While an Army official said Friday that Specialist Ivan Lopez' possible mental health problems were not the "direct precipitating factor" in Wednesday's shooting at Fort Hood that killed three people and wounded 16 others, his struggles nonetheless shone a light on mental health in the U.S. military. That spotlight revealed a problem still unsolved.
Lopez, 34, was apparently involved in an altercation with other soldiers that escalated. He had been undergoing treatment for depression and anxiety and had been assessed for post-traumatic stress disorder despite having completed a tour of duty in Iraq that did not take him onto the battlefield. The tragedy at Fort Hood might be an anomaly, but Lopez's mental health situation was not so unusual: after a decade of war, a huge number of men and women who have served in the U.S. military are suffering from injuries both mental and physical -- and not all of them are the result of combat.
A poll conducted by The Washington Post and the Kaiser Family Foundation found that more than half of the 2.6 million men and women who fought in Iraq and Afghanistan struggle with mental or physical injuries and feel that the government is not meeting their needs. There are myriad programs aimed at increasing employment and reducing homelessness among veterans, but mental illness can play a part in both. Experts say a more holistic approach to treating veterans is needed.
Loree Sutton, a psychiatrist and retired Army Brigadier General, told msnbc that drawing a line between combat and non-combat injuries obscures the reality of military conflict and its effects. “Whether an individual actually engages in combat, whether it’s shooting or being shot at, just to be deployed on a forward operating base, the entire time you’re there you’re exposed to fear and death. You’re witnessing it,” she said. “There’s an impact there.”
Just because there are resources available for servicemembers and veterans who need mental health treatment doesn’t mean that they’re taking advantage of it. Despite pervasive dissatisfaction and widespread suffering reported in the poll, mental health resources are already stretched thin. A Department of Veterans Affairs survey from November found that a full third of new mental health patients seeking care through the VA were not seen within two weeks. For psychiatry appointments, the average wait was longer than a month.
In Lopez's case, Lt. Gen. Mark Milley, the commander in charge at Fort Hood, told NBC News Thursday that Lopez had been “undergoing a diagnosis process” for post-traumatic stress disorder. Military officials also told NBC News that there was no record that Lopez saw combat while he was deployed in Iraq, nor were there any records that medically confirm a brain injury Lopez claimed he suffered from.
Sutton stressed that the even if the shooting at Fort Hood were related to Spc Lopez' health issues, that says nothing about other individuals. "The vast majority of service members would never commit an act of violence like this, just like the vast majority of people with mental illness wouldn’t do this," she said.
Iraq and Afghanistan Veterans of America (IAVA) founder and CEO Paul Rieckhoff cautioned against any rush to judgment.
“In moments like this, there is a tendency by some to paint a broad brush across the entire veterans community and it's important to guard against that mistake,” Rieckhoff said in a statement Thursday. “We encourage everyone -- especially those in the media and political positions -- to be thoughtful and responsible in their reactions and to remember that correlation does not imply causation."
He added, “At the same time we recognize that the vast majority of our military and vets are not in crisis, we must all acknowledge that there are indeed problems with the way mental health care and transitional support is managed and available to our service members and veterans."
IAVA members spent last week meeting with lawmakers and administration officials about suicide and increasing access to mental health care. Of those who have served in the military since 9/11, the Kaiser poll found one in two people report knowing a fellow service member who has either attempted or committed suicide.
Pre-existing mental health issues would not be unusual; a paper published in March as part of a landmark study into mental health among military personnel found that nearly one in five soldiers had a psychiatric disorder before they enlisted. Those problems could be made worse by deployment to war zones.
Greg Jacob, policy director of Service Women's Action Network, told msnbc that while combat trauma is the leading cause of PTSD for men, for women it is sexual assault and harassment. With medical records available for use in courts martial, many victims of sexual assault forego treatment out of fear that their mental health care records will be used to discredit their testimony.
"The huge thing about mental health treatement and mental health care is that you're encouraged to suck things up and deal with stuff," Jacob told msnbc. "There's a lot of attention on injury of physical problems, but when they're invisible wounds or mental health issues, then it's a personal issue."
The military has fought for years against the stigma of seeking mental health treatment. A 2008 study found that while around a fifth of soldiers returning from Iraq and Afghanistan reported major mental health problems, only half sought help. Doctors and veterans are already concerned that the shooting at Fort Hood will cause people to view PTSD as a precursor to violence and make it harder to reintegrate into society after leaving the service.
Sutton told msnbc that as in all other areas of military life, military leaders must set an example for their troops when it comes to mental health care. Leaders in the armed forces, Sutton said, must “view mental health as a force multiplier” and treat it as “on par with physical health.” Outside the military, communities must become involved if veterans are going to feel more comfortable reentering civilian life.
“We don’t return to the Pentagon, we return to communities,” Sutton said. “As troops re-enter civilian life, they need communities that can serve as safety nets as well as springboards.”