As journalists covering the Fort Hood mass shooting ponder possible connections between the shooter's mental health and his crime, they have largely ignored a major factor behind the inadequate support and treatment military service members have received for mental health conditions more generally: the vast over-commitment of troops to fight two wars simultaneously for over a decade.
Spec. Ivan Antonia Lopez killed three people and wounded 16 others before taking his own life at Fort Hood, TX, on April 2. Lopez served a four-month term in Iraq, though he reportedly did not see combat. He was being treated for depression and anxiety, and was in the process of being evaluated for post-traumatic stress disorder, or PTSD. PTSD can be triggered by a broad spectrum of emotional and physical traumas, including the loss of a loved one, seeing the after-effects of violence, and experiencing sexual assault, but it is still unclear if Lopez had this condition and the nature of his treatment is largely unknown. An Army psychiatrist who examined Lopez recently reportedly found no "sign of likely violence, either to himself or to others."
Many individuals with PTSD never demonstrate violent behavior, and the likelihood that they will commit mass murder "is extraordinarily small," according to Janice Krupnick, a professor of psychiatry at Georgetown University School of Medicine. (Studies have shown that people with mental health conditions in general are more often the victims of violent crime than the perpetrators.)
Again, Lopez's mental health may prove entirely irrelevant to the mass shooting. But a story that has been largely undercovered in the media is how rising rates of depression, suicide, and PTSD in the military relate to the military's over-commitment in the Iraq and Afghanistan wars. In order to supply enough service members to fight two wars simultaneously, the military abandoned previous regulations and put stress on already limited support systems, causing what commanders refer to as "overstretch."
Before the 2003 invasion of Iraq, Defense Department standards disqualified recruits who suffered from PTSD and hadn't receive treatment. But Army mental health experts acknowledged early on that those standards were being relaxed in light of the troop shortage. The need for more troops to fight both Iraq and Afghanistan -- and meet the Bush administration's specified troop commitment levels -- required Army mental health experts "to weigh the needs of the Army" ahead of the needs of the individuals. The Associated Press reported in 2006 (emphasis added):
Although Defense Department standards for enlistment disqualify recruits who suffer from post-traumatic stress disorder, the military also is redeploying service members to Iraq who fit that criteria, the [Hartford Courant reported].
"I'm concerned that people who are symptomatic are being sent back. That has not happened before in our country," said Dr. Arthur S. Blank, Jr., a Yale-trained psychiatrist who helped to get Post-Traumatic Stress Disorder recognized as a diagnosis after the Vietnam War.
The Army's top mental health expert, Col. Elspeth Ritchie, acknowledged that some deployment practices, such as sending service members diagnosed with post-traumatic stress syndrome back into combat, have been driven in part by a troop shortage.
"The challenge for us ... is that the Army has a mission to fight. And, as you know, recruiting has been a challenge," she said. "And so we have to weigh the needs of the Army, the needs of the mission, with the Soldiers' personal needs."
An Army-funded review of the mental health of soldiers who served from 2004 to 2009 found "one in five Army soldiers enter the service with a psychiatric disorder, and nearly half of all soldiers who tried suicide first attempted it before enlisting."
And it's not just new recruits. The Washington Post reported that a diagnosis and lack of treatment for PTSD was also no longer "a barrier to being redeployed" for troops sent to Iraq and Afghanistan, despite the fact that military mental health experts knew for years that redeployment without treatment could drastically increase the risk of damaging mental health conditions. In 2006, a Department of Veteran's Affairs study revealed that within just 30 days of redeployment Army and Marine Corps service members showed higher mental health concerns and higher probable PTSD rates. The risk increases with each additional deployment; one study found that 27 percent of soldiers reported serious combat stress or depression symptoms on their third deployment.
