So far, the reports from military sources and from those who know Hasan characterize the Virginia-born psychiatrist of Jordanian descent as a deeply religious man who opposed his country’s wars in Iraq and Afghanistan; an unmarried loner who had endured name-calling and harassment about his Muslim faith while in the Army; a visitor to Islamist Web sites; someone with questionable links to Imam Anwar al-Awlaki, a supporter of Islamist jihad; a psychiatrist shaken by the horrors his patients described; and a soldier so anxious about his upcoming deployment to Afghanistan with Madison, Wisconsin’s 467th Medical Detachment that he had hired a lawyer to try to get him a discharge.
Hasan’s relatives insist Hasan was a good doctor, and that if he was the shooter, he must have “snapped.”
Their comments raise questions about whether there is sufficient monitoring and caring for the behavioral health caregivers of service members and their families.
Although Darnall’s Kesling said she saw no sign that Hasan was experiencing burnout, she acknowledged that his job as a psychiatrist was intense. She told The Wall Street Journal that some Army mental health professionals experience burnout from the burden of hearing so many stories from traumatized veterans.
Military behavioral health providers describe crushing schedules with 10 or more patients a day, most of whom experienced devastating trauma or mutilation, according to a New York Times report.
The Army’s Mental Health Advisory Team (MHAT) survey of behavioral health personnel serving in Iraq or Afghanistan showed that the number of behavioral health personnel who reported high levels of burnout increased from 27% in MHAT-IV to 33% in MHAT-V. Results from MHAT-VI have not yet been released.
“Behavioral health providers facing deployment experience stress just as soldiers do,” said MAJ Christopher Warner, chief of behavioral medicine at Winn Army Community Hospital at Fort Stewart, Ga, who served 2 tours in Iraq as division psychiatrist for the 3rd Infantry Division.
“They must leave family and friends and be in harm’s way, plus they are charged with helping keep soldiers mentally healthy. Often, they face multiple deployments and feel as if their job is never done.”
Inadequate staffing is viewed as an additional stressor. Currently the Army has 194 civilian, 121 military, and 93 contract psychiatrists available to its population of more than half a million people, according to the surgeon general’s office.
A DOD Task Force on Mental Health, which heard expert testimony and made site visits to 38 military installations, warned in its 2007 report of increasing stress on mental health personnel because of shortages and high attrition rates.1
Psychiatrist Layton McCurdy, MD, distinguished professor and dean emeritus at the Medical University of South Carolina, and a DOD task force member, told Psychiatric Times that personnel shortages were the primary psychological stressor for behavioral health providers.
The combined military-civilian taskforce, McCurdy said, advised the DOD that it faced an “impending workforce train wreck” and needed to recruit more doctors and psychologists to address the increasing demand for services.
McCurdy said he personally talked with many psychiatrists and psychologists who joined the Armed Services with the anticipation of staying 20 years, retiring, and receiving a pension and who decided to explore something else careerwise.
These were young psychiatrists and psychologists who had children and who were experiencing multiple deployments as well as disruptions from being deployed for up to 15 months, McCurdy said so many were deciding not to re-up.
Questions about screening behavioral health professionals and providing them with adequate support have also arisen in the wake of the Fort Hood tragedy.
Warner, a USUHS graduate who completed his residency training in family practice and psychiatry at WRAMC, said, “Psychiatric residency training at Walter Reed Army involved frequent supervision by the senior resident, the attending physician, and videotaped counseling sessions, so there was one-to-one monitoring.”
There are 3 routes by which a troubled behavior health provider can obtain help, according to Warner. “Any soldier or military family member, including behavioral health professionals and other medical providers, is eligible for care through military medical services, the TRICARE network of civilian mental health providers, and the TRICARE Online counseling services,” he said.