ROBERT SIEGEL, host:
Now, a study that seems to show how the Army can reduce mental health problems among troops that are deployed to war zones. The American Journal of Psychiatry reports that when soldiers received additional screening focused on mental health problems before they deployed to Iraq, their units experienced far fewer problems than units that received more limited screening.
And it's not just because doctors were able to weed out those with the most obvious problems. The screening results were used to provide continuity of care, making mental health services accessible to those who were deployed and who had potential problems.
Dr. George Appenzeller, himself a colonel in the Army, is a co-author of the study.
Colonel GEORGE APPENZELLER (Physician Commander, Medical Department Activity-Alaska): Soldiers went into theater with a plan. They didn't have to re-engage in care once they got there. The plan was in place. The provider that takes care of them - just like your primary care provider back home - is ready, understands their issues and can reach out to them and make sure they stay engaged in care.
SIEGEL: So if I'm being deployed to Iraq and I had a prescription for an antidepressant back in the States, this isn't news to somebody when I arrive in Iraq - they know about me when I arrive and my needs will seen to?
Dr. APPENZELLER: Yes, sir. That's the core concept of the program is that it's not a new engagement in care. It's continuity of care throughout the entire deployment cycle that even continues to when they come home. So when a soldier comes home, we screen for any issues that they may be having and ensure that they continue to get that care at their home station.
This is the reverse. We take their care that they're getting at home on a day-to-day basis and make sure it continues when they're in theater.
SIEGEL: And the metrics of success here - when you look at the three combat brigades that were in Iraq, for you, how much better did they do? What's the critical number here?
Dr. APPENZELLER: In the first six months of their deployment, combat operational stress reactions were decreased, a risk reduction of 28 percent. Behavioral health disorders and thoughts of suicide were decreased, as well, and around the 50 percent range. And evacuations out of theater were decreased by approximately 50 percent.
This whole program was about taking good care of soldiers. And I think that the data shows that a good program of identifying those that have needs and having a plan in place to meet those needs improves their outcomes.
SIEGEL: And how much of a burden would that be for every unit that's deployed to have that kind of what you would describe as aggressive case management, as opposed to a more traditional mental health screening?
Dr. APPENZELLER: I can only speak to our personal experiences in this program. But we did not utilize any additional resources. It did take some more attention and manpower by the providers that are already there taking care of the soldiers. But we didn't require additional personnel to be moved into the units. And it didn't require additional screening assets, as we just added parts to what was already being done.
Time factor, however, it did take an additional - depending on whether someone screened, you know, to need the additional behavioral health evaluation before deployment - could add anywhere from, you know, 10 minutes to a half hour to the initial screening time.
SIEGEL: Is part of the issue here - achieving continuity of care for mental healthcare - eliminating stigma and having it understood that you can deploy with that prescription addressing your depression? When you get over there, there'll be somebody who'll be able to refill your prescription and take care of you there, too.
Dr. APPENZELLER: I think that reduction of stigma is critical to any behavioral health program, not just in the military but in society as a whole. And having people be successful, you know, within - all privacy was withheld, this was done discreetly. This was not anybody being told about it.
But soldiers being successful helps erase that stigma that it's going to affect your career or that, you know, people are going to look at you differently. So a successful soldier is really the best thing to fight stigma.
SIEGEL: Well, Dr. Appenzeller, Colonel George Appenzeller, thank you very much for talking with us.
Dr. APPENZELLER: Oh, any time. Thank you very much for having me.
SIEGEL: Dr. Appenzeller, a co-author of a study in the American Journal of Psychiatry, spoke to us from Fairbanks, Alaska.