Senators Urge GAO to Study the Military's Mental Health Care

Apr 19 2007

Obama, Boxer, Bond, Akaka, Harkin, Lieberman, Murray, McCaskill, Sanders ask for review in light of troubling reports

WASHINGTON, D.C. -U.S. Senators Barack Obama (D-IL), Barbara Boxer (D-CA), Kit Bond (R-MO), Daniel K. Akaka (D-HI), Tom Harkin (D-IA), Joe Lieberman (I-CT), Patty Murray (D-WA), Claire McCaskill (D-MO), and Bernie Sanders (I-VT) today sent a letter to the General Accounting Office (GAO) requesting a review of the Department of Defense's treatment of service-related mental health conditions affecting troops that have served in Iraq and Afghanistan. The letter comes in the wake of reports of poor treatment and conditions at Walter Reed Army Medical Centers, where many patients and family members described not receiving adequate mental health care, and more recent reports that suggest the Department of Defense (DOD) has not effectively screened and diagnosed mental health conditions.

Senators Boxer, Bond, and Obama had previously asked that the Department of Defense to examine command practices and culture related to mental health care with no response. As the DOD drags its feet, the senators have requested the GAO to investigate agency practices related to mental health screenings, diagnoses, referrals and treatment of service members.

"Recent reports suggest that the Department of Defense is ill-equipped to effectively screen and diagnose the increasing number of service members who are suffering from mental health conditions such as post-traumatic stress disorder," said Senator Obama. "I'm especially troubled by reports of some DOD commanders downplaying the serious mental health conditions confronting service members returning home from Iraq, and then redeploying those troops without proper treatment. It's time for a full accounting of how many of our troops are affected by post-traumatic stress disorder, other service-connected mental health conditions, and traumatic brain injuries, and for an evaluation of our readiness to help the generation of soldiers returning home from war rebuild their lives."

Senator Boxer said, "Two years ago, military doctors informed me that soldiers with serious mental health problems were being denied care and redeployed to Iraq. Sadly, even after we passed legislation and the Defense Department issued new mental health guidelines, they are not being followed. It is time for the GAO to investigate allegations of mistreatment and improper discharges. The health and well being of our service members must be a priority for the Pentagon and for all Americans."

"Combat stress and its impact on our soldiers and their families is a serious problem that continues to grow. Reports that our military is unprepared or unwilling to deal with Post Traumatic Stress Syndrome or other mental health problems are unacceptable. Being unprepared for these problems is no excuse for inaction. It is our duty to take care of the brave men and women who have answered the call to duty," said Senator Kit Bond.

"I am deeply concerned about the consequences of the conflicts in Iraq and Afghanistan on the mental health of those who serve," said Senator Akaka. "PTSD and other mental health problems, the often invisible wounds of war, can be terribly debilitating. As a senior member of the Armed Services Committee and Chairman of the Veterans' Affairs Committee, I am working to ensure that our wounded warriors receive a timely diagnosis of mental health problems and prompt and effective response. This effort must begin while servicemembers are still on active duty and there have been far too many reports that this is not happening. The results of this requested GAO review will be of great importance as we seek to ensure that DOD and VA meet the needs of our newest war veterans."

"With news that our soldiers will be serving longer tours of duty with shorter periods of rest at home, there is no better time to ensure the men and women who serve our country are getting the mental health services they need," said Senator Harkin. "We must do away with the stigma associated with mental illness and remove any obstacles to treatment."

"We have a moral obligation to care for our wounded troops and ensure they receive the best care," said Senator Lieberman. "Post-traumatic stress disorder is afflicting many of our service members and it is imperative that we accurately and efficiently diagnose and treat it. The stakes are high for those that are sacrificing their lives for our country and we must work together to correct any deficiencies that we find in our military's mental health system."

"We can't afford to wait until a year after our service members have returned home to discover the affects of the unseen wounds of this war," said Senator Murray. "PTSD is taking a horrible toll on our service members and their families and we must be sure today that they are being properly screened, tracked, and treated. We can no longer be unprepared for this mounting problem."

