COUNTERING MILITARY RECRUITMENT
Articles: Military Service: Casualties
Pentagon Report Criticizes Troops' Mental-Health Care
Ann Scott Tyson, Washington Post
June 16, 2007
U.S. troops returning from combat in Iraq and Afghanistan suffer
"daunting and growing" psychological problems -- with nearly 40
percent of soldiers, a third of Marines and half of the National
Guard members reporting symptoms -- but the military's cadre of
mental-health workers is "woefully inadequate" to meet their needs, a
Pentagon task force reported yesterday.
The congressionally mandated task force called for urgent and
sweeping changes to a peacetime military mental health system
strained by today's wars, finding that hundreds of thousands of the
more than 1 million U.S. troops who have served at least one war-zone
tour in Iraq or Afghanistan are showing signs of post-traumatic
stress disorder (PTSD), depression, anxiety or other potentially
disabling mental disorders.
"Not since Vietnam have we seen this level of combat," said Vice Adm.
Donald Arthur, co-chairman of the Department of Defense Mental Health
Task Force. "With this increase in . . . psychological need, we now
find that we have not enough providers in our system," he said at a
Pentagon news conference yesterday unveiling the report. "Clearly, we
have a deficit in our availability of mental-health providers."
The ongoing "surge" of more than 30,000 additional U.S. troops in
Iraq and Afghanistan will exacerbate this gap, as will the rapid
growth in the number of soldiers, Marines and other troops -- now
about half a million -- who have served more than one combat tour,
heightening the risk of mental illnesses, the report said.
As in the aftermath of Vietnam, the costs of untreated mental illness
will rise dramatically over time, the report warned. "Our nation
learned this lesson, at a tragic cost," it said. "The time for action is now."
Defense Secretary Robert M. Gates is required by law to develop a
plan of action within six months on the 95 recommendations included
in the 64-page report.
The task force, composed of seven military and seven civilian
professionals with expertise in military mental health, was formed in
May 2006. It based its report on visits to 38 U.S. military care
facilities in the United States, Europe and Asia; interviews with
care providers, military personnel and their families and commanders;
as well as expert testimony and research.
The task force found that 38 percent of soldiers, 31 percent of
Marines, 49 percent of Army National Guard members and 43 percent of
Marine reservists reported symptoms of PTSD, anxiety, depression or
other problems, according to military surveys completed this year by
service members 90 and 120 days after returning from deployments.
Two "signature injuries" from Iraq and Afghanistan are PTSD and
traumatic brain injury, it said. Symptoms include nightmares and
other sleep problems, trouble concentrating, anger, recklessness, and
self-medication with drugs and alcohol.
The task force identified several barriers to care, including the
stigma associated with seeking help, poor access to providers and
facilities, and disruptions in care as service members move locations.
"Stigma in the military remains pervasive and often prevents service
members from seeking needed care," the report said, citing anonymous
surveys that show most members with symptoms of mental health
problems do not seek help.
Some soldiers underreport problems because they want to stay with
their units, and military officials note that many soldiers
undergoing treatment for stress or other mental problems are allowed
to deploy again after a screening to determine the intensity of their
symptoms or depending on what medications they are taking. Those on
lithium, for example, should not deploy while those on another class
of medications similar to Prozac may be able to, said Army Col.
Elspeth Cameron Ritchie, who assisted the task force.
"If you have a post-traumatic stress reaction, it's not your fault,"
Arthur said. "It's up to leadership to say to folks that
post-traumatic stress reactions are an absolutely normal part of
combat operations."
Proposals by the task force to reduce stigma include embedding
health-care providers with units and offering treatment at primary
medical care facilities, where service members can seek psychological
help without singling themselves out. An additional recommendation is
for the military to begin training troops to become more
psychologically resilient, in part by conditioning them mentally,
much as they conduct their physical training.
"We can use virtual-reality therapy, typing smells in to create a
virtual environment, " that resembles a battlefield, said Col.
Jonathan H. Jaffin, commander of Army medical research.
National Guard and reserve members -- who often live far from
military bases and return from deployments to rural communities --
face "particularly constrained" access to clinical care as well as to
the military chaplains and family support networks that active-duty
personnel can tap, the report said.
"The current complement of mental health professionals is woefully
inadequate" to prevent and treat members of the military and their
families, the report said. But it called the process for recruiting
additional trained personnel -- both civilian and military -- "time
consuming and cumbersome," stating for example that the number who
could be recruited over the next six months would be "well below" the
number required to meet the needs.
The shortage is deepening as active-duty mental-health professionals,
also stressed by repeated deployments and other frustrations, are
leaving the military in growing numbers, the report said. The Air
Force has lost 20 percent of mental health workers from 2003 to 2007,
while the Navy lost 15 percent between 2003 and 2006, and the Army
lost 8 percent from 2003 to 2005.
Financial resources for mental health treatment in the military are
also lacking, the report found. Congress provided a boost of $600
million for PTSD and traumatic brain injury in the 2007 supplemental
war funding, but more will be needed, S. Ward Casscells, assistant
secretary of defense for health affairs, said at the news conference.
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