A call came in about a week ago to the Civilian Medical Resources Network from a Fort Carson soldier deployed abroad.
"This is a client who is actively suicidal and has not been able to obtain the services he needs," says Howard Waitzkin, a physician and sociologist at the University of New Mexico.
Discussions are continuing about how to help the soldier — e-mail correspondence with a civilian counselor will be the first step — but Waitzkin says the case points to what he considers an unavoidable problem with military medicine.
"There's a fundamental ethical contradiction," Waitzkin says. "Even if the military services try to improve things, [they still] run against the double agency problem."
The "double agency" problem basically boils down to this: Doctors and other health providers in the military face the twin, often-conflicting duties of looking out for the well-being of their patients while still supporting their branch's strategic goals.
Since 2006, the network, made up of more than 50 medical and mental health providers spread between both coasts, has worked with more than 250 service members at U.S. bases. Pointing to continued suicides among Fort Carson soldiers — five so far this year — and a string of homicides involving combat veterans from the post, Waitzkin now wants to bring the network here. He's looking for local psychiatrists, counselors and other medical providers to work occasionally with soldiers for little or no compensation. Once the providers are in place, he'd spread the word among active-duty soldiers that they are available, outside the services provided by the post.
How much they'll be needed is debatable. Frederick Coolidge, a psychology professor at the University of Colorado at Colorado Springs, says he's been impressed with how the post has responded to concerns about the mental health of soldiers, particularly under the leadership of Maj. Gen. Mark Graham, who departed the post earlier this month.
"Now, I think there's more sensitivity than ever," Coolidge says.
Responding to e-mailed questions from the Independent, Col. George Brandt, chief of behavioral health at Fort Carson's Evans Army Community Hospital, says the post continues to hire new mental health providers, with a 40 percent increase from a year ago.
As for the double-agency problem, Brandt writes that it is an "aspect every provider deals with and is actively discussed." Providers try to help soldiers do their jobs, but if they cannot, he continues, "then we typically are the first advocates for the soldier in that process."
Still, Waitzkin sees obstacles for some soldiers getting the care they need within the military system, particularly when junior enlisted soldiers must confide in providers who are well above them in rank and seniority. Contracting for providers outside the military can help, Waitzkin argues, but only if the providers are paid per visit, with no financial incentive to hustle soldiers back to the field.
About 80 percent of the cases that come to the Resources Network deal with mental health problems, and Waitzkin can reference some successes. Notably, one provider in the network worked with a soldier who was considering suicide or homicide in the wake of gruesome experiences in Iraq. Ultimately, the provider's recommendation helped get the soldier discharged.
As the network grows and word about it spreads, Waitzkin hopes it can help in similar cases.
"Our feeling," he says, "is there's a very large pool of unmet need out there."