The Darker Side Of American Military Mental Health Care

This is not an attack on our soldiers, but a sincere effort to end a tragic cycle of largely self-inflicted mental health crises.
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By way of introduction, I am a proud son, brother and father of war veterans so what follows is not an attack on our uniformed citizen soldiers, but a sincere effort to end a tragic generational cycle of largely self-inflicted wartime mental health (MH) crises since the First World War (WWI). After 26-years as a Marine Sergeant, Navy Commander, and military psychologist-it was a 2003 field hospital deployment in support of the Iraq invasion that opened my eyes to the painful reality that our country was grossly negligent in its preparation to meet even basic MH needs.

Inexplicable Delays in Admitting to a Major Public Health Crisis

In June 2007, the Congressional-mandated Department of Defense (DoD) Task Force (TF) on MH finally disclosed the realities of chronic systematic neglect in every component of mental health care: staffing, training, treatment, research, reintegration, organization, family support, and stigma-concluding that: “The Task Force arrived at a single finding underpinning all others: The Military Health System lacks the fiscal resources and the fully-trained personnel to fulfill its mission to support psychological health in PEACTIME or fulfill the enhanced requirements imposed during times of conflict” (Department of Defense Task Force on Mental Health, 16 June 2007; p.ES.2) . Astonishing, given modern trends of psychiatric casualties out-numbering the combined total personnel medically wounded-and-killed-in-action since the Second World War (WWII). Congress mandated the DoD TF in 2005 amidst suicide spikes, family grievances, and legal prosecution of untreated war veterans.

The military’s belated disclosure represents a clear betrayal of the government’s promise to bind the wounds of American citizens sent in harm’s way by our political leaders. Moreover, 21st century war planners had ready access to detailed documentation of requirements to meet wartime mental health needs by every generation since WWI, however, these so-called psychiatric lessons learned were actively ignored per the 2007 DoD Task Force. Tragically, the military was congratulated not chastised by political leaders. No ceremonial firings of medical leaders. Inexplicably, there has not been a single congressional investigation as to why MH lessons are repeatedly ignored resulting in predictable crises since WWI.

Identifying and Correcting Faulty Military Mental Health Policies

After retiring from the military, we established the Institute of War Stress Injury, Recovery, and Social Justice at Antioch University Seattle (AUS) whose mission is to investigate and generate critically-needed public awareness of the military’s MH policies responsible for the current, past, and future crises. Several of these harmful policies and proposed corrective actions is depicted in Tom Donahue’s recent documentary Thank you for your Service! such as creating an accountable leadership structure or Behavioral Health Corps akin to existing medical, dental, legal, supply, and veterinary corps-thus affording MH equal status and priority as physical health, as well as a zero tolerance policy for MH stigma including elimination of 203 stigma reinforcing policies reported by the Governmental Accountability Office (GAO, 2016).

Since 2007, military MH has received significant congressional, Presidential, and media scrutiny resulting in a tremendous amount of treasury, legislation, and executive orders intended to fix the problem. Consequently, an unprecedented number of military initiatives, web-based services, treatment programs, along with Veterans Treatment Courts and thousands of non-profits have been employed to address MH needs. Progress is monitored via commissioning numerous independent studies by the Institute of Medicine (IOM), RAND, and GAO. All of whom cite incremental change as well as striking non-compliance such as: “Through its review, the committee found that PTSD management in DoD appear to be local, ad hoc, incremental, and crisis-driven with little planning devoted to the development of a long-range, population-based approach for this disorder by either the office of the Assistant Secretary of Defense for Health Affairs (OASD(HA) or any of the service branches” (IOM, 2014; p.216).

Groundbreaking Study Reveals a Century-Old Mental Health Policy Harms War Vets and Families

More recently, in February 2017 researchers from Antioch University Seattle and Tulane University conducted the first-ever comprehensive review of the military’s 100-year-old frontline psychiatry policy prohibiting psychiatric treatment and evacuation of psychologically injured combatants. The military’s policy was adopted in WWI by every Western power to eliminate psychiatric attrition and disability pension costs threatening the ability to sustain war fighting and government finances.

The three-part review was published in the journal: Psychological Injury and Law after an extensive review of the literature since WWI. Researchers systematically examined military claims that its frontline mental health policies, currently referred to as combat and operational stress control (COSC) are beneficial to the health and well-being of service members and their families, as well as contradictory evidence including the British High Courts’ 2003 class action ruling in Multiple Claimants v. MoD (Ministry of Defense) whereby the MoD acted ethically by denying soldiers access to the same frontline psychiatry doctrine that the U.S. has embraced.

The ground-breaking study found resounding proof that the military benefits from its’ frontline policies by returning to duty over 95% of contemporary war-stressed veterans-in keeping with its explicit purpose. However, overwhelming evidence implicates the military’s frontline policies as substantially more harmful than beneficial to war veterans and their families-a well-established fact that the best predictor for conditions like PTSD is level of war stress exposure. Yet another policy contributing to MH crises aggravated by unrestricted deployment policies including permitting deployment of personnel with known psychiatric conditions.

In conclusion, the military’s mental health policies demand immediate congressional and Commander-in-Chief investigations or ensure perpetuating a social injustice for future generations and risk possible class action.