Secretary of Defense Robert Gates announced today that the military security clearance process will no longer include questions about mental health care history. This is a significant step in attempting to remove the stigma of receiving mental health care among military members, particularly in a time of war when post-traumatic stress disorder is affecting a staggering number of servicemen and women.
While DOD has been paying major lip service to the need to reduce the stigma of mental health care, this is the first tangible step forward in what will hopefully be a line of many.
The intensive security clearance questionnaire asks about the history of mental health care treatment, including dates, duration, clinician name and contact information. Not only does this inappropriately dissect an applicant’s mental health condition when there are already a number of mechanisms in place to establish if someone is fit to serve, it discourages military members from seeking out future help. Knowing that mental health and PTSD treatment are documented and reviewed reinforces the idea that the Pentagon sharply scrutinizes and brands those seeking mental health or PTSD treatment. Surveys of military members show a prevalent belief that seeking help could lead to lack of trust, difficulty being promoted, and at the very least (or most, considering the importance of mutual confidence in the military) failing to meet the expectations of one’s own unit.
How big of a problem is mental health care in the military? Although we can’t be sure of the exact numbers because stigmatization pervades accurate reporting of mental illness, over 80% of active-duty Marines deployed in Iraq have reported either witnessing or being part of a traumatic incident. Several VA centers are focusing on PTSD and a few specifically on suicide prevention. While this emphasis within the VA system should certainly be recognized, we can’t afford to wait for PTSD symptoms to manifest years, or even months, later—PTSD must be screened for and treated immediately upon redeployment, which is often when military members are not yet receiving VA care. A large component of ensuring that PTSD is screened properly and efficiently is eliminating the shame and scrutiny associated with mental illness in the military.
While the Department of Defense has a long way to go to truly improve its ability and commitment to screen for, diagnose, and treat PTSD and other mental illness, a simple change like eliminating a stigmatizing question on the security clearance questionnaire can set the precedent for culture change within the Department of Defense and clear the way for additional pressing reforms in the mental health care system.
For example, the Pentagon should focus more resources on National Guard and Reserve mental health and reintegration programs. The system was not designed for National Guard and Reserve troops to experience the same traumatic events as active-duty troops, and as a result, these civilian troops are sent back to their home states, given a cursory debrief, and told not to report for duty for 90 days. It is crucial that these troops nationwide start getting the screening and treatment they need within the first three months of their redeployments.
The Pentagon could also require that all redeployed military members go through mandatory, comprehensive, and periodic screening for PTSD to ensure that everyone receives treatment and no one is stigmatized for utilizing the services. Department of Defense officials often boast about administering an online tool that servicemembers can access to self-screen for PTSD, but self-screening requires initiative, recognition of symptoms, and acceptance of the possibility of mental illness. This means that if screening is left to the individual, those who are suffering the most might be the ones least likely to get treatment.
The Department of Defense has certainly not had an impressive track record in health care as of late, considering the recent exposé of inadequate care at Walter Reed as well as last week’s Pentagon report that stressed the need for additional mental health care resources nationwide. However, if Secretary Gates follows through on his stated commitment to improve mental health care within the Department of Defense, public confidence in military health care stands to improve significantly—as well it should if the Pentagon finally provides to our troops the resources and fair treatment they deserve.