S.O.S. (Stories of Service) - Ordinary people who do extraordinary work
From the little league coach to the former addict helping those still struggling, hear from people from all walks of life how they show up as a vessel for service and drive for transformational change. Hosted by Theresa Carpenter, a 29-year active duty U.S. naval officer who found service was the path to unlocking trauma and unleashing your inner potential.
S.O.S. (Stories of Service) - Ordinary people who do extraordinary work
Inside the Mind of a Military Psychiatrist with Dr. Robert Marietta | S.O.S. #216
Military psychiatrist Dr. Robert Moretta exposes the hidden flaws in our armed forces’ mental healthcare system—where administrative convenience often trumps genuine healing. From the overuse of adjustment and personality disorder diagnoses to avoid benefits, to a culture that discourages sailors from seeking help, Dr. Moretta reveals how these practices harm trust and recovery.
He shares firsthand accounts of blurred confidentiality, where providers are told to avoid diagnosing PTSD to keep paperwork simple, and how fragmented records across clinics and agencies leave struggling service members to piece together their own care.
Drawing on experience across multiple branches and the VA, Dr. Moretta outlines how standardizing policies could ensure consistent, recovery-focused care for all who serve.
Listen now, then explore his book Reflections of a Military Psychiatrist for deeper insights and solutions.
Whether you’re a veteran, military family member, or someone interested in the realities of military medicine, this conversation offers an unfiltered and compassionate look at the challenges—and hope—within the field of military psychiatry.
Buy Robert’s book - https://www.amazon.com/Reflections-Mi...
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Good day everyone Now, as you know, I do a lot of shows on mental health, but rarely. In fact, this will be the first time I've got the privilege now to sit down with a Navy psychiatrist who has actually worked in almost every branch of the military I believe you've even the VA and Dr Robert Moretta. How are you doing today?
Speaker 2:I'm doing great Thanks for having me.
Speaker 1:Well, thank you so much for being on the show and talking to us about the inside scoop of what goes on with military mental health. I was very lucky to receive an advanced copy of your manuscript and, oh my gosh, what a testament it is to not only the hardworking men and women in mental health but the insurmountable challenges that many of them face in trying to practice mental health. But before we get started, as I always do, welcome to the Stories of Service podcast Ordinary people who do extraordinary work. I'm the host of Stories of Service podcast and to get us started, as I always do, here's an introduction from my father.
Speaker 3:Charlie Pickard. From the moment we're born and lock eyes with our parents, we are inspiring others by showing up as a vessel of service. We not only help others, we help ourselves. Welcome to SOS. Stories of Service hosted by Teresa Carpenter.
Speaker 1:Hear from ordinary people from all walks of life who have transformed their communities by performing extraordinary work. And, as I said, welcome to the Stories of Service podcast. Dr Robert Marietta is a military psychiatrist and author of the new book Reflections of a Military Psychiatrist. His work offers a rare and candid look at the mental health challenges faced by service members from the perspective of the professionals who treat them. Today, he will be sharing his experiences serving at the Naval Medical Center, portsmouth during the 2022 suicide clusters aboard the USS George Washington and at the Mid-Atlantic Regional Maintenance Center, offering insight into the human cost of military service and the systemic pressures impacting mental health in the armed forces. We'll also talk briefly about Dr Marietta's career journey, from earning his medical degree at St Louis University to completing his psychiatric residency as chief psychiatry resident at Naval Medical Center, portsmouth, to serving as division psychiatrist in Okinawa with the 3rd Marine Division and then, after his time in the Navy, he continued to serve through the US Public Health Service, completing tours with the Air Force Coast Guard back to the Navy and, most recently, veterans Affairs. He's received numerous awards, including two Public Health Service Outstanding Service Medals, two Presidential Unit Citations and campaign medals for the COVID-19 pandemic and Ebola response.
Speaker 1:A fellow of the American Psychiatric Association. He remains deeply committed to supporting service members, veterans and their families. Welcome again, robert. Thank you so much, absolutely so. First off, I always ask people the most basic question where were you born and raised and what made you decide to initially join the service?
Speaker 2:So I was born in Philadelphia, pennsylvania, but I spent most of my childhood in a small town called Cape Girardeau, missouri, and it's kind of in the boot hill of Missouri. It's the biggest city between St Louis, missouri, and Memphis, tennessee, and it's a pro-military town. And have you ever seen the movie Gone Girl with Ben Affleck? I have, yeah, that was filmed in my hometown.
Speaker 2:Yeah, no-transcript, and my dad was a cardiologist, and so I kind of continued the family tradition of being a physician. And St Louis University it's a Jesuit school, it's kind of like they call it the Georgetown of the Midwest it's a Catholic school and it's focused on public service. And I was staring down a lot of medical debt due to the cost of education. Maybe I won't say when I went to school because I don't want to date myself, but yeah, going to medical school is very expensive and I came to find out about the health professional scholarship program, which basically the military will pay for you to go to school. It's like a full ride and then when you finish, when you graduate, you are commissioned as an officer and it was very competitive and I applied to different services.
Speaker 2:But so I joined the Navy that way and it was a great thing. Like I'm a pro military guy, I was a competitive swimmer and it sort of combined all my interests together. I was going to be a doctor and I was going to be near the water and so that's, that's kind of how it ended up for me. So after I graduated med school, I went to National Naval Medical Center in Bethesda, maryland Now it's called Walter Reed and I did a one-year internship in internal medicine In the Navy system. You have to apply for more training and it was like impossible to get internal medicine. You had to go on what's called a GMO tour. Being a competitive swimmer, I wanted to do an undersea medicine specialty but that didn't work out. But I I applied for psychiatry and I was offered the position and it was a great, very great career decision.
Speaker 2:Like I love the field, um you actually you know, if you do internal medicine or another field you don't get much time with a patient. But in mental health you get to spend a lot more time with the patient and get to know health. You get to spend a lot more time with the patient and get to know them and talk about things. So it's been a great career decision and I've been doing military mental health ever since.
