Monthly Archives: February 2013

Record number of military suicides begs questions about the path forward

Heather Rudow February 1, 2013

8410502197_b2223c9814_zDespite recent efforts from the Department of Defense to stem the rise in military suicides, the number of service members who took their own lives last year appears to have topped the number of troops killed in combat.

Despite the Pentagon’s recent efforts to hire more mental health workers, begin a long-term study of mental health for military personnel and expand the reach of mental health services for service members and their families, there were 349 active-duty suicides in 2012 — a record high.

Art Terrazas, grassroots advocacy coordinator for the American Counseling Association, believes if it were easier for licensed professional counselors to join in the Pentagon’s efforts, then the rising military suicide numbers would have a better chance of decreasing.

“The news is deeply saddening and, at the same time, troubling,” Terrazas says. “Any loss of life is tragic, and that tragedy is compounded when someone falls victim to suicide. What is also troubling is that despite the fact that mental health in the military has gained more attention in the past year and more efforts have been made to address mental health care, we continue to fall short of meeting the goal, which is reducing or eliminating suicides among our service members.”

Last year, ACA conducted an aggressive outreach campaign to various media markets to highlight the fact that the Department of Veterans Affairs fell behind in its efforts to recruit and obtain all available mental health clinicians, specifically licensed professional counselors.

ACA’s Public Policy Department believes the DOD has still not done enough to get military personnel the mental health services they need.

“From our point of view, if you are going to do all that you can to meet the mental health care demands of the troops, then that means you are going to utilize all the tools at your disposal,” Terrazas says. “[The DOD] is not doing that. They are sidelining thousands of counselors from working with our military members because of rules that they have created. The DOD is putting up its own barriers when it comes to recruiting every mental health clinician to combat this very serious problem.”

Terrazas says he hears from counselors across the United States almost every day who are being denied work at VA facilities.

“Many of these counselors are veterans themselves,” he continues. “Counselors have not been given the chance to help combat this problem simply because the government hasn’t allowed them to be part of the solution.”

ACA member David Fenell is one of those counselors who has been on both sides of the fence. As a colonel and behavioral sciences officer with the U.S. Army and Army Reserve, he retired in 2009 after 26 years of service, which included tours in Afghanistan and Iraq. Since then, he has counseled soldiers returning from deployments on how to fit back in with their families at home.

When Fenell first heard the news of the suicide numbers, he says he “felt sad that so many of our warriors were so desperate and in such pain. I was sad that they found no options, other than suicide, to relieve that pain and desperation. We try to prepare our soldiers to be resilient and provide them with tools to face adversity, but that training does not seem to have helped those who took their lives.”

Fenell believes the DOD has a lot of helpful programs for military personal in need. “Unfortunately, these programs were either not accessed by the struggling warriors or were not effective if used,” he says. “I know the DOD is currently reassessing its suicide-prevention strategies.”

Fenell points to a Dec. 24 issue of Army Times, which, he says, “reported that about half the 301 service members who committed suicide in 2011 had accessed a mental health provider or received inpatient care before committing suicide. About a third of these had received services within 90 days of their deaths. Over 50 percent of the service members who committed suicide had no known mental health diagnosis. Over 70 percent were drug- and alcohol-free at the time of their death.”

Part of the problem continues to be stigma, Fenell says.

“Service members may seek help but may not fully disclose the depth of their pain because they don’t want to appear weak,” he says. “Also, military mental health care, because of the intense demand for services, can be sporadic. So a client whose depression deepens may not have an appointment scheduled and may be unwilling to call emergency services.”

Lynn Hall, dean of the College of Social Sciences at the University of Phoenix and author of the book Counseling Military Families: What Mental Health Professionals Need to Know, agrees.

“My thoughts go to what are we not doing for these service members and how can life seem so hopeless [for them],” she says. “We talk about moving beyond the concept of the stigma of seeking help, but doesn’t this indeed suggest that we haven’t done enough to decrease this stigma?”

Hall, a member of ACA, says she has found through her research that three conditions are typically present when a suicide occurs:

  • A weapon is available and the individual has been trained to use it.
  • The individual has experience or some level of comfort with death.
  • The individual has a fear of being a burden on others.

With members of the military, Hall says, the first two conditions are present. “Military are trained to use weapons and have weapons available and, at least for those in combat, have experienced death. Therefore, it is only the third condition that perhaps we have not focused on enough in the mental health world.”

The most common characteristics of military life are change and transition, Hall says, and with any change or transition comes grief and loss. The power of accumulated grief over time to lead to high levels of distress is often not recognized, Hall says. “Every person in a military environment must learn how to make healthy transitions, and perhaps everyone going into the military needs to be assessed for prior loss and unfinished grief.”

