Abstract
This is the first of a two-part series of the contribution of organizational and leadership factors in perpetuating a generational cycle of preventable wartime behavioral health crises. The current study includes a comprehensive review of government-initiated studies on the policies, leadership, and organizational structure of military mental healthcare. Among other things, the paper reports on the persistent, serious inadequacies within the U.S. Department of Defense including fragmentation, gross inefficiencies, inadequate coordination, lack of leadership accountability and responsibility both within and across military mental health across all branches. It is hypothesized that these problems have led to past and present wartime crises and are linked to ignoring documented lessons learned. These lessons point to the need for an integrated, coordinated organizational structure with a clear chain-of-command and accountable leadership. Such leadership, it is argued, will ensure adequate planning, preparation, and implementation to meet military mental health needs. While first-order changes have been made over the years through several incremental system corrections that have been tried, second-order (structural and systemic) change is necessary to “fix” the system. The latter section of the paper calls for and describes a complete reorganization of military mental health to improve mental healthcare for military populations.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
The above list is only partial and does not represent the overabundance of new mental health and family support initiatives, resilience building, research, and transition support services developed throughout the DoD, VA, and private sector—all of which are in stark contrast to the neglected status of mental healthcare evident during the pre and early war phases (e.g., DoD TF-MH, 2007).
References
Appel, J., & Beebe, G. (1946). Preventive psychiatry; an epidemiologic approach. Journal of the American Medical Association, 131, 1469–1475.
Blimes, L. J. (2011). Current and projected future costs of caring for veterans of the Iraq and Afghanistan wars. Unpublished manuscript, Department of Economics, Harvard University, Massachusetts, USA. http://costofwar.org/sites/default/files/articles/52/attachments/BlimesVeteransCosts.pdf
Congressional Research Service. (2013). Post-traumatic stress disorder and other mental health problems in the military: oversight issues for the congress. 7–5700: R43175. Prepared by K. Blakeley and D. J. Jansen, August 8, 2013. www.crs.gov
Department of Defense. (2012). DoD directors of psychological health. DoD Instruction 6490.09 February 27, 2012. Washington, DC.
Department of Defense. (2013). Maintenance of Psychological Health in Military Operations. DoD Instruction 6490.05 of October 2, 2013. Washington, DC: Defense Logistics Agency.
Department of Defense Suicide Event Report. (n.d.). Retrieved from http://t2health.dcoe.mil/programs/dodser
Department of Defense Task Force on Mental Health. (2007). An achievable vision: report of the department of defense task force on mental health. Falls Church: Defense Health Board.
Department of the Navy. (2013). Memorandum of understanding between the Navy Bureau of Medicine and Surgery (BUMED), Marine and family programs division, and Marine Corps health services: Establishment of comprehensive psychological health services for active-duty Marines and their families. 7720 Ser 13UM90013 of 5 November 2013. Falls Church, VA.
Department of Veterans Affairs. (2015). Analysis of VA Health Care Utilization among Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn Veterans, from 1st Qtr FY 2002 through 1st Qtr FY 2015. Epidemiology Program, Post-Deployment Health Group, Office of Public Health, Veterans Health Administration. Washington, DC: Author. Retrieved from http://www.publichealth.va.gov/epidemiology
Gabriel, R. A. (2013). Between flesh and steel: a history of military medicine from the middle-ages to the war in Afghanistan. Washington DC: Potomac Books.
Glass, A. J. (1966a). Army psychiatry before World War II. In A. J. Glass & R. J. Bernucci (Eds.), Medical Department United States Army. Neuropsychiatry in World War II volume I: zone of interior (pp. 3–23). Washington DC: Office of the Surgeon General, Department of the Army.
Glass, A. J. (1966b). Lessons learned. In A. J. Glass & R. J. Bernucci (Eds.), Medical Department United States Army. Neuropsychiatry in World War II volume I: zone of Interior (pp. 735–759). Washington DC: Office of the Surgeon General, Department of the Army.
Glass, A. J., & Bernucci, R. J. (1966). Medical Department United States Army. Neuropsychiatry in World War II volume I: zone of interior. Washington DC: Office of the Surgeon General, Department of the Army.
Heaton, L. D. (1966). Forward. In A. J. Glass & R. J. Bernucci (Eds.), Medical Department United States Army. Neuropsychiatry in World War II volume I: zone of interior (pp. 13–14). Washington DC: Office of the Surgeon General, Department of the Army.
Institute of Medicine. (2013a). Substance use disorders in the U.S. armed forces. Washington, DC: The National Academies Press.
Institute of Medicine. (2013b). Returning home from Iraq and Afghanistan: assessment of readjustment needs of veterans, service members, and their families. Washington, DC: The National Academies Press.
Institute of Medicine. (2014a). Preventing psychological disorders in service members and their families: an assessment of programs. Washington, DC: The National Academies Press.
Institute of Medicine. (2014b). Treatment for posttraumatic stress disorder in military and veteran populations: final assessment. Washington, DC: The National Academies Press.
Jones, F. D. (1995). Psychiatric lessons of war. In F. D. Jones, L. R. Sparacino, V. L. Wilcox, J. M. Rothberg, & J. W. Stokes (Eds.), Textbook of military medicine: war psychiatry (pp. 1–34). Washington, D.C: Office of the Surgeon General, U. S. Army. Borden Institute.