Speaker 1:Awesome, Awesome. So tell me at that first duty station that you went to in the Navy, tell me a little bit about some of the observations that you had for your like your first impressions of working in the military mental health field.
Speaker 2:So I think you are you talking about the Washington DC, like the National Naval Medical Center.
Speaker 1:Yes.
Speaker 2:It was just kind of a rude wake-up call because I was used to living in a or working like at a civilian hospital where everyone is kind of warm and collegial and the um.
Speaker 2:The naval medical center was very malignant and kind of toxic and a lot of times I felt like it was Darth Vader choking me and it was completely unnecessary and there was some like hazing and bullying and you know it was. Yeah, it really was a wake up call to kind of go through that and people would you know like they would scrutinize you and they would say, you know you, you're not wearing the proper uniform or you're not. You know you're not.
Speaker 2:You can't wear scrubs in a hospital and I mean like there's a point to it. But it was just kind of carried away Like it was. It was kind of toxic and it took me a while to really adapt and adjust to that.
Speaker 2:I call that like the military persona you know and the doctor, senior doctors that I work with, you know they were not only were they senior doctors, but they were like Navy captains and they wanted everyone to know that, Like they wanted to make their presence and their authority known. And yeah, it was just a bit, it was a bit too much, but you know, I figured out.
Speaker 2:I kind of I think my colleagues felt the same way and we kind of toughened up and we figured out how you know how things work in the military, and then we just kind of adapted and went with it and we embraced it like you have to in order to survive.
Speaker 1:You do, you do. You have to find a way to be resilient even when you're in a toxic work environment and dealing with those challenges. I think the other thing that struck me when I was reading that portion of the book was also the procedures and processes that you got exposed to and how the programs and the programmatic side of mental health was not necessarily organized in a way where you guys felt like you were set up for success organized in a way where you guys felt like you were set up for success.
Speaker 2:Yeah, so I. I did my mental health training at. Naval Medical Center, portsmouth. Like after I transferred, I, I, I went down but it was getting a little bit of an echo here, but um, but yeah, it was difficult, it was very busy Shoot. I don't know what's going on, yeah.
Speaker 1:I can hear you just fine, and I'm not hearing the echo, too bad. Okay.
Speaker 2:But but yeah, like the Navy, it's like very busy. I was working very long hours and very, very challenging. Anytime a ship would go out, 10 people would come to the emergency room and say that you know they couldn't, they couldn't go out on the ship, you know. So I was working very long hours, sometimes like 80 hours a week or more, doing that like working on an inpatient unit, working on working in the emergency room working on an inpatient unit, working in the emergency room.
Speaker 1:What were some of the common challenges that you would say that you encountered while you were at Fort Smith, like what were some of the repeated patterns that you saw?
Speaker 2:Just so I would say people, our sailors, would come to the hospital complaining of toxic work environments and having difficulty coping. And then, you know they would. They would be in distress as a result, like they would be thinking about hurting themselves or other kind of dysfunctional behavior hurting themselves or other kind of dysfunctional behavior and so, like they would, they would present in a crisis and they would say you know, I've got to get off the ship. I've got to get off the ship. And so our job was to assist them, you know, and offer them like reassurance and encouragement, but also to, you know, focus on like fitness for duty, like what is your diagnosis? Can they, can they continue on in the Navy? And like what are? What are we going to do with them?
Speaker 1:Did you feel like, at that point, you had complete ownership of that decision? Like, did you feel like you were being pressured or did you feel like any of your colleagues were being pressured to give a certain diagnosis or to give certain opinions at that point?
Speaker 2:Um, yeah, I would say that there was a lot of focus on adjustment disorder and personality disorder and that a lot, you know, the senior doctors would over-diagnose people with adjustment disorder and personality disorder and they would say the treatment is getting them out of the Navy. And so, you know, we would take like an administrative action and write a letter saying that this person was incompatible with the Navy and then they would be released from the Navy. But it, yeah, it was. It's challenging because a lot of the sailors, like they, seem to want that, you know, they would present, they would present, and then you would say, well, what you know, what can I do to help you.
Speaker 2:And then you say, well, if we let you out of the Navy, is that going to solve your problem? And they would say, yes, it's going to solve the problem. But yeah, it's very stressful, like as a mental health provider, dealing with that. Like people are complaining of toxic work environments and then they're desperate and we're trying to figure out what to do and how to deal with them. And I would say, you know, over the past 20 years, I think some of that has changed, like there's more controls and more regulations, as far as like trying not to diagnose people with adjustment disorder and personality disorder.
Speaker 1:Yes, I remember when I fought my med board to stay in the Navy back in 1997, 98 rather, that everybody that was in my discharge planning group all had adjustment disorder and personality disorder and that was the first time I'd ever heard of borderline personality disorder and I didn't understand at the time that that was a very common diagnosis that everybody would get. Can you tell me a little bit that that was a very common diagnosis that everybody would get? Can you tell me a little bit? I'm curious is those diagnoses harder for people to collect benefits when they're med boarded, or does it make a difference?
Speaker 2:Well, a personality disorder is considered. It's called a CND, it's called a condition not disabling. So it's not, it's not a boardable condition, like you can't get any kind of disability rating. So you know, I have talked to veterans that had more severe conditions and the military, you know, misdiagnosed them or, you know, diagnosed something like that, and then it did affect the person. Like the person felt harmed. They felt like the mental health provider you know didn't behave in an appropriate manner and then they felt hurt by the organization and it just kind of left a mark on them. So yeah it does.
Speaker 2:It does affect people, it does affect their, their benefits, and you know, I have seen situations. In fact I got an argument with a military mental health provider one time, like they wanted me to change the diagnosis so that they could facilitate administrative discharge, and I I said I'm not going to do that, like I don't feel like it's appropriate, and I feel like I was retaliated because of that. But I do think I think it has gotten better over the years, but I still think it's a problem.
