On behalf of those who are suffering and will continue to suffer from the adverse consequences of the Department of Defense, Veterans Affairs, and command policies addressed herein, we recommend these changes be implemented immediately. The following recommendations are organized by policy area, and within each policy area, for the Department of the Army.
Ensure Respect for Soldiers’ Profiles
Violations of soldiers’ medically necessary work restrictions violates their rights to health and well-being. Commander discretion over soldiers’ profiles and access to treatment not only interferes with soldier well-being by impeding the treatment plan, but also perpetuates stigma against injured soldiers, and promotes a culture of fear whereby soldiers avoid seeking care.
End commander discretion over medically necessary work restrictions expressed by soldiers’ medical and mental health care providers, to ensure doctor’s orders are upheld within the chain of command. Ensure that no member of any of the DoD’s forces is forced to work or deploy against medical advice.
- DoD, as well as all branches of the US military, must implement specific policy and enforcement mechanisms barring commander discretion over the professional advice of medical and mental health practitioners working in the military.
- Install enforcement mechanisms and reporting procedures to address commanders who fail to support the pursuit of health care.
Stop Over-Medicating Soldiers and Unethically Prescribing Psychotropic Medications
Increase non-pharmaceutical treatment options for traumatic injuries and mental health concerns, as well as for medical conditions which would benefit from non-pharmaceutical treatment—such as referrals to specialist care and further testing.
Per the instruction of the DoD Inspector General, DoD must issue comprehensive policy to track and reconcile medication management in all departments and establish drug take-back programs.
Enhance medication management and oversight for any soldier prescribed multiple psychotropic medications. Provide easy access to civilian psychiatrist referrals where additional medication management is needed.
Discontinue the issuing of prescriptions without the assignment of diagnoses for complex medical conditions and mental health treatment.
Institute medication evaluations at an enforced standard of every three months, at minimum wherever psychotropic prescription drug treatment is necessary.
Install means for closely monitoring any soldier prescribed multiple or off-label psychoactive drugs for the treatment of PTSD and other mental health conditions. Severely restrict the prescription of benzodiazepines, atypical anti-psychotics, and other off-label drugs for the treatment of mental health conditions.
Provide Soldiers Adequate Physical and Mental Health Care
Increase the ratio of mental health professionals to soldiers both on base and in theater to ensure timely access to care and continuity of care, and expand referrals to civilian providers when necessary to meet soldiers’ needs for timely care and diagnosis.
- Reduce reliance on physicians assistants and medics instead of physicians for the diagnosis and treatment of conditions beyond their scope of practice.
- Ensure adequate civilian providers are covered under military insurance plans, emphasizing coverage for specialist providers.
Support service members in following through on treatment plans by providing child care during medical appointments and allowing passes to attend appointments during work hours, regardless of training schedules.
- Commanders and NCOs should not be permitted to disallow soldiers from attending health care appointments. DoD, DoA, and Fort Hood command should issue new policy clarifying command adherence to soldier appointments, and devoting resources to facilitate soldiers’ attendance.
Ensure that every soldier preparing to deploy is proactively contacted by a mental health provider who is assigned as their provider before and after deployment.
Improve tracking, record-keeping, and communications between health care providers.
Provide consistent medical records to the service-member at all times and to Veterans Affairs immediately upon discharge, to ensure continuity of care and diminish long transition times to access proper VA treatment.
Ensure Proper Command Response and Comprehensive Treatment for Military Sexual Violence
DoD and Fort Hood Command must work to ensure comprehensive physical and mental health treatment for survivors of sexual harassment and violence, and institute consistent command response with a focus on victim protection in cases of sexual violence. Training and leadership on sexual violence must turn away from victims and instead focus on perpetrators and leadership accountability for eradicating sexual violence, and must work to reduce the prevalence of sexual violence on both male and female service-members.
Ensure comprehensive physical and mental health treatment for survivors of sexual violence by instituting further protections and bolstering existing programs.
- Protect survivors of sexual violence from under-diagnosis of mental health conditions by instituting special treatment reviews for survivors within military treatment facilities, along with offering referrals to civilian mental health providers specializing in treating survivors of sexual violence.
- Honor records and diagnoses when they are voluntarily submitted by civilian providers treating victims of sexual violence.
Install means for consistent, comprehensive command response to instances of sexual violence, that focus on supporting and respecting the survivor.
- Implement protocols for victims to transfer units after reporting a sexual harassment or assault without approval from their direct chain of command.
- Institute mandatory evaluation criteria for NCOs on how well they address military sexual violence.
- Include commander and NCO evaluations on leadership climate for eradicating military sexual violence in regular performance and promotion reviews and make the results publicly available.
Ensure Confidentiality and Adherence to Principles of Medical Ethics
Ensure neither physicians assistants, nor any other medical or mental health personnel, are placed under any pressure or quotas for sending soldiers back to work when medically evaluating them.
Ensure soldiers have a right to confidentiality with their medical and behavioral health providers by requiring commanders and others privy to private health information to adhere to standard health care privacy regulations.[14
- Establish means of redress and accountability for breaches of confidentiality and improper release of private health information. If such breaches result in adverse effects on soldiers, e.g. in discharge proceedings, due compensation should be awarded.
Medical and mental health care providers serving in the US military should be governed by the same medical and mental health codes of ethics as civilian providers.
- DoD should allocate resources for regular, periodic review of adherence to these standards in all military treatment facilities and screening procedures, to be implemented by independent oversight bodies working in partnership with military leaders.
- Ensure that providers working in military treatment facilities adhere to ethical standards of care and diagnosis. Providers should never be placed under institutional duress or instruction to short-cut psychological evaluations or prescribe medication in any fashion otherwise than is standard in civilian medical practice.
Reinforce Soldier Care and Develop Leadership Accountability Mechanisms
Institute standards for soldier care a regular, binding, and enforceable component of the review and evaluation of leadership.
- Subject commanders and NCOs to regular, periodic review regarding their promotion of health care and well-being for soldiers in their charge, including their ability to foster a unit culture which works to destigmatize these issues.
- Include sections for adherence to profiles, promotion of health care, and destigmatization in NCO and Officer Evaluation Reports and make them integral criteria for promotion.
- Institute anonymous evaluations of NCOs and commanders by junior enlisted which are also considered on NCOERs and other leadership evaluations.