A Decade of War: Adapting to Meet the Mental Health Training Demands

Abstract

War has long yielded advancements inmedical techniques and understanding. The past 13 years have seen the USA fight two enduring wars and have brought forward numerous medical advances to include those that have impacted pre-hospital care, medical evacuation, bleeding control, and trauma response; however, some of the most critical advances have occurred in the identification and treatment of the invisible wounds of the war, posttraumatic stress disorder, and traumatic brain injury. With increased awareness and understanding of these conditions, nearly one out of every five returning combat veterans is identified with a mental health disorder [1]. This has significantly increased the demand for military mental health services and the requirements for military mental health providers. In the US Army alone, there has been a more than 150 % increase in mental health providers required to meet the mental health care needs of the returning soldiers [2]. The other military services and the Veterans Affairs (VA) hospitals have seen similar increases in demand. This situation was further complicated by the fact that during the post-ColdWar era of the 1990s, the uniformed services underwent a significant personnel reduction and Base Realignment and Closure. The result was a 30 % reduction in the uniformed medical provider force and closure of three of the nine military psychiatry training programs during this time frame [3, 4]. Because those military training programs produce more than 90 % of the uniformed service psychiatrists, growing the force in short demand presented numerous challenges. This prolonged period of war impacted those training programs. The type of patient and care demands at the teaching facilities significantly changed, teaching staffs were temporarily decreased in size as many of the military psychiatry staff were deployed to Iraq or Afghanistan, and residents were prepared for not only upcoming board certification exams but also soon-to-occur deployments to war zones. Additionally, faculty were challenged to manage and cope with their own deployment experiences while facing demands to teach new residents all while the profession of military psychiatry was facing increased scrutiny over rising suicide rates, deployment mental health screening, quality of posttraumatic stress disorder treatment, and even one military psychiatry graduate conducting a mass shooting. The purpose of this special collection of Academic Psychiatry is to highlight some of these unique challenges and address both the lessons learned and the advancements made in military psychiatry education. This collection opens with perspective and commentary pieces written by graduates of several military psychiatry training programs. Groom et al. [5] provide an interesting view from resident training at different points in time during the war effort. The period early in the war was marked by anxiety and unknown futures, whereas later in the war, challenges shifted to the expectation of deployment to a war zone as well as a growing sense of negativity toward the profession on the basis of enduring media reports. Complementing this perspective is a commentary from Capaldi and Zembrzuska [6] that highlights the challenges graduating residents faced deploying to a war zone less than a year after completing their training. Of note, military psychiatric residents completed all of the same Accreditation Council for Graduate Medical Education requirements as any other trainee but also had to prepare for the challenges of the battlefield. West et al. [7] highlight a specific training program that provides some of that preparation called Operation Bushmaster. * Christopher H. Warner christopher.h.warner.mil@mail.mil