A 2010 PBS Frontline special highlighted how the surge -- in which more than 20,000 additional troops were committed to Iraq in 2007 on top of existing forces -- particularly forced the recruitment and redeployment of troops who would otherwise have been ineligible. The special focused on the Third Platoon, which was sent back to Iraq after only one year at home, and then had their deployment extended to fifteen months. "The military now acknowledges that is not enough time for soldiers to recuperate," PBS reported. "Our ultimate goal is one year deployed, two years home," Gen. Peter W. Chiarelli, then-Army vice chief of staff, told PBS. "We have not reached that goal for all units. It's a supply and demand problem. I cannot do anything about the demand. I only have a finite supply. And when the demand goes up, and orders are given, we provide the soldiers."
A decade ago, the Associate Press reported that roughly 1 in 8 returning soldiers suffered from PTSD, according to the Army's first study of the mental health of troops who fought in Iraq. Now estimates place it closer to 2 in 10 -- a 60 percent increase. Suicide rates dipped last year from their alarming highs over the course of the wars. The rate of suicide (which can be sparked by a range of mental health issues) for those who served in Iraq and Afghanistan more than doubled from 2004 to 2009, while the rate for those who never deployed nearly tripled. Last year, the Department of Veterans Affairs announced that 22 veterans kill themselves every day.
There is some hope. President Obama issued an executive order in 2012 ordering Veterans Affairs to expand its suicide prevention and mental health services, and the Army has upped the number of mental-health professionals traveling with troops in the field. Following the previous Fort Hood shooting, in 2009, the Defense Department implemented numerous changes, and Defense Secretary Chuck Hagel remains committed to implementing those improvements in the system.
But according to Defense Department data, about 2.5 million Americans in the Army, Navy, Marines, Air Force, Coast Guard, and related Reserve and National Guard units have been deployed in the Afghanistan and Iraq wars. 400,000 service members have completed three or more deployments. Nearly 37,000 have been deployed more than five times. An excellent in-depth look at veterans from The Washington Post, published just days before the recent Fort Hood shooting, noted that more than half of the millions who were deployed "struggle with physical or mental health problems stemming from their service."
With those numbers, is it really any wonder that the military has struggled to provide adequate support to Ivan Lopez and others like him?
Image via Flickr user Dave O using a Creative Commons License
From the January 14 edition of Premiere Radio Networks' The Rush Limbaugh Show:
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Fox News contributor Kirsten Powers attacked the new health care law for requiring all new insurance plans to cover essential services such as maternity care and mental health care, ignoring the fact that individuals with these conditions are often discriminated against in the insurance market and that requiring coverage for these services will help the economy and reduce economic insecurity.
On the November 12 edition of Special Report, Powers complained that under the Affordable Care Act (ACA), health insurance plans are now required to cover benefits such as maternity care and mental health care, despite the fact that an individual might not ever need to use these services:
POWERS: The idea that they think that 50-year-olds should have maternity care is very concerning to me. You know, people are being forced to pay for things that they will not use. It is not for them to tell people -- I don't need to be told I need to have mental health coverage. If I wanted it, I would have gotten it. And I think people are getting a little fed up, even Democrats, with this stuff.
In fact, without the ACA's requirement that essential health benefits be covered by new insurance plans sold on the exchanges, Powers may not have been able to get mental health coverage or maternity care if she wanted it. Individuals who needed those services before the law's passage were routinely discriminated against while trying to obtain necessary health insurance, by being required to pay significantly more for coverage, left unable to get a plan offering specific coverage, or rejected from health insurance all together.
As CNNMoney explained, previously insurance companies were able to keep costs down for many by offering plans without some essential benefits, like maternity care and mental health services, and cherry picking "among applicants to only pick the healthiest ones." The New York Times reported that in 2011, "62 percent of women in the United States covered by private plans that were not obtained through an employer lacked maternity coverage," and a Washington Post columnist explained that according to the Department of Health and Human Services (HHS), nearly 20 percent of people currently in the individual market have "no coverage for mental-health cases, including outpatient therapy visits and inpatient crisis intervention and stabilization." (Approximately 57.7 million Americans experience a mental health condition per year, and half of all Americans will experience one in their lifetime.) Many individual market insurance plans did not offer these services.
The entire concept behind the Affordable Care Act was to change this, ensuring that all Americans, regardless of their personal finances or current health states, could have access to quality, comprehensive health insurance that covered their needs. The law thus mandates ten essential health benefits -- including maternity care and some mental health services -- that all new insurance plans must include at minimum for every American.
