Claire Dawson
The US Department of Defense has a directive that outlines the mental health conditions that prevent someone from serving in the armed forces. The US Army has specific criteria for psychiatric hospitalizations that can lead to a Medical Evaluation Board (MEB), which is the first step in military discharge or retirement. These criteria include the persistence or recurrence of symptoms that require extended or recurrent hospitalization, as well as the failure of diagnosed psychiatric conditions to respond to treatment within a year. The frequency of MEBs varies depending on the career field, and further research is needed to understand the underlying causes of these variations.
| Characteristics | Values |
|---|---|
| Psychiatric hospitalizations before MEB Army | Psychiatric hospitalization among youth ages 5-18 from 1990-1999 increased by 22% (from 8% in 1990 to 21.5% in 1999) |
| 20-60 out of 10,000 older adolescents who the military draws its enlistees from will be hospitalized as part of their treatment program | |
| 45% attrition rate within six months following hospitalization for a mental disorder in the U.S. military | |
| Hospitalization data is available for Army active enlistees for the period 1997-2002 | |
| Psychiatric conditions were the second leading cause of discharge in the Army (15%) | |
| Anxiety disorders: cannot enter the armed services if inpatient care or outpatient care for more than 12 months cumulatively was needed | |
| Affective Disorders: when the persistence or recurrence of symptoms requires extended or recurrent hospitalization | |
| Serious psychiatric illnesses that result in hospitalization require an MEB | |
| Referral to an MEB: diagnosed psychiatric conditions that fail to respond to treatment or restore the Soldier to full function within 1 year of onset of treatment | |
| Referral to an MEB: persistence or recurrence of symptoms sufficient to require extended or recurrent hospitalization |
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What You'll Learn
Anxiety, somatoform, dissociative, neurotic, and affective disorders
The US Department of Defense has a directive that provides a detailed list of mental health conditions that prevent a person from serving in the armed forces.
Anxiety disorders, such as panic disorder, obsessive-compulsive disorder, and generalized anxiety disorder, are among the conditions that disqualify individuals from military service. To be eligible for enlistment, individuals with anxiety disorders must not have received any inpatient care or outpatient care for more than 12 months cumulatively in the past 36 months.
Somatoform disorders, which are characterized by physical symptoms that cannot be explained by a medical condition and often overlap with anxiety and dissociative disorders, are also disqualifying conditions.
Dissociative disorders, including depersonalization and conversion disorders, are another category of mental health disorders that can prevent individuals from joining the military. These disorders involve a disruption in an individual's sense of identity or consciousness, and a history of these disorders is a disqualifying factor.
Neurotic disorders, while not specifically mentioned in the sources, likely fall under the broader categories of anxiety, somatoform, or dissociative disorders. These disorders are characterized by excessive anxiety, fear, or other negative feelings that are out of proportion to the situation and interfere with an individual's ability to function.
Affective disorders, also known as mood disorders, are another type of mental health condition that can affect an individual's eligibility for military service. These disorders include depressive disorders, such as major depressive disorder, and bipolar disorder. To be eligible for enlistment, individuals with depressive disorders must be stable and free of treatment or symptoms for a continuous period of 36 months. Bipolar disorder, on the other hand, is a disqualifying condition.
It is important to note that the rules for military enlistment are designed to protect individuals with mental health conditions and ensure their safety within the military. However, some advocates argue that the military should focus more on identifying and treating mental illnesses in recruits and established service members rather than solely on disqualification.
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Recurrent hospitalization and limitations of duty
The persistence or recurrence of symptoms that necessitate extended or recurrent hospitalization is a key criterion for referral to an MEB. This indicates that multiple hospitalizations for a psychiatric condition could lead to an MEB evaluation. However, the specific number of hospitalizations required is not explicitly stated and may vary depending on the individual's case and military branch.