Speaker 1:Right, right, and I think that that's one of the things that people aren't even educated about either. A young junior sailor doesn't understand that when they're getting that diagnosis it definitely impacts their ability to later on collect benefits, because a lot of times I would argue that if somebody's suffering some of those illnesses issues, they also might have anxiety, they might have PTSD, they might have other issues that the provider might not be screening for because they're just looking for that easy thing that can immediately process them out. And so now the service member might be in a position where they're going to have to go to the VA and try to get a higher level review after their initial review, or they're going to be prolonging their process out for something that they legitimately could be suffering from. But because they were given that initial diagnosis, because it was the easiest way to process them out, we may not be serving the member in the best possible way.
Speaker 2:I do want to mention. I think a lot of times in the military things go well and I guess I'm always an optimistic person. I think the things that we're talking about do occur and is a problem.
Speaker 2:But I hope and I feel that most of the time things go well. But I think it's a valid criticism and veterans tell me all the time they feel harmed by this. And you know, in my book I talked about I was at a department meeting and the department head. He stood up in front of everyone and said don't diagnose post-traumatic stress disorder because it's going to affect the command's ability to take administrative action.
Speaker 2:And you know, shortly after that I wrote about we had a patient that had post-traumatic stress and the other mental health provider said well, that's the diagnosis, but I can't write it in the chart. You heard what the department head wrote and I think it is a problem, but the benefit stuff is very complicated. I really don't know exactly how that works. But I think the other issue and I wrote about this, I feel like, numerous times in my book is if you have a mental health provider who's behaving like that, then they are sending a message, a viral message like don't ever go talk to the SHIP psychologist or don't ever talk to this mental health provider, because this is what's going to happen to you.
Speaker 2:And I feel like that actually is possibly a bigger problem. And I was talking to somebody recently and they said that there was a fatality on a ship and they were impacted by it and they wanted to get mental health treatment and they said they would never, ever talk to the shift psychologist because of their reputation and because of the things that they had seen happen to their fellow fellow sailors. And I think that's a problem Like it's. I think that I would like to see, you know, mental health providers not be involved in things that are negative, that people that are, at least that people perceive as negative, because then if somebody is having a problem, they can trust the person they're talking to and they don't have to worry about about those kind of things.
Speaker 1:Oh, I agree Absolutely and I think that, unfortunately, the disciplinary system and the mental health system are joined. They're joined together, and there are people who are facing disciplinary issues at times, who are worried that their mental health history will be weaponized or used against them in an administrative or a court-martial procedure. Is that something that you've seen or experienced firsthand?
Speaker 2:Yeah, I have seen that and that's something that I feel like could be tightened up with the DOD, that they should put better protections on records, to say that you can't use somebody's mental health records against them. If you have a fear that what you say is going to be used against you, then you're not going to get help, like you're going to avoid getting help and you're going to suffer in silence and it's going to make things worse. So, actually, you know, improving confidentiality and protections I feel like is better, better for the military. But I can tell you, you know, for example, I worked at a substance abuse treatment program for the Navy, briefly, and sailors, would you know they had like an incident, like a police blot or incident that brought them into treatment, but then it was clear that there was a bigger problem going on, like they had used another substance, but they're absolutely terrified to make a disclosure.
Speaker 3:You know, like if you I guess it's kind of bad enough but whatever happened, you know like they're afraid they're facing possible.
Speaker 2:You know consequences from that. But if they were to open up and say you know, look, there's actually more to it, like I was doing something else and I really want to get help. But so I think it makes more sense to, you know, have like protections in there and then allow people to discuss fully. You know what happened.
Speaker 2:I think a related thing is like family advocacy. You know, if there's an allegation of domestic violence and there's more to the story, you know people should be able to open up and talk about it for the purposes of like getting help and strengthening families and not be afraid of the consequences that that happen. But you know the the command. A lot of times they have like a lot of power, they can look at people's medical records and things, and you know it's like the command is kind of a prosecutor and a helper at the same time and it creates a really awkward situation for a service member because it's hard to trust somebody who's prosecuting you. You know, absolutely.
Speaker 2:Yeah, I think a lot of times like I wonder if there should be an independent prosecutor that would vet situations. Everyone kind of stays in their lane. But I have seen situations mental health records for the certain person because there's an investigation and I don't feel like that's a good idea. Like I feel like it tarnishes the image and reputation of mental health and it's, I think, if somebody did something wrong, like they shouldn't need to dig through their medical records in order to.
Speaker 2:I think that you can.
Speaker 1:You can prove that they committed the issue or they did the issue and you can take, you can divorce mental health from this completely and still conduct a good investigation, in my view, if they know that anything that they say is going to go back to their boss. I mean, we wouldn't have somebody from Target who's having problems. Their bosses get the mental health history thrown at their bosses, so why do we let people do that in the military? Now I agree with you on a safety issue somebody who's going to harm others or harm themselves, I see that that being a notable exception. But beyond that, I think that we really do need to make this process something separate, because some of the stories you shared in the book they break my heart and they were, they were.
Speaker 1:And then you also share a lot of success stories too. So don't get me wrong, there were a lot of things, times where mental health got it right, you were able to help somebody who needed the help. They went on and they did great things for our Navy. So we're not saying that those stories don't exist, but one of them that really stood out to me was when there was the sailor who had a lot of physical issues. I think it was with her back, I want to say, and she kept getting sort of the runaround and then turns out that there was really a mental health issue that was underlying it, that that wasn't being treated.
Speaker 2:Yeah, you know, you see a lot of that.
Speaker 2:And then there's like people are accused of malingering, people are accused of malingering, and then you see these situations where you know like there's I would say there's sometimes there's like these blurred boundaries between the mental health provider and the prosecution and they're talking about, how they're going to, you know, how they're going to deal with somebody, and it just I don't feel like that's right, you know, I feel like it should be completely separate lanes, like the mental health provider should not be, you know, colluding with the command.
