This report does not address veterans. However, approximately 80% of servicemember TBIs occur in a non-deployed setting. Efforts to address the stigma issue may be, at least in part, responsible for greater rates of mental health diagnoses. Not all costs of active duty and activated Reserve and Guard mental health treatment will appear in this chart, as not all servicemembers seek mental disorder treatment through the military health system. One recent study stated that the "quality of mental health care and counseling offered in DOD is unknown, and efforts to improve quality, such as training providers in evidence-based practice, are not integrated into the system of mental health care offered in DOD treatment facilities." In contrast, the unadjusted general population lifetime prevalence of PTSD in adults appears to be 8%; Neurobiology — Further research is needed to identify biomarkers of PTSD, brain imaging diagnostic models, and effective pharmacologic agents to enhance therapy-related learning; Programs and Services for PTSD in the DO D and VA — Both the DOD and VA have a played an active and pivotal role in the prevention, screening, diagnosis, and treatment of PTSD; however, further evaluation is needed to identify the effectiveness of these efforts; Prevention — DOD supports several PTSD prevention programs that build resiliency and teach servicemembers to anticipate some of the traumatic events commonly experienced in combat zones; Screening and Diagnosis — Screening measures for PTSD are essential to the identification of servicemembers and veterans that need treatment. Executive Order 13625

Executive Order 13625, "Improving Access to Mental Health Services for Veterans, Service Members, and Military Families," issued on August 31, 2012, contained a number of provisions designed to increase access to and the quality of mental health care for active duty servicemembers, including establishing an interagency task force with an annual reporting requirement as well as providing for increased mental health care staffing within the Department of Veterans Affairs. While Congress has taken significant interest in issues related to the psychological health of the active duty forces, including PTSD, alcohol and substance abuse, depression, traumatic brain injury, and other mental health concerns, significant areas for potential congressional oversight remain. These include:

		Research

The physical manifestations in the brain of mental health conditions, including PTSD, are poorly understood. Congress may also wish to examine the effectiveness of DOD initiatives to encourage servicemembers to seek care, and reduce the stigma of seeking mental health care. Congress may wish to be apprised of these evaluation efforts. Costs of Mental Health Care Treatment

DOD's spending on mental health care treatment has increased, as the number of active duty servicemembers receiving diagnoses of mental health conditions and seeking treatment for these conditions has increased. Psychological Health in the Active Duty Forces

Within the active duty forces, psychological health issues include diagnosed mental disorders, such as depression or PTSD, as well as other mental health problems, such as problems with personal relationships or family circumstances. Therefore, the servicemembers who deploy repeatedly may be more resilient. The report stated that the RAND National Defense Research Institute as well as the DOD Suicide Prevention Task Force were undertaking evaluations of matters related to suicide prevention.
Military servicemembers suffering from post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), and depression, as well as military suicides, continue to be a major concern of Congress. Numerous legislative provisions have been enacted over the past years to address these issues. Members will likely seek to offer legislation in the 113th Congress to address this complex set of issues. This report is intended to provide assistance in understanding the issues associated with psychological health in the active duty forces, potential congressional responses, and what questions may remain unanswered.
Key points in this report include the following:
mental disorders such as PTSD are poorly understood and in most cases cannot be physically identified but, rather, must be diagnosed using symptoms reported by the servicemember; estimates of the prevalence of mental health conditions in any given population may be greatly affected by the methodology used; diagnoses of mental health conditions among active duty servicemembers have increased substantially relative to non-deployed servicemembers. This increase may be due to the psychological toll of exposure to conflict, but may also be due in part to increased and improved screening methods as well as Department of Defense (DOD) efforts to reduce the stigma associated with seeking mental health treatment that might dissuade some servicemembers from reporting mental health concerns or accessing care; and reliable evidence is lacking as to the quality of mental health care and counseling offered in DOD facilities. A 2012 Institute of Medicine (IOM) study recommended that DOD undertake efforts to measure the effectiveness of efforts to improve quality, such as training providers in evidence-based practice, that are not integrated into the system of mental health care offered in DOD treatment facilities.
Significant areas for potential congressional oversight activities regarding psychological health in the active duty forces include the following:
research into the causes and physical manifestations of psychological health conditions, screening tools, and treatments; the effectiveness of screening and treatment efforts; servicemembers' access to mental health care, including efforts to reduce the stigma of seeking mental health care, waiting times for care, staffing levels of mental health treatment professionals, mental health care available in remote or deployed settings, and care available to de-activated Reserve and Guard members; the quality of mental health care available to servicemembers, including the use of appropriate and effective treatments by qualified mental health treatment professionals; oversight of ongoing program evaluation efforts, including evaluation of the variety of suicide-prevention, stigma-reduction, and transition assistance programs within the services and DOD; and the costs of mental health care for active duty servicemembers, including present costs through the Defense Health Program, as well as the future costs of mental health care once servicemembers are no longer part of the active duty forces.