Why Did the DoD Abandon a Report Tracking 139 Military Mental Health Programs?

Air Force Capt. Ben Landry struggled with depression and suicidal thoughts and checked himself into Cedar Springs Hospital in Colorado in 2020. He was lucky. “I got support from my unit,” he said.

Not everyone at the hospital did. Officers, Captain Landry heard, punished troops for seeking mental health services, issuing letters of reprimand or Article 15 disciplinary procedures, which can reduce pay and rank.

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.

His wife, Aleha, and their four children, have also struggled while continuing to advocate for military spouses and their families to be included in military psychological health programming. “It’s been hard on all of us,” Aleha told Truthout. In an 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 is announcing a new military veteran and 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.

But, since at least 2012, the military knew it had an accountability problem for programs on suicide, substance abuse, PTSD and sexual assault, according to unreleased Department of Defense (DoD) records provided to Truthout. While the military grappled with the psychological consequences of wars in Afghanistan and Iraq, the DoD was spending about $1 billion annually on mental health programs of questionable effectiveness with scant accountability, the unreleased DoD records, which include individual program evaluations, show.

In 2019, the DoD produced a final report out of a $53 million project that evaluated 139 military psychological health programs worldwide across the armed forces. It states that many programs, like Air Force Suicide Prevention, did not clearly track 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.

While the Air Force program prevented 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. No one knew, for example, if the lectures Landry attended increased help-seeking behavior and reduced 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 had been created or expanded, and no one knew how many existed, their cost or their 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 job went to the Defense Centers of Excellence. “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.”

Moreover, a series of directives demanded 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.

In 2016, then-Navy Captain Colston of the mental health oversight office 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. But, to do that, programs first had to collect the 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 Truthout followed up, asking for clarification.

The DHA also cited two non-concurring memos critical 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. Currently, the report is stuck in bureaucratic limbo, as its findings become increasingly outdated. Still, experts argue there is still a need for rigorous assessment.

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.”