ARLINGTON, Va. — The Army does not screen every soldier for mental and behavioral health, and even if it did, it is impossible to say if any of the current efforts would have flagged suspected gunman Maj. Nidal Malik Hasan and averted the tragedy at Fort Hood.
After eight years of war and millions of dollars spent, the Defense Department and Veterans Health Administration have built the most robust safety net of mental health initiatives the force has ever seen. But it is not enough to screen half a million soldiers. It was not enough to stop Hasan.
Instead, what has emerged are piecemeal studies and initiatives, questionnaires and outreach messages, many of which are focused more on screening incoming recruits rather than midcareer soldiers, and those coming and going from deployments rather than soldiers such as Hasan, who have never been downrange.
Some of these programs are designed to educate tens of thousands of servicemembers on the warning signs of stress, whether from combat, multiple deployments, relationship strains or financial problems — factors that for some can lead to suicide or violent outbursts, but for others are simply the trials of military life.
From the time soldiers clear initial recruiting health screens to the time before deploying, it remains largely up to individuals to seek help when and if they want it.
Short of a command referral, there is nothing that compels every soldier to face a mental health screening.
“Leaders at all levels across the Army are working hard to reduce stigma associated with seeking care and to build resilience in our military force,” said Cynthia Vaughan, chief spokeswoman for the Army Surgeon General’s office.
Roughly 34,000 soldiers have been diagnosed with post-traumatic stress disorder. And the Army has 194 civilian, 121 military and 93 contract psychiatrists available to its population of more than half a million people, according to the surgeon general’s office. In the war zones, there are about 200 behavioral health specialists deployed in Iraq and just 30 in Afghanistan.
In the fall of 2003, just months after the initial invasion of Iraq, the Army deployed its first Mental Health Assessment Team, leading to a cascade of changes and beefed-up health programs.
A 2004 study by the Walter Reed Army Institute of Research led to the Post-Deployment Health Reassessment, rolled out in 2005. Soldiers returning from the war zones fill out a questionnaire and face a health screener, though not a mental health specialist.
The following year, the Army introduced an anti-stigma program to encourage mental health screening. The program is active in 15 locations.
There are also a few programs for soldiers who have not deployed.
On Friday, Army Secretary John McHugh and Chief of Staff Gen. George Casey, in a news conference at Fort Hood, said that while the motives and background of Hasan remain under investigation, the Army had taken significant steps to boost such initiatives.
Casey highlighted a five-year study announced this summer that is being conducted with the National Institute of Mental Health. It will look at individual factors that, in the right combination, might lead someone to suicide — or perhaps a rampage shooting like the one that occurred there Thursday.
McHugh, however, recalled Thursday that during his Senate confirmation hearing he had criticized the same study for taking too long to find results.
In July, then-Army Secretary Pete Geren and Vice Chief of Staff Gen. Peter Chiarelli called it the “largest ever study of suicide in the military.” At a cost of $50 million, the plan is to screen 90,000 soldiers and up to 120,000 incoming recruits, and study 290,000 Iraq and Afghanistan veterans.
But participation remains voluntary and at full capacity, the study still would not examine hundreds of thousands of current servicemembers.
Perhaps no program is as touted as Comprehensive Soldier Fitness. This fall, the force rolled out its first Armywide, mental health-related diagnostic test required of all soldiers: an online test called the Global Assessment Tool.
Soldiers answer 170 questions, developed by military and civilian psychologists, about their physical, social, spiritual and emotional health, as well as about their family life. Based on those answers, soldiers are asked to choose from several training program options, ranging from attending online or on-base classes to trying self-improvement training techniques “tailored to your level of knowledge and ability,” said Brig. Gen. Rhonda Cornum, who oversees the program.
The system records that each soldier has completed the exam and was given options for follow-up. However, the Army does not track results, or what help soldiers sought.
“The results will not be reported to anyone other than the person who took it,” she said.
Cornum, in a roundtable with reporters in August, was careful to caution the test is not meant to diagnose medical problems.
“It was developed because we recognized we really did not have a preventive and strengthening model for psychological health,” Cornum said.
Cornum called it “risk mitigation”, and likened the program to spraying a swamp for mosquitoes rather than waiting to see who turns up with malaria and treating disease after it shows up.
It’s about resiliency, the new buzzword in military mental health.
“Some of us learn that when we were growing up,” she said. “But not everybody had the opportunities and role models that taught them that.”