Shortage of Mental Health Professionals in Military

Department of Defense (DOD) medical centers, community hospitals, and clinics throughout the United States were tasked with hiring 44 "contract" psychiatrists over the summer as a response to growing concerns about inadequate mental health care for soldiers in Iraq and Afghanistan and those returning home. According to Cynthia Vaughan, spokesperson for the US Army Surgeon General, the Army currently has 149 psychiatrists who are full-time military employees, either in the United States or with troops in Iraq and Afghanistan. The additional 44 civilian psychiatrists may be full-time or part-time, depending on the needs of the individual DOD facility that hires them.

The 44 psychiatrists are part of a larger group of about 200 mental health professionals the military was expected to hire in the near term. An inadequate behavioral medicine treatment staff was one of the problems underlined by the DOD Mental Health Task Force when it issued a report in June that concluded that "the military system does not have enough resources or fully trained people to fulfill its broad mission of supporting psychological health in peacetime and fulfill the greater requirements during times of conflict."

The report went on to say that contract mental health professionals "are inadequate for providing mental health services to service members and their families" for a number of reasons, including their inability to fully understand "the social and psychological context in which the patient functions."

"Clearly, we have a deficit in our availability of mental health providers," said Vice Admiral Donald Arthur, cochairman of the DOD Mental Health Task Force.

The members of the task force visited 38 military installations around the world. The report said its visits "clearly established that current mental health staff is unable to provide services to active members and their families in a timely manner; does not have sufficient resources to provide newer evidence-based interventions in the manner prescribed; and does not have the resources to provide prevention and training for service members or leaders that could build resilience and ameliorate the long-term adverse effects of extreme stress."

The report emphasized that the best place for active-duty soldiers in Iraq and Afghanistan to get mental health help was from professionals embedded in their units. "During site visits, service members told the task force that they were more likely to approach mental health professionals in uniform and to see them as an integral part of the combat team," the report said.

The fourth annual DOD survey of mental health needs of currently deployed Army personnel, completed in May and done independently of the task force report, found that in the most recent military cohort, more than 75% of personnel reported experiencing life-threatening situations, up from 45% in the previous study; 20% reported depression, anxiety, or acute stress.

Much of what is in the DOD Mental Health Task Force report has been known for some time. Concern about posttraumatic stress disorder (PTSD) and traumatic brain injuries among returning veterans from Iraq has been voiced from many quarters. The task force found that 38% of soldiers, 31% of Marines, 49% of the Army National Guard, and 43% of Marine reservists reported symptoms of PTSD, anxiety, depression, or other problems, according to military surveys completed this year by service members 90 and 120 days after returning from deployment. Secretary of Defense Robert Gates is required by law to develop a plan of action within 6 months on the 95 recommendations included in the 64-page report.

As has been the case in the past when mental health treatment deficiencies in the military have been the subject of hearings, members of Congress leaped to decry the new report's findings. Rep Susan Davis (D, Calif) introduced the Mental Health Care for our Wounded Warriors Act (HR 2612) on June 11. Davis just became chair of the Personnel Subcommittee of the House Armed Services Committee. Her bill would establish at least 2 Centers of Excellence in Military Mental Health. The purpose of the facilities would be to develop and implement long-term, comprehensive strategies to prevent, identify, and treat combat-related mental health conditions. But the bill would not put any additional mental health professionals with combat troops or necessarily expand the number of military psychiatrists—2 of the key recommendations of the Mental Health Task Force report. Senators Joseph Lieberman (I, Conn) and Barbara Boxer (D, Calif) have introduced companion legislation.

Loren Dealy, spokesperson for the committee, acknowledged that the bill includes no funds for additional mental health providers, although she added that the legislation restores 490 of the 900 medical personnel the Navy had planned to cut. Some of those people work in the mental health area, Dealy said.

The Defense Department authorization bill for fiscal year 2008, which starts October 1 and which the House passed in May, includes a military mental health initiative. However, that initiative directs the Pentagon to undertake new research, not put additional mental health personnel, much less psychiatrists, in the field. For example, the initiative would require a study of late- onset PTSD involving a cohort of service members who are at least 2 years removed from service in Operation Iraqi Freedom or Operation Enduring Freedom and in whom PTSD has not been diagnosed to identify the prevalence of undiagnosed PTSD and its impact on their continuing service.