Approximately 4 million U.S. service members took part in the wars in Afghanistan and Iraq. Shortly after troops started returning from their deployments, some active-duty service members and veterans began experiencing mental health problems. Given the stressors associated with war, it is not surprising that some service members developed such mental health conditions as posttraumatic stress disorder, depression, and substance use disorder. Subsequent epidemiologic studies conducted on military and veteran populations that served in the operations in Afghanistan and Iraq provided scientific evidence that those who fought were in fact being diagnosed with mental illnesses and experiencing mental healthâ€"related outcomesâ€"in particular, suicideâ€"at a higher rate than the general population. This report provides a comprehensive assessment of the quality, capacity, and access to mental health care services for veterans who served in the Armed Forces in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn. It includes an analysis of not only the quality and capacity of mental health care services within the Department of Veterans Affairs, but also barriers faced by patients in utilizing those services.

The U. S. Secretary of the Army appointed the Fort Hood Independent Review Committee(FHIRC or Committee) and directed it to "conduct a comprehensive assessment of the Fort Hoodcommand climate and culture, and its impact, if any, on the safety, welfare and readiness of ourSoldiers and units." In addressing this mandate, the FHIRC determined that during the time periodcovered by the Review, the command climate relative to the Sexual Harassment/Assault Responseand Prevention (SHARP) Program at Fort Hood was ineffective, to the extent that there was apermissive environment for sexual assault and sexual harassment.As set forth in this Report, specific Findings demonstrate that the implementation of theSHARP Program was ineffective. During the review period, no Commanding General or subordinateechelon commander chose to intervene proactively and mitigate known risks of high crime, sexualassault and sexual harassment. The result was a pervasive lack of confidence in the SHARP Programand an unacceptable lack of knowledge of core SHARP components regarding reporting and certainvictim services. Under a structurally weak and under-resourced III Corps SHARP Program, theSexual Assault Review Board (SARB) process was primarily utilized to address administrative and notthe actual substantive aspects of the Program. While a powerful tool by design, the SARB processbecame a missed opportunity to develop and implement proactive strategies to create a respectfulculture and prevent and reduce incidents of sexual assault and sexual harassment. From the III Corpslevel and below, the SHARP Program was chronically under-resourced, due to understaffing, lack oftraining, lack of credentialed SHARP professionals, and lack of funding. Most of all, it lackedcommand emphasis where it was needed the most: the enlisted ranks.A resonant symptom of the SHARP Program's ineffective implementation was significantunderreporting of sexual harassment and sexual assault. Without intervention from the NCOs andofficers entrusted with their health and safety, victims feared the inevitable consequences of reporting: ostracism, shunning and shaming, harsh treatment, and indelible damage to their career. Many haveleft the Army or plan to do so at the earliest opportunity.As part of the command climate, the issues of crime and Criminal Investigation Division(CID) operations were examined. The Committee determined that serious crime issues on and offFort Hood were neither identified nor addressed. There was a conspicuous absence of an effectiverisk management approach to crime incident reduction and Soldier victimization. A militaryinstallation is essentially a large, gated community. The Commander of a military installation possessesa wide variety of options to proactively address and mitigate the spectrum of crime incidents. Despitehaving the capability, very few tools were employed at Fort Hood to do so. Both the Directorate ofEmergency Services (DES) and the CID have a mandate and a role to play in crime reduction.Each contributed very little analysis, feedback and general situational awareness to the command towardfacilitating and enabling such actions. This was another missed opportunity.The deficient climate also extended into the missing Soldier scenarios, where no onerecognized the slippage in accountability procedures and unwillingness or lack of ability of noncommissioned officers (NCOs) to keep track of their subordinates. The absence of any formalprotocols for Soldiers who fail to report resulted in an ad hoc approach by units and Military Police(MP) to effectively address instances of missing Soldiers during the critical first 24 hours, again withadverse consequences.Consistent with the FHIRC Charter, this Report sets forth nine Findings and offers seventyRecommendations.

The health and economic costs of tobacco use in military and veteran populations are high. In 2007, the Department of Veterans Affairs (VA) and the Department of Defense (DoD) requested that the Institute of Medicine (IOM) make recommendations on how to reduce tobacco initiation and encourage cessation in both military and veteran populations. In its 2009 report, Combating Tobacco in Military and Veteran Populations, the authoring committee concludes that to prevent tobacco initiation and encourage cessation, both DoD and VA should implement comprehensive tobacco-control programs.

Transmittal letter.