Transcript Slide 1

Mission – Provide unsurpassed medical support to
TEAM KIRTLAND, Expeditionary Forces and our valued patients.
Mental Health Services During and After Deployment
Kirtland Air Force Base, New Mexico
Surety, Readiness, Support
Overview
• Deployment video
• Mental health services in Iraq
• Example of the “embedded clinician”
approach
• Determination of fitness for duty & case
example
• Questions and answer
Surety, Readiness, Support
Mission – Provide unsurpassed medical support to
TEAM KIRTLAND, Expeditionary Forces and our valued patients.
Service Delivery in a Deployed Setting
Maj (Dr.) Jorge G. Varela
Mental Health Clinic
Surety, Readiness, Support
Video
Surety, Readiness, Support
Baghdad Experience…
• Small installation responsible for flight line
operations at International Airport
• Medical facility
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31 Medics (ADAF/Guard)
2 large tents + smaller tents
4-7 beds
Surgical suite
Dental suite
Mental Health services
Mass casualty responses
Surety, Readiness, Support
Baghdad Experience
• One psychologist
• Dedicated area in tent
• Presenting Problems
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Relationship problems
Interpersonal conflicts
Repatriation
Critical Incident Stress
Tobacco cessation
• Services provided
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Counseling/therapy
Fitness for duty evaluation
Critical Incident interventions
Consultation to Commanders
Surety, Readiness, Support
Air Force Theater Hospital (AFTH)
Experience…
• Three functions
– Emergency surgical and other life-saving efforts
– Contingency Aeromedical Staging Facility (CASF)
– Outpatient medical clinic
• Four “wards”
– Medical/surgical recovery
– Intensive Care Unit
– Iraqi unit
• Multiple medical and surgical specialties
• Associated support capabilities
– Imaging
– Emergency room
– Pharmacy
– Chapel
Surety, Readiness, Support
Air Force Theater Hospital (AFTH)
Experience…
• Psychologist, Psychiatrist, Psychiatric Nurse,
three mental health technicians
• Clinic located in tent space, hardened building
• Mental health services
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Outpatient therapy
Consult evaluations
Redeployment interventions
Critical incident intervention
Command consultation
Fitness for duty evaluations
Surety, Readiness, Support
Air Force Theater Hospital (AFTH)
Experience
• Presenting Problems
– Relationship problems
– Interpersonal conflicts
– Critical Incident Stress
– Tobacco cessation
– Stability for transportation/movement
Surety, Readiness, Support
Things worth knowing…
• Technology has changed the experience
of the deployed Service member
– Internet
– Media coverage
– Digital photography
• Enhanced capability to deliver life-saving
care
Surety, Readiness, Support
Aeromedical Staging Facility
Surety, Readiness, Support
Theater Hospital
Surety, Readiness, Support
Outpatient Clinic
Surety, Readiness, Support
Mission – Provide unsurpassed medical support to
TEAM KIRTLAND, Expeditionary Forces and our valued patients.
Embedded Clinician Approach
Capt Corey Christopherson
Mental Health Clinic
Surety, Readiness, Support
Video
Surety, Readiness, Support
Embedded Clinician
Goal: Provide mental health treatment and services for
those Airman most frequently deployed and at risk for
traumatic exposure in support of OIF/OEF
Obstacles: Overcoming barriers to mental health
treatment for this population
– Stigma associated with mental health services
– Career impact concerns
Surety, Readiness, Support
Embedded Clinician
Action: The Embedding and Immersion of a 377
MDG mental health provider with 377 LRS
– Participation in unit activities
– Outreach services
Program Update
– Troops and leadership have appreciated MH services
– Steadily increasing utilization
– Word-of-mouth referrals
Surety, Readiness, Support
Embedded Clinician
Lesson Learned:
– Participation in unit activities seems to reduce negative
stereotypes/apprehension
– Helpful to deliver services in nontraditional manner (e.g.,
bring the services to them)
– Success enhanced if leaders educated regarding
identification and utilization
– Case Example
Closing Statement
– Initial expectations vs. actual results
– Successful outcomes
Surety, Readiness, Support
Mission – Provide unsurpassed medical support to
TEAM KIRTLAND, Expeditionary Forces and our valued patients.
Medical Evaluation Boards & Case Example
Capt (Dr.) Parker Niemann
Mental Health Clinic
Surety, Readiness, Support
Medical Evaluation Board
• Physician identifies a medical condition
where worldwide qualification may be in
doubt
• Mental Disorders
– Condition precludes satisfactory performance
of duties or worldwide assignability
– Impairment expected for longer than one year
– Recurrent impairment or recurrent impairment
expected
Surety, Readiness, Support
In Other Words…
• MEB is indicated when a mental health
condition
• Limits occupational functioning (> 1 yr)
• Limits ability to be deployed (> 1 yr)
• Has caused or will cause recurrent
impairment
Surety, Readiness, Support
“Unfitting” Illnesses
• Any psychotic disorder
• Unless it is brief, reversible, and with good prognosis
• Any mental Illness with
• Persistent duty impairment (> 1 yr)
• Recurrent duty impairment (> 1 episode in 12 months)
• Requirement for ongoing psychiatric support to
function
• Mood disorders requiring antipsychotics, lithium, or
mood stabilizers
Surety, Readiness, Support
Adminstrative Actions
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Personality Disorders (by themselves)
Adjustment Disorder
Sexual Perversions
Alcoholism
• Can MEB Medical Consequences of
Alcoholism
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Illicit Drug Use
Learning Disorders
ADHD
“Flying Phobia”
Surety, Readiness, Support
Other Considerations
• Overall reliability, judgment, and coping
skills
• Significance of symptoms and medication
side effects
• Availability of treatment
• Effect of being without treatment
• Risk of recurrence if exposed to trauma
• Ability to tolerate hostile or austere
surroundings
Surety, Readiness, Support
Requirements for Deployment
• Diagnosed disorders must exhibit stability
for at least 3 months prior to deployment
• Medications prescribed within 3 months of
deploying must demonstrate efficacy and
tolerability
• Clinical judgment is involved
Surety, Readiness, Support
What is in an MEB?
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Clinical assessment
Supporting diagnostic data (testing,
labs)
Supporting clinical records
Collateral data to assign military and
social/industrial impairment (e.g.,
supervisors, family members, others)
Surety, Readiness, Support