More Active Troops Are Using Private Mental Health Care Over The DoD’s. Here’s Why

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Dissatisfied with the quality of care and worried about reprisals from their command, service members are extensively seeking mental health care outside of the military, according to a new article in Military Medicine, an Oxford University Press journal.


The article’s authors concluded that military mental health professionals “must balance obligations both to patients and to the military command,” and the authors argue, “that ethical problems of trust and confidentiality become barriers to care,” according to an Oxford U.P. statement, provided to T&P; ahead of the article’s release. “Other barriers include stigma, a negative impact of seeking care on one's career, beliefs that care would not be effective, and lack of appropriate services.”

The study, published in the Feb. 27 article, “Military Personnel Who Seek Health and Mental Health Services Outside the Military,” was based on responses from 233 service members stationed across the United States and overseas in Afghanistan, South Korea, and Germany between 2013 and 2016.

The vast majority of respondents — 93% — cited poor quality of DoD mental health care as their reason for visiting a civilian mental health provider. Fear of reprisal accounted for nearly half of all respondents’ eschewing military mental health experts, and mistrust of command accounted for 38%.

“Current wars have led to a devastating public health epidemic of suicide and mental health problems among veterans and active duty GIs,” Dr. Howard Waitzkin, distinguished professor emeritus at the University of New Mexico and the lead author of the study, said in a statement. “The military should encourage and support GIs’ use of civilian-sector services that do not involve the ethical conflicts inherent in military medicine and mental health care.”

The article describes these “ethical conflicts” as the tension that exists when you have a mental health care provider who’s either part of the chain of command or beholden to it. It’s hard to have an honest and candid conversation about your mental well-being, many service members believe, with someone who can simply order you to undergo a course of treatment, or suffer consequences for refusing to do so.

“There shouldn’t be this coercive hierarchy,” Matthew Ellis, a former Marine infantryman who suffered a traumatic brain injury following a pair of improvised explosive device strikes in Marjah, Afghanistan, told Task & Purpose. “I shouldn’t have to jump through hoops to try and get help.”

Ellis was injured in an IED strike while on foot on Feb. 18, 2010, and again less than a month later on March 10, while in an MRAP as part of the quick reaction force for 1st Battalion, 6th Marine Regiment.

After the second IED strike, which went off directly under his MRAP, he was evacuated stateside, where he received treatment at the Navy Medical Center in Bethesda, Maryland, in spring 2010. While there, he spent time in a mental health ward as part of his treatment for his TBI, but said he felt ostracized by his military care providers, and the feeling persisted once he returned to Camp Lejeune, North Carolina.

“It's the way that they force it, because it’s the military,” Ellis said, adding that it usually played out like so: “No, you’re gonna listen to what I say, because I outrank you.”

“But when it comes to my health, my mental health, I don’t care that I’m in the military,” Ellis, who left the Marines in 2011 as a sergeant, told T&P.; “I was on Ambien and it made me see shit, shadows and shit — and I was telling them that I was seeing stuff I wasn’t supposed to, and their response was, ‘You’re just going to have to deal with it.’”

Eventually, Ellis said, he refused to speak with his military mental health care providers, and he demanded an off-site consult. “I just wasn’t getting the treatment I needed from the military. It was really just a check in the box,” Ellis said, adding that during one of his initial appointments with a military psychologist, he had to explain to the doctor what a traumatic brain injury was.

“Why am I explaining this shit to you?” Ellis recalls asking. “You’re the fucking doctor.”

By August of 2010, he began seeing a civilian psychologist in New Bern, North Carolina, where “they knew exactly what was going on. It wasn’t someone straight out of an officers training school, who went to some damn medical course, now they’re just there. On the civilian side, the doctors were more trained, more competent.”

Related: For Most Vets, PTSD Isn’t The Problem, ‘Transition Stress’ Is. Here’s What That Means »

Ellis isn’t alone in his frustration over the quality of mental health care provided by the military. According to the Military Medicine authors, 93% of service members they interviewed reported that military mental health care providers were unresponsive to their needs.

“I felt like they were kind of going through the motions, like it’s one of those things where maybe you see it everyday, so you kind of stop caring,” Army Staff Sgt. Kimberly Hackbarth told T&P.;

Hackbarth saw military care providers while stationed at Fort Hood, Texas, and Fort Campbell, Kentucky, for post-traumatic stress disorder stemming from her nine-month deployment to Afghanistan in 2012, and eventually sought treatment off-base.

“I felt like they didn’t care as much about soldiers, and I don’t know if that’s because they’d seen soldiers who were faking having PTSD,” Hackbarth said. “But I just genuinely felt that they didn’t care as much as the civilian providers did off-post.”