Additionally, the focus is on the impact of the psychiatric condition on the service member's ability to perform their duties effectively. Recurrent symptoms that necessitate limitations of duty or the need for a protected environment are also considered grounds for an MEB referral. This means that if a service member's psychiatric condition repeatedly interferes with their ability to carry out their assigned tasks or requires significant adjustments to their duties, it could result in an MEB evaluation and potential discharge.
It is important to note that the MEB process aims to ensure the well-being of service members and maintain the operational effectiveness of the military. While recurrent hospitalizations and limitations of duty are significant factors, they are assessed in conjunction with other criteria, such as the response to treatment, the severity of the condition, and the individual's career field.
Advocates have called for increased efforts to identify mental illness in both recruits and established service members, not solely for the purpose of discharge, but to provide earlier treatment and assistance. This highlights the need for a comprehensive approach to addressing mental health issues within the military, beyond the scope of hospitalizations and duty limitations.
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Mental disorders and impairment in reality testing
Mental disorders with impairment in reality testing can result in an individual being referred to a Medical Evaluation Board (MEB) and potentially discharged from the military. Reality testing is a psychotherapeutic function that allows an individual to reflect on and evaluate their relationship with the objective or real world. It is the ability to differentiate between self-generated stimuli (thoughts, imagery, feelings) and external stimuli (perceptions) and to assign appropriate meaning to experiences. Limited reality testing capabilities can be a function of a mental disorder. For example, hallucinations and delusions are often considered signs of a failure of reality testing.
Psychosis is a severe impairment in mental functioning with a disturbance in reality testing. Psychotic disorders include schizophrenia, schizophreniform disorder, schizoaffective disorder, and substance-induced psychotic disorder. To meet the DSM-IV criteria for schizophrenia, an individual must show continuous signs of a disturbance for at least 6 months, with two or more of the following symptoms present during a 1-month period: delusions and hallucinations. Delusions are fixed, false ideas that are inconsistent with an individual's culture or religion and cannot be corrected by rational argument. Hallucinations are perceptual experiences that occur in the absence of an actual stimulus, with auditory and visual hallucinations being the most common.
Bipolar disorder and schizophrenia have similar manifestations, including delusions, hallucinations, paranoia, and ideas of reference. Schizophrenia has an onset during adolescence in 40% of males and 23% of females and is associated with significant social deficits, poor initiative, abnormal thought processes, and a high risk of suicide. The prognosis of schizophrenia is guarded, with significant morbidity and mortality. Psychotic features may also be associated with mood disorders, trauma-related disorders, pervasive developmental disorders, and personality disorders.
In the context of the military, mental disorders with impairment in reality testing can lead to referral to an MEB if they fail to respond to treatment or restore the soldier to full function within 1 year of the onset of treatment. Recurrent hospitalization or persistence of symptoms necessitating limitations of duty or interference with effective military performance can also be grounds for referral to an MEB. For example, anxiety disorders, such as panic disorder, require inpatient or outpatient care that disqualifies an individual from entering the armed services. Other disqualifying conditions include obsessive-compulsive disorder, post-traumatic stress disorder, dissociative disorders, and a history of suicide attempts. However, some advocates argue that the military should focus more on identifying and providing treatment for mental illnesses in recruits and service members rather than discharging them.
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Eating disorders and treatment resistance
Eating disorders are a prevalent issue in the military, affecting both men and women across all branches. The exact rates of eating disorders in the military are unknown due to stigma, underdiagnosis, and underreporting. However, research suggests that female soldiers are six times more likely to be diagnosed with bulimia nervosa than women in the general population, with even higher rates among female marines. The military environment, with its emphasis on physical fitness, regular weigh-ins, strict regimens, and rules, can foster unhealthy coping mechanisms and contribute to the development of eating disorders.
