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Mission – Provide unsurpassed medical support to

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. Overview. Deployment video Mental health services in Iraq

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Mission – Provide unsurpassed medical support to

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  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

  2. 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

  3. 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

  4. Video Surety, Readiness, Support

  5. Baghdad Experience… • Small installation responsible for flight line operations at International Airport • Medical facility • 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

  6. Baghdad Experience • One psychologist • Dedicated area in tent • Presenting Problems • Relationship problems • Interpersonal conflicts • Repatriation • Critical Incident Stress • Tobacco cessation • Services provided • Counseling/therapy • Fitness for duty evaluation • Critical Incident interventions • Consultation to Commanders Surety, Readiness, Support

  7. 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

  8. Air Force Theater Hospital (AFTH) Experience… • Psychologist, Psychiatrist, Psychiatric Nurse, three mental health technicians • Clinic located in tent space, hardened building • Mental health services • Outpatient therapy • Consult evaluations • Redeployment interventions • Critical incident intervention • Command consultation • Fitness for duty evaluations Surety, Readiness, Support

  9. Air Force Theater Hospital (AFTH) Experience • Presenting Problems • Relationship problems • Interpersonal conflicts • Critical Incident Stress • Tobacco cessation • Stability for transportation/movement Surety, Readiness, Support

  10. 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

  11. Aeromedical Staging Facility Surety, Readiness, Support

  12. Theater Hospital Surety, Readiness, Support

  13. Outpatient Clinic Surety, Readiness, Support

  14. 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

  15. Video Surety, Readiness, Support

  16. 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

  17. 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

  18. 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

  19. 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

  20. 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

  21. 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

  22. “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

  23. Adminstrative Actions • Personality Disorders (by themselves) • Adjustment Disorder • Sexual Perversions • Alcoholism • Can MEB Medical Consequences of Alcoholism • Illicit Drug Use • Learning Disorders • ADHD • “Flying Phobia” Surety, Readiness, Support

  24. 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

  25. 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

  26. What is in an MEB? • 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

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