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TORKHAM GATE, Afghanistan — The toll from the tragic shooting at Fort Hood extends beyond the base, beyond the families of the dead and wounded, to outposts such as this one.
Army psychiatrist Nidal Hasan had been chosen to be part of an ambitious plan to treat U.S. troops here in Afghanistan who need psychological counseling where counselors are often not available. As a result, the Pentagon is flying record numbers of therapists and other mental health workers into combat areas.

But Friday's rampage at Fort Hood, where Hasan is alleged to have killed 13 people and wounded 29 others, has thrown those efforts into some disarray.

At least three of those killed were therapists slotted for Afghanistan. And six who were wounded are part of the 1493rd Combat Stress Control team to which Hasan was assigned and which was heading to Afghanistan, the Army says.

SHORTAGE: Military therapists strained
Army spokesman George Wright said Sunday that commanders are wrestling with whether to cancel deployment of the team because it was so decimated by the shootings. "This will represent a challenge," Wright says, "but we anticipate we can meet the challenge."

American troops are spread out in more than 350 locations across Afghanistan, says Army Col. Wayne Shanks, a media spokesman. One in three soldiers say they can't reach a counselor when they need to, according to an Army survey last year.

Where psychologically damaged troops in far-flung places cannot reach a therapist, the military now flies therapists to them in numbers not seen before.

Col. Carl Castro, a psychologist and director of Army Military Operational Medicine, says "flying mental health care providers exclusively to servicemembers who need help is unprecedented. It's almost like the EMTs (emergency medical technicians) that you see on the interstate when they block the road and land the helicopter. It's just never been done."

As of now, about 45 uniformed mental health workers are spread out across eastern Afghanistan. Teams of psychologists, psychiatrists and social workers fly to four dozen isolated bases or outposts each month.

An additional 25 U.S. military behavioral health specialists are in southern Afghanistan and were to be joined in the months ahead by about 45 additional therapists, says Army Lt. Col. Jeffrey Hill, a psychiatrist who overseas behavioral health care for soldiers in Afghanistan. The plan had been to "disperse them as far forward as possible," Hill says.

Hasan had told his family he had no desire to go to war. Earlier this year, President Obama sent more troops to Afghanistan, increasing the demand for mental health providers. As a result, the Army is pushing a policy of sending into combat soldiers who have never been overseas.

For Hasan, with 12 years of service and no deployments, it was time to go. The assignment would have been jarring for someone with only desk-bound clinical care experience at Walter Reed Army Medical Center.

"For me, it's particularly painful," said S. Ward Casscells, the Pentagon's former top doctor. "Our focus was on the doctors to dig deep and do all they can for these (troops). To have one of our own do this is personally crushing."

Casscells retired in April as the Pentagon's assistant secretary for health affairs.

'Really close to the fight'

Psychologists and psychiatrists take physical risks in Afghanistan, flying over mountainous terrain by helicopter or running the gauntlet of roadside bombs by convoy. Outposts are rocketed. Counselors get stranded at a base for days or weeks when helicopters are diverted elsewhere.

"We're really close to the fight. We're really close to where the rubber meets the road," says Air Force Lt. Col. Randall Nedegaard, a psychologist who leads the Air Force combat stress control teams here.

The problem is particularly difficult at places such as the fire base at Torkham Gate, 4,000 yards from the Pakistani border.

On a recent morning weeks before the Fort Hood shooting, psychologist and Air Force Capt. Sara Wright and mental health technician Catherine Lobbestael descend by helicopter out of the Hindu Kush mountains to touch down. Working as a Combat Operational Stress Control Team — the same assignment slotted for Hasan — Wright and Lobbestael immediately set about providing counseling to distressed soldiers at this tiny outpost.

If there is such a thing as a paramedic for troubled minds in combat, these two women — in their body armor and backpacks, with 9mm pistols strapped to their hips — play that role.

"Casualties" waiting for them include a sexual assault victim, a grief-stricken soldier and a G.I. stressed for having shot someone by accident. There is also a company of Georgia National Guardsmen, some traumatized by rocket attacks or watching buddies get killed.