Mental Health and Security Clearances

May 1, 2008 at 7:19 pm | Posted in Mental Health, Military | 2 Comments

In mid-April one of Lt. Nixon’s “Iraq News” Updates referenced a RAND study on the mental health needs of OEF and OIF veterans. The updates separate news items into “The Good”, “The Bad”, and “The Ugly”. The RAND Study was placed in “The Ugly”. Without getting into huge detail, the study basically found that 1 in 5 veterans of OIF and OEF reports experiencing mental health problems (e.g. symptoms of PTSD and Major Depression). Given that this study was based on a sample size of 1,965 individuals from 24 different communities, it is safe to assume that these results reflect the extent to which the population of OIF and OEF veterans experience symptoms of these disorders. This translates to over 300,000 individuals with mental health needs.

When the report first came out, everyone focused on the “numbers” and there was a hue and cry for better treatment and increased access to treatment for veterans. While I don’t disagree with the importance of accessible quality treatment, there was a whole area of the study that was either glossed over or not mentioned at all in the news reports- barriers to treatment.

Barriers to treatment can come from many sources- including individual, cultural/societal, and institutional. The truth is, it just doesn’t matter how good and available the services are if individuals aren’t willing to use them. Included in a summary of the report available for free online (you can download it in pdf here or view online at this link ) is a figure depicting the prevalence of the top five barriers to care for individuals experiencing symptoms indicating they might benefit from mental health services. Three of the top five barriers have clear linkages to either military culture, institutional policies, or both.

Today the government took a huge step toward addressing one of these concerns. Among individuals with symptoms of either PTSD or Major Depression who reported barriers to care, 44% indicated that concerns about being denied a security clearance were one factor that kept them from obtaining mental health care. This is of particular concern for individuals who are career military and need to maintain high level security clearances for their job.

Today an official change in the question relating to mental health care on the Questionnaire for National Security Positions, Standard Form (SF) 86 has been put in place. Under the new wording for the question, individuals completing the form can answer “no” when asked “In the last 7 years, have you consulted with a health care professional regarding an emotional or mental health condition or were you hospitalized for such a condition?” if the consultation/treatment is not court ordered and is “strictly related to adjustments from service in a military combat environment”. This is huge. Let me repeat. THIS IS HUGE.

The wording is open enough that it leaves a lot of latitude for both the mental health professional and the individual receiving care. As long as the treatment isn’t court ordered or following an act of violence perpetrated by the individual receiving care, just about anything could fit into this category. People will no longer have to “back door” themselves into treatment by addressing individual issues during marital therapy (in the past you could check “no” if the treatment was for marital problems and sometimes people would use this as a “screen” and basically try to address individual problems during couples sessions). By not referencing specific disorders or diagnostic categories, the importance of the specific diagnosis from the mental health professional is lessened.

The military is undertaking other steps to try to reduce the societal, cultural and institutional stigma of receiving mental health care and the steps are all important, but this one is huge. I know I seem a bit “over the top” about this, but trust me….it’s huge.

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2 Comments »

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  1. Thanks ABWF, this is a big deal. A lot of the help for PTSD falls by the wayside due to bureaucratic red tape as well, which groups like IAVA try to provide oversight in Washington to correct.

  2. Lt Nixon- I agree that red tape is also a problem. Add this to the VA being woefully underfunded and there is a lot that needs to be taken care of related to the “infrastructure” of the care system. VA and DOD both are hiring additional mental health professionals with many new job openings dedicated to PTSD and substance abuse treatment (alcohol in particular is often used to self-medicate mental health problems such as depression and anxiety). I don’t think there is any one answer that will “make everything better”, so I’m glad to see that action is being taken on several fronts.


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