Speaker 2:And that's a big recommendation I had at the end of my book is that there should be a DOD instruction and it should say that communication between a command and a mental health provider should be positive and focused on strengthening a member and reducing crises and there should not be collusion regarding disciplinary actions or other things. Regarding disciplinary actions or other things, I just don't think. I think if they could make some of those changes, I think mental health would be better, better in the military. But yeah, you just see stories like that where the command it's like the dual agency, where the command is the prosecutor and helper simultaneously and it just doesn't go well. I feel like it kind of sets people up for failure.
Speaker 1:So Darren Lopez had a question here and he says how does this work for people to have their mental health?
Speaker 2:history disclosed with HIPAA laws. So I may not be the person to really give you, you know, like a solid answer on that, but if you look at the HIPAA statute, there's actually an exemption there for the military and I do believe that commanders at least at some points in my career commanders have the authority to to review somebody's medical record and also, you know, the commander has like a medical advisor and that person has the authority, I would think, to like, review a medical record and then provide feedback to the commander and I would just say, you know, nine times out of 10, everything goes well. You know, like they're trying to command.
Speaker 2:Yeah, I did tell some stories in my book where you know the command worked with mental health and they really wanted to help somebody and they want to know, you know they want to know what's going on so that they can they can assist the members, so that they can, you know, make things have a good outcome.
Speaker 1:Right. Tell me a little bit about what happened when you were the physician on the I think it was at Portsmouth Naval Hospital and the USS George Washington had a cluster of suicide deaths.
Speaker 2:Tell me a little bit about what your involvement was during that timeframe well, I I was an outpatient provider working in the clinic just seeing patients, and then also I had worked at the start at the alcohol treatment program, so, but I was at naval medical center, I think from 2019 to 2022, so I kind of saw you what events leading up to it and kind of you know what happened in the aftermath. But yeah, it's kind of like captures. I mean, I feel like in my book I tried to discuss, you know what I feel like military mental health struggles with you know and you so I feel like the ID reports and things like they. It was kind of like an investigation.
Speaker 2:But it really didn't talk about the mental health, you know, and the, the stuff where the people don't trust the, the mental health provider on the ship, like that was something that I heard consistently people having difficulty accessing care, like the SHIPS mental health having a multi-month backlog and really the same as the Naval Medical Center. And then you know just kind of like what they were talking about with the MARMAC. Like you know, all these people on limited duty and people complaining of toxic work environments and being placed on limited duty and you had like a thousand people on limited duty and undergoing the med boards process and, yeah, just kind of the the system kind of being um overwhelmed and backlogged People staying on light limited duty for extended periods of time and sometimes that lack of admission and lack of purpose while they're on light limited duty also contributes to exasperating some of the mental health problems.
Speaker 2:Yeah, I think so. You know, complicated, there's always multiple factors going on that affects people. But let's say you're in a toxic environment that's understaffed and you're under extreme pressure, and then you kind of have a breaking moment and then the people on the ship are mad at you because instead of having 10 people now they have nine people. So they blame you for, you know, basically having kind of falling apart and then you get put on limited duty. So you're hurting from that, like the sailors are hurting from how they were treated, from their working environments, from kind of toxicity, and then they get put on limited duty and then they're kind of lacking purpose and structure. And this is all through my lens, like somebody may disagree, but yeah.
Speaker 2:And then the mental health system.
Speaker 2:You know kind of being flooded with too many people and having trouble getting in there to be seen in a timely manner.
Speaker 2:And then you know in the Marmac investigation reports it talked a lot about limited duty and med boards and just having trouble tracking people, that people kind of get lost in the system and slip through the cracks and then just just a high turnover of personnel, like it's um, people like me are kind of burned out and frustrated and then all you can really do is kind of move on to a different job.
Speaker 2:Or you know, like there's there's a high demand of mental health services in the navy. So you know it's you're, you're always getting moved somewhere else, like there's always a crisis somewhere else or a greater need. So you get, you get pulled and you get moved somewhere else. And then another thing that was going on was was the DHA takeover, I guess the defense health agency and they're trying to, you know, figure out like what, what their direction is and how they're going to proceed forward, and it just affected, it affects everyone, like you're trying to. It seemed like there's a lack of a clear direction or vision. And then, yeah, we also had a problem with, like the, the mental health provider contract.
Speaker 2:So I wrote about that in my book where you know, one day I came into work and a bunch of doctors like quit, and they said that I guess their their contracts like a new contractor took over and they were told they they had to take a significant pay cut. And then it's like life doesn't work like that, you know. So it's like people are like, okay, I'm gonna, I'm gonna find a different job yeah, yeah just kind of a mess.
Speaker 2:You know, people, people stressed out and everyone trying to, you know, do the best they can and advocate for the sailors in the face of all these, all these issues.
Speaker 1:Right, and one of the ways that I think that the military can improve this is when they are facing provider shortage. What they did here I can speak from personal experience here in Gulfport, mississippi was that you get referral to a community care provider. So that can also alleviate that burden. Is, if the person is unable to be seen at the military clinic, then there needs to be an option available for the person to receive a referral to to a place out in town. Obviously, that won't work for somebody who's who's deployed, but for the people who are still state, who are stateside, I think that's a really great option, because then, um, that can fill the gap. That can fill the gap when those services aren't available.
Speaker 1:And I mean, we all know there are things like military one source or fleet and family.
Speaker 1:But the other issue with doing that instead is that you're not going to get medical care, so you'll get counseling, and sometimes that's all you need. So you'll get counseling, and sometimes that's all you need. And you have to make that decision about whether or not you want to receive straight counseling through Military OneSource or through Fleet and Family. Don't just automatically go in your medical record and so if you're needing documentation later on for a disability claim. Once you're out of the military, it is on you to ensure that you've gotten those records from those other clinics and even if it is a community care clinic, it would apply in that regard is that it's on you to get those care records if it's not through military mental health or not through a military provider. So that's another thing that I think a lot of people don't think about, because I'm having to chase down a lot of civilian documentation because those kinds of records aren't an automatic procedure. The burden is on the service member to get those records and ensure that they're updated to their file.
Speaker 2:Yeah, I think those are all good points. But as you're talking, I'm just kind of thinking about my time with the Navy and other services. But yeah, it's kind of a mess sometimes because it's like the folks are getting counseling from those family programs but the hospital providers, like you, can't see what's happening.
