Mental Health in the US Army

Real Insanity: My Take on The Mental Health System in the Army
By Spc. Mike Lydon

As the war in Iraq has begun winding down, of late the Army's been dealing with suicide as the main threat. And rightly so, when a soldier kills himself not only does the Army lose a potentially valuable team member, but morale is shattered and productivity no doubt takes a hit. It also sours a whole family if not a whole town against the military.

Even so, I was surprised to see an anti-suicide campaign beginning to unfold. We were given suicide prevention classes, cards full of numbers that we could call for help, we were made aware of the supposedly unlimited resources available to those of us who were considering going down that dark path. I was somewhat taken aback that the Army would even begin to make this much of an effort to save us individually.

But, like many of the Army's programs, I've seen this push for mental health more or less reveal itself as the cobbled together pile of crap that it is. I want to tear through the approach piece by piece so that you, the reader, can come to understand my frustration with this system.

First off, the Army's culture is partly to blame. Before I explain why, I want to explain exactly what a mental disorder is. A mental disorder can often be when a helpful or useful trait is applied excessively or at inappropriate times. Being jumpy will save your life when you are in a guard tower, in a patrol base in Iraq. Being jumpy is not a useful trait at a barbecue when you're in America, therefore we call it Post Traumatic Stress Disorder. The Army's culture of “suck it up, drive on” is extremely helpful when deployed. The ability to just stomach a problem and deal with the immediate, life or death issues is hugely important when you're on a FOB in the middle of enemy infested land. However, it's entirely counterproductive in garrison. Much like a mental disorder, it's just a trait taken out of context.

In the Army culture, it is unacceptable for a soldier to ever quit, for anything. Soldiers that are hurt and can't participate in PT are labeled as “profile riders”, soldiers that can't do work because they're mentally incapable are accused of shamming, being weak, or anything else. The stigma for admitting any weakness at all is huge. And in the military, where you are without your traditional friends and family, the pressure to conform is huge, especially if you plan on staying in for any acceptable length of time. So, for an E-4 fighting to get his E-5, to go to your NCO (Non-Commissioned Officers) and say “Hey Sergeant, I have a problem...” is pretty similar to going up to the same NCO and saying “Hey Sergeant, I'm too fragile to handle responsibility!” How can you effectively deal with a problem that is socially unacceptable? Especially because in the military it is expected that your NCO's be there to guide you through ANY and ALL big problems you have. Are you an alcoholic? Your NCO walks you into rehab. Are you broke? Your NCO shows you how to get the loan you need to get by this month. Are you in need of mental health expertise? Too damn bad.

Secondly, the Army's efforts at educating their soldiers about mental health issues are at best half hearted. Occasionally, the entire unit has to stop work for a day and sit down and listen to a suicide prevention class. Usually, the battalion/squadron chaplain reads a bunch of redundant information off of a powerpoint. Nobody ever pays attention, nothing is learned, and all we have to show for this class is the fact that I have gotten just a little bit more behind at work. Thanks! A lot of soldiers I know, self included, have often joked that the suicide prevention classes make to want to kill themselves more, not less.

Due partially to the stigma against it, mental health isn't properly taught to soldiers, in my humble opinion. Suicide prevention shouldn't be a block of instruction, it shouldn't even be “suicide prevention”, it should simply be leaders with some knowledge of mental health issues keeping an eye on their soldiers, talking to them 1 on 1 or in small groups to make sure they're brought up to speed. We soldiers learn most of our essential skills this way, why we can't be taught about keeping yourself mentally in shape is simply beyond me.

Thirdly, I have to complain at the utter lack of professionals the average soldier has access to. In a normal unit, if you twist your ankle, the next morning you go to sick call, see a medic who sends you to a doctor, you get the stuff you need to get better and continue on. But most Army units don't have that kind of access. There actually is an actual Army job title called “Mental Health Specialist” (68X in Armyese). This is important to note, because every unit has what they call an “MTOE”, which is basically a complete listing of what equipment and personnel we're allowed to have, listed by rank and job title.

