Reservist, Stigmatize Thyself

By Bob Brewin

March 11, 2013

Army Reservists and National Guardsmen get their care from private clinicians when not on active duty, making it difficult to develop a comprehensive health record without self-reporting.

Such self-reporting becomes dicey when it involves behavioral health conditions, such as post-traumatic stress disorder or substance abuse, which can pop up after combat tours.

The Army Behavioral Health Task Force report released last Friday acknowledged this conundrum. “Soldiers are often reluctant to have their medical information released to their unit commanders for fear of stigmatization or limitations on their continued service,” the report acknowledged.

Reserve and Guard troops, the report said, need training  to “reinforce the importance of ensuring that the Army receives and maintains complete and accurate BH [behavioral heath] medical records in order to ensure the best delivery of care possible. “

Clinicians in private practice “are usually unaware of the need to provide feedback to DoD regarding the identification of significant service-limiting conditions and some believe they are prohibited from doing so due to medical confidentiality requirements,” the report said, and quickly added, “there are provisions within the Health Insurance Portability and Accountability Act to allow for such disclosures.”

Doctors who provide care to Reserve and Guard troops covered by the Veterans Affairs Department or the TRICARE military insurance program “must be aware that when BH conditions limit the soldier’s military job performance, that feedback should be shared with DoD medical providers,” the report said.

The Army plans to develop a training program for clinicians to reinforce the requirement to provide it with behavior health information, backed up by legal reminders.  “Such training should include the information the DoD needs, why the DoD needs it, what laws and regulations apply to the communication of such information, and how to communicate required information back to the DoD,” the report said.

This mandate could drive Reserve and Guard troops with PTSD or substance abuse problems away from treatment due to the stigma the Army acknowledged in its report.

I have a buddy who needed PTSD counseling after his second Iraq tour,  and he made sure he found a counselor way outside the system who would provide such  care without reporting it, as he considered a record of a PTSD diagnosis as career-threatening.

And, will private docs, already overburdened with insurance paperwork, really follow through on generating even more paperwork for the Army?

By Bob Brewin

March 11, 2013