Air Force Capt. Air Force Capt. Ben Landry suffered from depression and suicidal thoughts. He checked himself into Cedar Springs Hospital, Colorado in 2020. He was very lucky. “I got support from my unit,” he said.
However, not everyone in the hospital did. Captain Landry heard that officers sent letters of reprimand to troops for seeking mental healthcare services. Article 15 disciplinary procedures can also be used, which can result in a reduction of rank and pay.
For years, Captain Landry had endured Air Force Suicide Prevention Program mandatory lectures on how to identify symptoms of distress that had, unintentionally, ostracized him as “a danger to society,” he said.
Aleha, Aleha’s wife, and their four kids have also struggled. However, Aleha continues to advocate for military spouses as well as their families to be included into military psychological health programs. “It’s been hard on all of us,” Aleha told Truthout. In op-ed, she called the Air Force’s Suicide Prevention Program a “Band-Aid program” that sent Captain Landry “further underground and only coached him on what not to say.”
Now, President Joe Biden announces a new military veteran. suicide prevention strategy in an attempt to address a larger problem of how the U.S. military treats service members’ mental health conditions, including the “adoption of rigorous program evaluation” for suicide prevention programs.
According to unreleased Department of Defense records, the military knew that it had an accountability problem regarding programs on suicide, substance abuse and PTSD, at least since 2012. Truthout.The DoD records that include individual program evaluations show that the DoD spent approximately $1 billion per year on mental health programs. While the military was dealing with the psychological effects of wars in Afghanistan, Iraq, and Pakistan, the records of the DoD show that the DoD spent about $1 billion annually on these programs.
The DoD released a final report in 2019 from a $53 million project which evaluated 139 military psychological programs across all armed forces. It was found that many programs such as Air Force Suicide Prevention didn’t clearly track their costs. Other programs had insufficient staffing and resources, and most lacked sufficient data to determine if a program improved a person’s mental health, according to the report.
The Air Force program did not prevent suicides. according to a separate 2010 study, it had not established adequate monitoring to “secure long-term effectiveness.” The more recent internal DoD evaluation scored the program in the bottom third of the military’s 139 programs. For example, it is unknown if Landry attended lectures that increased help-seeking behavior or decreased suicide.
“There is insufficient evidence for or against suicide prevention efforts,” explained Mike Colston, a retired Navy captain and former director for Mental Health Programs in DoD’s Health Services Policy and Oversight office. That’s why “program evaluation is essential to research, track outcomes and discover programs that can do both those things,” he told Truthout.
But, the DoD’s Defense Health Agency (DHA), established to manage military health care, never released the 2019 final report to Congress or military leadership, and abandoned the project infrastructure created to continually assess programs.
Why?
In 2011, the Pentagon’s Program Analysis Division — recently formed by then-Defense Secretary Robert Gates to study the DoD’s most complex strategic problems — wanted to know which military psychological health programs actually improved the mental health of service members and their families.
Many programs were created and expanded. No one knew the cost of these programs, nor their impact on health outcomes. The problem, explained Rani Hoff, director of Yale’s Northeast Program Evaluation Center, was that the “programs were deployed willy-nilly with no guidelines or oversight,” and had little or no evidence base to know if services were effective.
In turn, the Office of the Secretary of Defense, Cost Assessment & Program Evaluation directed a massive evaluation of the DoD’s growing billion-dollar program network. The Defense Centers of Excellence took over the job. “We had a proliferation of programs that were well-intentioned,” said Jonathan Woodson, a former assistant secretary of defense for health affairs who authorized an expansion of the project. “But we needed a process to vet them.”
A series of directives required a reckoning. In 2012, President Barack Obama’s Executive Order 13625 ordered the DoD to review programs and rank them by effectiveness, including health outcomes. Additionally, at least three succeeding annual National Defense Authorization Acts required the DoD to “eliminate gaps and redundancies,” report on “the present state of behavioral health services,” and detail “improvements” in treatments.
2016: The then-Navy Captain Colston was the head of the mental health oversight bureau testified before the Senate Armed Services Committee on Personnel, explaining that the project was “working internally to make psychological health and traumatic brain injury efforts more effective, cost-efficient, and beneficial to Service Members, Veterans, and their families.” He noted these services “account for more than $1 billion annually.”
To begin, the project measured a proxy for outcomes — effective administrative function — to at least determine if programs worked as intended. It was, Woodson explained, an “iterative approach,” one that would, eventually, measure health outcomes. However, in order to measure health outcomes, programs had to first collect data.
Programs wanted to improve — and some were making progress — when the DHA closed the evaluation project in 2019. To explain its decision, the DHA cited a changed “operational landscape” in its response to Truthout’s Freedom of Information Act request, and also claimed releasing the final report “could damage progress” it had “made with more standards and standardization of military treatment facilities.” The DHA did not respond when TruthoutFollow up and ask for clarification.
Two non-concurring memos were also cited by the DHA as criticisms of the report. However, Woodson called the agency’s response “an awful explanation.” Hoff called the memos accurate but unfair, and said the project was unable to measure outcomes not because of a flaw in its method, but because programs never collected data to do so. The report is currently in bureaucratic limbo because its findings have become increasingly out of date. Experts still believe that rigorous assessment is necessary.
Meanwhile, Captain Landry, now in the Air Force Reserves, “is in a good place,” he said. “I’m on the right medication,” he told Truthout. “I see the right people. I’ve got a good circle of family and friends.”
