December 11, 2009
In the campaign to help soldiers find normalcy after returning from combat, Fort Carson is preparing for the toughest battle yet — the return this spring of the 4th Infantry’s 4th Brigade Combat Team.
Since 2005, Colorado Springs has seen a rash of crimes by returning troops. Fifteen soldiers from the post have been arrested in at least 12 murders since 2005. The majority of the arrests came from the 3,500 soldiers of the war-weary 4th Brigade, known as the 4-4, now in Afghanistan.
Correctly identifying which returning soldiers need help and giving them effective health care are crucial if the community is going to avoid another bout of violence, military and civilian leaders said.
U.S. Sen. Mark Udall, D-Colo., called caring for veterans “a matter of life and death for our service members — and civilians.”
Fort Carson officials say they are ready.
“When the 4-4 returns, we’ll do everything we can to not have the same experience,” said Col. James Pasquarette, Fort Carson’s deputy commanding general for support. “The first step in that process is realizing there is an issue. We’ve done that.”
Fort Carson released a report in July, called the EPICON study, that, for the first time, officially linked soldiers’ crimes to combat experience, substance abuse and gaps in health care.
Since then, military and civilian groups have made progress toward providing better care, officials said.
Fort Carson has overhauled how it identifies soldiers who need help, created preventive classes to bolster troops’ resiliency and added hospital staff to treat them.
Just as important, the command has tried to demolish the long-standing stigma against mental illness that kept soldiers from seeking help.
“Things have changed,” said Capt. Samuel Preston, the 4th Infantry Division psychiatrist. “This is not the Fort Carson of two years ago.”
Perhaps the most striking change is the post’s acknowledgement of the connection between combat, mental-health problems, suicide and crime.
“It used to be tight-lipped,” said Paul Sexton, director of Pikes Peak Behavioral Health Group, which has treated some Fort Carson soldiers. “Now, it is much more out in the open.”
But reversing the trend in violence has proved difficult. Crime and suicide statistics are at, or above, their highest levels — even with the 4th Brigade out of town. And the stigma that often keeps soldiers from seeking help seems to be alive and well.
The Gazette contacted more than a dozen 4th Brigade soldiers in remote outposts in Afghanistan recently via e-mail. While most said they had more chances for treatment and mental-health education, many said post-traumatic stress disorder is a bogus label used by wimps and scam artists.
A specialist in the 3rd Squadron, 61st Cavalry Regiment wrote: “When you get 30 male infantryman all getting shot at by the same bullets and you go to combat stress (counseling), you look weak.”
A sergeant in the 2nd Battalion, 12th Infantry Regiment wrote that PTSD “is an excuse that someone came up with to get money out of the military.”
“We are not where we want to be,” when it comes to the stigma, Pasquarette said. “I think the leadership gets it. Not long ago, we had senior leaders calling PTSD a sign of weakness. I do not ever hear that anymore in public or private. My concern is down at the first line — young sergeants and below who haven’t had the benefit of schooling, education and experience.”
‘Greater care’ required
Since June, the 4th Brigade has been locked in a bloody struggle in vexing mountain terrain, facing bombs, firefights and large-scale assaults. Halfway through a yearlong tour, 25 soldiers have been killed.
“We’ve learned a lot,” said Lt. Col. Nicholas Piantanida, deputy commander for clinical services at Fort Carson’s Evans Army Community Hospital. “The requirement for (psychiatric) care is based on a unit’s combat experience. Given that, I would submit to you that, with the 4-4, we are getting ready to welcome home a unit that requires significantly greater care.”
Piantanida said Fort Carson is talking to brigade leaders now, before they come home, to gauge soldiers’ needs.
“We’d rather do that ahead of an alcohol and drug event, a domestic-violence event, a suicide, or, God help us, a homicide,” he said.
In the past, some returning troops, afraid of being labeled as crazy or weak, lied on Army questionnaires designed to identify those at risk of PTSD. Many who tried to seek help later were taunted by superiors. Some fell into substance abuse and crime.
Fort Carson officials say a new screening system is designed to catch even soldiers who are suspicious of the PTSD label.
Since August, returning Fort Carson soldiers have gone through an “enhanced redeployment screening process” in which they are tested while in Iraq or Afghanistan and given a “green, amber, or red” rating.
Soldiers flagged red — because they have expressed thoughts of suicide or murder, or have had a significant loss at war or at home — are met as they step off the plane in Colorado Springs by a behavioral-health professional.