However, by MTOE my Squadron (of roughly 400) does not have any at all. Every Troop has a chemical warfare guy, because they're essential. (For you civilians out there, a Squadron would have 3-5 Troops in it) But for the whole squadron, we can't afford just 1 more guy? Just 1 lowly counselor to help soldiers deal with their mental issues? This doesn't even deal with the fact that an actual Psychologist or Psychiatrist doesn't seem exist outside of a hospital setting in the military. A battalion sized element has it's own surgeon to deal with severe trauma. But they have no organic mental health capacity. I'm not saying we shouldn't have that surgeon, he saves lives, but somebody who's got a DSM-IV sitting on his bookshelf might not be bad to talk to every so often.

Of course, the answer the Army would give is to “go to the chaplain.” I respect that chaplains these days are more of “spiritual advisors” rather then priests in uniform. I also understand that for many people throughout history, speaking to a priest has been helpful for dealing with their issues. But those people are generally part of that priest's parish or congregation, or at a minimum of the same faith. I am not of the same religious affiliation as my chaplain. But that's neither here nor there, it seems that many chaplains have independently reached the conclusion that most soldiers don't want to hear about God or Jesus, just to get their issues resolved. But here's the qualm, that guy, the chaplain, is not a mental health professional. He doesn't have the in depth training a Psychologist would have in therapy techniques. Nor can he write prescriptions like a Psychiatrist. All he can do is pray for me, and frankly, that doesn't inspire confidence in this Scout.

And my final gripe is simple... the Army's emphasis on mental health is purely for suicide prevention. That's it. The classes we get are called “suicide prevention” and are aimed solely at not taking your own life. They're dealing with a symptom, not the ACTUAL issue, and that issue is that our fair profession is potentially very destructive mentally. But they have no real capacity to deal with it. By the time a soldier is considering killing himself, it's already too late. If he's gotten that far gone, then there was ample opportunity lost for that soldier's psyche to be properly taken care of. People don't just wake up one day from a good month and say decide to kill themselves. It's a long, dark trail they travel, one that leaves lots of signs and must go through a lot of waypoints and with many good times to cut it off. If the Army would stop thinking of it as “suicide prevention” and think of it as “mental fitness”, I promise you less soldiers would be killing themselves.

Many would also point out the fact that the Army is a high stress game we play. Constant deployments wreak havoc on the families that many soldiers need to depend on for emotional support. The fact that all soldiers are the playthings of an uncaring bureaucracy that will occasionally move us at a whim is hugely depressing. Dates for deployments move constantly in both directions, with many soldiers feeling the burn as they struggle to ready themselves for these capricious and shifting deadlines. This doesn't even begin to touch legitimate combat stress, or the fact that many Army families don't last the first deployment. However, I don't think these things can change, and even if I did, we all volunteer to put up with that when we enlist. So, I won't list that as a major fault, because, frankly, that's how it has to be in my line of work. Nothing is guaranteed, nothing is set in stone except the fact that the worst is yet to come.

To me, it seems that this entire program is just to keep Congress from getting angry at some high ranking officers. It's purely CYA (Cover Your Ass) for the top tiers of the military so they don't have to explain themselves. I think it's a program that needs to be taken much more seriously if they're going to try and save any soldiers. How to do this? Glad you asked, here's my suggestions.

First off, make Mental Health Specialists more common. Every Squadron or Battalion sized element has a medical platoon, 1-2 68X's won't break any budgets when added across the board, and they can spend their time educating soldiers and helping their brothers deal with stress, while teaching healthy coping techniques.

Secondly, make some mental health knowledge mandatory for NCO's and Officers. Normally, when an E-4 goes to the board to try out for his stripes, he's asked a battery of questions, many of which are about how to take care of soldiers. They have to know how to apply for emergency loans, how to enroll a soldier in AA, and other things like that. Some questions about how to recognize depression won't hurt, will they?

Thirdly, schedule an hour long therapy session for soldiers after they come back from a deployment, and possibly before they go to a deployment. I understand this can be pretty demanding logistically, but this would give actual Psychologists and Psychiatrists the chance to identify high risk personnel and if possible offer them free sessions and encourage them to work their issues out.

I realize that getting the Army to change the way it deals with anything is a painful process. However, it doesn't come near the pain of having to keep burying our brothers in arms because the bureaucracy and insanity of the military got in the way of them being able to live.