Contribution of Military Organization and Leadership Factors in Perpetuating Generational Cycle of Preventable Wartime Mental Health Crises: Part One

Abstract

This is the first of a two-part series of the contribution of organizational and leadership factors in perpetuating a generational cycle of preventable wartime behavioral health crises. The current study includes a comprehensive review of government-initiated studies on the policies, leadership, and organizational structure of military mental healthcare. Among other things, the paper reports on the persistent, serious inadequacies within the U.S. Department of Defense including fragmentation, gross inefficiencies, inadequate coordination, lack of leadership accountability and responsibility both within and across military mental health across all branches. It is hypothesized that these problems have led to past and present wartime crises and are linked to ignoring documented lessons learned. These lessons point to the need for an integrated, coordinated organizational structure with a clear chain-of-command and accountable leadership. Such leadership, it is argued, will ensure adequate planning, preparation, and implementation to meet military mental health needs. While first-order changes have been made over the years through several incremental system corrections that have been tried, second-order (structural and systemic) change is necessary to “fix” the system. The latter section of the paper calls for and describes a complete reorganization of military mental health to improve mental healthcare for military populations.