Mentally Unfit, Forced to Fight
"The challenge for us ... is that the Army has a mission to fight. And as you know, recruiting has been a challenge,'' she said. "And so we have to weigh the needs of the Army, the needs of the mission, with the soldiers' personal needs.''
But The Courant's investigation shows that troubled soldiers are getting lost in the balance:
Under the military's pre-deployment screening process, troops with serious mental disorders are not being identified -- and others whose mental illness is known are being deployed anyway.
A law passed in 1997 requires the military to conduct an "assessment of mental health'' on all deploying troops. But the "assessment'' now being used is a single mental health question on a pre-deployment form filled out by service members.
Even using that limited tool, troops who self-report psychological problems are rarely referred for evaluations by mental health professionals, Department of Defense records obtained by The Courant indicate. From March 2003 to October 2005, only 6.5 percent of deploying service members who indicated a mental health problem were referred for evaluations; overall, fewer than 1 in 300 deploying troops, or 0.3 percent, were referred.
That rate of referral is dramatically lower than the more than 9 percent of deploying troops that the Army itself acknowledges in studies have serious psychiatric disorders.
In addition, despite its pledges in 2004 to improve mental health care, the military was more likely to deploy troops who indicated psychological problems in 2005 than it was during the first year of the war, the data show.
The Courant found that at least seven, or about one-third, of the 22 soldiers who killed themselves in Iraq in 2005 had been deployed less than three months, raising questions about the adequacy of pre-deployment screening. Some of them had exhibited earlier signs of distress.
Also, at least three soldiers who killed themselves since the war began were deployed despite serious mental conditions, including bipolar disorder and schizophrenia.
The military relies increasingly on antidepressants, some with potentially dangerous side effects, to keep troops with known psychological problems in the war zone.
Military investigative reports and interviews with family members indicate that some service members who committed suicide in 2004 and 2005 were kept on duty despite clear signs of mental distress, sometimes after being prescribed antidepressants, including a class of drugs known as SSRIs.
In one case, a 26-year-old Marine who was having trouble sleeping was put on a strong dose of Zoloft, an SSRI that carries a warning urging doctors to closely monitor new patients for suicidal urges. Last April, within two months of starting the drug, the Marine killed himself in Iraq.
Some service members who experienced depression or stress before or during deployments to Iraq described being placed on Zoloft, Wellbutrin and other antidepressants, with little or no mental health counseling or monitoring. Some of the drugs carry warnings of an increased risk of suicide, within the first weeks of their use.
Those anecdotal findings conflict with regulations adopted last year by the Army cautioning that antidepressants for cases of moderate or severe depression "are not usually suitable for extended deployments.''
Also, the military's top health official, Assistant Defense Secretary William Winkenwerder Jr., indicated in testimony to Congress last summer that service members were being allowed to deploy on psychotropic medications only when their conditions had "fully resolved.''
The use of psychiatric drugs has alarmed some medical experts and ethicists, who say the medications cannot be properly monitored in a war zone. The Army's own reports indicate that the availability and use of such medications in Iraq and Kuwait have increased since mid-2004, when a team of psychiatrists approved making Prozac, Zoloft, Trazodone, Ambien and other drugs more widely available throughout the combat zone.
"I can't imagine something more irresponsible than putting a soldier suffering from stress on SSRIs, when you know these drugs can cause people to become suicidal and homicidal,'' said Vera Sharav, president of the Alliance for Human Research Protection, a patient advocacy group. "You're creating chemically activated time bombs.''
The military is sending troops back into combat for second and third tours despite diagnoses of PTSD or other combat-related psychological problems -- a practice that some mental health experts fear will fuel incidents of suicide and violence among troops abroad and at home.
Although Department of Defense standards for enlistment in the armed forces disqualify recruits who suffer from PTSD, the military is redeploying service members to Iraq who fit that criteria. The practice, which military experts concede is driven partly by pressure to maintain troop levels, runs counter to accepted medical doctrine and research, which cautions that re-exposure to trauma increases the risk of psychological problems.
At least seven troops who are believed to have committed suicide in 2005 and early 2006, and one who has been charged with killing a fellow soldier, were serving second or third tours in Iraq. Some of them had exhibited signs of combat stress after their first deployments, according to family members and friends.