Maxine Trent has been in overdrive the past few days as she and her staff have offered mental-health services to military personnel and others shaken by Thursday’s massacre at Fort Hood.

There’s much more work to do than hours in the day.

Yet, Trent has made a point to take time to check on how the therapists on her staff are holding up. It’s something she tries to do regularly anyway. But the concept of “self-care” has taken on even more importance in light of information that the Army psychiatrist who allegedly carried out the mass shooting may have been negatively affected by the steady stream of battlefield horrors he heard about from returning soldiers.

Osman Danquah, the liaison to Fort Hood from the Islamic Center of Greater Killeen, speaks to media Friday. Danquah said "something just didn't seem right" about suspected shooter Nidal Malik Hasan when the man sought counsel from him. (Cox News Service photo)

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“It really shakes your faith in everybody’s ability to take care of yourself,” said Trent, who is coordinator of Scott & White Homefront, which serves veterans of the Afghanistan and Iraq wars and their families.

An Army psychiatrist “is the last type of person you expect to have that break and behave in that manner,” she said.

Other local therapists agreed that self-care for mental-health professionals is something that needs to be looked at more in the wake of the Fort Hood tragedy. While the military and society in general have made great strides in recognizing the crushing stress soldiers and their families are facing because of the protracted war on terror, there has been less attention paid to the burden that stress can place on mental-health providers, they said.

Therapists who spend day after day listening to the horrifying details of war can experience “secondary traumatization,” experts said. That means they can develop a set of psychological symptoms similar to post-traumatic stress disorder just by hearing someone else’s accounts. The phenomenon is also sometimes referred to as compassion fatigue or vicarious traumatization.

Add to that the crushing caseload that many mental-health professionals have — especially in military settings — and even the most competent, caring therapist can struggle, said Dr. Kathryn Kotrla, associate dean and chairwoman of psychiatry and behavioral science at the Texas A&M Health Science Center College of Medicine Round Rock campus.

“You have a double whammy when you’re on a base and you have an endless pool of need and the need is deeper and darker than anything you’ve seen before,” Kotrla said. “. . .We all know we should be more careful and more attentive to self-care, but it’s hard to do. We got into this profession to help people, and many of us will stretch ourselves thin. We stay too late, we see too many patients and self-care goes out the window.”

Kotrla, Trent and others emphasized that there is no excuse for the actions allegedly taken by Maj. Nidal Malik Hasan, an Army psychiatrist who worked at a hospital on Fort Hood. They also pointed out that it has not been determined that the accounts he heard from patients played a role in the attack.

Such speculation has been fueled by comments made by a cousin, Nader Hasan, who told The New York Times that the psychiatrist was affected by what he heard from soldiers who returned from Iraq and Afghanistan with post-traumatic stress disorder.

“He was mortified by the idea of having to deploy,” Nader Hasan told the Times. “He had people telling him on a daily basis the horrors they saw over there.”

One thing that is not up for debate, Trent said, is that the ongoing nature of the war on terror is posing a set of circumstances that the military and its mental-health providers have never had to deal with. In past conflicts, soldiers might have been called on to do three hardship tours in a 20-year span, she said. Now, multiple deployments in quick succession are the norm. Some service members she is treating have already been deployed five times and are scheduled to return to the battlefield within the year.

“We’ve never been here before in history,” Trent said. “This isn’t going to go away.”

Kotrla agreed, saying she knows from conversations with mental-health professionals at Fort Hood and other military installations that they have extremely large caseloads because of the number of soldiers that return with problems. The sheer volume would be difficult enough, she said, but the pain and anger felt by many military patients is also daunting, she said.

“It is so raw, it is so fresh,” Kotrla said.

Plus, therapists know many of the soldiers they are treating for PTSD and other war-related disorders will be redeployed, Kotrla said. It’s not unlike treating a sex-abuse victim knowing she will have to go home to her abuser, she said.

“You have people you know are hurting, and the best you can do is patch them together and put a Band-Aid over a gaping wound, psychologically speaking,” Kotrla said.

Kotrla, who worked in Central Texas for the Department of Veterans Affairs from 2002 to 2007, said she has yet to see a mental-health environment that does enough to safeguard the well-being of providers. Most providers do try to look out for each other, she said.

But it is time for the mental-health community to look at how it might develop more formalized, built-in processes to help providers manage stress, Kotrla said. Therapists tend to have tough personas and typically aren’t good about asking for help, she said.

“It would undoubtedly provide a healthier system,” she said.

U.S. Rep. Chet Edwards, D-Waco, said he is confident the Army will examine “who helps the helpers” and figure out how that support might be improved.

“The Army is the best of the best at learning from past problems,” Edwards said.

In addition, Edwards said it is important that lawmakers continue to allocate more to provide more mental-health services for military personnel and veterans. Congress has increased such funding dramatically in recent years, he said, but the need continues to grow as well.

“In the wake of this tragedy, we need to even double up on those efforts,” he said.

In the meantime, Trent said, she will continue to do her best to help her staff stay healthy so they can help others. That involves formal measures, such as regularly scheduled meetings where therapists discuss cases, and informal practices like encouraging employees to take short de-stressing breaks at work and engage in hobbies at home.

“You’ve got to have the discussions about not only the guys you’re trying to help but how you stay in your chair and help yourself,” Trent said.

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