Powers' argument also ignored that requiring insurance companies to cover these essential services in all health plans has significant economic benefits.
The Wall Street Journal attacked the Affordable Care Act's (ACA) Medicaid expansion by claiming that Medicaid beneficiaries would have better health outcomes with no insurance at all. But the Journal's analysis relies on an inaccurate reading of an Oregon health care study and ignores that Medicaid has been shown to lower rates of depression, reduce financial strain, and benefits low-income children, mothers, and veterans.
Fox News' Martha MacCallum scapegoated individuals with mental health conditions by suggesting that increased institutionalization is a solution to mass shootings, ignoring the dangers that poses to individuals with these conditions and the need for greater gun safety.
On the September 19 America's Newsroom, MacCallum suggested that Aaron Alexis, the Navy Yard shooting suspect, should have been institutionalized for a mental health condition, asking if we have "become so PC that we do not understand" the need to institutionalize some "categories of people." She also criticized the medical system for only institutionalizing people who have previously been convicted of a crime:
Have we not become so PC that we do not understand that there are categories of people -- many people who do not deserve to be institutionalized, but some do. And if this man had been institutionalized, something that we, you know, seem to never do any more in this country -- in fact, Adam Lanza's mother, according to the reports after Newtown, wanted to institutionalize her son. She was worried that he would do something. But unless you have been convicted, you cannot be institutionalized. So what do we do about this?
According to the Department of Veterans Affairs, Alexis never reported that he was depressed or that he was considering harming himself or others prior to the shooting. He sought treatment solely for insomnia. Doctors said he was "alert and oriented" and never asked for an appointment with VA mental health specialists.
MacCallum's solution raises as many questions as it answers, most critically who gets institutionalized and when.
Institutions, or psychiatric hospitals, can play a role in treatment for people with severe mental health conditions, but they are not the most effective solution in every case.
Fox News falsely claimed the Obama administration had done little to address issues of mental health following recent mass shootings, hiding the fact that gun violence prevention legislation backed by President Obama included mental health provisions and that the president has signed multiple measures aimed at increasing Americans' access to mental health services.
On September 17, President Obama called on Congress to strengthen background checks for gun purchases following the mass shooting at the Washington, D.C. Navy Yard by a former Navy reservist who had clearance to access the base as a civilian contractor and who had passed a background check to purchase the gun he brought with him.
On September 18, Fox & Friends criticized the call for stronger gun laws following the tragedy, with co-host Brian Kilmeade saying "the focus really should be on mental illness" and accusing doctors of letting dangerous individuals out "wild in society." Co-host Steve Doocy then criticized President Obama over the tragedy, saying that "[a]fter the Newtown massacre, what did the President of the United States say? He said his administration, quote, 'would bring mental illness out of the shadows.' What have they done so far? They've had a conference in June. Nothing has happened."
Doocy and Kilmeade's fixation on mental health as the solution to gun violence is misplaced, as studies have shown that people with mental health conditions are more often the victims of violent crime than the perpetrators. In fact, 96 percent of violent crimes "are committed by people without any mental-health problems at all."
But Doocy was also wrong: Obama and Senate Democrats have supported gun violence prevention legislation which addressed mental health issues, and Obama has signed multiple measures to increase access to mental health services for those who need them.
From the September 18 edition of Fox News' America's Newsroom:
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Rush Limbaugh dishonestly claimed that he never cited the use of concussion-preventing technology in the NFL as a sign of culture becoming "chickified."
During the August 26 edition of his radio show, Limbaugh said that he has never claimed that concussion-preventing technology is a sign that things are becoming "chickified":
LIMBAUGH: I never once have been critical of the NFL for trying to reduce concussion-related injuries. Now, we have talked about, you know, wearing pink accoutrements in the month of October and other elements of football that are becoming chickified, but not the concussion-related.