Kang, H. K., Bullman, T. A., Smolenski, D. J., Skopp, N. A., Gahm, G. A., & Reger, M. A. (2015). Suicide risk among 1.3 million veterans who were on active duty during the Iraq and Afghanistan wars. Annals of Epidemiology, 25, 96–100.
Kilpatrick, M. E. (2007). Statement by Michael E. Kilpatrick, MD Deputy Director, Force Health Protection and Readiness Programs, Department of Defense. In U.S. Congress House of Representatives (Ed.), Invisible casualties: the incidence and treatment of mental health problems by the U.S. military. Washington, DC: U.S. Government Printing Office. Hearing before the U.S. Congress House of Representatives Committee on Oversight and Government Reform, First Session, May 24, 2007, Serial No. 110–111 (pp. 63–79).
Kirkland, F. R. (1996). Preface. In J. A. Martin, L. R. Sparacino, & G. Belenky (Eds.), The Gulf War and mental health: a comprehensive guide (pp. 19–31). Westport: Praeger Publishers.
Menninger, W. C. (1948). Reactions to combat. Psychiatry in a troubled world (pp. 134–152). New York: Macmillan.
National Council for Community Behavioral Healthcare. (2012). Meeting the behavioral health needs of veterans: operation enduring freedom and operation iraqi freedom. Washington, DC. Retrieved from http://www.thenationalcouncil.org/wp-content/uploads/2013/02/Veterans-BH-Needs-Report.pdf
Ramchand, R., Acosta, J., Burns, R. M., Jaycox, L. H., & Pernin, C. G. (2011). The war within: preventing suicide in the U.S. military. W74V8H-06-C-0002. Prepared for the Office of the Secretary of Defense Center for Military Health Policy Research. Santa Monica: RAND.
Ramchand, R., Schell, T. L., Karney, B. R., Osilla, K. C., Burns, R. M., & Caldarone, L. B. (2010). Disparate prevalence estimates of PTSD among service members who served in Iraq and Afghanistan: possible explanations. Journal of Traumatic Stress, 23(1), 59–68.
Russell, M. (2006a). Mental health crisis in the Department of Defense: DoD Inspector General Hotline Investigation #98829 submitted by Commander Mark Russell, USN on 05JAN2006. Available upon request via Freedom of Information Act (FOIA) at Department of Defense; Office of Freedom of Information, 1155 Defense Pentagon; Washington, DC 20301–1155.
Russell, M. (2006b). The future of mental health care in the Department of Defense. Invited testimony before the Congressionally-mandated Department of Defense Task Force on Mental Health, on 19–20 October 2006, San Diego, CA. Transcript available on Defense Health Board (http://www.ha.osd.mil/DHB/mhtf/meeting/2006oct.cfm)
Russell, M. C., & Figley, C. R. (2015a). Investigating recurrent generational wartime behavioral health crises: part one of a preliminary analysis. Psychological Injury and Law, 8(1), 106–131. doi:10.1007/s12207-015-9224-4
Russell, M. C., & Figley, C. R. (2015b). Generational wartime behavioral health crises: part two of a preliminary analysis. Psychological Injury and Law, 8(1), 132–152. doi:10.1007/s12207-015-9223-5
Russell, M. C., Figley, C. R., & Robertson, K. R. (2015). Investigating the psychiatric lessons of war and pattern of preventable wartime behavioral health crises. Journal of Psychology and Behavioral Science, 3(1), 1–16.
Seidenfeld, M. A. (1966). Clinical psychology. In A. J. Glass & R. J. Bernucci (Eds.), Medical Department United States Army. Neuropsychiatry in World War II volume I: zone of interior (pp. 567–603). Washington DC: Office of the Surgeon General, Department of the Army.
U.S. Army. (2006). Communications plan: OIF/OEF mental health final. Approved on 23 May 2006 by Brigadier General Mari K. Elder, Deputy Chief of Public Affairs, Washington, DC.
U.S. Navy. (2007). Mental health public affairs guidance January 23, 2007. Washington, DC: Navy Medical Department, Navy Medicine West. Bureau of Medicine and Surgery.
Weinick, R. M., Beckjord, E. B., Farmer, C. M., Martin, L. T., Gillen, E. M., Acosta, J. D., … Scharf, D. M. (2011). Programs addressing psychological health and traumatic brain injury among U.S. military service members and their families. Prepared for the Office of the Secretary of Defense Center for Military Health Policy Research. Santa Monica, CA: RAND.
Zoroya, G. (2007). Navy Psychologist: “Navy faces crisis.” USA-Today. Retrieved from http://usatoday30.usatoday.com/news/health/2007-01-16-ptsd-navy_x.htm
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Russell, M.C., Butkus, S.N. & Figley, C.R. Contribution of Military Organization and Leadership Factors in Perpetuating Generational Cycle of Preventable Wartime Mental Health Crises: Part One. Psychol. Inj. and Law 9, 55–72 (2016). https://doi.org/10.1007/s12207-016-9252-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12207-016-9252-8