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Over the nearly 30 years that passed between the end of the Vietnam War and the initiation of combat operations in Afghanistan and Iraq, significant changes occurred in both the military and in the field of behavioral health. For the military, Vietnam brought the end of a very unpopular war in which returning service members were not viewed as heroes, but rather treated very poorly. Indeed, many service members themselves were ashamed of their service.
The military at that time dominantly consisted of draftees who served 1 year tours in Vietnam and subsequently left the service. Reports throughout the conflict were rampant with allegations of maladaptive behaviors to stress to include drug and alcohol abuse, fratricide, unethical battlefield behaviors, and numerous unpro- fessional behaviors within the local village communities.
Since that time, the military made significant transitions to an all-volunteer force, which also focused on combating those maladaptive behaviors by instituting ethical principles and values expected of all soldiers. As time progressed though, the perceived need by the American public and Congress for the military declined, especially after rapid and successful military actions such as Grenada, Panama, and the stunning success against the Iraqi Army in Operation Desert Storm/Desert Shield. These swift and decisive victories, coupled with the fall of the Soviet Union and victory in the Cold War, left the USA as the sole super power in the world.
There was a corresponding belief that we no longer required a large standing military force. Over the decade of the 1990s, the military was significantly down- sized, as the thinking was that we would no longer engage in a large-scale war but rather smaller regional issues. The USA also thought that with our technological superiority of our equipment, we would not be challenged by large state actors. This led to limited involvement in Somalia, Bosnia, and Kosovo, operations other than war, that never carried a large military footprint.
The military medical system was initially spared from this reduction in force. However, many felt that much of the military healthcare system could be contracted or privatized and/or questioned the need for a uniformed military medical force.
Military psychiatry during this time saw a significant reduction with the closure of teaching programs and hospitals and a reduction in the overall force strength. By the time Operation Enduring Freedom kicked off in 2001, less than 10 % of the mili- tary mental health force had any deployment experience.