Mental Health and the Military

by Heidi Bistoli

In recent years people have been calling attention to the mental health of United States military veterans and service members, particularly as our nation has been involved in two decades of conflict. 

It’s estimated that there are approximately 18 million veterans and 2.1 million active-duty and reserve service members. More than 6% of the U.S. population is either in the military or a veteran. Out of those who served in Iraq or Afghanistan alone, an estimated 14% to 16% have depression or post-traumatic stress disorder (PTSD). Suicide, traumatic brain injuries, substance abuse, and interpersonal violence are other issues this group faces. It’s not just service members and veterans who suffer, either. Their families are affected, too. 

Mental Health and Enlisting

For a person considering enlisting in the Armed Forces, some mental health disorders can disqualify them from joining. 

Not only do you have to be pass the physical and fitness requirements, but you must pass mental muster, too. Psychotic disorders are one disqualifier. Neurotic, anxiety, mood, somatoform, dissociative, or factitious disorders that required inpatient treatment, six-plus months of outpatient care, or symptoms that mar your ability to do the job – these can also disqualify one from service. So can some personality and behavior disorders. A history of or current drug or alcohol abuse or addiction should also exclude someone from enlisting. 

People still enlist despite the rules, however. A 2014 study found that one in four non-deployed U.S. military had some kind of mental disorder, and two-thirds of that group had a disorder before they enlisted. Further, more than one in 10 military had at least two disorders (aka a dual diagnosis). 

Some suggest the “don’t ask, don’t tell” rule keeps people’s diagnoses in the shadows. One problem with that rule being overlooked or ignored is that enlistees serve without receiving needed help. Deployments are stressful enough, but the military culture doubles down on it in many ways. There’s a stigma attached to mental disorders, and service members may fear that the truth of their condition will damage their career

Overcoming Mental Health Stigma

The military has softened its stance on mental illness, however, encouraging better mental health, because it’s vital to successful missions. The Department of Defense has gone so far as to state that leaving mental disorders untreated is a greater threat than the mental health condition itself. (There are a number of mental health options for service members, veterans, and their families, too.)

In 2014 the rule was set that seeking help for a mental conditon (even a suspected one) would not harm one’s career. Making the choice to seek help could not only prove good for the individual in need, but it could improve the health and functioning of the unit. If an individual is ordered by their commanding officer to get a mental health evaluation, however, that could prove detrimental. 

That turn toward openness and erasing stigma surrounding mental health issues is a good shift. Being in the military is both mentally and physically demanding, even during peacetime, but in times of war and global instability it can be multiplied. 

Risks of the Job

Risks come with the job, and there is no limit to how badly military service can go for an individual soldier. Death, dismemberment, and severe mental trauma are real possibilities. So are closed-head injuries and traumatic brain injuries in a war zone, along with the very serious risk of addiction that can manifest during and after recuperation from serious injuries and other aspects of military culture.

Maintaining mental health while participating in active military service can be a daily struggle. This doesn’t only apply to the battlefield. The National Institute of Health indicates, "Deployment is associated with smoking initiation, unhealthy drinking, drug use and risky behaviors." 

Even those who are not actively deployed, those in training or administrative tasks for example, can still be exposed to all these dangers secondhand, through association with those who have been deployed. 

Protecting Mental Health

All sorts of strategies have been implemented to protect the mental health of those in the service, most of them revolving around limiting exposure. 

In previous eras the American military was very careful to keep the amount of time that the ordinary person was in uniform short, punctuated by long breaks for rest and recuperation. Over time, America's new all-professional military had largely phased this out, but efforts to return to a more healthy ratio are being initiated.

That’s one step toward avoiding burnout and allowing service members to enjoy more time at home and with family. 

As for mental health, one Department of Defense report found that in recent years about 8% of active duty military personnel have some sort of mental health condition. About 16% of military medical visits were for mental health matters. The most common issues addressed were adjustment disorder, anxiety, and depression. (Other conditions treated included substance abuse, bipolar disorder, and PTSD.) That 8% average is lower than the U.S. population’s overall, which affects one in five in any given year. The report authors did caution, however, that troop may not always seek help while they’re enlisted, so that reticence could be driving the numbers downward. 

