Military Mental Health
Understanding the crisis
With suicide rates dramatically rising and increased attention to the violence of veterans who struggle with mental illness, the military has been under increased pressure to provide ready access to mental health treatment, and to reduce the stigma associated with seeking mental health treatment.
The pressure, according to a new report, has largely gone unanswered. According to a new Government Accountability Office report, the Pentagon has done little to address the stigma soldiers face for seeking mental health treatment. This report comes in spite of a number of studies showing both that service members face unique health issues and that they often fail to receive adequate treatment.
The Unique Mental Health Issues Service Members Face
Almost a quarter of military members have symptoms of at least one mental health condition, with more than 10% qualifying for a diagnosis of two or more mental illnesses. Some soldiers entered the military with mental health problems, but many acquired their mental illness while serving their country. Some of the unique challenges soldiers face include:
-Foreign combat. Soldiers may be forced to kill others, watch their friends be injured or killed, face the near-constant threat of death, see military actions that undermine their core values, and suffer catastrophic injuries.
-Long separations from their family. Even soldiers who never serve abroad often face long separations from their families for training activities.
-Significant loss of control. The military tightly controls much about soldiers’ lives.
-Uncertainty. Service members may not know what the future holds. They wait to learn about life-threatening deployments, new job assignments, and other life-altering transitions, impeding their ability to plan for the future and creating anxiety.
Barriers to Accessible Mental Health Treatment in the Military
Numerous studies have documented the fact that service members struggle to access mental health treatment. Long waits at VA hospitals mean that many soldiers languish for months with serious symptoms of PTSD and depression. And often, soldiers’ privacy takes a backseat to other concerns. The GAO report details the story of one military installation where there was only one way to access mental health treatment—through a so-called “elevator of shame.”
Some of the many other treatment barriers soldiers face include:
-Professional consequences for seeking treatment. One recent study found that more than a third of soldiers thought they might be denied promotions or experience other backlash if they sought mental health treatment.
-Dishonorable discharges. Soldiers are routinely dishonorably discharged for displaying symptoms of mental illness, and the oversight body charged with re-evaluating these decisions rules in favor of soldiers in less than 4% of cases. Being dishonorably discharged can affect a soldier’s benefits, and may even affect his or her ability to secure civilian employment.
-Inaccessible treatment. When soldiers must go through the military system to seek treatment, they worry about privacy issues, causing some to forgo treatment altogether. In other cases, soldiers are stationed in far-flung regions of the world, where treatment may be nonexistent or of poor quality.
-Lack of mental health screenings. Soldiers may not realize that the symptoms they experience are associated with mental illness, or may deliberately conceal their feelings. Without mental health screenings, soldiers struggling with mental health issues may continue working even when they pose a danger to themselves or to others.
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Reforming the Military’s Approach to Mental Health
A number of panels have recommended measures that might improve access to quality mental health for soldiers. Some possibilities include:
-Reducing stigma by creating mental health screenings and treating mental health as similar to any other disease.
-Not discharging soldiers for seeking treatment or experiencing symptoms of mental illness.
-Removing barriers such as public shaming. Soldiers should be able to seek treatment in private.
-Taking proactive measures to reduce mental health problems, such as addressing military sexual harassment.
-Allowing soldiers to choose to go outside the military health care system for mental health care at the military’s expense.
Until such reforms occur, soldiers may continue to die at their own hands—or harm the people they love the most.
Klime, P. (2015, September 11). Panel: Stigma is obstacle to mental health care. Retrieved from http://www.militarytimes.com/story/military/benefits/health-care/2015/09…
Philipps, D. (2016, February 19). Veterans want past discharges to recognize post-traumatic stress. Retrieved from http://www.nytimes.com/2016/02/20/us/veterans-seek-greater-emphasis-on-p…
Willingham, V. (2014, March 4). Study: Rates of many mental health disorders much higher in soldiers than in civilians. Retrieved from http://www.cnn.com/2014/03/03/health/jama-military-mental-health/
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Zoroya, G. (2016, May 5). Pentagon perpetuates stigma of mental health counseling, study says. Retrieved from http://www.usatoday.com/story/news/nation/2016/05/05/study-slams-pentago…
Joel Young, M.D., teaches psychiatry at Wayne State University, and is the Medical Director of the Rochester Center for Behavioral Medicine.