The U.S. armed forces are unable to meet the mental health needs of service
members today and are not likely to do much better in the future without
additional funding and staff, according to a draft report issued by the
Department of Defense Task Force on Mental Health in May.
"The challenges are enormous, and the consequences of nonperformance
are significant," said the report.
The task force is a joint military-civilian body, authorized by Congress,
which conducted inquiries for a year before delivering the report to the
secretary of defense.
A separate study, the Army Surgeon General's Mental Health Advisory Team IV
(MHAT IV), surveyed 1,767 soldiers and Marines serving in Iraq and found that,
among numerous factors, the level of combat, family separation, and multiple
deployments placed the greatest stress on the troops' mental health. MHAT IV
was established by the Office of the U.S. Army Surgeon General at the request
of the commanding general of the multinational force in Iraq and supervised by
its command surgeon.
The task force acknowledged existing work by the military services toward
psychological health, but added that these efforts were falling short of the
need. Task force members consulted experts, visited 38 military bases around
the world, and listened to public testimony. The military health system lacks
the resources and fully trained staff to meet peacetime needs for troops and
their families, much less the increased demands posed by the fighting in Iraq
and Afghanistan, they said.
Stigma remains a significant barrier to care, and current psychological
screening procedures do not overcome the bias against seeking mental health
services. There are also gaps in what services are available, where they are
offered, and who receives them, said the report. Family members have poor
access to services, and the myriad military organizations dealing with mental
health are poorly coordinated and fall under different chains of command.
Moreover, there are not enough active duty mental health professionals, and
there will be fewer in the future without "substantial
Quality of treatment is not up to standard, either.
"There do not appear to be sufficient mechanisms in place to assure
the use of evidence-based treatments or the monitoring of treatment
effectiveness," said the report.
The task force recommended that the Department of Defense build a"
culture of support for psychological health" by updating
knowledge, improving access, increasing funding and training, and
incorporating education about mental health in every phase of military
Finally, the task force noted that, as in civilian life, the medical and
mental health systems place too much emphasis on short-term treatment models
and not enough on long-term management of chronic disorders.
The MHAT IV evaluated the mental health of troops in Iraq from August
28-October 3, 2006. Its report was completed in November 2006, but was
released only last month. The study was based on anonymous surveys filled out
by troops and on information gathered from behavioral health and primary care
personnel and others. Troops surveyed included 79 percent from active
component forces, 8 percent from the Reserves, and 13 percent from the
National Guard, although results were not broken down by service
Among the troops, combat exposure and the length of deployment had the
greatest impact on mental health status, according to the report. Troops
facing high levels of combat were two to three times more likely to screen
positive for anxiety, depression, acute stress, or any mental health problem.
For instance, 30 percent of troops who spent at least 56 hours a week
patrolling outside their base camps screened positive for mental health
problems, compared with 11 percent who spent 12 hours a week "outside
The more times troops were sent to Iraq and the longer they served there,
the higher their rates of mental health and marital problems. About 27 percent
of those returning to Iraq screened positive, compared with 17 percent of
those on their first tour of duty there.
That indicates, said the report, that "previous deployment experience
per se does not 'inoculate' soldiers against further increases in mental
The 2003-06 average annual suicide rate among troops in Iraq was 16.1 per
100,000, higher than the average Army rate of 11.6. Existing suicide
prevention training was not designed for application in a combat zone, said
the MHAT IV.
For the first time, MHAT IV asked troops questions about battlefield
ethics. Only 38 percent of Marines and 47 percent of Army soldiers said that
noncombatants should be treated with dignity and respect. Rates were higher
among troops who had high combat exposure or screened positive for mental
health problems. The report recommended improved battlefield ethics training
to better prepare for encounters with civilians and to know how to report
The MHAT IV found that very few military mental health care providers had
been trained in combat and operational stress control. This training should be
required before they ship out to Iraq, according to the report. Also
recommended was more extensive mental health awareness training for troops,
noncomissioned officers, and junior officers before, during, and after
deployment. Allowing troops to remain at home for 18 to 36 months between
deployments would allow them to recover their mental health more fully.
A summary of the Department of Defense Task Force on Mental Health's
report is posted at<www.ha.osd.mil/dhb/meetings/2007-05/media/MHTF-Report_%20DRAFT_Executive_Summary_02MAY07.pdf>."
Mental Health Advisory Team IV Operation Iraqi Freedom Final
Report" is posted at<www.armymedicine.army.mil/news/mhat/mhat_iv/MHAT_IV_Report_17NOV06.pdf>.▪