“We take them by the arm and say, ‘Hey, before you go home, we really want to make sure you are safe. Let’s have you talk to someone,’” said Lt. Col. Mary Krueger, the 4th Infantry’s surgeon.
A few days after returning, every soldier answers an expanded questionnaire to screen for PTSD and depression.
If they say they have no problems, they are rated “green” and can leave. Otherwise, they are rated “amber” and have to wait for further screening.
“We know soldiers want to go home, so they tend to underreport symptoms,” Preston, the psychiatrist, said.
So the new screening includes input from commanders. If a soldier’s captain or sergeant has expressed concern, the soldier is automatically bumped up to amber.
Amber soldiers go immediately to a licensed social worker for an in-depth interview. If the social worker recommends more help, the soldier sees a psychologist or psychiatrist that day who can prescribe medication and counseling.
Three months after soldiers complete the first screening, they are screened again to catch delayed symptoms.
“The Army was slow to get started in recognizing this was problem, and then slow to act, but I think they are committed now,” said Udall, who has monitored Carson’s struggles with PTSD.
Road gets easier
Access to counseling is now easier than after previous deployments.
In August, Fort Carson created three mobile behavioral-health teams, each assigned to a brigade on the post, so soldiers can get counseling and medication without having to go to the hospital. Commanders plan to add a fourth team soon.
Since 2006, Fort Carson has referred hundreds of soldiers to civilian counselors because it didn’t have enough staff, Piantanida said.
The post’s behavioral-health staff has almost doubled this year, to 104.
The budget for behavioral-health care on post has grown from $3 million in 2008 to $6 million in 2009 and is expected to hit $8 million in 2010.
The hospital plans to expand and begin treating soldiers who need intensive care, including inpatient care, so it can stop relying on civilian counselors and the local psychiatric hospital Cedar Springs.
“The belief is, if we can keep a soldier around other soldiers, within the structure and support system they are used to, there is a better chance we can get him better and back to doing his job instead of chaptering him out for behavioral health,” Pasquarette said.
But some civilian providers expressed doubt that Fort Carson can provide the best care for all soldiers with PTSD.
Kateri Koverman, a licensed social worker who specializes in counseling soldiers with PTSD, said she has heard concerns from local civilian counselors.
“We want to be sure that Fort Carson can handle the huge influx of men and women who have been deployed — that they are not underdiagnosing them or undertreating them,” she said.
Simply having more doctors and mental-health staff may not be sufficient, she said.
“Not all people want to be treated by the very system that may have caused the mental-health issues to begin with,” she said.
The post is also participating in a pilot program that tries to prevent PTSD.
This month, the 4th Infantry Division will send 30 soldiers to the University of Pennsylvania to become trainers for a new Comprehensive Soldier Fitness program, which aims to teach troops to create the social relationships, communications skills and relaxation techniques necessary for withstanding the hardships of deployment. The techniques will eventually be taught to all Fort Carson.
Commanders say the changes are making a difference. This year, Fort Carson started a committee to monitor the numbers of suicides or homicides, including attempts or threats.
Preston, who sits on the committee, said the numbers have trended downward. In September there were 12. In November, there were five.
The 4th Brigade’s commander, Col. Randy George, said his soldiers have more mental-health care than any previous deployment, and brigade commanders have stepped up the monitoring of soldiers’ stress levels.
Some troops on the ground report seeing the increased care, while others don’t.
“There was a very intense firefight in July,” a sergeant in the 2nd Battalion, 12th Infantry Regiment said recently via e-mail. “It really affected a lot of people. The battalion knew this, and they sent a mental health care provider. ... We sat in a group session and talked everything out, and she offered further help if anybody needed it or wanted to talk in private. I think this was extremely helpful.”
Other soldiers in more remote areas haven’t seen care beyond an occasional visit from a chaplain.
Even for platoons that get attention, it is uncertain if the efforts are effective. Some soldiers are skeptical.
A sergeant in the 2-12 said he thought the mental-health classes for soldiers missed the point.
“They are a waste of time for the people giving them and for us here on the ground,” he said via e-mail.
“There is nothing you can tell us that will help with stress. The reason there is combat stress is ’cuz we are undermanned and get only one day off a month.”
Contact the writer: 636-0223.
Gazette reporter Tom Roeder contributed to this report.