Official instructions "avoid declaring a soldier mentally ill in war zones"

Can you believe this one?

Army Policy: Deferring Mental-Health Diagnoses in War Zones
By MARK THOMPSON
March 15, 2012


Some Army mental-health professionals say official instructions urging them to avoid declaring a soldier mentally ill in war zones keeps too many such ailing troops in combat. It’s part of a stretched Army’s quest to keep troops on the front line, they say. They suggest such rules may have played a role in keeping the soldier who carried out last Sunday’s massacre in Afghanistan, although there is no evidence of that.

But it makes for a strange section heading in Army Field Manual 4-02.51 on Combat and Operational Stress Control:

Defer Diagnosis of Behavioral Disorders


It tells Army mental-health workers to tilt toward a diagnosis of normal combat stress instead of an abnormal behavioral disorder when in a war zone:

During assessment, COSC [combat and operational stress control] personnel must always consider BH [behavioral health] disorders that resemble COSR [combat and operational stress reaction], but defer making the diagnosis. The COSC personnel favor this default position to preserve the Soldier’s expectations of normalcy…This is also done to avoid stigma associated with BH disorders and to prevent the Soldier identifying with a patient or sick role. Deferral is also preferred because some diagnoses require extensive history collection or documentation that is unavailable during deployment situations.

“The intrusion of well-intentioned but bad policy has made doctors less effective at preventing homicides and suicides,” an Army mental-health expert says. “The uncomfortable truth is that military mental-health system is designed to avoid recognizing manic symptoms or delusions – symptoms that put someone at increased risk for suicide or homicide.”

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