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Friday, September 12, 2014

Pres. Obama outlines strategies for improving mental health services, before the American Legion’s 96th convention

as reported by Rose L Thayer | Foot Hood Herald | Sept 10, 2014

Standing before the American Legion’s 96th convention last month, President Barack Obama outlined new executive actions to improve mental health services for active-duty service members, veterans and their families.

The 19 initiatives range from improving the transition process from active duty to utilizing Veterans Affairs’ services to improving community resources and awareness of available mental health care.

The groundwork for many of the goals of the initiatives has already begun at Fort Hood.
Enhancing mental health care where service members work.
In 2010, Fort Hood began opening embedded behavioral health clinics as part of an ongoing effort by DOD to move this type of care to where service members work. These clinics don’t replace any facilities, but are meant to enhance what is available at Darnall.
One of Obama’s actions is to continue to support this work while collecting an analyzing data from embedded clinics, and to design a study to determine if this approach is equal to or more effective than the traditional way in which patients seek care within a clinic or hospital setting.
Fort Hood has seen success in the model and has plans to expand its embedded behavioral health care, said Col. Jeffrey Yarvis, chief of soldier behavioral health services for Carl R. Darnall Army Medical Center.
The goal is to open up to 11 of these clinics within the footprints of units, he said. The fifth one opened in April, and officials are scouting locations for the sixth.
“They are doing pretty well,” Yarvis said of the clinics.
The current requirement is for each of Fort Hood’s four brigade combat teams to have a clinic, but because of their success, Darnall is expanding to include more units — perhaps co-locating some of the clinics to serve more than one unit.
“It eliminates the ‘us and them’ mentality. It’s a team effort,” Yarvis said.
This also helps break down any stigma of seeking treatment, he added.
“The bottom line is commanders have a better appreciation of what we do,” Yarvis said.
Each clinic has about 11 to 13 personnel, with five of them as nonmedical support. Each provider sees about seven to eight soldiers a day, Yarvis said.
He credits the success of the model to the hospital’s “visionary command,” which also added behavioral health to Darnall’s primary clinics. This gives primary care managers a “better sense of how to identify behavioral health issues,” Yarvis said.
“This really is the ‘Great Place’ in terms of the great things that happen here,” he said.
Improving patient safety and suicide prevention.
The president included three actions to specifically to improve patient safety and suicide prevention, and Fort Hood has laid the groundwork for two of them.
The first of these is expanding access to opiate overdose reversal kits. The action requires these kits and training be available to every first responder on military bases or other areas under DOD’s control.
Maj. Chris Mitchell, director of pre-hospital care and an emergency physician at Darnall, said the president is referring to the drug, naloxone, an opioid antagonist.
The kits have an auto-injector similar to an EpiPen, Mitchell said.
“It’s designed for use by a nonmedical person to just inject through the skin ... basically to save someone’s life,” he said.
Currently, Fort Hood ambulances are equipped with naloxone, but for use by trained medical staff who know how to give injections.
“It’s also not that common. We don’t have heroin as a major problem on Fort Hood,” Mitchell said. “It’s not often used in the emergency department.”
While his first responders do see some abuse of opioid narcotics, such as morphine, hydrocodone and oxycodone, these pills forms don’t cause as severe a reaction injecting heroin.
Mitchell said he’s aware of the president’s initiative, but that Fort Hood hasn’t made progress toward getting the auto-injectors for nonmedical first responders.
“There’s nothing wrong with pushing this ... other than the cost,” Mitchell said. “It’s a good initiative to educate the public about opioid overdose and ways to help their family members and their friends.”
Another of Obama’s safety and suicide prevention actions includes providing new opportunities for service members, veterans and their families to give back unwanted medications.
These new programs will create ways to safely dispose of these drugs and reduce the opportunities for abuse.
Every year Fort Hood offers two days to return drugs, said Dr. Adam B. Alvarez, Darnall’s chief of clinical pharmacy. His department assists with these days, because pharmacies are unable to accept drugs back from customers. The next of these days is scheduled for Sept. 27.
“The pharmacy will be there to be a liaison if people have questions about drugs,” Alvarez said.
While it’s possible for people to research online how to destroy prescription drugs properly through the Drug Enforcement Agency, these days help people who just want to get the medicine out of their home.
“If you have children, it’s important to keep (drugs) away from kids,” he said. “It’s also important to keep them out of the environment as well.”
Some people keep drugs for years — long after the prescription expires, Alvarez said.
“If it wasn’t used in the last year, you don’t need it,” he said.

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