From Former Army Psychiatrist, Answers On Mental Health Treatment

The recent shooting at the Fort Hood Army base has raised questions about how the military deals with mental health issues. Melissa Block talks with Doctor Steve Xenakis, a retired Retired Brigadier General in the Army and a psychiatrist, about the stresses of military life and how mental illness is treated in the military.

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MELISSA BLOCK, HOST:

According to the commander at Fort Hood, the shooter, Ivan Lopez, had an unstable psychiatric condition. The secretary of the Army told Congress yesterday that Lopez was undergoing treatment for a variety of mental health conditions, including depression, anxiety and insomnia, and he'd been prescribed a number of drugs to address those.

To talk about some of the questions this raises about mental health and the military, I'm joined by Dr. Steve Xenakis. He's a former brigadier general, retired from the Army. He served as chief psychiatrist at Fort Hood back in the '80s and was part of the crisis response team sent there after the mass shooting in 2009. Dr. Xenakis, welcome to the program.

STEVE XENAKIS: Good to be here.

BLOCK: Army officials are saying that Ivan Lopez had received a full psychiatric evaluation one month ago. According to the Army secretary, that review didn't indicate any sign of likely violence either to himself or to others. So I wonder how hard it is to predict future violent acts from your perspective as a psychiatrist.

XENAKIS: Well, I think the first thing is that it was a month before the incident occurred, and the question, what happened after that. I mean, how many times was he seen between that evaluation and the time of the incident? Because a lot can change in terms of a person's feeling of instability or their mood, explosiveness. I would like to learn more about had he been seen frequently between that time and how closely he was being monitored.

BLOCK: So the time factor is one concern. I've been looking at a Pentagon review after that 2009 shooting, and they said this, that in terms of assessing violence indicators, research-based screening questions do not exist, and there is no current ability to reliably predict violence. Does that seem about right to you?

XENAKIS: It does. I mean that's why seeing people frequently is important, particularly if there are other reasons to suspect that their mental health might deteriorate, and they could in fact act in a way that they'd be dangerous to themselves or others. And clinicians I think need to take positive action to instruct people and prepare them and their families so that they'll be safe and that they'll be secure and that they know what they need to do to protect themselves.

BLOCK: That Pentagon review also found that the existing policies didn't really address all the risk factors or violence indicators, which would be financial or occupational trouble, things like that, not the Nidal Hasan scenario of a self-radicalized terrorist but internal pressures.

XENAKIS: I think that's the case. I have felt for some time, and I was advising the senior Army leadership and the leadership of the Department of Defense, that we needed to broaden our view of the stresses. We need to bring it all together in a way that we get a holistic picture of the soldiers and the families. The way the Army works is programs are siloed, and so financial support's in one particular service, and drug and alcohol and family support and employment, and there's not a place where it's all brought together, and somebody can get a good picture of the soldier's world.

BLOCK: Of course there's a lot that's still not known about the particulars of Ivan Lopez' case, but based on what you've read and what the Army has said about him, do you see concerns, indicators of something that you would've worried about something going wrong?

XENAKIS: Yeah, right, I mean, I don't know, so I'm speculating, but a couple things that I've seen that worry me is he was having financial stresses, problems. The other factor that I've read, his parent died in the fall. You know, that can certainly induce serious grief, and it can even further weigh down on a person's mental state.

BLOCK: And as you step back and think broadly about what happened at Fort Hood and what it might mean for the military going forward, where does that take you?

XENAKIS: Well, I mean, I think it means that as we look at the downsizing, really the climate and the pressures that come with that are going to be felt intensely with those soldiers that might have to get out and they don't want to get out. So this is a tough time, and resources are being reduced, and people are going to have to figure out how to do it and avoid these kinds of incidents.

BLOCK: Well Dr. Xenakis, I appreciate your talking to us. Thank you so much.

XENAKIS: Thanks for calling.

BLOCK: That's Dr. Stephen Xenakis, a psychiatrist and former brigadier general, retired from the Army.

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