A pilot program started five years ago that assigned a clinical therapist aboard a Navy carrier has grown to include 10% of the service’s complement of 120 psychologists.
Lt. Cmdr. Scott Johnston, Ph.D., who heads up the Navy’s Psychology at Sea program, said that 12 aircraft carrier battle groups now have a psychologist assigned. The psychologist provides services to 10,000 sailors on 12 ships in each carrier group.
The program, which started in 1996, was a radical change in how the Navy treated mental health problems in the fleet, Johnston said.
Historically, sailors in need of psychological counseling or other mental health services were medivaced to one of the Navy’s shore hospitals at considerable expense and time.
The first psychologist in the program was assigned on the USS Kittyhawk. Two more carriers, the USS Nimitz and USS Constellation, were added in 1997. Now, all carrier groups have a psychologist aboard.
“Having a psychologist aboard the carrier means we can treat sailors in their environment, with the support of the chain of command, before symptoms escalate,” Johnston explained.
Johnston said research has shown that treating combat stress patients as close to the front lines as possible is preferable to moving them too far away from the conflict.
“Medivacing a patient off a ship increases the sailor’s identification as a patient and worsens his or her prognosis,” he said.
It’s also expensive. Johnston said it costs the Navy around $20,000 to medivac a sailor off a ship to a shore facility.
Johnston gained his insight into the psychology at sea program when he served as the psychologist for the USS Constellation Battle Group in 1999 in the Arabian Gulf.
“I never worked so hard, had so much fun and felt so professionally fulfilled,” he said.
During his six-month deployment, Johnston said he conducted more than 150 new evaluations, provided 600 follow-ups and conducted 200 group sessions.
During that time, he said, only one sailor was medivaced for further evaluation and treatment that required an MRI and neuropsychological evaluation.
He was the senior member and training officer for the critical incident stress management team, which was activated when a sailor died on liberty.
“Having this team in place helped the other sailors grieve and inoculated them against future psychopathology,” Johnston said.
Johnston, a graduate of the Pacific Graduate School in Palo Alto, Calif., said adjustment disorders, alcohol dependence, depression, post traumatic stress disorder and suicide ideation were among the range of psychopathology he encountered during his tour of duty.
Adjustment disorders were most prevalent at the beginning of the deployment, with many sailors desiring to leave the ship, he said. At the end of the deployment, problems were most typically related to family reintegration.
“Many sailors dealt with abandonment of significant others and difficulties with pending reunification with family members,” Johnston added.
Johnston said group therapy was used in dealing with the large numbers of patients–particularly those sailors dealing with stress and anger issues.
Johnston recently completed a short hitch at the Navy hospital in Keflavik, Iceland. He had previously been stationed in San Diego. He is now working in Washington, D.C., treating, screening and monitoring the Marines who guard the President.