What a drag it's been these past few weeks to watch the military brass-those kings of accountability, at least when it comes to other people's behavior-huffing and bluffing and outright lying about what they knew and when they knew it. First we had to endure the sight of them gaping over the news that the sexual-violence crisis they've done nothing to squelch since the assault of 83 women and seven men at the Tailhook Air Force convention in 1991 has worsened. Now those same Pentagon officials are shocked, simply shocked, by the military's spiking suicide rates, despite the fact that those numbers, which have been rising steadily for the past 12 years, come from their own reporting system (and some claim are still an undercount).
The only thing worse than the Pentagon's faux surprise has been the complicity of news organizations willing to echo its talking points. Shame on The New York Times for last week's "Baffling Rise in Suicides Plagues the U.S. Military." Disturbing, yes. But there's nothing "baffling" about the news that more active-duty troops killed themselves in 2012 than were killed in combat in Afghanistan in the same year, and that the number of suicides has doubled from a decade ago.
As the Government Accountability Office (GAO)-Congress's nonpartisan investigative wing-and a variety of media outlets attest, there's been only one thing better documented than the military's unwillingness over the past 25 years to throw any real muscle into ending its culture of widespread sexual assault. And that's the military's unwillingness to acknowledge the prevalence of post-traumatic-stress-disorder (PTSD) and other mental-health issues plaguing service members and to enact serious reforms aimed at curbing and treating mental illness in its ranks. The military's systemic incompetence on this issue continues despite years of analysis and criticism, not only from service member advocacy organizations, but also from within the Beltway.
Consider the drubbing administered to both the Department of Defense (DOD) and the Veterans Administration (VA) by the GAO last November. The report cited "a lack of leadership, oversight, resources, and collaboration" as contributing to the military's "inability" to "address a host of problems for wounded, ill, and injured servicemembers as they navigate through the recovery care continuum." All of those issues came under greater congressional scrutiny in the wake of the public uproar that followed the Washington Post's 2007 Pulitzer Prize winning investigative series on conditions at Walter Reed Army Military Center, the VA's flagship in D.C. The GAO concluded that the military had utterly failed to rectify the conditions the series had cited: Mold-stained and cockroach-filled outpatient facilities; byzantine paperwork mazes and overlong wait times to receive care; inadequate resources for soldiers with diagnoses of PTSD.
Despite the fact that Walter Reed has the largest psychiatric department in the Army, the Post's reporters found it still lacked "enough psychiatrists and clinicians to properly treat the growing number of soldiers returning with combat stress." Earlier that year, the head of psychiatry had "sent out an 'SOS' memo desperately seeking more clinical help. ... Individual therapy with a trained clinician, a key element in recovery from PTSD, is infrequent, and targeted group therapy is offered only twice a week."
But surely these are problems that money can solve. So did the $2.7 billion dollars that Congress poured into the Pentagon's maw in the three years following the Post's series do anything to change the way that the DOD and VA address treatment and research for "the signature wounds of the wars in Afghanistan and Iraq"-psychological health (PH) and traumatic brain injury (TBI) treatment? That's hard to say, because the GAO's January 2012 report found "that DOD programs supporting P.H. and TBI treatment and research are poorly coordinated, and the department has failed to provide reliable and comprehensive data on how more than $2.7 billion in funds for such programs have been used in recent years." In other words, there's no way of knowing what, if anything, went into patient care.
There is, by the way, no good reason why the DOD or VA should have been caught flat-footed by the waves of veterans that flooded their facilities in 2006, more than a third of whom reported symptoms of stress or other mental disorders as they returned from the wars in Iraq and Afghanistan. At least two of its own top people-the chief of psychiatry at Walter Reed and the Executive Director of the VA's National Center for Post-Traumatic Stress Disorder-had published pieces in a 2004 edition of the New England Journal of Medicine predicting the crisis.
