Sacrifice and Service, Protectors and Teachers: The Role of Military and Veteran Patients in Training Early-Career Psychiatrists

The USA is home to more than 2 million active military members and reservists and 21million veterans [1, 2]. Beyond their immense service in protecting this country, active military members and veterans are our great partners in academic medicine. It is estimated that two thirds of US physicians and half of US psychologists in practice received some portion of their clinical education at Veterans Administration (VA) hospitals [3]. In 2013, the VA had 118,799 clinical trainees [3]. The VA has created and sustained our nation’s largest integrated health care system, which is organized into 23 regional networks [4]. Most VA medical centers (124 of 152) are affiliated with allopathic and osteopathic medical schools, including military medical training facilities [3]. Further, the VA’s medical centers and independent clinics are also affiliated with more than 1800 unique colleges and universities [3]. Veterans and members of the active military and reserves are not only our country’s defenders—they are the teachers of our country’s health professionals. The mental health concerns of veterans, members of the active military, and reservists are immense, and this fact makes the partnership between academic medicine and the VA and military medical system particularly salient for academic psychiatry. A veteran commits suicide nearly every hour (21–22/day), a rate that is double that of the general population and that has been escalating more rapidly than the general population [5, 6]. Mental disorders are the leading cause of hospitalization of members of the armed forces [6]. Approximately one-half million veterans are “service connected” for a significant mental illness, and veterans with direct combat experience are especially burdened with posttraumatic stress disorder, depression, anxiety, and substancerelated conditions [7]. For these reasons, the VA has defined priorities related to recovery, coordinated and holistic care, mental health–primary care integration, around-the-clock service, genderand culture-sensitive care, evidence-based treatments, community-based care, and care that engages families [8]. These initiatives represent key opportunities for clinical education, providing innovative, forward-looking, and outcomes-oriented training experiences. In this issue of Academic Psychiatry, Lieutenant Colonel Christopher Warner has assembled an outstanding collection of peer-reviewed papers focusing on the role of the military and veterans in academic psychiatry. I met Lt Colonel Warner not too many years ago through one of these partnerships when he was a Ginsburg Fellow for the American Association of Directors of Psychiatric Residency Training. Shortly thereafter, he completed his training and was serving as a Division Psychiatrist where he carried tremendous responsibility for the mental health of his military colleagues in Iraq. Now Warner serves as the Consultant to the US Army Surgeon General for Psychiatry, a senior military mental health advisor in the US Army. He graduated from the US Military Academy at West Point and received his medical degree from the Uniformed Services University of Health Sciences. Warner is dually trained in family medicine and psychiatry, and he currently serves as one of the two US delegates to the North Atlantic Treaty Organization Research and Policy Group on Mental Health andMoral Dilemmas.Warner has served in many leadership roles in the US military, including as the Division Surgeon for the 101st Airborne Division and an integral member of the medical planning team for Operation United Assistance in Liberia. His operational deployments also include two rotations to Iraq in support of Operation Iraqi Freedom. Warner’s awards, decorations, and honors are numerous and * Laura Weiss Roberts acadpsych@gmail.com