Wednesday, May 27, 2009



Gaps In Mental Health Screenings Still Haunt Military
Little Progress In Expanding Screenings

By MATTHEW KAUFFMAN | The Hartford Courant
May 12, 2009

Chad Barrett had attempted suicide and was suffering post-traumatic stress disorder by the time his unit prepared for a third combat tour in Iraq. A psychiatrist had recommended the staff sergeant be separated from the military for his own good, but Barrett wanted to stay with his Army colleagues.

And when it came time for deployment, Army commanders were happy to oblige.

Barrett, who had spent a dozen years in the Army, shipped out in December 2007 with prescription bottles of Klonopin for anxiety, Pamelor for depression and migraines, and Lunesta and Ambien for sleep problems. But the drugs did not control his despair and mood swings. And less than two months after arriving in Iraq, Barrett popped open some of the bottles and committed suicide by overdose. He was 35.

"I understand that they have a mission, and mission comes first. I completely get that," Barrett's widow, Shelby Barrett, said from her home near Fort Carson in Colorado. "But they took a soldier who was not mentally capable of doing the things that he thought he was capable of doing. And I think they took him just as another boot on the ground. They needed their numbers."

Related links
Chad Barrett Photos
2006 Courant Investigation: Mentally Unfit To Fight
U.S. Soldier In Iraq Kills 5 Comrades At Stress Clinic
Mental Health Referrals Graphic
Suicides Among Soldiers Graphic
More than two years ago, Congress ordered the military to implement tighter psychiatric screening for combat troops to keep mentally troubled service members out of the war zone.

But new pre-deployment data obtained by The Courant indicate there are still gaps in the military's screening policies, and that the military is still arranging professional mental health evaluations for only a tiny fraction of the troops it is sending into battle.

Pre-deployment screening records show that in 2008 and early 2009, barely more than 1 percent of deploying troops were referred to a mental health professional as part of their preparations. Even among troops who acknowledged seeking mental health care in the year before deploying, nearly nine out of 10 were deemed mentally fit without seeing a mental health professional.

Service members who acknowledge past mental health care are typically interviewed by medical technicians who decide if a mental health referral is warranted. After stories in The Courant in 2006 detailing deficiencies in mental health screening and treatment for combat troops, Congress instructed the military to establish specific guidelines for determining when those referrals should be made.

But a Defense Department spokesman acknowledged last week that specific guidelines were never developed.

The number of mental health referrals is little changed from 2007, even as the military grapples with a steady increase in depression and stress among combat troops. Just Monday, an American soldier was in custody after killing five fellow troops at Baghdad's Camp Liberty in a shooting at a military clinic for treating stress.

Since the invasion of Afghanistan in 2001, more than 210 service members have killed themselves while serving in Iraq and Afghanistan, and the suicide rate has risen significantly since the beginning of those campaigns. Army-wide, there have been 64 confirmed or suspected suicides in the first four months of this year, with the suicide rate among soldiers now exceeding the demographically adjusted civilian rate.

Undermining Security?
Paul Sullivan, executive director of Veterans for Common Sense, said he believes inadequate pre-deployment screening is partly to blame for the jump in mental illness and suicides. The military's formal pre-deployment mental health assessment consists of a single question on a survey that asks service members if they have sought care or counseling for their mental health in the previous year.

A 1997 federal law required the military to assess the mental health of all deploying service members, and Sullivan said that should mean a face-to-face evaluation — particularly for the 40 percent of service members who have deployed more than once.

"Until DOD [Department of Defense] is in full compliance with that law, DOD is harming our service members and they are undermining our national security," Sullivan said. "And the military leadership bears personal responsibility for continuing the practice of sending unfit soldiers to war."

Military officials have acknowledged that repeated deployments and the high "operational tempo" of the wars have taken a toll on soldiers' mental well-being. But they defend their mental health screening, saying the pre-deployment preparations now include a check of each service member's medical records, and that annual health assessments offer an opportunity to discover mental health issues.

"The pre-deployment health assessment is then just an opportunity to check if anything new has come up since their last assessment or since their last health care visit," said Dr. Michael E. Kilpatrick, director of strategic communications for the Military Health System.

Military officials also say pre-deployment screening is only one tool used to build a mentally healthy force.

