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Day 1 Discussion 95 DR. SUTTON: It means so much to me and members of my team that each of you would spend this kind of time and this kind of energy to figure this out. Because, as the Secretary of Defense has said, we are truly in uncharted territory going into year number nine of this conflict. What has been said here about needing to look for novel ways to look for paradigms, ways of communicating with this generation, is critical. Some wag once said, “Culture eats strategy for lunch any day.” I would welcome anybody’s thoughts on how we can accelerate relevant cultural change that fits this generation. Keep in mind, our troops today knew our country was at war when they raised their hands and said, “Here I am. Send me.” That was well before the economic downturn happened. They are a group who do not think of themselves as sick. They prefer to think of themselves as injured. They have been raised and trained to be part of a team. Perhaps that is why the Army slogan “Army of One” was relatively short lived and has now been replaced with “Army Strong.” They develop bonds of trust with their coaches. When that trust is fractured, no good comes out of that. It is a wound that has to be dressed. We have a bit of that going on right now in the three years following the wound that was exposed and endures at Walter Reed. So I need help from each of you here. How can we help dress that wound of mistrust that still exists, not just between our providers and our public, our leaders and our providers, but within each of us as citizens of this great nation and as global citizens of this very small planet Someone once said that a wound inflicted is a wound endured. We as a nation have sent our sons and daughters into harm’s way. We have inflicted this wound and together, to heal, we must endure it together. That is going to take time. That is going to take thinking. It is going to take bringing together novel thoughts and novel ideas. It is going to take humility because, I can assure you, not only do we not have all the right answers at this point, I am not sure we have even asked all of the right questions. I would just ask us all to keep asking the right questions, and above all, let us measure whatever success we achieve on this journey through the eyes of our warriors and their loved ones, whom we are so privileged to serve. DR. BROWN: I returned with Wendi Cross and Doug Zatzick and perhaps some others from a conference last week on dissemination and implementation. The thing I would be interested in looking at is how we move from an information production system, which includes things like clinical knowledge as well as some research studies, to a knowledge implementation system where we can actually move practice and policy. DR. CROSS: I would be interested in having people talk a little bit about the difference between the confluences of factors around help-seeking. We talk a great deal about getting people to seek help but I guess I am wondering about the flip side. If you ask somebody if you could help them, would they accept the help What is the difference between being on each side of that relationship I am also interested in credible messaging and how that might be helpful. DR. ZATZICK: Disaster and terrorism, clear, simple, eloquent models, ideas that will help me out because I do not know what to do. I have been working with Chuck Engel on his STEPS-UP trial, trying to help him think about returning Central Asian veterans. We need clear, simple, and eloquent ideas to lend these hardheaded clinicians and to help other people implement trials. DR. URSANO: The good news is that we have created a marvelous list. The bad news is that we now all own it, and not just within this meeting. We will clearly only
96 Stigma and Barriers to Care — Caring for Those Exposed to War, Disaster and Terrorism take a small piece of that which we will ever be able to touch. We have created a list that we all own and that we all have said we wish to address and go after. I look forward to our discussions tomorrow which will be targeted around the concept of recommendations. It is most helpful for you to let your memory processes think around a clear recommendation, to make two or three sentences of justification that fall into the categories of education, training, research, leadership (policy), and then interventions — clinical and population. I look forward to moving to that level of discussion so that we take our ideas, digest them and come forward with what we would like to see changed and formulate that into recommendations in the proper category. Thank you all for an excellent day.
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FORUM ON HEALTH AND NATIONAL SECURI
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ii Bruce G. Link, Ph.D. Professor,
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