By Sandra Basu
WASHINGTON — In the aftermath of a mass shooting at Fort Hood, TX, last month, questions were once again being raised about how effectively the military can identify servicemembers with mental health issues who are prone to violence.
In response, military officials pointed out that, even when military personnel may have mental health issues, healthcare privacy rules sometime make it difficult to inform involved commanders.
The shooting, which left three soldiers dead and 16 wounded before the shooter took his own life, followed one at the Navy Yard in Washington last year that left 12 workers dead as well as the shooter.
April’s tragedy also was the second mass shooting to take place at Fort Hood in the past five years; in 2009, an Army psychiatrist opened fire, killing 13 people and injuring 32.
“We need to let investigators do their work and help us all understand exactly how this happened,” Secretary of Defense Chuck Hagel said last month after the tragedy. “As you all know, the department is in the process of implementing recommendations of the views that followed the Navy Yard shooting last year. As the Fort Hood investigation unfolds, we will continue to take a close look to identify any new lessons learned, and implement those, as well.”
Army Secretary John McHugh told lawmakers at a Senate hearing last month that, while the military services have done a great deal since the tragedy at Fort Hood in 2009 to track inside threats and identify troops who have mental health issues that could lend themselves to violence, it remains critical to determine what went wrong.
“We need to know what that was and if we failed in some way against our current policies. We need to be honest with ourselves and with you and hold ourselves accountable,” he said. “But if we identify new challenges, new threats we hadn’t recognized before, we have to put into place programs to respond to them.”
Dispute with Army
What is known is that, prior to the recent shootings, the gunman, Army Spc. Ivan Lopez, had been involved in a dispute with Army superiors, officials said. While investigators were still trying to determine the motive of the gunman, the shootings put DoD’s mental health resources into the spotlight.
After the shooting, Fort Hood’s commander, Lt. Gen. Mark Milley, reported that strong evidence indicated Lopez “had a medical history that indicates unstable psychiatric or psychological condition.” He was undergoing evaluation for PTSD at the time of the shootings, military officials said.
At a hearing on Capitol Hill, McHugh told lawmakers that Lopez had been examined by a psychiatrist the month before the shooting and that there was no indication recorded at that examination suggesting “any sign of likely violence either to himself or others.”
At that hearing, Sen. Richard Blumenthal (D-CT) asked whether there was enough screening of individuals in the military “to know whether they are dangerous.”
Army Chief of Staff Gen. Ray Odierno said that Lopez had been screened and that military mental health services had “made some really good progress” with screenings, which he said had increased. He also said that the number of Army behaviorial health specialists has increased by about 150% over the last five years.
“We do quite significant screening today, but it doesn’t mean that it is right and it doesn’t mean we can’t improve it. We have to constantly evaluate this. This is something we will have to deal with for a very long period of time and that is the consequence of 13 years of war,” Odierno said.
McHugh also pointed out during the hearing that deploying troops are assessed in five behavioral touch points and that, regardless of deployment status, all soldiers undergo a behavioral health assessment every year.
“We are tryng to keep as close a watch on soldiers as we can, but clearly we believe that there are more things we can do to identify problems in the more discrete stages of their development to try to get soldiers added help where under our current toolkit it may not be so obvious,” he said.
The “biggest problem,” according to Odierno, is how to share information with receiving commanders about a soldier’s previous mental health problems without violating the individual’s right to privacy. While healthcare providers may be aware of a soldier’s mental health issues, in some cases receiving commanders may not have the benefit of that information because of limits set by the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
“For example, if a soldier has mental health counseling at Fort Bragg, NC, and he moves to Fort Carson, CO, sometimes we have difficulty moving that information with them because of HIPAA. That is the concern. We are trying to develop systems that allow us to do some of that but it is difficult,” he explained.
At another Senate hearing last month, the Navy surgeon general, Vice Adm. Matthew Nathan, MD, further explained that receiving commanders are alerted to the mental health of servicemembers if they are deemed unfit to perform their missions but otherwise may not know.
“We wrestle with how much to share with commands because the individual servicemember may not come forward for routine or for otherwise troublesome symptoms or issues if they believe that everything they will tell somebody is going to be given to their commander or given to other people,” he said.
PTSD and Violence
Meanwhile, a VA blog posting titled “PTSD Does Not Equate to Violence” suggested that some major media outlets had rushed to find a reason for the mass shooting and had “jumped on the fact that the accused gunman was being evaluated for PTSD.”
“With a few keystrokes, assessing troops for PTSD became a kind of litmus test for future violence. Nothing could be further from the truth, and this isn’t the first time speculation has blurred the line between what PTSD is and its social stigma,” the blog stated.
The blog further noted that “the truth is that research shows most veterans (and non-veterans) with PTSD are not violent.”
“PTSD has different characteristics for different people, and exposure to combat isn’t the only way a person can become affected by it. It’s a normal reaction to a terrible event. To try to force a “violent veteran” story ‑ willingly or not — is both irresponsible and counterproductive,” the blog stated.
The blog added that such stigma can “make those who need to connect with help for PTSD wary of a diagnosis.”
With a long history of point of care testing at both of its predecessor organizations, the Walter Reed National Military Medical Center (WRNMMC) laboratory services staff were keenly aware of the advantages of using portable testing devices to obtain rapid patient assessments.
Lifting weights is one way servicemembers keep in peak physical condition during deployment.