The national mental health reform program that went into effect last summer is expected to shake things up in the Israel Defense Forces, which is anticipating a significant increase in youths who will report for the draft with psychiatric diagnoses that do not necessarily reflect their mental state.
As a result, the army is likely to take all such diagnoses with a grain of salt, and perform more of its own evaluations to assess the conscripts’ true emotional condition. The army will also reevaluate some of the psychological criteria that currently restrict the assignment of conscripts to certain military jobs.
“Because we understand we will have more guys marked with all kinds of psychological rankings, we want to make the system more flexible,” said Dr. Ariel Ben Yehuda, head of the clinical mental health branch in the IDF, addressing a recent conference of the Israel Child and Adolescent Psychiatric Association. “For example, by updating the list of jobs and taking a list of 100 quality jobs that are closed to people with psychiatric diagnoses and opening them up, because we think there is no problem with doing so.”
The mental health reform is meant to expand mental health services and make them more accessible to the public through the HMOs. But a sore point – which has been criticized by professionals – is that before receiving psychological or psychiatric help, patients must obtain a psychiatric diagnosis.
As a result, people suffering from some sort of temporary distress cannot get help, or even worse; they may play along to obtain a diagnosis that doesn’t really reflect their condition – but which will be registered in their medical files and follow them throughout their lives, including their military service. According to the professionals, the most common diagnosis is “adjustment disorder,” a personality disturbance that doesn’t sound particularly harmful, but includes a wide range of symptoms like depression, anxiety, inability to cope with stress, and various physical symptoms.
The IDF is aware that under the new rules, psychiatrists might issue diagnoses to young people so that they can receive treatments that in the past they could have received without being so labeled, which is why Ben Yehuda asked the physicians he was addressing to be aware of the ramifications and to cooperate with the military medical system.
He noted that the new regulations were making many military doctors uncomfortable. “We take seriously anyone who comes and tells us that the psychiatrist who saw him recently decided that the diagnosis he received in sixth grade is no longer relevant,” and now the military will likely be confronted with large numbers of such discrepancies.
Medical information about conscripts comes from their family doctors via a form the draftees are meant to have the doctors complete for the IDF. Not all family doctors take the forms seriously. Evaluating the mental state of draftees is based on several sources of information: an initial meeting with a psychotechnic evaluator as part of the induction process, the declaration by the conscript, a meeting with a mental health professional in certain cases, and from information the army requests regarding hospitalizations for mental health issues.
In general, any mental health diagnosis leads to a drop in the soldier’s medical profile and limits the tasks he will be eligible for during his military service. The psychiatric diagnoses that qualify a patient for treatment under the reform will automatically disqualify a recruit from combat service, except for a diagnosis of trichotillomania, which is a compulsive urge to pull out one’s hair.
The military system, however, is trying to be more flexible with recruits, Ben Yehuda said.
“By definition, when you say psychiatric disturbance, you’re talking [medical] profile,” he said. “Sometimes, during the course of service, we allow all kinds of exceptions for various nuances. When we think that giving a certain profile to someone won’t serve any purpose in terms of his routine behavior, we sometimes avoid giving a [low] profile for ethical reasons, not medical ones.”
The military system, he added, has some of its own mental health classifications that are not clinical diagnoses, like “adjustment difficulty,” which has nothing to do with the above-mentioned adjustment disorder. This is an internal classification with differing levels that allow conscripts access to a wider range of jobs. “The idea behind the adjustment difficulty classification is that it doesn’t block the candidate from a specific job but allows him to serve under special circumstances – close to home, for example,” Ben Yehuda said.