Military personnel are making extensive use of outside mental health services, suggesting that the mental health services offered within the military are not meeting the needs of active duty service members, according to a new study published in the journal Military Medicine.
Overall, the most common reasons that service members gave for seeking outside care were as follows:
- insufficient and unresponsive services (93 percent);
- fear of reprisal for seeking services (56 percent);
- mistrust of command (48 percent);
- pre-existing mental health disorders (22 percent);
- military sexual trauma (22 percent), and;
- cost as a barrier to receiving health care (19 percent).
Guilt about killing or injuring others were common experiences.
“Current wars have led to a devastating public health epidemic of suicide and mental health problems among veterans and active duty GIs,” said the study’s coordinator, Dr. Howard Waitzkin, distinguished professor emeritus at the University of New Mexico.
For the study, researchers based at the University of New Mexico, Albuquerque, as well as in Texas, Oregon, and Massachusetts, collected quantitative and qualitative data for 233 clients between 2013 and 2016.
Professionals working as volunteers in the Civilian Medical Resources Network received referrals of active duty service members from the GI Rights Hotline, staffed by members of peace and faith-based organizations. Military clients were located throughout the United States and also in Afghanistan, South Korea, and Germany.
These military members showed very high rates of psychiatric disorders. Nearly half (48 percent) reported suicidal thoughts; 72 percent of clients met criteria for major depression, 62 percent post-traumatic stress disorder (PTSD), 20 percent generalized anxiety disorder (GAD), 25 percent panic disorder, and 27 percent alcohol use disorder. In addition, 38 percent of clients reported mistrust that their command would meet their needs, and 24 percent gave a history of pre-military mental health treatment.
Many clients related a history of pre-military (46 percent) and military (73 percent) trauma. Of those with military trauma, 52 percent gave accounts of combat-related trauma, while 59 percent reported non-combat related trauma, e.g., physical or sexual assault.
During recent years approximately 80 percent of referrals to Civilian Medical Resources Network involved mental health problems and 20 percent physical health problems, with an overlap of mental and physical problems in about 10 percent of cases.
The majority of the clients were male (82 percent) and between 18 and 26 years of age (58 percent). Sixty-two percent identified themselves as White, 16 percent Black, 15 percent Hispanic, two percent Native American, and four percent Asian/Pacific Islander. Most clients were in the Army (64 percent), were of lower rank (82 percent), and had completed high school or some college (78 percent).
Military service involves high rates of suicide, recently averaging 20 per day among veterans and over one per day among active duty military personnel. During recent wars in Iraq, Afghanistan, and elsewhere, more active duty personnel have been dying from suicide than from combat.
The article noted that military health and mental health professionals must balance obligations both to patients and to the military command and argues that ethical problems of trust and confidentiality have become barriers to care. Other barriers include stigma, a negative impact of seeking care on one’s career, beliefs that care would not be effective, and lack of appropriate services.
“The military should encourage and support GIs’ use of civilian-sector services that do not involve the ethical conflicts inherent in military medicine and mental health care,” Waitzkin said. “Such civilian services should be based in not-for-profit organizations that do not benefit financially by restricting their services.”
Source: Oxford University Press