Military Hopes To Do Better Job Of Meeting Troops' MH Needs

Mental health advocates hope a planned task force will provide insight into the effectiveness of the Department of Defense's (DoD) efforts to identify and treat mental illness among active-duty military members.

The DoD missed the April 7 deadline to appoint the 14-member panel, but a spokesperson said in mid-May that it was nearly ready to begin work. The panel, composed of half military personnel and half civilian appointees, including several medical experts, was mandated by the National Defense Authorization Act of 2006 to provide an independent voice on how the services handle mental health treatment issues.

The Defense Task Force on Mental Health was charged with conducting“ a thorough assessment of existing mental health policies and programs and to make comprehensive recommendations on how they can be improved,” according to a May 2 letter from Sen. Barbara Boxer (D-Calif.) that criticized the department for missing its appointment deadline.

Boxer sponsored the legislation mandating the task force, in part as a result of concerns over what she described as the rising number of suicides among active-duty members of the military.

In a letter to Senate colleagues last year, Boxer cited figures that identified a 29 percent increase in suicides among Marines from 2003 to 2004—the highest increase in at least a decade. And recently, the Army announced that last year's suicide rate was its highest since 1993. Eighty-three Army soldiers on active duty committed suicide in 2005, 25 while deployed to Iraq and Afghanistan—a 24 percent increase over the prior year, she said.

Almost 1,700 service members returning from Iraq in 2005 indicated that they harbored thoughts of hurting themselves or that they would be better off dead, according to the first comprehensive screening of Iraq war veterans conducted by the Army Center for Health Promotion and Preventive Medicine. Nearly 20,000 reported nightmares or unwanted war recollections; more than 3,700 said they had concerns that they might “hurt or lose control” with someone else.

“These developments are extremely troubling and portend potentially even more troubling times in the months and years to come if we do not act now to significantly enhance the mental health care for our military personnel and veterans,” Boxer said in her letter to Senate colleagues.

Also troubling to mental health advocates were reports of undertreatment of military personnel by DoD officials. A draft of a report by the Government Accountability Office (GAO) obtained by the Washington Post and reported in its May 11 edition, found that nearly 80 percent of service members returning from Iraq and Afghanistan who were at risk for posttraumatic stress disorder (PTSD) were not referred by military clinicians for further help. The report found that 9,145 of 178,664 service members who took a DoD screening test were at risk for PTSD, but only 22 percent of those at risk were referred for help.

In response to the GAO report, Assistant Secretary of Defense for Health Affairs William Winkenwerder Jr. said that the 22-percent referral figure did not include soldiers who were referred to group counseling, a military chaplain, or a primary care provider for evaluation or treatment of PTSD signs, according to a May 13 article in the Post.

The task force is required within a year of it appointment to submit a report to the defense secretary and Congress on a long-term plan to improve the effectiveness of the military's mental health treatments, including ideas for new education programs and medical services.

One area the task force is to review, Boxer said in an April 29 letter to Defense Secretary Donald Rumsfeld, is reports that troops are being redeployed to Iraq despite being diagnosed with psychiatric conditions. She cited press reports and “similar reports from military doctors and service members” received by her office.

The task force “would be an appropriate vehicle for examining DoD deployment policies for service members suffering from mental health conditions,” Boxer wrote.

The law instructs the task force to “take into consideration completed and ongoing efforts by the Department of Defense and the Department of Veterans Affairs to improve the efficacy of mental health care provided to members of the Armed Forces by the departments.”

A Department of Veterans Affairs spokesperson knew of no previous outside assessment of VA mental health programs, although multiple offices within the department continually perform internal assessments.

Approximately 317,000 veterans with a primary or secondary diagnosis of PTSD received treatment at VA medical centers and clinics in Fiscal 2005, according to data from the VA. More than 50,000 veterans received PTSD-related services at Vet Centers during the same time frame.

Nearly 16,000 Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF) veterans were seen for PTSD at VA medical centers from Fiscal 2002 to Fiscal 2005. Another 3,000 OIF/OEF veterans were seen in the VA's Vet Centers during that period.

The National Defense Authorization Act for Fiscal Year 2006 (PL 109-163), which mandated the task force, is posted at<http://thomas.loc.gov/cgi-bin/query/F?c109:3:./temp/~c109BpyYHV:e35352:>. The GAO PTSD report is posted at<www.gao.gov/new.items/d06397.pdf>.▪