Speaker 2:Like there's a kind of bureaucratic or stovepipe mentality. You know stovepipe mentality and so you know, like I would see a sailor and they'd say, well, I saw the counselor of fleet and family services 32 times and I'm like, well, what you know, what was that for? Or what were your, what were you diagnosed with and what was the type of treatment you received? And you can't really see it and you get this kind of fragmented care where everyone's kind of all over the place.
Speaker 2:But, um, yeah, what works best is when there's crosstalk, when, um, people, you know, when I worked for an air force clinic and, for example, family advocacy fell under medical and that was different than the navy and the family advocacy team, they had offices in the mental health clinic so you could walk down the hall. And Navy and the family advocacy team, they had offices in the mental health clinic so you could walk down the hall and talk to a family advocacy clinician and they had better sharing of information and records. But, yeah, they call that. Yeah, if you go, if you see a non-military provider, a lot of times the the medical records they don't make it into the system and that that.
Speaker 1:It's on you to do it, it is on the service member they don't make it into the system and that that you have to.
Speaker 1:it's on you to do it, it is on the service member 100 to do it, and and more junior service members aren't going to think to do that just because it's not something that um you, you sometimes don't even understand why you even need them, uh, at that point, and then it's sometimes too late to to do that. One of the things I had to do when I was in London is after almost every appointment I had to get copies of my paperwork and then I just worked a relationship out with Lake Heath where I would do DSAFE all my records and thankfully it worked, I mean, but I did it over the course of two years and it was only because I knew that I was going to be retiring soon and I needed that documentation. But that taught me a lot. I ended up having to FOIA for my military one source records which I got, and I'm still waiting on my fleet and family service records.
Speaker 1:I still haven't gotten them from all my years of serving and it's just a very interesting concept that in the military these things are so, like you said, so stovepiped into different organizations and sometimes perhaps it was done by design so that those services would be confidential and people would not be worried that those pieces of information would appear in their medical record. But it had, unfortunately, an adverse effect of sometimes, like you said, the provider that the person's seeing at the same time, or maybe a few months later or years later, doesn't understand the history or the record of care because of the fact that it's been so fragmented across all these other organizations that serve the military.
Speaker 2:Yeah, I feel, like you know, in my mind I see the numbers, like the suicide numbers for active duty, for veterans, and it's higher than it should be, and that's my personal opinion Like I feel like we can do a better job, like I feel like the numbers should be below the national population average and I think the things that we're talking about could achieve that. You know, like if you can improve sharing of records and crosstalk, if you can improve protections for privacy, if people can talk to a mental health provider without fear of prosecution.
Speaker 1:For sure.
Speaker 2:I want to mention like at one point in my career there was a Navy admiral and he was a psychiatrist. This was like 20 years ago and he said if a patient tells you they're homosexual, they should be reported for prosecution. And at the time I think that nobody really agreed with him that that was appropriate, but it's kind of legal.
Speaker 2:You know, like if somebody says that they committed a crime or something, I guess there's a rule that you can report them. But I think there was an actual situation where that occurred, like a sailor told a mental health provider that and they reported them. And then they I think the military decided that what they did was not illegal but it was unethical. I think the person got removed from their professional association because they said that was the wrong thing to do. But I think that we could you know they should clarify that out, that we could you know they should clarify that out, like when, when does can a mental health provider make a disclosure?
Speaker 1:and that should not be used for prosecution. Yep, the other thing that you addressed in terms of solutions in your in your book were um, can you tell me a little bit about process standardized operating procedures? I struggle to understand why each branch does mental health differently Like. Why isn't there a DOD or DHA standardizing some of the procedures that mental health is governed by?
Speaker 2:I'm a fan of standardization. I'm pretty sure there's people that would disagree with me because they would tell you that you know, like the Army and the Navy, they're different and they have special needs.
Speaker 2:But in some ways they are, in some ways they aren't you know, and it's interesting, the experiences that I've had that each service has like strengths and weaknesses had, that each service has like strengths and weaknesses. But but to me it makes sense to kind of standardize it out and have the same system and policies for everyone especially. You know, I live here in hampton roads and, um, it's a they call it like a tri-service market. It's actually more than that, because there's coast guard but there's like army, air force, coast guard, navy here and there's marine corps too if you consider them another service. So if everyone was doing the same thing and everyone was following the same rules and everyone was, you know, using the same systems, to me it would just kind of flow better. And you know, I I mentioned in my book that at one point I saw this research project where somebody was trying to inventory all the mental health policies and there's, I think, there was like 300 of them or 250.
Speaker 2:It's just like it's too much, it's too confusing, like they should kind of standardize it down and then everyone should deserve the same quality of care. So if an airman sees mental health and they get diagnosed with major depression and they get a board, then a sailor should have that same opportunity. Like they shouldn't be diagnosed differently, they shouldn't be, you know, handled differently. So I just that's kind of an observation that I have that things are kind of chaotic and they're kind of fragmented and it just creates all this, this chaos and confusion.
Speaker 2:And I think I wrote a few examples of that in my book where there was like a navy psychiatrist. I was working at an army hospital and it just things are completely different for mental health, like the way, the way the army does things, or you have. I think there's probably other situations like that where you know another, let's say, a soldier, would work at a Navy hospital or something, and it just would. I think that to me it seems like the defense, the DOD, is headed in that direction where instead of having like a Navy hospital, they're having like a DHA hospital.
Speaker 1:So why not just standardize it, like you said, like standardize those procedures as well. What were some of your observations from going from the military system to the VA system?
Speaker 2:to the VA system. So, yeah, the VA is, it's focused on recovery and I feel like it's you know, I've had many discussions with some of my colleagues and it's I feel like it works better. It's certainly not perfect and a lot of people have criticisms of the VA and other agencies, but it's more focused on, like, protection of people and recovering and strengthening people, whereas the DOD system is, like it's fixated on fitness for duty. You know, a lot of times I feel like it's kind of a mistake that you know, like you're a sailor and you go see a mental health provider. Seventy five percent of their energy is focused on you know what's your?
