Military's mental health failures belie promises


Army Spc. Jeffrey Henthorn, 25, of Choctaw, Okla., was sent back to Iraq for a second tour even though his superiors knew he had twice threatened suicide. When he killed himself in 2005, an Army report says, the work of his rifle was so thorough that fragments of his skull pierced the barracks ceiling.

Army Pfc. David L. Potter, 22, of Johnson City, Tenn., was diagnosed with anxiety and depression while serving in Iraq in 2004. Records show that Potter remained on active duty in Baghdad despite a suicide attempt and a psychiatrist's recommendation that he be separated from the Army. Ten days after the recommendation was signed, he slid a gun out from under another soldier's bed and shot himself through the mouth.

These deaths are among the most extreme failures by the U.S. military to screen, treat and evacuate mentally unfit troops, a Hartford Courant investigation has found.

Pressed by troop shortages, the military has increasingly sent, kept and recycled troubled service members into combat - practices that undercut past assurances that it would improve mental health care. Besides suicides, experts say, gaps in such care can fuel violence between soldiers, accidents and critical mistakes.

Among the paper's findings:

Despite a congressional order that the military assess the mental health of all deploying troops, fewer than 1 in 300 service members sees a mental health professional before shipping out.

Once at war, some unstable troops are kept on antidepressants and anti-anxiety drugs with little or no counseling or medical monitoring, in violation of the military's regulations.

Some troops who developed post-traumatic stress disorder are being sent back to the war zone, increasing the risk to their mental health.

These practices helped fuel an increase in the suicide rate among troops in Iraq, which reached an all-time high in 2005 when 22 soldiers killed themselves - accounting for nearly one in five of all noncombat Army deaths.

Military officials had pledged to Congress in late 2003 to improve mental health services after a spate of suicides in Iraq during the first seven months of the war.

The Courant investigation found that at least 11 service members who committed suicide in Iraq in 2004 and 2005 were kept on duty despite exhibiting signs of significant psychological distress.

The newspaper obtained records under the federal Freedom of Information Act. It interviewed more than 100 mental health experts, service members, relatives and friends.

The Army's top mental health expert, Col. Elspeth Ritchie, acknowledged that some deployment practices have been driven in part by a troop shortage.

"The challenge ... is that the Army has a mission to fight. And, as you know, recruiting has been a challenge," she said. "And so we have to weigh the needs of the Army, the needs of the mission, with the soldiers' personal needs."

But troubled troops often get lost in that balance. Under the military's pre-deployment screening process, troops with serious mental disorders are not being identified, and others whose illnesses are known are being deployed anyway.

A law passed in 1997 requires an "assessment of mental health" on all deploying service members. But the only "assessment" is a self-reported question on a pre-deployment form filled out by service members.

Even troops who report problems are rarely referred for evaluations by mental health professionals, Department of Defense records show. From March 2003 to October 2005, only 6.5 percent of deploying service members who indicated a mental health problem were referred for evaluations.

Military reports and interviews with relatives also show that some service members who committed suicide in 2004 and 2005 were kept on duty despite signs of distress, sometimes after being prescribed antidepressants with little or no counseling or monitoring. Those findings conflict with regulations the Army adopted last year that discourage the use of antidepressants for "extended deployments."

The use of psychiatric drugs has alarmed some medical experts and ethicists, who say the medications cannot be properly monitored in a war zone.

"I can't imagine something more irresponsible ... when you know these drugs can cause people to become suicidal and homicidal," said Vera Sharav, president of the Alliance for Human Research Protection.

Defense Department standards for enlistment disqualify recruits who suffer "persistent post-traumatic symptoms," but the military is redeploying service members to Iraq who fit those criteria.

Eight months ago, Staff Sgt. Bryce Syverson of Richmond, Va., was being treated for a breakdown traced to his 15-month tour in Iraq as a tank gunner. He was diagnosed with post-traumatic stress disorder and depression, and was put on a suicide watch and antidepressants.

Today, Syverson, 27, is part of a quick-reaction force in Kuwait that could be summoned to Iraq at any time."Nearly died ... because of the medication that I am taking," he wrote in a recent e-mail to his parents and brothers. "Head about to explode from the blood swelling inside, the lightening storm that happened in my head, the blurred vision, confusion, dizziness and a whole lot more."

Bob Johnson, a psychologist in Atlanta, counseled soldiers last year as chief of combat stress control for the Army's 2nd Brigade.

"If there were an endless supply [of soldiers], the compassionate side of you just wants to get these people out of here," he said. "But I had to kind of put that aside."

Lisa Chedekel and Matthew Kauffman write for The Hartford Courant.

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