Issues and care
For years, the military and others have been assessing the mental health needs of service members and quality of care. A large-scale, nongovernmental assessment of the psychological and cognitive needs of military service members conducted by RAND Corporation found that nearly 20% of military service members who have returned from Iraq and Afghanistan—300,000 in all—reported symptoms of PTSD or major depression. Nevertheless, only slightly more than half have sought treatment.
Rising suicide rates among the troops have prompted a 5-year, $50 million collaboration between the Army and NIMH to identify causes and risk factors. In 2008, the Army reported 140 confirmed or suspected suicides (20.2 suicides per 100,000 troops—nearly twice the national rate of 11.01 suicides per 100,000 US population). As of press time, the Army has reported 64 potential active-duty suicides for 2009.
Since 2003, the Army Surgeon General has dispatched Mental Health Advisory Teams (MHATs) to survey soldiers as well as health care and unit ministry team members, particularly in Iraq and Afghanistan, said Lt Col Paul D. Bliese, chief of military psychiatry at the Walter Reed Army Institute of Research. Bliese was project director for MHAT-V, which was released last year (http://http://www.nccosc.navy.mil/reports/mhat/mhat_v/mhat-v.cfm).
“The MHAT reports systematically quantify mental health concerns and go a long way toward informing policies such as deployment length and behavioral health resourcing,” Bliese told Psychiatric Times. A report on the MHAT-VI mission to Iraq is now being finalized.
The top finding of MHAT-V, Bliese said, was the degree to which combat intensity and mental health demands had increased in Afghanistan. A second key finding linked mental health and family-related concerns to deployment duration.
“By the end of a 15-month deployment, the statistical models predicted that approximately 30% of junior enlisted intended to divorce or separate, up from 10% at the beginning of the deployment,” Bliese said. “Likewise, the data showed the degree to which mental health problems tended to peak about two-thirds of the way through a deployment, but even with some lowering of problems in the 3 or so months immediately before returning (‘redeployment optimism’), the rates of problems roughly tripled from initial levels at the end of 15 months.”
Noncommissioned officers (NCOs) on their third or fourth deployment had significantly lower morale, more mental health problems, and more stress-related work problems than NCOs on their first deployment, according to the MHAT-V report. For example, among male NCOs, 27.2% reported mental health problems on their third or fourth deployment compared with 11.9% on their first deployment.
The issue of adequacy of behavioral health staffing for the troops was also raised in the MHAT-V report. At least 1 behavioral health provider (officer or enlisted) is needed per 1000 service members, according to the report. The current staffing ratio for Army and Navy behavioral health personnel to soldiers or Marines is 1:1426.