Speaker 2:diagnosis Are you fit for duty? When the real issue is like, how can we help, like, how can we make you a better sailor? How can we help you recover or strengthen from whatever it is you're suffering from? How can we help you recover or strengthen from whatever it is you're suffering from? And I feel like a lot of times that the fitness for duty stuff is like chasing a paper tiger, like it's kind of a waste of energy and it's better to just you know better to focus on what are we going to do. You know how are we going to fix it.
Speaker 2:It kind of gets back to what I was saying. Like you go see a mental health provider and on the first time they diagnose you with a bad diagnosis and then initiate your process for discharge. Like that's, that's wrong. Like it's not, it's not helpful to the military, it's not helpful to the member, it's not helpful to the member and but yeah, the VA, I think it. It has a different approach, like it's more focused on recovery. And I just hear, hear better stories Like you don't. You don't hear stories like a mental health provider like screened after you know, screened at the patient and what was really harsh to them.
Speaker 1:Gotcha, what was your intent by writing the book and putting this out into a non-medical audience, into the public Like? What is it that you hope to achieve with writing this book?
Speaker 2:So I'm a military psychiatrist and I have over 20 years of experience military psychiatrist and I have over 20 years of experience, and I was kind of at a point in my career where I wanted to make a contribution to my field. And also, you know, over the course of my career, you know, I've heard all these stories about human suffering and I wanted to advocate for my patients, for service members, for veterans, for their families, because I think we can do a better job. And you know, when there's a lot of talk about military mental health and you read, you know, you read an article, you know, say, something happens but you never really see the full picture Like it's. It's a complicated thing and there's there's many different spinning wheels, you know. And so what I wanted to do was I wanted to advocate and eliminate human suffering and I wanted to do a deep dive and I wanted to, you know, stimulate a discussion about military mental health.
Speaker 2:And just, you know, is there anything we can do to move the needle forward? That's what my colleagues and I say. And you know, since I would say, since World War II, especially since Vietnam, military mental health has slowly moved forward and we're getting better and better at it and we're definitely not done. And so that's what my hope is. I hope that people would. You know I set out to create a discussion in academic work. I hope people would think about it. And you know, let's collaborate, let's put our heads together, just like I'm recommending in the book. You know, let's all work together and let's figure out how we can improve mental health.
Speaker 2:And yeah, I'm a big fan of your show and so much of the topics that you cover affect people's mental health. And you know, if you feel like you're being unfairly treated or the promotion system isn't fair or you've got a toxic work environment, those things, those things have to be addressed. Like, if you can address those things, if you can work on the underlying issues, then we can get at those numbers you issues, then we can get at those numbers, then we can reduce suicide, we can reduce the impact the military and mental health has on its members.
Speaker 1:Absolutely, robert.
Speaker 1:I mean, that's the root cause diagnosis, and that's what I really look to do when I do a podcast is I want to look at what is the root cause issue that's causing the problem and just doing simple things like standardizing the standard, the treatment across services, so people know what to expect when they go into a provider's office.
Speaker 1:Making sure that there's always off-duty referrals if there's not enough providers in a military hospital. Making sure that people get a diagnosis that is accurate to the symptoms, not one that will process them out quickly but is accurate to the symptoms that they describe. Understanding the rules on disclosure the service member walking into a provider, knowing what can be disclosed to their chain of command and what can't be disclosed to their chain of command, and having that conversation up front. Having a requirement to even maybe sign a disclosure form or a form that you understand what will be shared and what won't be shared those are all things that we could be doing to enhance the level of care. Another thing that I wanted to ask you your thoughts about, another thing that I wanted to ask you your thoughts on, that Do you think there's more exploration that could be done in those areas?
Speaker 2:Well, I want to comment on that, but you have me so thinking so much and excited there with previously what you were saying.
Speaker 2:but but yeah, I'm 100 on board with what you're saying, like I feel the dod could provide more direction by cleaning up those policies and saying you know your, your medical records are not going to be released to, you know, for criminal prosecution, and they could could better explain kind of what situations you know records would be released or how they would be used.
Speaker 2:Because I feel like if it doesn't say and I got this feedback from a number of people if a policy doesn't say what you can't do, then it means you can kind of do it, you know. So if do it. I feel like a lot of times people are acting, they feel like they're acting in good faith, everyone's trying to do the best they can and then it's like something kind of goes bad. I've seen a situation where I talked to a command one time and I felt like what I was doing was proper and then the command made kind of inappropriate disclosures and then it made the situation worse. So if you could kind of clean up the, the policies and you know kind of iron it out a little bit more so people understand where their lanes are and and then, yeah, absolutely what you said.
Speaker 2:You know, like if and I personally feel that the mental military, mental health provider should not be involved in negative personnel actions because it just I feel like it creates more harm than good, or they should, they should use like an independent person to do that, so like, let's say, I'm a treating provider and then somebody else is like an independent assessor, and that way, that way the patient, the service member they don't.
Speaker 2:You know, they don't have to be confused or they don't have to feel like the doctor is harming you know, I feel like there's a lot of room for improvement as far as those issues go. Um, but yes, as far as alternative treatments, yeah, the military mental health system, they're focused on what they call evidence-based treatments. You know, they want to make sure that the treatment is safe and effective and there have been situations where treatments made things worse. So I mentioned in my book there was a form of psychological debriefing that actually made things worse. There was some research about it, but the idea that somebody was involved in some kind of trauma and that they were going to do like a debriefing and it caused it actually increased the risk of PTSD, like forcing somebody to talk about something when they weren't ready. So I feel, like the military, they want to the military and just everyone in general, they want to make sure that treatments are safe and effective.