That same year the GAO published a report titled, "More Information Needed to Determine If VA Can Meet an Increase in Demand for Post-Traumatic Stress Disorder Services," which it followed five months later with another report, this one unsubtly titled, "VA Should Expedite the Implementation of Recommendations Needed to Improve Post-Traumatic Stress Disorder Services" (emphasis mine). In it, the GAO notes the VA's lack of full compliance with any of the 24 recommendations in its earlier report, including 10 that were carryovers from the very first recommendations issued by the Special Committee on PTSD within the VA nearly 20 years before.
Clearly a military in the midst of a recruiting crisis, and with no end to the war in sight, was not looking closely for signs of mental illness in prospective and active service members. Nor was it willing to acknowledge what it found, especially if that meant removing another warm body from an over-stretched unit, letting the public see the negative consequences of an already unpopular war, or paying for treatment or compensation.
The same month the GAO's follow-up report was released, in February 2005, Army Spec. Jeffrey Henthorn, a young father and third-generation soldier, killed himself in Balad, Iraq. The M-16 he used was so powerful that "fragments of his skull pierced the barracks ceiling." According to the Hartford Courant, which featured Henthorn's story in a series called "Mentally Unfit to Fight," he "had been sent back to Iraq for a second tour even though his superiors knew he was unstable and had threatened suicide at least twice, according to Army investigative reports and interviews."
Henthorn was 1 of 22 soldiers who killed themselves in Iraq or Afghanistan in 2005- nearly double the rate of the year before. Three others whose stories were featured had been kept in combat and given potent psychotropic medications-with little supervision and despite the potential of these drugs to increase suicidality.
So enough with the military's alleged bafflement over the rising service member suicide rates. If they really want to address the issue, here are three places they could start. First, stop impeding the rapid transfer of veterans from the DOD system to the VA system. Under the current ridiculous system, even though a service-member's paper file is transferred automatically from the former to the latter, but she cannot access VA services until she enrolls online or in person. The DOD and VA have already wasted a billion dollars worth of taxpayer money ineffectually trying to combine their data systems according to a June 2012 GAO report. So the time has come to recruit the first random kid who walks through MITs long corridor to take the task on: surely she could do better.
Next, comply with Veterans Health Administration (VHA) policy, which requires that all first-time patients requesting mental health services receive an initial evaluation within 24 hours, and a comprehensive diagnostic appointment within two weeks. As Stars and Stripes reported, the Inspector General already busted the VHA in April 2012 for saying that 95 percent of its new patients were seen in that time frame, when in fact the average wait time is closer to two months. Hire more staff. And curb the habit the military has developed over the past decade of spending more than $4.5 billion handing out antidepressants, antipsychotics, and anti-anxiety drugs. That money could buy a lot of one-on-one therapy and support groups. Consider actually treating the service members in the military's care rather than dosing them into oblivion.
Finally, remove the systemic disincentives that have for decades discouraged service members from coming forward: Being separated from buddies; kept for weeks or months of evaluation, and prevented, by the letter that goes into a reporting service-member's file, from any career advancement in the military or any future employment as a police officer, a firefighter, or an emergency medical technician. The military could also demonstrate its belief in the core value of addressing mental health issues by integrating it into the Soldier's Manual of Common Tasks. If recognizing and addressing signs of mental distress is meant to be as natural and vital a task as performing first aid to restore breathing or pulse, then let it be taught right alongside the other rudiments of basic training.
Let's face it: it takes a potent combination of media attention and public outrage along with a strong dose of presidential and congressional will to exert the kind of pressure it takes to force the military to actually change its entrenched culture. The DOD's latest sexual assault report might have died in the 24/7 news cycle if the release of the study revealing a new spike in those numbers hadn't been followed by multiple arrests of some of the same (male) officers in charge of ending sexual assault for ... sexual assault.
It's plenty exciting-now that the president has finally spent some political capital and sat down with Hagel and the brass-to see the branches of government start pressing the military to clean out its Augean Stable as far as sexual assault goes. But what will it take, if not the suicides of hundreds of men and women, to warrant the same kind of attention for the military's mental-health crisis?
