The tragic shootings at Fort Hood put the media spotlight, once again, on mental health issues. The shooter may not have left sufficient clues around to his mental state but clearly this was a very disturbed person who took the lives of three others as well as himself and injured many more. There have been other issues related to mental health that have focused on the military-the high incidence of rape, suicide, suicide attempts and domestic violence.  One of the most significant recent findings was a study conducted by the National Institute of Mental Health http://www.nimh.nih.gov/news/science-news/2014/suicide-in-the-military-army-nih-funded-study-points-to-risk-and-protective-factors.shtml which found the suicide risk (including attempts as well as completed suicides) was NOT higher in those who had been deployed. Half of those surveyed reported suicide attempts before they enlisted.

This leads me to think about who volunteers for the military during a time when we are at war.  We have an all volunteer army so this is a self-selecting group. Not surprisingly, the studies show that rates of mental illness were much higher in enlisted personnel than in officers. Many who become officers are from families with a history of military service and the reason for joining is to continue the family tradition. Officers also have higher levels of education.  This does not mean officers are immune from substance abuse, domestic violence or even suicide but the rates are much lower than the rates found in the enlisted cohort.

So who enlists? In recent times a recession with high unemployment rates will drive many to choose a military career who might not otherwise. The military remains one of the greatest equal opportunity employers with greater job security than civilian life, excellent family health benefits, educational opportunities and often housing subsidies.  Access to military bases offers discounted shopping opportunity which adds to a low rate of base pay.  But during the past 13 years, joining the military has also often meant a higher risk of deployment to very dangerous combat zones.  Who wants to be a warrior? Probably people with a higher level of anger and aggressive tendencies to begin with. The study showed a higher than civilian rate of ADHD prior to enrollment which means greater impulsivity and excitability.

Marital instability is one of the highest risks for violence in all populations.  In the military, where deployment means long periods of separation and base living uproots people from extended family support systems, the stress on relationships is high.  The risk of suicide increases at the point of relationship breakups or divorce.

Who wants to go to war? Aggressive personalities and thrill seekers are those most attracted to military service outside of those who enlist out of financial necessity. Is there underlying psychological pathology or instability in those with that profile?  it seems likely.  Our American “heroes” and warriors only constitute 1% of the population. We want to be strong militarily as a country but perhaps we are taking as our warriors some of the most frail and vulnerable (speaking psychologically) among us. Then we place them in situations where they are separated from family and mainstream society, where substance abuse is widespread and exposure to extreme danger and trauma is likely. Under these circumstances, dangerous behavior outside of combat seem highly likely to me.

What needs to change?  Recruiters eager to make quotas don’t want to look too closely at enlistees but perhaps we need to do more psychological screening. Is the budget for mental health personnel adequate?  Is there a way to better protect the privacy and confidentiality of those who seek help?  What can we do to encourage greater acceptance of the need for help. It is not enough to admire our military service personnel as heroes, we need to help them cope with the difficult challenges military service presents.

What can be done? If we continue with an all volunteer army then it seems we need to do more to support the mental health and safety of these troops. We spend 100’s of billions on our military. There is little dispute over costs for the latest missiles, jets, electronics etc. but do we allocate enough for mental health? Clearly not.