Speaker 2:So you read all the stuff on social media and people are really excited about certain treatments, but it's hard to kind of justify. You know, we want to make sure that we're not doing harm to people. But yeah, I'm excited about the future. I mean, there seems to be new and upcoming treatments that are available, but it's kind of tricky. And then I feel like it also gets to discussion of money. Those treatments cost money and they want to get paid, and who's's going to pay for it and who's going to authorize it, and it turns into a big mess.
Speaker 1:Right it is.
Speaker 1:It is tough, and I mean the VA is struggling with that, struggling with trying to figure out what, what kinds of treatments, alternative to diagnosis and medication that can be done.
Speaker 1:I was very fortunate when I was in London seeing an off-base provider who referred me to a psychiatrist who administered EMDR, and I found the EMDR to be very beneficial because what it did is it removed the emotional charge of what we were discussing and it turned it into something very objective and it truly did help me move past some of these these issues, because I was able to see it from a almost like a, from a lens of outside, looking in, and I I really think that there are other alternatives out there, that that can help and and that we should do our best to provide people with the resources and the means to do so.
Speaker 1:But your book was excellent, not only because you attacked the issue from so many different angles. You shared your experiences across the services so you could do contrast and comparison among the branches and then even the VA, and then you also use different case studies to describe some of the major issues that you would see. And the other piece that I liked about it is that it was not at all a hit piece. It was a piece that is driven towards reforming the system by pointing out ways that we can be better.
Speaker 2:I appreciate that and I feel like the military has a tendency to witch hunt people and go after people and I think I did mention the human suffering element and I just wanted to capture in my book like the stories that I hear and like how people are treated, like how that affects their lives, and I feel like that's an easy fix. You know we talk about experimental treatments or expensive medications or other things, but you know how you treat somebody is free, like if you, if you have a service member that's under your command, like you can treat them in a respectful way and you can be sensitive to them and you can treat them like a human being, and that that probably is the best protective factor, I think, for mental health. And just, yeah, I think a lot of those stories that I put in there, just kind of how people are treated.
Speaker 2:Diego, he wrote a book. He was a Navy SEAL. He wrote a book about mental health and his experiences, his journey, and he talked about feeling there was a career smashing anvil over his head at all times and if he made the slightest mistake, then the career smashing anvil is going to come down and it's going to strike, and I think it's. I think the military does that too much. I think that there's too much pressure on service members and that I think we could do something about that, like we could the way that we treat people. We could, you know, we could reduce the pressure on people and I think a lot of the stuff that that your guests talk about.
Speaker 2:You know about a military justice. It's like the the pressure is too great, like the stakes are too high. You know about a military justice. It's like the the pressure is too great, like the stakes are are too high. You know, if you make a mistake, um, maybe losing a career isn't the best, best thing, maybe you should get some kind of punishment or pay a fine. And then they say don't ever do it again. And gosh, you know, you learned your lesson and you're a better sailor or whoever because of that. But but yeah, maybe we need some some justice reform, um to to treat people better. But I, I like I said I appreciate what you said and, um, I believe that, um, you know, kind of a systems approach that if we kind of study what's going on without blaming people, you know we can, we, can we can get at issues.
Speaker 2:We can work together, we can collaborate, we can make the world a better place. And and often I I do feel that there's some bad apples out there. But a lot, a lot of time probably most of the time people feel like they're doing the right thing and then it's like the system just kind of sets everyone up for failure and then it just kind of explodes. And then we're kind of sets everyone up for failure and then it just kind of explodes and then we're kind of we're left holding the bag every every show I do um.
Speaker 1:an example would be I just recently had adam dorito on and he had a case where his, his medical records uh were. He had a command directed evaluation that he didn't even know was. Was was being the way it was going to be written or characterized, had no input into it and it was. It was dated several months after he uh had the evaluation and it was just this idea that he wasn't even informed of properly of the process. But when we go back to where his problems started on the case, it came down to one lieutenant colonel who was in charge of him and the way that this one lieutenant colonel was treating him.
Speaker 1:And I often think that every single problem in the military stems from a problem between two people.
Speaker 1:At the end of the day, it's a problem between one person and another person, and then everybody takes sides on this issue and everybody kind of falls in somewhere where they either isolate the person who's who's who's um the victim or being discriminated against or they sympathize with the boss or everyone hates the boss, but no one will speak up or speak out because they're afraid to lose their job.
Speaker 1:So there's always this dynamic that happens, and I do think that part of what will fix mental health is reforming the promotion system and the incentives that we say will make people rise to the top, and I think that that is something that I'm really hopeful that the administration will further look at. We've seen that with Stu Scheller. He's working on ways in which we can improve the military officer promotion system and I think that those reforms will really go a long way in helping people like yourself on the back end of the mental health issues Because, again, as we go into these root cause analysis issues, it's really, at the end of the day, about treating people better and treating people with more kindness.
Speaker 2:Yeah, I 100% agree.
Speaker 2:And a lot of times when people come to me they're complaining of like a toxic work situation and the behavior is like outrageous.
Speaker 2:Like if the service member had a camera or something and put it on YouTube, that lieutenant colonel or whoever would be in a lot of trouble.
Speaker 2:But you know, it's the idea that you know, and I personally have had these types of leaders that they look good on paper and they get the job done and they make the chain of command happy, but other than that they have a downside, like they're not very good with people and they're kind of harsh and abrasive, and I don't think that type of leadership style is conducive to mental health.
Speaker 2:Like you need and I'm I'm a firm believer in like a 360 degree evaluation, like that the people under you know should be rating the person above and that way, if you had somebody like that, they could, that could become apparent, and then the people picking the promotions would be well, you're perfect in all these areas, but on interpersonal like you're number two and you need to work on that next year and come back and maybe we'll give you a promotion. But that type of stuff it really affects people. And then, yeah, I agree with you. I feel like a lot of times the command gets angry at somebody and then they're. I feel like the military is like the mafia sometimes.
Speaker 1:Like you're.