The relevant questions then become, Hall says, “Does something in the military experience trigger this fear of being a burden on others? Is this what pushes service members over the edge? Being a burden on their families and/or their communities because of their emotional state or even their physical injuries?” If so, Hall says, “might we not focus on this aspect of ‘healing’ for all in the military, or possibly focus more on preventative measures in military training?”

Terrazas believes utilizing counselors is one of the only ways to reduce the number of suicides in the armed forces.

“Federal agencies have made the decision to place barriers that keep counselors from treating service members, military families and veterans,” Terrazas says. “Even though past congresses and presidents have clearly stated that counselors should be part of the effort to treat invisible wounds of war, there seems to be an effort in several agencies to promulgate rules that keep counselors from working [with] the VA and the DOD. Those rules need to be changed so that we can start getting as many mental health clinicians as we can into this fight. It wouldn’t require an act of Congress, it wouldn’t require a lot of hoops to jump through. All it would take is for the administration to [make] some common sense changes so we can get people the help they need. [Counselors] have not been given a chance to help solve the problem.”

Fenell, too, thinks counselors could play a much greater role in the effort to reduce military suicides.

“Licensed professional counselors are trained to establish effective and continuing therapeutic relationships with their military clients,” he says, “and many suicidal service members need a stable, ongoing, supportive relationship to help get through the darkest periods of their depression. Counselors can effectively provide that type of intervention.”

Additionally, Fenell points again to the Army Times issue which states that the most noted causes of military suicide were broken relationships, workplace problems and financial problems. “Licensed professional counselors can be effective in helping in each of these problem areas,” he says.

Hall says she believes that on a local level, “Every single counselor, social worker, psychologist, even physician, who sees a service member must be screening for suicide ideology. This is not something that should happen only when there is a crisis or major loss, but with everyone. We in the mental health world are perhaps not paying close enough attention to the accumulation of grief/loss issues and assume that if someone ‘looks’ healthy because they are capable of functioning, that they are indeed healthy.”

She also questions whether society has the responsibility of raising boys in a less stereotypical way, teaching them that “being a warrior with all its ingrained messages about being dependable, not needing help, being strong, not being weak or invincible is not the ultimate demonstration of being male. The military is, for some young men, the exaggeration of this stereotype, and we may not have enough up-front assessment of our young people to determine the reasons why someone joins.”

It is ACA’s hope that the suicide rate will go down to zero next year. But unfortunately, Terrazas says, there is no indication that will happen.

“The RAND Corporation told us that in 2009, we lost more service members to suicide than we lost in combat in either Iraq or Afghanistan, and 2012’s numbers are higher than they were in 2009,” Terrazas says. “While there has been a lot of work and a lot of resources have been dedicated towards ending this terrible problem, we as a country are still failing and we as a country need to do more. We just hope that both the Department of Defense and the VA will finally listen to recommendations that ACA has made over the past year so that we can get more counselors where they’re needed. And we hope that we all remember this and remind ourselves that this is part of the true cost of war. This is part of the price that we pay when we activate the members of our armed services, and it’s a cost that we should never forget.”

Heather Rudow is a staff writer for Counseling Today. Contact her at hrudow@counseling.org.

Monmouth University counseling students coordinate relief efforts after Hurricane Sandy

Heather Rudow

photoWhen historic “superstorm” Hurricane Sandy tore through the East Coast this past October, more than 120 lives were lost and countless others were changed forever, as storm victims were forced to rebuild homes, businesses and lives in the aftermath. Two counseling students at Monmouth University in West Long Branch, N.J., decided to help in any way they could — even if it didn’t necessarily result in practicing any counseling themselves.

Monmouth students Jennifer Trimarchi and Ellen Brody, both members of the American Counseling Association, knew they wanted to get involved with Hurricane Sandy relief efforts even though they were not qualified to counsel survivors. In order to be eligible to provide counseling, students had to be at the practicum or internship-level of the counseling program — Trimarchi and Brody do not begin that until the end of this month.

“When [Hurricane Sandy] happened, we met with our professor because we wanted to do something for the people in the area who had been affected,” says Trimarchi, who is also president of Monmouth’s Counseling Students Association (CSA).

Joanne Jodry, a counseling professor at Monmouth University, says the students filled an important role that some of the members of the disaster relief crisis teams could not. “Some of the people on the teams didn’t have any houses,” says Jodry, who is the CSA faculty adviser and a member of ACA and the New Jersey Counseling Association. “It was really up to them.”