"Our men and women returning from war should receive mental health care equal to the physical medical care they are given, and anything less is unacceptable," Senator McCaskill said. "It took this country 15 years after Vietnam to look at the mental health needs of veterans. We can't do that to another generation of soldiers."

"The men and women who put their lives on the line for this country deserve the best care we can provide," Senator Bernie Sanders said. "What has been revealed about Defense Department health care is a disgrace that needs to be addressed. We need to find out whether there is a concerted effort by the Defense Department to shortchange our soldiers and veterans who are in need of mental health care and other benefits they have earned."

The text of the letter is below:

The Honorable David M. Walker
Comptroller General
Government Accountability Office (GAO)
441 G Street, NW, Room 7125
Washington, DC 20548

Dear Mr. Walker: We are writing to request that the General Accounting Office (GAO) undertake a review of Department of Defense (DOD) screenings, diagnoses, referrals and treatment of service members who may have Post Traumatic Stress Disorder (PTSD) and other mental health conditions related to their service in Iraq and Afghanistan. Several of us previously wrote the DOD requesting an examination of command practices and reports of biases and misdiagnoses in the treatment of mental health-related injuries such as PTSD and other deployment-related health problems, including Traumatic Brain Injury (TBI), but have not yet received a response. The stigmas associated with PTSD and other mental health needs are no less potent within the military than in the civilian world. Indeed, reports from soldiers suffering from PTSD suggest that the stigma is worse, with some military commanders appearing to minimize the significance of PTSD and other mental health needs; or suggesting that a service member is malingering to avoid redeployment. There are allegations of commanders at Fort Carson, Colorado denying soldiers access to mental health care and instead ordering them redeployed for additional tours in Iraq. We have also heard of cases in which service members with PTSD are diagnosed as having "personality disorders" that the Army considers "pre-existing," thus depriving otherwise eligible combat veterans of disability benefits and much-needed mental healthcare. Because the stakes for our service members' and their health are so high, we must move quickly to investigate and correct any deficiencies.

We have come to learn about a number of upsetting allegations at Fort Carson. Therefore, for the purposes of an expedited review, we request to be briefed initially by GAO on these immediate cases. We ask that you subsequently focus your inquiry not only on Fort Carson but on system-wide mental health deficiencies within the DOD.

With the significant burdens already being placed on our service members and their families with multiple extended deployments, we must ensure that they are not further burdened with any humiliation, stigmatization or other minimization of genuine mental health needs. Our service members are risking their lives for our nation's security; it is our moral obligation to care for them. We therefore ask the GAO to assess:
  1. Known cases of improper discharges or misdiagnoses and patterns of systematic stigmatization employed by military commanders regarding the mental health needs of service members throughout the chain-of-command at Fort Carson and across DOD departments;

  2. The growing number of discharges for personality disorders, and whether or not such discharges are being improperly used when service members should in fact be given a mental health diagnosis that DOD does not consider preexisting;

  3. The overall number of misdiagnosed cases of PTSD, other mental health conditions, and TBIs (at Fort Carson and force-wide);

  4. DOD progress in implementing previous mandates to develop force-wide criteria and procedures for screening, diagnosing and referring mental health cases for follow-up treatment;

  5. The efficacy of the DOD's current mental health safety net and treatment capabilities: for example, what current mechanisms are available to service members in the event of misdiagnosis?;

  6. the steps and resources required to implement one-on-one, face-to-face mental health screenings for all returning service members;

  7. The number of service members, men and women, reporting mental health concerns related to sexual assault during deployment; and whether current DOD personnel training and diagnostic guidance is sufficiently responsive to the needs of both men and women.

We seek to ensure that the DOD has the resources necessary to diagnose and treat service-connected injuries that impact the mental health of U.S. service personnel. It is vital that the U.S. military ensures it is treating the mental health needs of our forces with the same priority and resource investments it is devoting to physical injuries. If you would like to discuss this request, please contact [redacted].

Thank you for your assistance in this matter.