STEVE INSKEEP, HOST:
It's MORNING EDITION from NPR News. I'm Steve Inskeep.
DAVID GREENE, HOST:
And I'm David Greene. Good morning.
The lawyer for the soldier suspected of killing unarmed Afghan civilians last week says his client may have suffered from diminished capacity - or, in other words, a mental breakdown. That possibility has focused attention on the Army's ability to detect and treat psychological problems among soldiers. NPR's Martin Kaste reports on how the Army's system works in theory and in practice.
MARTIN KASTE, BYLINE: The Army has been under a lot of pressure to do more for soldiers with conditions like post traumatic stress disorder. In 2010, Congress mandated more intensive screening. And the Army is following orders.
COL. REBECCA PORTER: The screening begins while they're still in theater.
KASTE: Col. Rebecca Porter is chief of behavioral health in the U.S. Army Surgeon General's office. She says soldiers in combat zones get a preliminary assessment from their superiors.
PORTER: It's a form - almost like a spreadsheet - that they complete on their soldier. And it comes back, then, through medical channels to us.
KASTE: That's supposed to warn the Army about returning soldiers who showed troubling behavior while overseas. But there aren't always outward signs, so the Army also has the returning soldiers answer questionnaires.
PORTER: Asking about difficulty sleeping, for example. Or are you having financial difficulties?
KASTE: The problem is, those questions are pretty transparent.
SCOTT SWAIM: Doesn't take a rocket scientist to realize what they're asking you.
KASTE: Scott Swaim is a licensed mental health counselor who works with veterans, most of whom come out of Joint Base Lewis-McChord, the home installation of Sgt. Robert Bales, the suspect in the Afghanistan massacre. Swaim says it's tempting for soldiers to, as he puts it, pencil-whip their way through the mental health questionnaires.
SWAIM: A person that just says no, no, no, no, no - and then you move on. Because you know if you say yes, then you're either not moving on - and you're going to get held up in the line, which pulls you out of your team, which - nobody wants to be, really, pulled out of their unit.
KASTE: He says you answer yes only if you really want the Army to know you need psychological help. Swaim is a counselor for a program that's run by the state of Washington. And even though the program is meant for vets, it also attracts some active-duty soldiers. They come in looking for the kind of confidential therapy that they don't think they can get on base.
SWAIM: Whatever you say goes through the chain of command and becomes that whole, unfortunate joke about being part of your permanent record. And indeed, it is.
KASTE: Col. Porter says that's not quite true. She says Army counseling is confidential, with certain caveats.
PORTER: Unless there's some indication that their duty performance is going to be impacted or they're dangerous to themselves or others, those of us in the behavioral health field cannot report to the commander that the soldier's in treatment.
KASTE: That's not very reassuring to Greg Miller. He was just discharged from Joint Base Lewis-McChord. And while he was deployed to Iraq, he says he couldn't sleep and wondered if he was losing his mind. When he got home and asked for help, he says the mental health system on base was like an assembly line.
GREG MILLER: Kind of like they're tech support. They're reading off a list: Well, is it turned on? Is it plugged in? Well, how about this? How about that? Well, try this, you know.
KASTE: And as to confidentiality, Miller says his Army-provided counselor wouldn't give him a straight answer.
MILLER: There was a fine line, and she couldn't quite say where it was. But she was going to decide when I crossed it, and they will notify your chain of command if they think you're a threat to yourself or someone else. So it's out there, but they can't tell you exactly where. But I don't know what that means.
KASTE: Real mental health confidentiality may not be possible in the armed forces, says counselor Scott Swaim. He used to be in the Air Force. And he says the reality is, the mission comes first.
SWAIM: If I'm flying an aircraft with five individuals and one of them can't do it, for some reason, I'd probably want to know why.
KASTE: He believes the lack of confidentiality might just be an unfortunate sacrifice that's inherent to serving in the military.
Martin Kaste, NPR News. Transcript provided by NPR, Copyright NPR.