As coordinators on behalf of Monmouth University, Trimarchi and Brody were in charge of signing up interested counseling students to join relief efforts, which were coordinated through the Federal Emergency Management Agency (FEMA) and Monmouth County Division of Mental Health & Addiction Services, and assigning students to the sites. They also coordinated the efforts of other non-practicum-level counseling students who wanted to help. These students participated by joining in cleanup efforts and donating supplies and food.

“We were trying to keep it as organized as possible so none of these FEMA sites were overwhelmed and none of the victims were overwhelmed either,” Trimarchi says.

Trimarchi and Brody were completely in charge of the endeavor since Monmouth faculty members were consumed with their own rebuilding efforts post-Sandy, Jodry says. Though many of the faculty from Monmouth’s psychological counseling department also participated by frequently visiting FEMA sites to assist the students and provide any supervision necessary when they could.  Trimarchi and Brody’s coordination efforts lasted from the end of October until around Christmas, when the government was able to hire individuals to provide the counseling services that the students were offering.

Jodry was able to be the connection for the students to FEMA through the Monmouth County Division of Mental Health & Addictions. Each county has its own disaster crisis team, connected to FEMA, and coordinated with local officials who were notified that the students were interested in helping.

“These two were just amazing with the amount of work they did,” Jodry says. “They came in and worked their fingers to the bone. They were on call 24 hours a day.”

Steve Horvath, assistant director of Monmouth County’s Division of Mental Health & Addiction Services, echoes Jodry.

“The efforts of the Monmouth University students was a critical piece of the response, and I am very appreciative of their help,” he says. “It was really a self-directed response.”

Most of the counseling students were sent to an evacuation shelter that was originally located at Monmouth University but was then relocated to the Monmouth Park Race Track. At one point, Horvath says, the shelter’s population swelled to roughly 1,100 inhabitants.

The students filled a very necessary gap at the shelter. “FEMA people were helping these people deal with bureaucratic things such as signing papers and getting help from the government,” Horvath says. “But a lot of these were people who were crying, and a lot of these people needed handholding, and that’s where these Monmouth University students came in.”

This was especially important, Horvath says, because about half the team of regular responders had been personally affected by the storm.”

Most Monmouth students hail from places outside of the New Jersey shore area, making it easier for them to volunteer, as they were not as directly impacted by the hurricane.

Brody says she enjoyed the role of coordinator because she was able to help in multiple ways. “I did want to help in some way, and although I couldn’t provide counseling [myself], I did want to help my peers who [needed] to get those hours for graduation as well as help those in the community get connected with the services they needed.”

Some of the Monmouth counseling students were interning at sites that were closed down because of the storm, so they used the FEMA sites as part of their supervised practice.

Trimarchi feels she impacted the community and made a difference in the victims’ lives even though she was not on the ground with them.

“I felt that I was helping even though I wasn’t going in to counsel people,” she says. “I was helping by sending people and food into these sites. I was helping in some sort of way, and that’s what I hope to do in some sort of way when I start my internship.”

While Brody’s home was not impacted by the hurricane, she lost her job at the café where she worked in Monmouth Beach. “They’re still in the process of completely renovating and gutting it,” she says.

Brody says she was grateful to take on the task of coordinator because it gave her a way to channel her desire to help the hurricane victims.

“It made me feel as though I had a purpose during this time,” she says. “The entire area was devastated, but I didn’t know where to direct my efforts. I didn’t know where to start and it was great to have some place to direct my efforts even though I couldn’t be there in a hands-on sort of way.”

Trimarchi says the role of acting as a coordinator came naturally to her. “People asked me, ‘Are you stressed out? Are you overwhelmed?’ But honestly, I was happy to do this,” she says.

Since acting as a coordinator, Trimarchi is now hoping to get trained in crisis intervention counseling. “I don’t think I had an interest in that before,” she says. “God forbid this ever happens again, I do want to be more prepared.”

Brody feels a renewed sense of faith in her career path since the coordination efforts.

“It’s definitely [reaffirmed] that this is the career path I want,” she says. “All these people can band together and bring that sense of community back together. We were all disconnected [after Hurricane Sandy], but these counseling students can go into the community and bring the community back together, and that is a powerful thing. Coordinating these efforts proved even more strongly that being in the counseling profession is exactly where I want to be.”

Heather Rudow is a staff writer for Counseling Today. Contact her at hrudow@counseling.org.

Why I am tired of thanking our members

Richard Yep

Richard YepI know it is an unusual headline for a column, but in looking back through past issues of Counseling Today, I was struck by the number of times I have expressed appreciation to so many of you for contacting ACA about volunteering your services after some natural or person-made disaster. I am constantly in awe of your goodness and your willingness to use your skills and expertise to help those affected by tragedy. So, don’t get me wrong. I genuinely appreciate your willingness to help. But I am concerned about the increasing number of times I am compelled to thank you each year.

