GAO Report Raises Questions About Mental Health of Discharged U.S. Servicemembers

More than 60% of U.S. servicemembers separated for misconduct from fiscal years 2011 through 2015 were diagnosed with mental illness or substance use disorders within two years before their separation, according to a report released yesterday by the Government Accountability Office (GAO).

GAO's analysis of Department of Defense (DOD) data found that of the 57,141 servicemembers separated for misconduct between 2011 and 2015, 16% (9,142) had been diagnosed with posttraumatic stress disorder (PTSD) or traumatic brain injury (TBI), and 23% (13,283) received an “other than honorable” characterization for their service, leaving them “potentially ineligible” for health benefits from the Department of Veterans Affairs (VA), the analysis said.

“As a result of policy inconsistencies and limited monitoring, DOD has little assurance that certain servicemembers diagnosed with PTSD or TBI receive the required screening and counseling prior to being separated for misconduct and that all servicemembers, including officers, have been trained on how to identify symptoms of mild TBI in the deployed setting,” the report stated.

To ensure PTSD and TBI are appropriately considered prior to separating servicemembers from the military for misconduct, GAO recommended the Secretary of Defense take several actions, including directing the Air Force and Navy to address inconsistencies with DOD policy related to PTSD and TBI screening; training servicemembers, including officers, on how to identify mild TBI in the deployed setting; and ensuring that the military services monitor adherence to their screening, training, and counseling policies.

“PTSD and TBI can be difficult entities to diagnose because they are based on self-report and history,” said psychiatrist Elspeth Cameron Ritchie, M.D., M.P.H., a retired Army colonel, in response to the analysis. As psychiatry consultant to the Army Surgeon General from 2004 through 2008, she helped developed policies regarding PTSD and TBI. “Sorting through whether misconduct is actually related to PTSD and TBI can be challenging.”

For related information, see the Psychiatric Services article “Barriers to Engaging Service Members in Mental Health Care Within the U.S. Military Health System.”

(Image: iStock/MTMCOINS)

Senators Hear Testimony on MH Care and Suicide Prevention for Veterans

A bipartisan group of U.S. senators expressed concern at a hearing Wednesday about what they see as the slow pace of change in the Veterans Health Administration’s (VHA) mental health care system—a concern intensified after listening to two women whose sons, veterans of Iraq or Afghanistan, had died by suicide.

“When people are hurting, they don’t want to wait to get help,” stressed committee chair Sen. Bernie Sanders (I-Vt.), who then asked how the $5 billion authorized for hiring additional clinicians was being spent. Those funds were not specifically allocated for mental health care providers, replied psychiatrist Harold Kudler, M.D. (above, right), chief mental health services consultant for the VHA. However, the agency was nevertheless allocated a share of those funds to recruit more providers, increase points of access, and test new modes of outreach in rural areas.

Still other avenues could be explored in the effort to reduce the number of veterans who die by suicide, said psychiatrist Elspeth Cameron Ritchie, M.D., M.P.H., (above, left), a retired Army colonel who is now chief clinical officer of the Washington, D.C., Department of Behavioral Health and a member of an Institute of Medicine panel that studied the effectiveness of treatments for posttraumatic stress disorder.

The VHA should, for example, conduct more research to understand which of its patients are at increased risk for suicide, Ritchie said. Service members also should be screened with closer attention to specific tasks they performed while deployed, as well as for any toxic exposures—like Agent Orange or the antimalarial drug mefloquine—which might produce symptoms of psychiatric illness or increased suicide risk.

The testimony was presented as the Senate considered the Clay Hunt SAV [Suicide Prevention for American Veterans] Act, which includes measures for suicide prevention and medical school loan forgiveness for psychiatrists and certain other practitioners who join the VHA.

For more about mental health issues that affect veterans and the findings of the Institute of Medicine report, see the Psychiatric News article “Pentagon, VA Lack Data to Assess PTSD Care Systems.”

(Image: Aaron Levin/Psychiatric News)