Mental Health Standards for Combat Deployment: In Reply

We thank Dr. Nevin for facilitating additional discussion of appropriate psychiatric screening practices for U.S. military personnel deploying to combat zones. He provides evidence that predeployment psychiatric screening practices have been, and may still be, suboptimal in identifying personnel with a history of mental disorders (1,2). Moreover, Dr. Nevin cites an example of an enhanced predeployment program developed by Warner and colleagues (3) that increased the rigor of predeployment screening without causing substantial numbers of personnel to be disqualified for deployment. In light of possible deficiencies in current screening practices and evidence of potentially better screening paradigms, Dr. Nevin challenges our apparent reluctance to change the status quo.

However, we believe that the recommendations in our article have been misconstrued. We stated, “Any attempt to further restrict deployability of service members with psychiatric diagnoses might lead to greater avoidance of care. Therefore, tightening of current deployment policy might have severe and unintended negative consequences.” Thus we have no opposition to more rigorous screening; rather, our concern lies with subsequent decisions that overly restrict deployment. We applaud the work of Warner and colleagues because it has improved the accuracy of screening without substantially restricting deployability. The latter is key, because military surveys indicate that service members worry that receipt of mental health care may limit their deployability.