As I write this, our most recent tragedy is the shooting at Sandy Hook Elementary School in Newtown, Conn., in which 20 schoolchildren and six school staff members were killed. This past July, one of our own ACA members, Alex Teves, was among 12 people killed at a shooting at a movie theater in Aurora, Colo., as he shielded his girlfriend from harm. Fifty-eight others were wounded in that massacre. Look back over the past several years, and all you have to do is mention Columbine, Virginia Tech, 9/11, Oklahoma City or any number of other places to remember the horror of what humans can do to other humans. And I know a good number of you are involved in responding to tragedies and traumatic incidents that occur around the globe as well.

In addition, let’s not forget the violent acts conducted in many urban areas each and every day. Professional counselors working in community agencies, private practices, hospitals, schools and colleges are brought in (or volunteer their time) to help in the aftermath of these occurrences as well.

In the wake of such person-created tragedies, there often follows an outcry for politicians to focus on gun control. However, we are now hearing more people talk about access to mental health services as well. To me, this is a long-overdue demand that should be free of partisan or ideological bickering on the part of our elected officials.

I hope you will chime in on this discussion as well. Why? Because as professional counselors, counselor educators or graduate students preparing to practice, you are the ones who have seen the suffering that is the result of a society with inadequate access to mental health services.

I realize we cannot always know with certainty what makes someone engage in an act as horrific and heart-wrenching as what took place at Sandy Hook Elementary School — an act that caused virtual strangers thousands of miles away to shed tears upon hearing about it. But what we do know is that the work you and your colleagues do really can be instrumental in reducing the probability of even more heinous acts.

Isn’t it about time that we all let our public policymakers know that properly funding mental health services really is an investment that will reap greater benefits to society than they have even imagined? I understand the importance of a balanced budget and spending within our means. But I also realize there are times when investing in services can benefit all of society and will lead to an even more prosperous (and peaceful) world.

As always, I look forward to your comments, questions, and thoughts. Feel free to call me at 800.347.6647 ext. 231 or via email at ryep@counseling.org. You can also follow me on Twitter: @RichYep.

Be well.

 

Deep federal spending cuts averted — for now

Scott Barstow, Art Terrazzas & Jessica Eagle

Hours after the start of the new year, Congress and President Obama agreed to a package of tax cuts, tax increases and spending changes to avert the major policy changes scheduled to take place under previous law. The Senate passed the package — the American Taxpayer Relief Act (H.R. 8) — by a vote of 89-9, and the House of Representatives followed suit with a vote of 257-167. Both chambers passed the bill Jan. 1.

Under the legislation, the tax increases scheduled to take effect at the beginning of the year were removed for most Americans. Tax rates for individuals making more than $400,000 and couples making more than $450,000 went up 4.96 percent. The measure makes permanent the tax cuts for households making less than those amounts.

The measure also postpones for two months the major spending reductions that had been scheduled for Jan. 2. School counselors and educators remain in a holding pattern regarding what to expect in terms of spending, however. Congress has yet to decide on funding levels for education programs for the second half of federal Fiscal Year 2013, extending from the end of March through the end of September. The 113th Congress, which began its term Jan. 3, was faced with immediately having to begin hammering out either a broader deficit reduction agreement, including both spending cuts and tax increases, or another short-term measure to allow time for more negotiation. Because of the budgetary discussions being postponed for two more months, we are unlikely to see the new Congress tackle laws such as the Elementary and Secondary Education Act, the Carl D. Perkins Vocational and Technical Education Act, and the Individuals with Disabilities Education Act. These major education laws fund and support school counselors and their students, and each of these laws is long overdue for reauthorization.

H.R. 8 postpones for one year the 27 percent reduction in physician payment rates that was scheduled to take effect at the beginning of January. The Congressional Budget Office estimated this postponement to cost $25.2 billion over the next 10 years. The 113th Congress will remain under pressure to somehow address this issue in 2013 without the underlying payment formula being changed. This will provide us with another potential vehicle for attaching legislative language to establish Medicare coverage of counselors.

HHS proposes rule for essential health benefits

On Nov. 26, the Department of Health and Human Services (HHS) issued a proposed rule regarding the “essential health benefits” that health plans will be required to offer through state insurance exchanges beginning in 2014. The Affordable Care Act stipulates that health plans must cover 10 categories of health benefits, including “mental health and substance use disorder services, including behavioral health treatment.” In the proposed rule, HHS would require health plans to provide these services in a manner consistent with the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA). Although HHS needs to issue more regulations to fully implement MHPAEA, it was important that the parity requirements were linked with the essential health benefits requirements under the Affordable Care Act.

