The Army inspector general is conducting a system-wide review of mental health facilities to determine whether psychiatrists overturned diagnoses of post-traumatic stress disorder to save money, a move that comes as the case of a U.S. soldier suspected of killing 16 Afghan civilians has brought fresh attention to the strains of war.
Army Secretary John McHugh told Congress on Wednesday that the service is trying to determine whether the change in diagnosis was isolated or a common practice. Sen. Patty Murray, D-Wash., who pressed McHugh at a committee hearing, said the forensic psychiatry unit at Madigan Army Medical Center on Joint Base Lewis-McChord is being investigated for reversing diagnoses based on the expense of providing care and benefits to members of the military.
"Not only is it damaging for our soldiers, but it also really furthers the stigma for others that are — whether they're deciding to seek help or not today," Murray said.
Since 2007, more than 40 percent of the cases involving candidates for retirement had been overturned, according to statistics cited by Murray. Of the 1,680 patients screened at Madigan, more than 690 had been diagnosed with post-traumatic stress disorder. The psychiatric team reversed more than 290 of those diagnoses.
"The surgeon general (Lt. Gen. Patricia Horoho) has asked the inspector general of the Army to go and examine all of the similar facilities and locations," McHugh told Murray and members of the Senate Appropriations defense subcommittee. "To this point, we don't see any evidence of this being systemic. But as you and I have discussed, we want to make sure that where this was inappropriate, it was an isolated case, and if it were not, to make sure we address it as holistically as we're trying to address it at Madigan."
What Murray referred to as the "invisible wounds of war" have moved to the forefront of the national debate after a shooting spree earlier this month in two Afghan villages that left women and children dead. A suspect in the case, Staff Sgt. Robert Bales, 38, is being held in Fort Leavenworth, Kan., while a military investigation continues. Bales, who enlisted in the military after the Sept. 11 terrorist attacks, did four tours of duty in Iraq and Afghanistan, according to court records and interviews.
"We have in the military writ large over 50,000 folks in uniform who have had at least four deployments," McHugh said.
Bales was assigned to the 2nd Battalion, 3rd Infantry Regiment of the 3rd Stryker Brigade Combat Team, of the 2nd Infantry Division, which is based at Lewis-McChord. Whether Bales sought treatment at Madigan is unknown.
Army officials said they are committed to strengthening the psychological resilience of its troops and leadership is taking deliberate steps to ensure help is available to soldiers and families dealing with PTSD and other psychological effects of war.
Army officials say soldiers sent to war may be checked up to five times, including before being deployed, during combat, once they return home and six months and a year later. Every soldier returning from deployment completes what the Army calls a Post Deployment Health Assessment and a face-to-face interview with a mental health professional. The Army screens soldiers for depression and PTSD, asking questions to find out about any social stressors, sleep disruption and other problems. Those who are detected as having problems go on to a second phase of screening.
Officials say, however, that no test is considered diagnostically definitive for mental illness in general or PTSD in particular.
More than 134,900 Army personnel were diagnosed with traumatic brain injuries between 2000 and 2011. Of those, 75 percent or more than 100,000 were diagnosed as having a mild or regular concussion. Army policy calls for every service member involved in a blast, vehicle crash or a blow to the head to be medically evaluated.
Asked specifically about the Bales' case, McHugh said he was confident in the military justice system.
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