Killeen, Texas: The shooting rampage at Fort Hood has once again focused attention on the military’s mental-health system, which, despite improvement efforts, has struggled to address a tide of psychological problems brought on by more than a decade of war.
Military leaders have tried to understand and deal with mounting troop suicides, worrying psychological disorders among returning soldiers, and violent incidents on military installations such as the one that left four people dead and more than 16 injured at the Army post in Texas on Wednesday.
But experts say problems persist. A nationwide shortage of mental-health providers has made it difficult for the military to hire enough psychiatrists and counsellors. The technology and science for reliably identifying people at risk of doing harm to themselves or others are lacking.
Officials have yet to identify a motive behind the actions of the Fort Hood shooter, Army Specialist Ivan Lopez, who took his own life. But they have said he was taking medications for anxiety and depression.
Lieutenant General Mark Milley, the commanding general at Fort Hood, said on Friday that an examination of Lopez’s record showed no combat injuries or contact with the enemy. He said an argument was a “direct, precipitating factor” leading to the shooting.
Experts stress that the mentally ill are more likely to be the victims of violence rather than the perpetrators and that American society, not just the military, struggles with how to handle mental illness.
Although Lopez sought treatment for his depression and anxiety, there remains in the military a stigma that prevents soldiers from seeking the help they need, said Barbara Van Dahlen, president of Give an Hour, a non-profit group that connects troops and their families with free mental-health services.
“The military is reliant on self, focused on the other, mission first, stop whining, suck it up,” Van Dahlen said. ”It’s only in the last 10 years that the military, to its credit, started to think about, OK, we had better focus on taking care of our mental-health needs or we are going to be in trouble.”
Growing alarm about suicides and violence within the military has prompted unprecedented efforts to beef up systems to help soldiers cope with multiple deployments and adjust to life after war. The Army has launched the largest-ever study of mental-health risk and resilience among military personnel, and set up a $US65 million facility dedicated to treating traumatic brain injury, post-traumatic stress disorder and other psychological problems.
The military also has started deploying psychiatrists and counsellors to serve alongside soldiers in war zones and conducts therapy sessions for returned soldiers and their families.
Despite these efforts, there have been hundreds of active-duty suicides since 2011, according to figures from the Army and non-profit groups.
Some advocates believe the military lacks adequate funding to identify and treat mental issues and that many of the diagnostic tools available are outdated and inadequate.
For example, post-traumatic stress disorder is diagnosed using a list of questions.
“Imagine going to your doctor because you think you have a broken leg and your doctor asks 20 questions,” said retired General Peter Chiarelli, a former Army vice chief of staff. “And then your doctor says, ‘You don’t have a broken leg. You can go home.’ You’d say, ‘Aren’t you going to X-ray my leg?’ That’s how we diagnose PTS.”
The military, he said, needed to fund research aimed at developing more advanced tools, including brain-imaging scans and blood tests.
General Chiarelli also said the military’s efforts to hire more clinicians to diagnose and treat post-traumatic stress had been impeded by an overall national shortage. That, in turn, has led to an over-reliance on prescription drugs instead of more time-consuming treatments.
Nonetheless, some Army officials say, the resources provided at installations such as Fort Hood are quite substantial. But the demand for them is high. Fort Hood, and the Darnall Army Medical Centre there, provides psychiatrists, psychologists and family-life chaplains to help people with anxiety, depression and post-traumatic stress.
“Could we use more? There’s always a need for more, especially after 12 years at war,” said a mental health professional at Fort Hood.
This article first appeared on the Sydney Morning Herald on 7 April, 2014.