The American Counseling Association submitted comments on the essential health benefits regulations, expressing strong support for requiring plans to adhere to MHPAEA requirements in providing essential health benefits. ACA also expressed support for the proposed rule’s provisions regarding existing state-mandated health benefits. In the rule, HHS requires states to defray the costs of providing state-required benefits that go beyond the essential health benefits package. However, HHS is proposing that states not be required to defray costs associated with abiding by state laws related to provider types — such as requiring coverage of services provided by counselors. State counselor coverage laws should be viewed as upholding patient access to care, not as establishing benefits different from those required under the Affordable Care Act.

New Congress offers new opportunities for advocacy

January marked the beginning of the 113th Congress, meaning new senators and representatives from across the country were sworn in and began their work. Although many members of Congress were re-elected, quite a few new faces are serving in Washington for the first time.

In light of this recent turnover, we are encouraging ACA members to visit the offices of their federal lawmakers as they begin this new session. You can find out who your senators are by visiting senate.gov and who your congressmen and congresswomen are by visiting house.gov.

Please take some time to visit their official websites and sign up for their e-newsletters, Twitter accounts and other social media outlets. You can then be notified about events near you where you might get the opportunity to talk to your elected officials about counseling issues. We encourage ACA members to stay in touch with their legislators in Washington so these public officials will know about the needs of counselors and their clients, as well as the wonderful work that counselors do in their communities.

It starts and ends with you!

Bradley T. Erford

Bradley-TThis month’s cover story is on bullying, a terrible societal concern among our youths, but also one that still occurs regularly in the adult population. Although some studies indicate that physical bullying is declining among school-age youths, relational aggression and cyberbullying have yet to peak. The humiliation experienced by victims of any kind of bullying is devastating — at any age.

One of the factors often linked to bullying behaviors is the environmental context. People who experience bullying behaviors do not feel safe in their environments. They also feel disempowered to make the behaviors and insults stop. We have made great strides in passing policies and codes of conduct, but we have a long way yet to go.

Unfortunately, bullying is not an act that occurs just between the bully and the victim. Bystanders and witnesses (youths and adults) perpetuate and support this behavior by failing to intervene. The same is true in relational aggression, cyberbullying and even gossiping — all are aimed at destroying the social connections of the victim. Making society a more peaceful and equitable place requires constant vigilance; quick, thoughtful actions; and mutual respect among all people. How we deal with conflict, gossip and the people affected is a reflection of who we are as professionals — and as human beings. We would never treat our clients and students that way; there is no place for physical or relational aggression in the safety of a confidential counseling relationship based on genuineness, respect and empathy.

As a professional community, we are a microcosm of this larger society and have the opportunity to create an environment for respectful, peaceful discussions about issues of importance to express opinions and forge consensus. Often we are successful; sometimes we fail. Some of you are aware of the recent conflicts that have played out on professional Listservs, where counseling professionals have engaged in what I can only describe, in the politest terms, as uncivil discourse. Although I heartily support freedom of speech, the tone of the “discussion” on one Listserv led to dozens of people leaving the Listserv altogether. I imagine many, many more removed themselves without signing off publicly. This incident made me recall that just because we have the freedom to say something doesn’t mean that we have to — or even should. There truly is a difference between a right and a responsibility.

ACA is committed to sustaining the environmental context of respectful discourse that our members expect — one that treasures the richness that comes from diverse thoughts and perspectives aimed at elevating our clients and students through legislative and social justice initiatives. The “soft launch” of ACA’s exceptionally improved website in mid-January is a testament to this mission. It provides cutting-edge professional information, such as the new ACA Practice Briefs, and allows groups of members to connect in safe environments for educational, professional and interpersonal development.

ACA respects and values the diverse beliefs of our members and believes the path to meaningful professional and social change is through engagement, discussion, collaboration and thoughtful, proactive professional and legislative initiatives. This path is the polar opposite of physical, cyber- and relational aggression. Words mean things; behaviors matter. How we treat others and mind our manners are extensions of who we are at our core.

My deepest hope is that from these events, a culture of civility, nurturance and forgiveness will continue to be forged, and that ACA, its divisions, branches and professional partners will continue to represent a place where all members feel welcome and where all voices — not just the most persistent, the loudest and certainly not the rudest — can be heard. We need to model for our students, clients and each other how to resolve conflict productively and create an environment of safety, respect and support. It all starts and stops with each and every one of us.