Speaker 2:you know you made the mafia boss mad and they feel like you crossed them. So they're going to teach you a lesson to. It's going to be a lesson for you and it's going to be a lesson for everyone else and don't ever cross the chain of command again. And I don't. I think that's like a mistake and it I that type of mentality. It really really affects people. It's kind of negative, it's kind of toxic and we should do more to get rid of that. But I like, like I, I like the idea of having an independent prosecutor, because if you're a commander and you're mad at somebody, are you really being objective? You know, like maybe it would be better to have an independent prosecutor to look at it and say, well, yeah, this guy, he made them mad. But it's not enough here to like prosecute, but we're going to do this or just just something else. You know just, and then I hear this a lot that people feel the the system is stacked against them, you know, and a lot of times people don't know what they're doing or they just kind of something bad happens and they make a mistake and then it's like the full weight of the command is thrown on.
Speaker 2:It was explained to me at one point that, let's say that somebody has a DUI right or some kind of incident, they're basically facing multiple pathways of adverse action simultaneously, so like if you had a DUI, you could be facing prosecution from civilian authorities, you could be facing UCMJ action. You can face medical disqualification, like you're let's say you're overseas or something, and they say well, you had an alcohol incident, we're disqualifying you and sending you home. You can also face adverse personnel actions like you could lose your pay, you could lose your qualification or you could lose something else, and then, on top of all that, you can get a bad evaluation. And so you've got like six or seven pathways. I'm sorry, I didn't really count, but you're, you know you're, you're hurting, you made a mistake.
Speaker 2:And then you know the full weight of the US government is coming after you and it's it's like it's too much, like it's that career ending handle smashing you, and then it just, it just negatively affects people like we should. Maybe we should think a little bit differently, like how could we, how can we hold somebody accountable but at the same time, you know, set them up so they can learn a lesson and then have a career instead of you know all or nothing. You screwed up. We're cutting your head off and that's it, and you're. You know it's just too much. It's just too much for people.
Speaker 1:I agree, robert. I mean I had a DUI in 2014 and I'll tell you like the second chance that I was given was invaluable and I've known junior sailors that have had been given second chances. And then I've known junior officers and junior sailors that weren't given second chances and it all seems very random and it doesn't seem sometimes to match who deserved one and who didn't. And I think it's really unfortunate that the system is set up that way, because then somebody like myself who does get a second chance, then all the people that didn't get a second chance are very upset and resentful and think it's not fair. And I mean I agree, like I don't think we should just throw people away because they make a mistake, and I mean I'm living proof that you could make a mistake and still recover and move on. And in fact, my incident was instrumental in helping another junior officer recover from hers. Later on, I was able to write a letter for somebody who had had a also a DUI and was able to recover from her incident and move forward. So I was very fortunate to be able to be in that position and if you know, that hadn't happened to me and I hadn't been given that second chance, I wouldn't have been able to do that for her, and so I think that those lessons are important to also point out.
Speaker 1:There are good people, there are wonderful people in the military, and I've been blessed to have some of them in my path. I've also worked for some of the worst leaders out there, who were awful, and it's just one of those things where we really can do things to improve the conditions that even that that that Cause the mental health conditions. To begin with, and not everybody starts on the same page. Certain environments and certain climates and work are going to impact people differently, and some more severely, based on their personal mental health history, and I think that we have to just be aware of that and do what we can to help people grow as best we can. But if people want more information or the book, tell me a little bit about where they can find it.
Speaker 2:Well, we'll post a link in the chat, but you can just search from your bookseller, like Amazon, amazon or Barnes and Noble.
Speaker 1:Yep, and it is called. The book is called Reflections of a Military Psychologist. It is available. Hold on, I'm going to put you on. Give me a minute here. Hold it up for a second, cause I'm going to put you on a full screen again. So there's the book Reflections of a Military Psychologist, and I know it just got released and I'm really excited for people to read it. If you read it and you like the book, please go on Amazon, go on where you found it and put up a review. And as we close out the call I think I think we're at the top of the hour a little over Tell me about what the reception has been so far, about the book.
Speaker 2:I've gotten very positive reception. I had the article from the other doctor, he really liked it.
Speaker 2:People they want to know about military mental health. I was talking to a doctor and he was working with a veteran, a sailor, and he liked the book he felt like it gave him insight into what the sailor was suffering from. But, yeah, very positive and I think everyone agrees with me that this is a problem we should, as a country, we need to come together, we need to address, we need to make things better for veterans. Yeah, I'm looking forward um for discussion and um and gosh, I I really enjoy talking to you, man. I I was thinking about what you're saying about the substance stuff and um, yeah, the the like subjective application of military justice, like it. You know, I've seen people that had, um, a mild alcohol incident and the government threw the book at them and ruined their career.
Speaker 2:And then you see other people that I've seen people that had multiple incidents and the government to kind of turned a blind eye to it, and so it just affects people. So hopefully, you know, maybe the DOD could standardize that out a little bit more. Yep, I agree All. Hopefully, you know, maybe the DoD could standardize that out a little bit more Yep.
Speaker 1:Well, thank you All right, yeah, thank you so much. I'm going to meet you backstage to say goodbye, but I'll go full screen Appreciate you coming on the stories of service podcast and thank you so much for sharing this contribution to our, to our community. I think it's incredibly important.
Speaker 2:Thank you.
Speaker 1:All right guys Out of town this week. So I'm in Columbus, ohio, for the VFW convention and to see my family and also celebrate one of my friends' 50th anniversary I'm sorry, 50th birthday. I'm also going to be going to the New York City Navy SEAL Sw uh sponsored by the Navy SEAL foundation. That'll be this weekend and then next week I'll be back in town and doing podcasts again, I believe. Next week I have the gentleman who started the hots and cots app, which is an app that reports on dining facilities and housing and birthing, and I just can't wait to get into it. He is also a truth teller in his own right, so really looking forward to talking to him.
Speaker 1:Thank you so much for joining us. Please get Robert's book. It is so good, I mean so many great examples of ways we can make things better and case studies and just things that I think will really resonate with a lot of people who've been through the mental health system or know somebody who has, and ways we can help one another and be better. So, as I always close these calls, please take care of yourselves, take care of each other and enjoy the rest of your evening. Bye-bye now.