In order to remedy the problems raised in the report — subpar care exacerbated by an uneven power dynamic between a care-provider and a patient — the authors suggest making non-military care more readily accessible. And there appears to be a significant need.

The troops polled for the study met the criteria for a mix of disorders, ranging from major depression, which affected 72% of respondents, to post-traumatic stress disorder (62%). Many respondents also met the criteria for generalized anxiety disorder (20%); panic disorder (25%); and alcohol use disorder (27%). Roughly one-quarter of the troops surveyed had a history of pre-military mental health treatment.

“Due to inherent contradictions in the roles of military professionals, especially the double agency that makes professionals responsible to both clients and the military command,” the article concludes, “the policy alternative of providing services for military personnel in the civilian sector warrants serious consideration.”

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Air National Guard/Capt. Holli Nelson.
(Photo: CNN/screenshot)

NAVAL BASE SAN DIEGO — A Navy SEAL sniper on Wednesday contradicted earlier testimony of fellow SEALs who claimed he had fired warning shots to scare away civilian non-combatants before Chief Eddie Gallagher shot them during their 2017 deployment to Mosul, and said he would not want to deploy again with one of the prosecution's star witnesses.

Special Operator 1st Class Joshua Graffam originally invoked his Fifth Amendment privilege before Navy Judge Capt. Aaron Rugh gave him immunity in order to compel his testimony.

Graffam testified that Gallagher was essentially justified in the shooting of a man he is accused of unlawfully targeting, stating that "based off everything i had seen so far ... in my opinion, they were two shitheads moving from one side of the road to the other."

Spotting for Gallagher in the tower that day, Graffam said, he called out the target to him and he fired. He said the man was hit in the upper torso and ran away.

Graffam, who joined the Navy in 2010 and has been assigned to SEAL Team 7's Alpha Platoon since September 2015, deployed alongside Gallagher to Mosul in 2017, occasionally acting as a spotter for Gallagher when the SEALs were tasked with providing sniper support for Iraqi forces from two towers east of the Tigris River.

Another SEAL, Special Warfare Operator 1st Class Dalton Tolbert, had previously testified under direct examination by prosecutors that, while stationed in the south tower of a bombed-out building in June 2017, he had observed Gallagher shoot and kill an elderly civilian.

"He ran north to south across the road," Tolbert testified on Friday. "That's when I saw the red mark on his back and I saw him fall for the first time. Blood started to pool and I knew it was a square hit in the back." Over the radio, he said he heard Gallagher tell the other snipers, "you guys missed him but I got him."

Former SO1 Dylan Dille, who was also in the south tower that day, testified last week that he watched an old man die from a sniper shot on Father's Day. He said the date stuck out in his mind because he thought the man was probably a father.

Later that day, after the mission, Graffam said he spoke with Dille about the shooting and they disagreed about the circumstances. Dille, he said, believed the man was a noncombatant.

"I, on the other hand, was confident that the right shot was taken," Graffam said, although he said later under cross-examination that the man was unarmed. Dille previously testified that the SEALs were authorized to shoot unarmed personnel if they first received signals intelligence or other targeting information.

Photo: Paul Szoldra/Task & Purpose

Graffam described the man as a male between 40 and 50 years old wearing black clothing, giving him the impression of an ISIS fighter who was moving in a "tactical" manner. He testified that he did not see anything like Dille had described.

Graffam further testified that he didn't see Gallagher take any shots that he shouldn't have on that day or any other.

Although Graffam said he did not hear of allegations that Gallagher had stabbed a wounded ISIS fighter on deployment, he testified that he started to hear rumblings in early 2018. Chief Craig Miller, he said, asked him at one point whether he would "cooperate" with others in reporting him.

When asked whether he would like to serve with Miller again in a SEAL platoon, Graffam said, "I don't feel as confident about it." A member of the jury later asked him why he'd feel uncomfortable deploying with Miller and he responded, "I just wouldn't."

Graffam said he would serve with Gallagher again if given the chance.

Under cross examination by prosecutors, Graffam said he couldn't say whether there were warning shots fired that day, though Dille and Tolbert both said happened. "There were multiple shots throughout the day," Graffam said.

Prosecutors also asked him about his previous statements to NCIS, in which Graffam said of Miller that "he has good character" and was "a good guy." Graffam confirmed he said just that.

Defense attorney Tim Parlatore, however, said those statements were back in January and "a lot had happened since then." Parlatore said Graffam had also said at the time that Gallagher was a good leader.

"That part remains unchanged, correct?" Parlatore asked.

"Yes," Graffam said.

The defense is expected to call more witnesses in the case, which continues on Thursday.

(U.S. Air Force photo by Airman 1st Class Alexi Myrick)

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