Mental health issues in the armed forces

Adeoye Oyewole

I am not certain whether, some two decades ago, the Nigerian armed forces envisaged the possibility of a war of the terrorist type. The Nigerian military had been basking in the euphoria of decades of handling a civil war.

The exact status of the Nigerian military in terms of artillery and other logistics necessary to engage  

in a fierce battle over the decades may not have been optimum apart from barely sufficient weaponry to guarantee the suppression of mutinous soldiers following a failed coup attempt; or to guarantee the success of a coup d’état.

The Nigerian military had contributed immensely to the continued existence and development of Nigeria. The ongoing war on terror is peculiarly challenging for our armed forces, not only in terms of the requisite training but also in the requirement of military hardware, coupled with a cumulative build-up of mental health issues.

In this warfare, the battle lines are not defined. The attacks are not only sporadic but idiosyncratic, as human shields are often employed in a way that can confuse the most effective military command.

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Psychiatrists in the U.S. military have tried to deal with these consequences, even when contributory to the military goal of preserving manpower and reducing the debilitating impact of psychiatric syndromes, by implementing screening programmes to detect factors that predispose individual to mental disorders, providing early intervention strategies for acute war-related syndromes, and treating long-term psychiatric disability after deployment.

Witnessing acts of warfare, including killing, torture, and widespread devastation, can be severely upsetting. Witnessing death, destruction and torture; experiencing unexpected and, at times, continuous threats to one’s life or particularly in hostilities and killing can potentially lead to mental health problems.

The rate of major depression is five times high among soldiers as it is among civilians; intermittent explosive disorder is six times as high; while post-traumatic disorder is nearly 15 times as high.

Nearly half of soldiers had some mental condition when they enlisted. One study finds that about 14 per cent of soldiers had thought about taking their own lives, though the main reasons for the surge remains unknown.

In a U.S. military study, almost 25 per cent of nearly 5,500 active-duty, non-deployed armed soldiers surveyed tested positive for a mental disorder of some kind; while 11 per cent within that sub-group also tested positive for more than one illness. Some of those conditions are related to the hard experience of a war time army, and nearly half of the soldiers who were diagnosed with a mental disorder had it when they enlisted.

When it came to suicidal thoughts, one study found that of the 14 per cent of soldiers who had thought about taking their lives, 5.3 per cent had planned suicide and 2.4 per cent had actually made one or more attempts. Although the causes for the rise in army suicides still remain unknown, some factors could be detected, especially for those with emotional problem at the point of recruitment.

In addition to these mental health issues, many soldiers have experienced traumatic brain injury or multiple concussions from combat. With effective treatment, 70-90 per cent of soldiers with mental illness achieve improved quality of life.

Military service can affect the family also, as adolescent children of military parents have greater emotional and behavioural problems than do adolescents whose parents are not in the military. It is important to remember that the mental health challenges that service members experience can have ripple effects on their immediate family while they are serving and upon their return home. There are a variety of things military famiy members and spouses can do to understand the warning signs of and treatment options for mental health issues, including talking with someone in their network of care who could be a psychologist, a relative or a religious leader. Again, such individuals could be referred to a psychologist who could do a mental health evaluation and management.

There is definitely a new but serious challenge for the Nigerian military medical corps, especially following the new engagement with war on terror. There is, of necessity, the need to create a strong mental health department within the medical corps that will be actively involved in screening individual for mental illness, especially at the point of recruitment.

As a consequence of involvement in active combat, soldiers need to be evaluated from time to time for the occurrence of mental health issues and promptly managed. Some of the cases that are interpreted as disobedience to the commanding authorities either at the war front or at the barracks even before deployment may have mental health undertones. There is also the need for robust rehabilitation for soldiers who are discharged from the military, in order to enhance their reintegration into the civilian population.

Not to be left out are widows, widowers and orphans of dead soldiers who should enjoy such rehabilitative efforts, with mental agenda as a crucial focus

  Adeoye Oyewol