Treatment for eating disorders in the military is crucial, as failing to respond to treatment within a year can lead to referral to a Medical Evaluation Board (MEB), which can result in military discharge or retirement. Various therapies are available to treat eating disorders, such as prolonged exposure therapy, cognitive processing therapy, eye movement desensitization and reprocessing, and cognitive behavioral therapy. These treatments aim to address the underlying trauma, change unhelpful beliefs, relieve stress related to traumatic memories, and modify behaviors associated with disordered eating.
Inpatient care is an intensive treatment option that provides round-the-clock treatment and care, minimizing triggers and stressors during early recovery. Other options include outpatient, partial hospitalization, and virtual care, which can be beneficial for those unable to commit to inpatient treatment.
While the military has implemented changes to fitness testing, such as removing waist circumference measurements in the Air Force, the unintended consequences of physical fitness standards on eating disorders in the Marines have been highlighted. Providing routine screening for at-risk populations can help identify active-duty patients with eating disorders.
The stigma surrounding mental health and eating disorders in the military can create barriers to treatment. However, seeking help is imperative to protect one's physical and mental health and the safety of their teammates and country. By talking about eating disorders and seeking treatment, service members can help lessen the stigma associated with these issues in the military.
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Referral to a Medical Evaluation Board (MEB)
The MEB is comprised of a group of medical authorities, with a minimum of two medical professionals, one of whom must be a physician. For psychiatric conditions, the case must be evaluated by a doctor of psychology or a psychiatrist. The MEB is responsible for gathering any additional information or evidence that may be needed by the Physical Evaluation Board (PEB). This includes medical records, commander's statements, and personal accounts to assess the severity of the condition and how it impacts military duties. The MEB will also write a Narrative Summary (NARSUM), which is a detailed medical report summarising the service member's medical condition, history, and treatment, and outlining how the condition affects the member's ability to perform their duties.
If the service member disagrees with the MEB, they can submit a rebuttal, which the MEB will consider and make changes if deemed appropriate. The MEB determines medical acceptability, but only the PEB has the authority to decide if a service member is unfit for duty. The MEB reviews the conditions and makes recommendations to the PEB on which conditions are medically unacceptable. If the MEB finds the service member's condition medically unacceptable, they refer the case to the PEB, which will decide on fitness for duty and potential separation or retirement. If the PEB needs more information, they may send the case back to the MEB for additional evidence.
The MEB process can significantly impact a service member's military career and future benefits. If the MEB determines that the service member's condition meets retention standards, they will return to duty and continue their military career. However, if the MEB finds that the condition does not meet retention standards, the case will be referred to the PEB, which will decide on the appropriate course of action.
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Frequently asked questions
MEB stands for Medical Evaluation Board, which is the first step in military discharge or retirement.
Referral to an MEB can be due to a diagnosed psychiatric condition that fails to respond to treatment or restore the soldier to full function within a year of onset of treatment. It can also be due to a mental disorder with gross impairment in reality testing, resulting in interference with social adjustment or duty performance. Persistence or recurrence of symptoms that require extended or recurrent hospitalization, necessitate limitations of duty, or interfere with effective military performance can also lead to an MEB referral.
Disqualifying mental health conditions for joining the U.S. military include a history of obsessive-compulsive disorder, post-traumatic stress disorder, dissociative or conversion disorder, depersonalization, hypochondriasis, somatoform disorders, or pain disorder related to psychological factors. A history of an adjustment disorder within the last six months, recurrent episodes of adjustment disorder, or paraphilias like voyeurism or exhibitionism are also disqualifying. Additionally, a history of alcohol or drug abuse, dependence, or suicidal behavior disqualifies individuals from joining the military.
A study from 1990 to 1999 in Washington State showed that the rate of hospitalization for school-age children (ages 5 to 14) increased by 22 percent during the 1990s. Among adolescents ages 15 to 19, there was no significant change in the rate of psychiatric hospitalization, but the proportion of hospitalizations due to psychiatric conditions increased from 14.5% in 1990 to 21.5% in 1999.