Limbaugh is contradicted by remarks he made during the August 12 edition of his show, which were highlighted on his website under the headline "NFL Helmet Sensors Latest Sign of Chickification":
Former New York Giants defensive lineman Leonard Marshall chastised Rush Limbaugh for "irresponsible" rhetoric and downplaying efforts to reduce concussions in football. Marshall's comments came on SiriusXM's The Agenda, hosted by Media Matters senior fellow Ari Rabin-Havt.
Limbaugh recently complained about the use of sensors in NFL helmets to monitor head injuries, saying it was evidence of "politics that has permeated football," and concluding:
LIMBAUGH: But I'm telling you it's being chickified. The whole thing, everything in our culture is being chickified. And some things fine, but not everything.
On Wednesday, Rabin-Havt asked Marshall, a two-time Super Bowl champion and 12-year NFL veteran, to respond. Marshall said Limbaugh's comments were "irresponsible" and cited several instances of teenagers being severely injured while playing football:
MARSHALL: It's very irresponsible. How about you become the father of a 17-year-old boy who plays in a football game on a Friday night, and is in need of medical attention. It takes 15 minutes for the medics to get there to attend to this kid who gets injured, and your kid dies on the football field. How about being that parent?
CNN reported on August 18 that a high school football player in suburban Atlanta died after suffering an on-field injury after coaches tried to revive him on the field while awaiting an ambulance Friday night.
Marshall also cited the example of Josh Haddock, a former high-school football star in Georgia who in 2010 suffered an injury during practice that required brain surgery. Haddock reportedly is helping to develop a helmet that could alert people to head injuries.
Marshall challenged Limbaugh to become part of the solution:
MARSHALL: Watch and hope that there is change coming down the pike. Be part of that change. Be part of trying to empower young people with knowledge and information about the risk associated with playing tackle football.
From the June 6 edition of Fox News' Fox & Friends:
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From the April 5 edition of MSNBC's All In with Chris Hayes:
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This American Life host Ira Glass is defending a recent report on his program in the face of criticism from those who say it painted a false picture of disability programs.
On March 22, Media Matters detailed how the public radio segment, which also ran on the NPR programs Planet Money and All Things Considered, promoted several myths to criticize Supplemental Security Insurance over the program's rate of growth, hurdles towards qualification, and successes it has had in reducing poverty. The story drew further criticism from Center for Economic and Policy Research co-director Dean Baker, who said it "got some of the basics wrong," and University of Connecticut law professor James Kwak, who said it suffers from "facile extrapolation from the individual story to national policy."
But in a statement to International Business Times, Glass stood by his program's work. He told IBT that "our report on disability programs was fact checked line by line by an outside fact checker, in addition to fact checking by the reporter and her editors" and that "We know of no factual errors. We stand by the story."
Right-wing media outlets have latched on to the report, which also ran on the NPR programs Planet Money and All Things Considered, and used it to amplify their false message that increased disability benefits indicate fraud in the system.
National Review praised the report as "brilliant" and the Washington Examiner offered it as evidence that disability benefits are "a voluntary life sentence to idle poverty." Breitbart.com praised NPR "for reporting the truth--a truth that conservatives have been highlighting for decades."
Public radio program This American Life pushed a series of myths about Supplemental Security Insurance (SSI), a Social Security program that supports families that include children with disabilities. The piece ignored that the recent rise in disability benefits is tied to the recession and higher rates of poverty, that qualifying for benefits is difficult, that SSI encourages employment, and that the current program has significantly reduced poverty among children with disabilities.
In an attack on efforts to strengthen gun legislation, frequent Fox News guest Star Parker asked if background checks would prohibit women who have had abortions from purchasing firearms by invoking a long-debunked link between abortion and mental illness.
Appearing on the March 19 edition of Fox News' Hannity, Parker attacked proposals to impose universal background checks for firearm purchases. Parker asked if background checks, which would consider mental health, would apply to "people who have had abortions" because " according to the studies, [they] have a tendency to have mental challenges later on":
The claim that abortion is linked to mental health problems has long been debunked. The American Psychological Association formed a task force in 2008 "to examine the scientific research addressing mental health factors associated with abortion, including the psychological responses following abortion." The task force found "no credible evidence" of such a link:
From the January 17 edition of Fox News' America Live:
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