Confusion regarding the psychological damage wrought on some by military service and combat experience is hardly new: nineteenth-century officals called it "nostaliga" and treated it with music and exercise. But the present-day United States military has very clearly not performed well in the mental health sphere. Newly announced increases in funding and personnel are encouraging to those concerned about necessary revisions to antiquated policies; the carefully organized mental health task force's assertion that the military's program "has fallen significantly short" and that its staff is "woefully inadequate" made such a response necessary. Now comes the time to argue about its relative sufficiency.
The army has promised to expand its psychiatric roster by 25%, adding $33 million and 200 new staff members to address the mental helath problems reported by returning soldiers. In response to the mental health report as well as the embarrassing Walter Reed scandal, the US Senate, in a rare moment of conscience, also passed a bill allowing for several important systematic reforms: increased disability pay, expanded health care for VA family members, more widespread use of brain scans to test for debilitating head injury (one of the most common complaints among veterans) and less "red tape" to give returning soldiers easier access to treatment resources related to physical problems as well as PTSD and depression. The bill will also lead to the hiring of an unspecified number of professional therapists to work at VA health centers, hopefully tempering the increased suicide risks posed by veterans who cannot get adequate access to the services they need. Finally, the bill paves the way for large-scale studies regarding the special needs of female service members, who make up more than 16% of our military. The hiring of 200 new psychiatrists will obviously not eliminate the PTSD epidemic, but it is certainly the best response to come from Washington in some time.
In another, little-covered angle on this painful topic, the military has also encountered problems regarding the recruitment and subsequent enlistment of individuals with histories of psychiatric treatment and/or mental instability. Caught between concerns about lagging recruiting goals for an already understaffed military and the problems borne of a policy allowing such potentially disruptive individuals to serve, the Army has, according to some reports, adopted a "we don't need to know" attitude toward the past mental health problems of its recruitees Those with serious mental illness whose ultimate goal is military service may choose not to reveal their treatment histories if at all possible:
Although enlistment standards disqualify applicants with anxiety disorders, personality disorders, major depression and other problems that could interfere with military duty, applicants are not compelled to disclose those diagnoses, and no one double-checks. The inadequacy of that self-reporting process is widely acknowledged within the military.
The army also allows for medical waivers that apply to mental, as well as physical, illness. Those who lie about their history can be accused of "fraudulent enlistment," but the most severe punishment is discharge. Opinions on the matter differ both within the military and without, but officials clearly believe it more important to reach enlistment goals than to spend the extra time and money required by a more stringent filtering process. Many believe the current approach to be too strict as it is, making the very believable point that basic training is a more than satisfactory tool for weeding out those whose psychological status will detract from their ability to perform as needed. A five-year project to develop a more efficient mental health questionnaire for applicants has come to an inconclusive end. Whatever changes do occur will obviously be slow in coming. Ideally, the military would be able to keep disturbed individuals from enlisting while including those whose mental health problems would not prevent them from serving effectively. The search for such a balance continues, but the addition of more professionals should, at the very least, serve as a temporary salve for the U.S. military's unfortunate mental health service record.
|