.”

Since the 4th Brigade came home this spring, the Army has been tracking it and comparing it with a similar brigade at Fort Carson to see if the changes are effective. Carson officials won’t say which brigade is the comparison, but researchers at the Walter Reed Army Institute of Research say it is the 3rd Brigade, 4th Infantry Division, which spent 15 months in Iraq in 2007 and 2009.

The 4th Brigade had a higher number of casualties — 39 soldiers killed in action, versus 12 in the comparison brigade. The intense combat would seem to suggest more suicides and violent crimes. But that is not what the brigade is seeing.

The 4th Brigade had 50 percent more soldiers who screened positive for some kind of behavioral health issue, Fort Carson said, but 60 percent fewer soldiers who were treated in the local psychiatric hospital, Cedar Springs Hospital, for having suicidal or homicidal thoughts. That suggests more soldiers got help early, so fewer reached the point of desperation.

Similarly, 50 percent fewer soldiers in the 4th Brigade were involved in what the Army calls “high risk incidents,” which can include a fatal drunken driving accident or a violent crime, such as assault or attempted murder.

Most striking, the murder rate among soldiers in the brigade has dropped. In the six months after the unit’s 2007 deployment, five soldiers were arrested for murder. Since the brigade returned from Afghanistan this spring, one has.

“I am not one to throw up the mission accomplished banner,” Gen. David Perkins,  Fort Carson commander, told a group of mental health workers in Colorado Springs this fall. “All it takes is one bad weekend to change everything, but we’re on the right track.”

Crime and suicide rates at Fort Carson can rise and fall depending on how many troops are here versus overseas, but that has been true since at least 2003, and rates had been steadily climbing each year. The fact that rates are now falling is significant, Perkins said.

The Army is taking notice. The commander of the hospital at Fort Bliss, Texas, and the Army’s Deputy Surgeon General have toured in the last few months to learn what they might apply elsewhere in the force.

Col. James Mingus took over command of the 4th Brigade this summer. He said the toughest challenges may lie ahead.

Six months after soldiers return from Afghanistan, the euphoria of coming home has worn off, he said. Money soldiers saved overseas is generally spent, and problems with family have had time to grow raw.

“The honeymoon is over,” he said. “This is when we typically see an upward trend in problems, but we are still doing very well.”

He has a monthly meeting with behavioral health providers, chaplains and military police to assess the “risk level” of the brigade.

He said the trends could reverse without warning, but “we are way ahead of where I thought we would be.”

Across Fort Carson, signs of progress are more mixed. Suicides are down more than 43 percent compared with the 2009 figure, according to the Army.

But the arrest rate of soldiers in El Paso County has crept up every year since the start of the Iraq war, from 34 per 1,000 in 2009 to 36 per 1,000 in 2010, according to data from the El Paso County Sheriff’s Office.

2010 is on track to be a record year for arrests.

Kopp, the psychologist, said she will know all the programs, extra screenings and increases in staff are having an effect when the soldiers she’s seeing now no longer need to come see her.

“That is what most of these guys want. They want to go back to their unit. The big motivator for them is to get better so they can deploy again,” she said.

That creates a challenge new in itself, she added. One unique to a long war in which troops often go back for multiple tours of duty.

“You might be treating someone with PTSD knowing that they could be traumatized again,” Kopp said. “That is different than working with any other population. If I was treating a rape survivor with PTSD, for example, I wouldn’t intend to prepare them to get raped again. So it is definitely a challenge.”


Contact the writer: 636-0223

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