Pre-deployment health screening reduces behavioral problems, study shows

This is the second story in an ongoing series.

An Army study released earlier this week concluded a new pre-deployment health screening process helped reduce combat stress, psychiatric and behavioral disorders, and suicidal thoughts among troops. But veterans advocates said the service lags 14 years behind mandates to conduct such assessments before troops deploy to combat.

Read the entire Broken Warriors series. In 2007, the Army provided extra pre-deployment behavioral heath screening for soldiers from three 3rd Infantry Division Brigade combat teams at Fort Stewart, Ga., prior to their deployment to Iraq in 2008. The service reported in The American Journal of Psychiatry that these soldiers experienced less combat stress than troops in three other units that did not receive the extra screening in face-to-face sessions with psychiatrists, clinical psychologists, or licensed clinical social workers.

The 10,678 soldiers who took part in the program answered an extra 15 questions pertaining specifically to behavioral health during their pre-deployment health screening. Questions included "Are you currently taking any medications for a mental health condition?" and "Do you have any past or recent history of suicidal or homicidal thoughts, plans, or attempts?"

This extra screening identified 347 soldiers on psychotropic drugs, including 96 initially deemed unfit to deploy. Since these troops were considered essential to the mission, the Army received a waiver from U.S Central Command to send them to Iraq, and while in theater provided them with counseling on a monthly basis.

Soldiers involved in the study who had been prescribed psychotropic drugs received only a three-month supply of the drugs instead of a 180-day supply under CENTCOM policy, as reported by Nextgov Monday.

Col. George Appenzeller, one of the authors of the study, said the added questions in the pre-deployment interviews enabled doctors to identify troops who either were not fit to deploy, or who could benefit from a doctor's supervision while deployed.

The Army's Office of the Surgeon General said the study showed a proactive stance on mental health care can help soldiers faced with multiple deployments.

"We're excited about what this study shows," said Maj. Gen. Patricia Horoho, the Army's deputy surgeon general. "It is the first direct evidence that a program is effective in preventing adverse behavioral health outcomes."

Paul Sullivan, executive director of Veterans for Common Sense, praised the Army for its new approach to determining the mental health fitness of troops before they deploy to combat, but said the service actually was required to conduct the exams 14 years ago. The 1998 Defense Authorization Act , which Congress passed in 1997, mandated such assessments.

That bill required the secretary of Defense to conduct pre-deployment and post-deployment medical examinations (including an assessment of mental health) to accurately record changes in the medical condition of service members during the course of their deployment.

This mandate was quickly dropped when the Iraq war started in March 2003, Steve Robinson, then executive director of the National Gulf War Resource Center, told a House Armed Services Committee panel on Jan. 21, 2004.

Robinson testified that then Assistant Secretary of Defense for Health Affairs William Winkenwerder viewed pre-deployment screening as unnecessary just days after the invasion of Iraq, despite the fact that it was required by law and by a Defense Department policy issued on Oct. 6, 1998. Robinson said Winkenwerder reversed this stance a month later.

In a May 2008 report, the Government Accountability Office said Defense faced several challenges in conducting effective mental health assessments. Among them, troops who were eager to deploy or afraid of the stigma associated with mental health problems weren't likely to disclose their concerns on health assessment forms.

In March 2009, the Hartford Courant reported its review of screening records showed that in 2008 and early 2009, barely more than 1 percent of deploying troops were referred to a mental health professional as part of their pre-deployment preparations.

Maria Tolleson, a spokeswoman for the Army surgeon general, said the Army has improved its mental health screening process. "We now have physical and psychological pre-deployment screening, post-deployment screening, and yet another screening three to six months post deployment," she said.

Soldiers are evaluated for medical and behavior health problems, including family-related issues. If problems are uncovered, primary care physicians or specialists conduct more detailed examinations to ensure soldiers are fit to deploy, she said.

Current pre-deployment screening includes self-reported data as well as interviews with health care providers.

Sullivan said the health assessment form that troops fill out is part of the problem, as it has just one line pertaining to mental health. He said the new approach taken in the Fort Stewart study begins to meet the requirements of the 1998 Defense Act that military personnel undergo a mental health examination before they are cleared for combat.

Tom Vande Burgt, an Army National Guard veteran who served in Iraq and runs the Lest We Forget post-traumatic stress disorder peer-support group in Charleston, W.Va., with his wife, Diane, said "Pre-screening is only as good as the person giving the information." Many soldiers will lie about the state of their mental health to avoid missing a deployment with their comrades, he said.

Commanders or their medical staff need to be given electronic access to the medical records of their troops -- including prescriptions for psychotropic drugs -- so they can intelligently assess whether or not they are fit for deployment, Vande Burgt said.

They also need access to information on drugs prescribed to troops while they are deployed, Vande Burgt said. Defense lacks such a system today , a fact he said he has a hard time understanding.

"If I can access eBay from anywhere in the world, have merchandise sent directly to my house, order and pay for it with PayPal, then I am pretty damn sure the existing medical computer systems can be fixed and upgraded to track prescriptions," Vande Burgt said.