The Pentagon has launched numerous programs to build mental "resiliency" among troops, combat the stigma associated with mental health care and increase access to care. Earlier this year, for example, Army leaders proposed scrapping a policy that required commanding officers to be notified when one of their soldiers sought counseling.

The military has also stepped up training throughout the chain of command to urge service members to act when they see suicidal tendencies in their colleagues. The Army even uses a role-playing video game to teach soldiers how to respond to signs of depression.

Numbers Still Low
The small number of troops seen by a mental health professional — about 1 in every 90 preparing for deployment — is still an increase over the early years of the Iraq war, when about 1 in 300 service members was referred for a mental health evaluation. While that growth has meant thousands of additional evaluations each year, the numbers are still far below military scientists' own estimates of the number of mentally troubled troops.

On the pre-deployment form, about 2.7 percent of troops deploying in 2003 said they had sought mental health care. In 2008 and 2009, that figure jumped to nearly 5 percent. But critics say the screen still fails to identify mentally troubled troops who have not sought mental health care or who are too embarrassed to admit they have.

For soldiers who acknowledge recent mental health care, about 12 percent are now referred for a professional evaluation, up from an average of about 7 percent in early years of the war.

Sullivan, the veterans' advocate, said every soldier with recent mental health care should receive a face-to-face evaluation with a mental health specialist before being given deployment orders and a rifle.

But Kilpatrick, with the Military Health System, said service members with a history of mental health care may have completed their treatment and have no need for a new referral. "Since each individual situation is different, it is up to the provider in discussion with the service member to determine their current medical needs and to make an individual determination," he said.

Related links
Chad Barrett Photos
2006 Courant Investigation: Mentally Unfit To Fight
U.S. Soldier In Iraq Kills 5 Comrades At Stress Clinic
Mental Health Referrals Graphic
Suicides Among Soldiers Graphic
Soldiers who say they have not recently sought mental health care are almost never referred for a professional evaluation. Among those troops, about 1 in 180 were referred for an evaluation in 2008 and this year, though that number has also grown since the beginning of the war, when troops who answered "no" to the mental health care question had a 1-in-1,000 chance of being referred for mental health evaluation.

Sullivan called those figures "shameful" and said sending troops to war without a face-to-face medical and mental health evaluation is akin to knowingly sending an aircraft on a long-range mission with inadequate fuel and ammunition. But because of a shortage of money and doctors, he said, he does not expect the military to improve screening.

"It's a question of supply and demand," Sullivan said. "The demand for mental health care and the demand for medical services for these exams is far higher than the supply of physicians available to conduct these exams and provide treatment."

Pattern of Stability
Congress in 2006 also ordered the military to establish minimum mental health standards for deployment, which led to new Defense Department rules barring the deployment of troops with bipolar or psychotic disorders and requiring that troops with mental health disorders demonstrate a "pattern of stability, without significant symptoms," for at least three months prior to deployment.

Shelby Barrett said her husband had no such pattern of stability as his third deployment approached. "No. Not at all," she said. "Not when the police had to be called here three or four times for domestic issues."

Barrett said her husband lost several friends during earlier combat tours and had become depressed and volatile.

Overall, the military in recent years has deployed fewer service members who reported recent mental health care, with 82 percent deployed in 2008 and 2009, compared to 88 percent in 2005. The overall deployment rate has also declined, but not as sharply.

The pre-deployment data were drawn from a health form filled out by service members in all branches each time they prepare for a combat deployment. The database, with names and other identifying information removed, includes information for more than 2.5 million deployments since the beginning of the wars.

But Kilpatrick said numbers of referrals and deployments don't tell the whole story.

"Looking at a database doesn't reflect the complexity of the overall process," he said. "While we can never say that each and every individual with a mental health condition is identified and treated, we do feel comfortable that the life cycle of assessment and health care delivery is comprehensive."

That does not ease Shelby Barrett's pain, or her anger that the Army did not do more for one of its own.

"My husband was one hell of a soldier. My husband was one hell of a man — until his mind couldn't take any more," she said. "And that's the easiest way for me to put it. That's the easiest way for me to make sense of it."

>> Matthew Kauffman will talk about this story on the Fox 61 morning show between 8 and 9 today.

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