Mental health surveys divert few soldiers from deployment

Madigan Army Medical Center

By ADAM ASHTON | The News Tribune (Tacoma, Wash.) | Published: June 30, 2013

A small fraction of soldiers deploying out of Joint Base Lewis-McChord during the peak of the Iraq War were removed from combat missions because their answers on last-minute screenings raised concerns about their mental health, according to data obtained by The News Tribune.

Just 250 out of more than 72,000 pre-deployment health surveys reviewed at Madigan Army Medical Center between 2006 and 2010 led to soldiers being taken off combat tours after they revealed signs of ailments such as post-traumatic stress disorder or head injuries. That’s less than 0.4 percent of the surveys that were completed.

The numbers appear small, but they come from a group of soldiers who had been considered healthy and ready to deploy when they took the surveys in the months before they were scheduled to leave the country.

“These are the people who have already drawn their gear and are on the ramp,” said Madigan Commander Col. Dallas Homas.

The data shed new light on one of the safety valves military officials put in place after it became clear they would be sending soldiers in an all-volunteer Army on multiple combat tours, continually exposing the same troops to insurgent bombs in Afghanistan and Iraq.

Army-supported studies since 2007 have shown that repeated deployments increase the probability soldiers will experience PTSD.

Dozens of questions are on the surveys, asking soldiers about sleep, anxiety, nightmares and other habits that could suggest an underlying behavioral health condition. If doctors grow concerned, they direct a soldier to a one-on-one appointment with a specialist and then consult with a commander about whether the service member should deploy.

Conditions such as PTSD and depression are regarded as treatable ailments, so officials have to make a judgment call on whether service members can deploy with those diagnoses.

“It takes savvy behavioral health guys. It takes savvy leadership. It’s not a medical-only issue,” Homas said. “It takes collaboration.”

One soldier who likely took the survey more than once was Staff Sgt. Robert Bales, who this month admitted to slaughtering 16 Afghan civilians during his deployment last year in Kandahar province.

His attorney said Bales had at one time been diagnosed with PTSD at Madigan and that Bales suffered lasting effects from a concussive head injury.

The News Tribune could not determine whether Bales was ever identified in the late-screening process. Defense attorney John Henry Browne declined to comment on specifics of when Bales received a PTSD diagnosis or how he was treated. It’s not clear whether Bales, 39, showed signs to friends and family that he was troubled by PTSD before he deployed to Afghanistan in November 2011. “I thought he was very capable,” his direct supervisor, 1st Sgt. Vernon Bigham, testified at the pretrial hearing.

The difference between what Bales revealed to friends and what he might have been going through internally highlights the shortcomings of any written behavioral health test.

“Army guys that have PTSD don’t even want to admit it,” Browne said in an interview. “It’s that whole thing about manning up. There’s a cultural bias against admitting you have PTSD.”

Most soldiers on the eve of their deployments want to go overseas for a range of reasons, such as testing themselves at their profession, supporting their team or earning extra money.

Those factors could lead a soldier to minimize descriptions of trauma-related symptoms.

“Most of it is team dynamics. It’s like a sports team. If you don’t show up for the big game, you might not be trusted,” said Col. Mark Baggett of Madigan’s Behavioral Health Department.

Bales’ emotional and mental health at the time of his last deployment likely will be a key part of his defense at his August sentencing trial. In the best case for him, Bales would receive a life sentence with a chance at parole.

So far, his attorneys have been guarded in court about Bales’ past distress. To opposing attorneys they have not revealed much specific information about the soldier’s past.

“There’s no evidence (Bales) has PTSD,” said Army prosecutor Lt. Col. Jay Morse at Bales’ plea hearing this month. At that time, Morse had not been able to read an unredacted copy of Bales’ mental health records.

The pre-deployment health screenings typically take place less than 60 days before a unit leaves for war. The News Tribune requested a breakdown of their outcomes for each year between 2006 and 2010.

All totaled, 486 service members were referred to behavioral health specialists because of their surveys. Of those, 236 returned to their units and deployed, another 190 went back to their units but did not deploy, and 60 ultimately received medical retirements.

Some of these numbers could represent soldiers who were screened more than once, if they deployed from Lewis-McChord multiple times during this period.

These days, the pace of deployments at Lewis-McChord has slowed significantly in the past year. About 4,000 local soldiers are in Afghanistan now, down from about 10,000 at this time last year.

The largest Lewis-McChord unit currently in the war zone left one-fourth of its 4,000 soldiers at home when it deployed last fall. The 4th Brigade, 2nd Infantry Division so far has sent home another 1,000 soldiers from the group it took to Kandahar province.

With those trends, Army commanders can be more cautious about sending veterans back to combat because fewer troops are needed overseas.

“You’re not being forced to take everybody,” Homas said. “When there are fewer needed, it’s easier to make that decision on the side of caution.”

The pre-deployment surveys have their origins in the first health screenings of Stryker soldiers coming home from Iraq in 2004. They later became mandatory for soldiers deploying out of Lewis-McChord, and they were used more than 41,000 times in 2009 alone.

Retired Air Force officer John Meyer helped develop both the pre-deployment and post-deployment surveys at Madigan. He grew interested in the psychological effects of war during his service in the Vietnam era.

“I was very much aware that we were sending people out with mental instability,” he said. “It always stuck with me.”

Adam Ashton: 253-597-8646 adam.ashton@ thenewstribune.com blog.thenewstribune.com/military

from around the web