Army Mental Health: Better Screening Yields Better Results

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Just how closely should the nation be screening its troops for mental fitness before they’re shipped off to war? We are seeing, again and again, that bad things — depression, divorce, suicide, murder — can happen in combat’s wake. If there is a way to weed out — that may not be the right word — the folks who might be driven to such ends by war, is it the government’s job to keep them at home?

You bet, say five Army mental-health experts in the April issue of The American Journal of Psychiatry:

This predeployment screening process was associated with a decreased need for clinical care for combat stress, psychiatric and behavioral disorders, and suicidal ideation…this systematic program evaluation provides the first direct evidence to support the use of a service-wide program of predeployment mental health screening following this model.

Standard military screening referred only 0.3 percent of troops for mental-health evaluation before deploying. The more rigorous checkups advocated by the doctors involved in the study drove that up to 7.7% — and kept 0.7 percent of screened soldiers from deploying. That’s a small, but significant number: with 100,000 troops in Afghanistan, for example, it represents 700 people — each one a potential problem for the military and his or her family.

“This study provides the first direct evidence that a program that combines pre-deployment support and care coordination in theater — involving primary care, unit surgeons and behavioral health personnel — is effective in preventing adverse behavioral outcomes for soldiers during deployment,” Army Lieut. Col. Christopher Warner, the lead author, said last week.

Now at Fort Leavenworth’s Command and General Staff College, Warner previewed these findings for me last year when he was supervising the behavioral health unit at Fort Stewart, Ga. “We saw a significant reduction in soldiers who had to be evacuated from theater, or duty limitations — having their weapons removed,” he said. “The bottom line is by doing that (pre-deployment surveys) we actually kept soldiers linked into care, and kept them in the fight.”

The authors helpfully provide a chart that details just where a soldier bound for combat can be derailed if he or she doesn’t pass muster, mentally. Think of it as kind of a New Jersey Turnpike for the mind, with lots of exits available:

An editorial in the journal praises the research as a key first step toward keeping soldiers well: “It is incumbent on the U.S. military to prospectively evaluate these new programs in order to provide high-quality evidence-based systems for supporting soldiers in the field, as well as for soldiers who have returned to their base or home.”