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Mental health services available to service members and their families will be fundamentally transformed through a plan developed by a special "Red Cell" team within the Department of Defense (DoD), top military psychologists say.

Organized in June, the team has six months to come up with a plan to implement recommendations made by the DoD's Task Force on Mental Health, says Capt. Morgan T. Sammons, PhD, the Navy's psychology specialty leader and a Red Cell member.

The task force report, delivered to Secretary of Defense Robert Gates on June 14, states that the military's mental health system "does not have enough resources, funding or personnel to adequately support the psychological health of service members and their families in peace and during conflict."

"What we're really trying to do is imbue a new philosophy of mental health service delivery across all the services," Sammons says.

Congress included $900 million in the DoD's supplemental budget for fiscal years 2007 and 2008 to fund more mental health services, as well as more research on the effects of traumatic brain injuries (TBI) and treatments for TBI and post-traumatic stress disorder (PTSD). APA continues to contribute to this effort through its federal advocacy for DoD mental health services and research, as well as for the Center for Deployment Psychology, a DoD training initiative, created by APA's Education Directorate in consultation with Sammons and other leading military psychologists.

Through the plan, military officials seek to promote a culture of psychological health that will reduce stigma and ensure military personnel have access to appropriate services, Sammons says.

In related efforts, the Department of Veterans Affairs (see "The Department of Veterans Affairs' continuum of care") is hiring several hundred more psychologists to work with veterans and boosting efforts to screen veterans for TBI and mental health concerns. And following an association report that highlighted the psychological needs of service members and their families-and recommended ways for the DOD to improve care-APA is devising a long-range plan for how to meet those needs.

The need to reduce stigma and ease access to care have been recognized by military leadership and Congress, says Air Force Col. James Favret, PhD, psychology consultant to the Air Force Surgeon General and another Red Cell member.

"There's some consensus that these are all good things. It's just now a matter of how do we make this happen in the best way," Favret says.

The need for military psychologists

The report comes as the military struggles with a shortfall of active-duty psychologists, compared with the number of positions authorized.

According to officials, the Army is down 20 percent from its full complement of 123 psychologists. The Air Force, which is missing 17 percent of its 235 authorized psychologists, only filled 11 of its 23 internship slots this year.

And the Navy, which also provides psychological services for the Marine Corps, is down 29 percent, with only 87 of its 122 psychologists in non-training positions on board.

Concurrent with these shortfalls in the active-duty psychologist ranks, thousands of service members are dealing with the effects of combat stress, including PTSD from their experiences in Iraq and Afghanistan. Others face the cognitive and emotional effects of a TBI, an injury often caused by blasts of the improvised explosive devices favored by insurgents in Iraq.

The numbers of service members who need help is only expected to grow as deployments continue and more service members experience more than one deployment.

According to Post-Deployment Health Re-Assessment (PDHRA) data, 38 percent of soldiers and 31 percent of Marines reported psychological symptoms. Among those who have deployed more than once, the percentages spike up to 40 percent for soldiers and 35 percent for Marines. The PDHRA is administered to service members 90 to 120 days after returning from a deployment.

To meet the increased needs, the military services want to recruit and retain more psychologists by offering expanded loan-repayment programs, signing bonuses and bonuses for extending time on active duty.

The Army increased the number of internship positions to 25 this year, and wants to accept 30 interns next year, says Col. Bruce Crow, PsyD, the Army's psychology consultant. That's more than double the number of interns accepted just five years ago.

The Army is also piloting a new training track for active-duty psychologists this year, offering commissions to up to five psychologists who have completed their internships and earned their doctorates, but need their postdoctoral year for licensure.

Both the Navy and Air Force hope to increase the number of psychologists brought in through "Direct Accession" programs, whereby licensed psychologists apply for a commission.

Besides bringing on more psychologists to active duty, the Army, Navy and Air Force are all hiring psychologists as civilian contractors or federal employees, and making therapy more available to active-duty service members who are reporting mental health concerns at newly organized deployment health centers.

APA: focusing attention, pushing for training

Back in February, APA drew attention to the need for expanded mental health services through a report written by the association's Presidential Task Force on Military Deployment Services for Youth, Families and Service Members. The report found that military personnel face barriers to mental health services that include limited access and availability, as well as stigma. To address this, the report recommended increased coordination of DoD mental health services.

Following that report, APA President Sharon Stephens Brehm, PhD, called for nominations for a second task force, the Presidential Task Force on the Psychological Needs of U.S. Military Service Members and Their Families. "The goal is developing a long-range strategy for the association to help meet the needs of military personnel and their families," says Ron Palomares, PhD, APA staff liaison to the new task force. As a way to ensure that APA's plan is of most benefit to military personnel and their families, the association invited DoD and VA officials to each appoint a liaison to the task force, explains APA Senior Policy Advisor Ellen Garrison, PhD.

APA's push to secure more military mental health funds also includes working with DoD and Congress to support a new training initiative, the Center for Deployment Psychology. The center,located at the Uniformed Services University of the Health Sciences near Washington, D.C, brings together military psychologists, interns and civilian psychologists for two-week courses, says David Riggs, PhD, the center's executive director.

The center will host five two-week courses this year, but hopes to find ways to increase that number in 2008, says Riggs. Working with state psychological associations, the center is also stepping up its efforts to host local, one- to three-day training sessions for civilian psychologists.

"I think the center fills a really valuable niche, in that we're looking to provide the training that will get people to where they can help the soldiers and their families when they come back,"he says.