Military Psychology

- these individuals often have relatively normal reactions to situational events including problems adjusting to military life they have simply not talked with anyone to help put the event and their response into context and gain the support needed to resolve their stressors also in this category are individuals who made inappropriate comments about suicide or homicide (eg when drinking or after a relationship breakup) but do not represent a true danger to themselves or others

-also in this category are individuals who have engaged in criminal misconduct but don't have any mental health disorders in this instance the evaluator is conveying to the commander that there are no migrating circumstances to the misconduct or inappropriate behavior the member is fully responsible for his or her actions and the unit should hold the member accountable

- return to duty is also a common outcome for individuals seen for non-emergent evaluations many of whom present with mood and adjustment disorders in sum the member is exhibiting enough symptoms to receive a mental health diagnosis although not to the degree warranting an unfit-for-duty finding( eg medical evaluation board)

-these individuals run the diagnostic gamut from those distressed cause of divorce or occupational dissatisfaction to those diagnosed with moderate levels of anxiety of depression to those dealing with personal or combat related trauma as many of these individuals can benefit from psychoeducation, therapy, and/or medications the providers interaction with the member's commander can gave members the opportunity to access these interventions

-if unable to perform their military duties cause of a mental health disorder some members will meet criteria for the medical evaluation board there is some flexibility with respect to other significant mental health disorders including major depression, panic disorder, and PTSD the consensus from the field is that if there is no or minimal improvement after 8 to 12 months of treatment and/or all levels of care have been offered without results(ie outpatient, intensive outpatient, medication, and inpatient) and/or illness has had demonstrable and detrimental impact on the member's ability to perform military duties and medical evaluation board should be initiated conditions that are presumed to have existed prior to military service (eg personality disorders, ADHD, or learning disabilities)are not grounds for an medical evaluation board

-finally there are those individual whose character structure and the associated attitudes, emotions, and/or behaviors are in the opinion of the provider the primary source of their difficulties in the military a recommendation for discharge should be made when the prognosis for rehabilitation is poor and/or he potential for continued difficulty with occupational demands, misconduct, or action out is high poor rehabilitation potential is often demonstrated by unsuccessful attempts but the members to conform their behavior to military standards in the past, despite unit and mental health intervention should it be noted that the various service handle the recommendation for administrative separation differently

-the Navy and Marine Corps differentiate between fitness for duty and suitability for duty put simply a finding of not fit for duty generally results in a limited duty board or a full medical board diagnoses in this category are usually significant mental health conditions such as psychotic disorders and severe mood disorders diagnoses such as learning disorders and personality disorders are considered issues of suitability and these recommendations are channeled through the command's legal department instead of the medical board

-although the eventual outcome is essentially the same for all services the language needed in reports to the commander is dramatically different id faced with having to provide an evaluation to a member of a different service it is usually prudent to consult with a psychologist in the other service or talk to the judge advocate general (JAG) of the service member's command for guidance

-for service members deemed to be imminently or potentially dangerous the first priority is minimizing risk posed to themselves or others in addition to ensuring that they receive emergent psychological evaluations, precautions to minimize risk include notification of the intended victim, restriction of access to the potential victim, provision of orders prohibiting all contact with the victim( ie military protective orders), restriction of the consumption of alcohol and use of firearms, an/or implementation of a suicide watch

-in addition to ensuring that the members are transported and monitored in a timely and appropriate manner the commander must endeavor to consult a mental health provider in addition the commander is responsible for informing the members of their rights as soon as is practicable and providing a written memorandum to the provider of the conditions underscoring the emergent evaluation evaluations conducted under these circumstances must occur within 24 hours of the initial request and will produce a specific assessment of the risk for imminent danger as well as plans for periodic reassessment until the member is no longer at significant risk finally the report should clearly state if the member is recommended for expeditious discharge a recommendation made when there is a pattern of behavior indicative of the significant potential for continued risk it is our experience that the diagnosis a personality disorder( ie borderline personality disorder, antisocial personality disorder) is invariably associated with these situations

-as hospitalization is the disposition for a majority of these referrals a critical element soon becomes the members' consent vs. the necessity for involuntary admission the vast majority of individuals admitted to military hospitals for evaluation and/or treatment do so on a voluntary basis but the process of involuntary admission can be fraught with pitfalls

-as in the civilian community active duty service members can be involuntarily admitted to a mental health unit only if there is clear evidence of severe mental disorder leading to an immediate risk of harm to themselves or others as their condition permits the members must be informed in writing of the reasons for the admission as well as their right to communicate with an attorney, inspector general, or member of congress

-initial evaluation by the attending mental health provider must occur within 24 hours of admission and in the event that continued hospitalization is warranted the member should be informed both orally and in writing of the reason in addition a second independent mental health evaluation must be preformed within 72 hours of admission

- this latter determines whether