The Crisis of Military Mental Health Deserves To Be Told

The Toll Two Wars In Ten Years Has Taken

As journalists covering the Fort Hood mass shooting ponder possible connections between the shooter's mental health and his crime, they have largely ignored a major factor behind the inadequate support and treatment military service members have received for mental health conditions more generally: the vast over-commitment of troops to fight two wars simultaneously for over a decade.

Spec. Ivan Antonia Lopez killed three people and wounded 16 others before taking his own life at Fort Hood, TX, on April 2. Lopez served a four-month term in Iraq, though he reportedly did not see combat. He was being treated for depression and anxiety, and was in the process of being evaluated for post-traumatic stress disorder, or PTSD. PTSD can be triggered by a broad spectrum of emotional and physical traumas, including the loss of a loved one, seeing the after-effects of violence, and experiencing sexual assault, but it is still unclear if Lopez had this condition and the nature of his treatment is largely unknown. An Army psychiatrist who examined Lopez recently reportedly found no “sign of likely violence, either to himself or to others.”

Many individuals with PTSD never demonstrate violent behavior, and the likelihood that they will commit mass murder "is extraordinarily small," according to Janice Krupnick, a professor of psychiatry at Georgetown University School of Medicine. (Studies have shown that people with mental health conditions in general are more often the victims of violent crime than the perpetrators.)

Again, Lopez's mental health may prove entirely irrelevant to the mass shooting. But a story that has been largely undercovered in the media is how rising rates of depression, suicide, and PTSD in the military relate to the military's over-commitment in the Iraq and Afghanistan wars. In order to supply enough service members to fight two wars simultaneously, the military abandoned previous regulations and put stress on already limited support systems, causing what commanders refer to as "overstretch."

Before the 2003 invasion of Iraq, Defense Department standards disqualified recruits who suffered from PTSD and hadn't receive treatment. But Army mental health experts acknowledged early on that those standards were being relaxed in light of the troop shortage. The need for more troops to fight both Iraq and Afghanistan -- and meet the Bush administration's specified troop commitment levels -- required Army mental health experts “to weigh the needs of the Army” ahead of the needs of the individuals. The Associated Press reported in 2006 (emphasis added):

Although Defense Department standards for enlistment disqualify recruits who suffer from post-traumatic stress disorder, the military also is redeploying service members to Iraq who fit that criteria, the [Hartford Courant reported].

“I'm concerned that people who are symptomatic are being sent back. That has not happened before in our country,” said Dr. Arthur S. Blank, Jr., a Yale-trained psychiatrist who helped to get Post-Traumatic Stress Disorder recognized as a diagnosis after the Vietnam War.

The Army's top mental health expert, Col. Elspeth Ritchie, acknowledged that some deployment practices, such as sending service members diagnosed with post-traumatic stress syndrome back into combat, have been driven in part by a troop shortage.

“The challenge for us ... is that the Army has a mission to fight. And, as you know, recruiting has been a challenge,” she said. “And so we have to weigh the needs of the Army, the needs of the mission, with the Soldiers' personal needs.”

An Army-funded review of the mental health of soldiers who served from 2004 to 2009 found “one in five Army soldiers enter the service with a psychiatric disorder, and nearly half of all soldiers who tried suicide first attempted it before enlisting.”

And it's not just new recruits. The Washington Post reported that a diagnosis and lack of treatment for PTSD was also no longer “a barrier to being redeployed” for troops sent to Iraq and Afghanistan, despite the fact that military mental health experts knew for years that redeployment without treatment could drastically increase the risk of damaging mental health conditions. In 2006, a Department of Veteran's Affairs study revealed that within just 30 days of redeployment Army and Marine Corps service members showed higher mental health concerns and higher probable PTSD rates. The risk increases with each additional deployment; one study found that 27 percent of soldiers reported serious combat stress or depression symptoms on their third deployment.

A 2010 PBS Frontline special highlighted how the surge -- in which more than 20,000 additional troops were committed to Iraq in 2007 on top of existing forces -- particularly forced the recruitment and redeployment of troops who would otherwise have been ineligible. The special focused on the Third Platoon, which was sent back to Iraq after only one year at home, and then had their deployment extended to fifteen months. “The military now acknowledges that is not enough time for soldiers to recuperate,” PBS reported. “Our ultimate goal is one year deployed, two years home,” Gen. Peter W. Chiarelli, then-Army vice chief of staff, told PBS. “We have not reached that goal for all units. It's a supply and demand problem. I cannot do anything about the demand. I only have a finite supply. And when the demand goes up, and orders are given, we provide the soldiers.”

A decade ago, the Associate Press reported that roughly 1 in 8 returning soldiers suffered from PTSD, according to the Army's first study of the mental health of troops who fought in Iraq. Now estimates place it closer to 2 in 10 -- a 60 percent increase. Suicide rates dipped last year from their alarming highs over the course of the wars. The rate of suicide (which can be sparked by a range of mental health issues) for those who served in Iraq and Afghanistan more than doubled from 2004 to 2009, while the rate for those who never deployed nearly tripled. Last year, the Department of Veterans Affairs announced that 22 veterans kill themselves every day.

There is some hope. President Obama issued an executive order in 2012 ordering Veterans Affairs to expand its suicide prevention and mental health services, and the Army has upped the number of mental-health professionals traveling with troops in the field. Following the previous Fort Hood shooting, in 2009, the Defense Department implemented numerous changes, and Defense Secretary Chuck Hagel remains committed to implementing those improvements in the system.

But according to Defense Department data, about 2.5 million Americans in the Army, Navy, Marines, Air Force, Coast Guard, and related Reserve and National Guard units have been deployed in the Afghanistan and Iraq wars. 400,000 service members have completed three or more deployments. Nearly 37,000 have been deployed more than five times. An excellent in-depth look at veterans from The Washington Post, published just days before the recent Fort Hood shooting, noted that more than half of the millions who were deployed “struggle with physical or mental health problems stemming from their service.”

With those numbers, is it really any wonder that the military has struggled to provide adequate support to Ivan Lopez and others like him?

Image via Flickr user Dave O using a Creative Commons License