Depression, substance abuse, PTSD can occur when human beings have to deal with overwhelming trauma and grief, but soldiers are expected to continue operating at an extremely high level through it all. This can be dangerous on the battlefield and when conducting sensitive political operations. Symptoms such as flashbacks, heightened anxiety, and intrusive thoughts can turn disastrous. 

Suicide Risk

One worst-case outcome is suicide and suicide attempts, the reasons for which are complex

One analysis offered insight into the impaired decision-making capacity of the mentally ill in active service. Among sucidal veterans and service members, a large number of were divorced or separated. Others named trouble with substance abuse or addiction. Further complicating things, the average suicidal soldier listed 10 or more reasons why they were considering ending their life. But the most common reason, by far, was the anguish and psychological pain they experienced because of things that happened while on active duty. The trauma of combat and combat conditions, the anguish and self-recrimination that came with those experiences, these had affected them so deeply that they no longer wished to continue living. 

Consider this chilling decision in its context. It is the end of the chain of decisions. The American military is all-volunteer. That means that every soldier is there because they decided, on some level, that they wanted to be there.  

Now, as a direct result of their decisions, they have been confronted with situations so horrific that they wish to reject everything that brought them to that point. Suicide presents itself as a final rejection of all decisions, the ultimate statement of mistrust in oneself. They’ve arrived at a place where they never want to decide anything ever again.

How could another human being find safety among people undergoing such titanic pressures? It is a true tribute to humanity that so many soldiers perform admirably while they are in the service, handling the crippling pressure and performing their duties with professionalism and empathy. And then, when they get home, often they fall apart.

Mental Health After Leaving the Service

The reason these concerns are being taken so seriously, to the point where the government is willing to pay somebody for four years in exchange for one year of service, is that the mental health statistics for veterans are grim. 

The suicide rate for veterans is much higher than the rate for civilians. Substance abuse, anti-social behavior, and other assorted mental illnesses are similarly common. 

It is important to note that not everyone encounters trauma while serving in the military, but a substantial proportion of people in uniform do. Approximately three-quarters of American military veterans report PTSD as a direct result of their time in the service. Even the vast American bureaucracy erected to treat these issues, with 266,000 employees in the Veterans Administration alone, is overwhelmed by the magnitude of this problem.

Strategies to Diagnose and Treat Mental Health Issues in the Military

Untreated mental illness poses the very real responsibility of harm to day-to-day operations, a tense mission, and consequently, other people. Those consequences could force them to live with the guilt and antecedent trauma from what they've done for the rest of their lives. 

All these reasons and more illustrate the need to prioritize mental health among veterans. It is necessary for them, and for the people around them. It is necessary while they are in the service, and it is necessary after. It is every bit as important to make sure that unsuitable people don't end up in positions of military responsibility as it is to treat the people who have been in those positions with dignity, respect, and the full measure of care to which they are entitled. 

Prompt diagnosis and reliable treatment are vital. Physical symptoms can mask or exacerbate psychological issues, and the difficulties of recovery are a far-too-common gateway to pharmaceutical misuse and eventual addiction. The prognosis of treatment is improving as more and more resources are focused on this critical matter. It only remains to seek it out and to use it, to fight for themselves as ardently as they did for their nation.

Sources - Veteran and Military Mental Health Issues - Medical Conditions That Can Keep You from Joining the Military - Can You Serve in the U.S. Military With Mental Illness? - Substance Use and Military Life - Veterans & Active Duty - Help for Service Members and Their Families General Risk of Substance Use Disorders - 1:3 Deployment-To-Dwell Ratio to be Standardized Under DoD Policy Starting in Nov - Mental Health Disorders in Trips Far Below National Average Military Suicide Rates Are at an All-Time High; Here’s How We’re Trying to Help - Share of U.S. veterans with PTSD since 9/11, from 2017 to 2021 - Virginia Rehab and Addiction Resources