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Assessing Fitness for Military Enlistment: Physical, Medical, and Mental Health Standards
entered into the system; in other cases, data accessibility is limited due to privacy concern; and in still other cases, relevant data on conditions and outcomes are not linked.
As for all other categories of health and medical conditions, data on the number and percentage of applicants who are screened out at the recruiting stations for mental health reasons are not collected. Data on the number and percentage of medical prescreens identified with mental health issues (positive response to Item 16 on the medical prescreen form) that are forwarded to the MEPS are also not collected.
The committee obtained data from the MEPCOM Integrated Resource System (MIRS) for medical failures and waivers from May 1, 2003, to April 30, 2005, in all active forces. Of 429,116 total applicants, 4,303 failed for psychiatric reasons (Code 40), or 6.1 percent of all failures. Of the 4,303 failures, 1,468 were granted a waiver (34 percent). Using standardized medical billing and diagnostic codes (International Classification of Diseases [ICD]), the 4,303 psychiatric failures are divided among roughly 50 diagnoses, of which roughly 25 percent are attention deficit and hyperactivity disorder and related problems, 15 percent are drug and alcohol abuse and related disorders, and the remainder are categorized among a wide range of mood and anxiety disorders (see tables in Appendix B).
The number and percentage of recruits per year who leave the military during basic or advanced training due to all psychiatric conditions are available, but not for specific diagnoses or mental illness conditions. The number and percentage of recruits with mental health waivers who leave during basic or advanced training are believed to be available by linking existing databases, but this information is not generally sought nor used by the military, not routinely monitored for patterns or trends, and not routinely available. The number and percentage of applicants with mental health waivers who receive mental health care in basic or advanced training could possibly be determined through detailed review of individual medical charts and personnel databases, but for obvious reasons this approach has some significant cost implications, as well as raising the issue of privacy concerns. Similarly, no data are available about the attrition of recruits who have received outpatient mental health care, but these data could also be developed with appropriate direction and financial support.
The 2003 Annual Report of the Accessions Medical Standards Analysis and Research Activity makes limited data available about mental health disqualifications, waivers, hospitalization, and “existing prior to service” discharges:
Mental health disqualifications: In 2002, the mental health conditions for which medical disqualifications occurred at the MEPS were