Military Psychiatrists - what is deployment like?

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woof_iamadog

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Currently in medical school and strongly considering psychiatry. Also really want to serve in the military. I am interested in joining the reserves or national guard because this seems most doable given my family situation.

What is it like to deploy to a combat zone as a psychiatrist? Where do you work - in a combat support hospital? Is it exciting, or mostly quiet and boring? What kind of issues do you see? Do you feel like you make a positive impact, or does it feel futile? How much talk therapy vs "medication management" do you do? Are patients afraid to talk to you due to stigma/career issues or do you feel appreciated by your patients?

Thank you.

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What is it like to deploy to a combat zone as a psychiatrist?

Quite busy! On my last deployment---a sea one, an amphibious squadron of 3 ships and a USMC expeditionary unit---we deployed with x2 FPs, x1 EM, x1 OBGYN, x1 GS, and x1 Psychiatrist. By far, the busiest guy was the psychiatrist. And that we had him in our battle group probably saved us some 40 to 50 medevacs. He managed acute SI, depression, etc etc. So useful was he that his involvement was briefed up to the CNO, and I think a psychiatrist is now standard for every deploying ARG (before it was just an add on, i think).

Have fun, go nuts . . . (no pun intended)
 
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Thanks for the reply. That's encouraging that military psychiatrists are very busy and useful when deployed - that is exactly what I was hoping to hear.

ARG = Amphibious Readiness Group?
 
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Thanks for the reply. That's encouraging that military psychiatrists are very busy and useful when deployed - that is exactly what I was hoping to hear.

ARG = Amphibious Readiness Group?

Yes.

Go easy....'very busy' does not necessarily mean 'clinically-meaningful busy'. You wont see much Axis I stuff, you will see a lot of Adjustment Disorder.
 
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You do see an occasional psychotic break, as they're the right age for new onset schizophrenia.
 
Didn’t want to start a new thread on a similar topic — I’m an M3 and setting up auditions in next few months. Thinking psych and was wondering if any docs (esp Army) would be willing to give some career advice by pm?
 
Sure. But what you don't do is long term management of anything Axis I, b/c they're almost immediately separated from the military.
This isn’t the case at all.

I don’t know the data of how many servicemembers hold Axis I diagnoses, but I know that last I heard, 17% of active duty servicemembers were on SSRIs and 6% of deployed troops. That was DoD testimony to congress a few years back. SSRIs are pretty good yardsticks for long term management of Axis I.

Psychosis and Bipolar (often) will get you a quick separation. But not depression, anxiety, and PTSD.

Bad info that reduces servicemembers from seeking out mental health care because they think this will put them on the block for medical separation is bad juju.
 
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SSRIs are pretty good yardsticks for long term management of Axis I.
They are?! the 17% figure you quoted is probably all-comers, not just Axis 1. We pass 'em out like candy nowadays, you know that.

If you have a clear Axis 1 diagnosis, you'll likely be separated in 1-2 years(x2 LIMDus+medboard). I'm not stating anything secret here, we know this. Non-Axis-1, well-controlled, compliant with treatment, and you can do your job...you're welcome to stay. And that's the way it should be, the military doesn't have the time nor resources to manage/treat non-compliant schizophrenics.

And what's worse now is that our Psychiatry departments are refusing to see any one non-active duty (at least at my home institution). I've heard more than one resident complain about doing a 4-year psych residency so they could learn to how to separate a sailor for adjustment disorder.
 
They are?! the 17% figure you quoted is probably all-comers, not just Axis 1. We pass 'em out like candy nowadays, you know that.

If you have a clear Axis 1 diagnosis, you'll likely be separated in 1-2 years(x2 LIMDus+medboard). I'm not stating anything secret here, we know this. Non-Axis-1, well-controlled, compliant with treatment, and you can do your job...you're welcome to stay. And that's the way it should be, the military doesn't have the time nor resources to manage/treat non-compliant schizophrenics.
I think you’re confused as to what Axis 1 means.

Axis 1 is literally ALL of mental health except for Personality Disorders. PTSD, anxiety, depression, adjustment is all Axis 1. If your mom dies and you’re sad, it’s Axis 1. If you give birth and have the “baby blues,” it’s Axis 1. If you get counseling for your binge drinking, it’s Axis 1. It also contains schizophrenia and bipolar disorder, but that doesn’t mean Axis 1 somehow indicates a level of severity. It just means “mental illness” minus personality disorders.

So if you’re prescribing an SSRI, there’s a 99% chance it’s for an Axis 1 pathology. I don’t know any other diagnosis you would write it for (except for some outside the box stuff like premature ejaculation). I would imagine PCPs still use Axis 1 coding for their use, even if they don’t think of it that way.

I’m Army, but I have worked with enough Navy to know that you don’t separate any sailor with an Axis 1 pathology after a year. You don’t qualify for medical separation based on diagnosis, you qualify based on level of functioning. The vast majority of service members with Axis 1 pathology (like PTSD, anxiety, and depression) are fully deployable and without accommodation.

What tends to end careers isn’t seeking out mental health issues and getting treatment. What tends to end careers is failure to comply with standards due to behavior, drugs, or alcohol because of lack of treatment for pretty basic mental health issues due stigma and bad info.
 
And what's worse now is that our Psychiatry departments are refusing to see any one non-active duty (at least at my home institution). I've heard more than one resident complain about doing a 4-year psych residency so they could learn to how to separate a sailor for adjustment disorder.
Yep. This is the reason I avoided HPSP from the jump: diversity of cases in military residencies.

The military psych residencies get great exposure to PTSD and pretty good exposure to depression and anxiety. Where they suffer is management of Severe Mental Illness because folks with SMI tend to get separated. You get some exposure to first breaks in stressful environments, as you do mania, but you don’t get long-term management of these disorders because the servicemembers is separated.

Where military psych really gets the short end of the stick is doing these separations which are often the failure of commands to discipline and administratively separate servicemembers. The amount of referrals for “adjustment” that is really behavioral and should be treated as discipline, is really astonishing. But once a soldier is referred for separation for adjustment disorder, it’s a mental health thing and command has little to do with it. Much easier than actually taking corrective action on the behavior and dealing with it administratively within the command. Oi...
 
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I think you’re confused as to what Axis 1 means.

Axis 1 is literally ALL of mental health except for Personality Disorders.

Ok, yes I was using Axis 1 to mean a higher level of acuity (or non-Axis 2: we can't do much for personality disorders, unless the patient is cognizant of said disorder and willing to change).

It's a shame, I've had quite a few dependents and retires in my clinic with real deal pathology (BP1, Schizophrenia), they'd make great patients for a Psych R3 or R4. I can't imagine how devoid my training would have been if we only saw active duty (ie no real diabetes, heart failure, etc).
 
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Seems that the only thing that may improve BPD is dialectical behavioral therapy. They were high maintenance out at sea.
 
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