The psychological health of active duty servicemembers has been an issue of significant concern for Congress in recent years, with particular attention to the links between deployments and psychological health concerns, such as post-traumatic stress disorder (PTSD). News stories have emphasized the challenges faced by some servicemembers returning from deployments, but psychological health is a salient issue for the entire active duty force. It should also be pointed out that mental health issues are not unique to servicemembers or military service. Research suggests that an estimated 26.2% of Americans ages 18 and older experience a diagnosable mental disorder in any given year. Within the Department of Defense (DOD), the Office of the Assistant Secretary of Defense (Health Affairs) is primarily responsible for the medical aspects of mental health issues. The individual military services (Army, Navy, Marine Corps, and Air Force) also conduct a variety of mental health programs and suicide prevention efforts. In 2012, a Defense Suicide Prevention Office was opened to provide suicide prevention services across all the services. This report will discuss the prevalence of different psychological health concerns within the Armed Forces, current mental health screening and treatments, and DOD responses. It will also provide an overview of the recommendations of key reports and studies, past congressional actions and funding, and current issues for Congress. Finally, the report discusses specific mental health issues, including PTSD, alcohol and drug use disorders, depressive disorders, traumatic brain injury, and suicide in more detail. This report does not address veterans. Veteran's mental health issues are addressed in CRS Reports CRS Report R41921, Mental Disorders Among OEF/OIF Veterans Using VA Health Care: Facts and Figures , by [author name scrubbed], CRS Report R40941, Traumatic Brain Injury Among Veterans , by [author name scrubbed], and CRS Report R42340, Suicide Prevention Efforts of the Veterans Health Administration , by [author name scrubbed]. Overall, mental health disorders have significant impacts on servicemember health care utilization, disability, and attrition from service. In 2011, mental disorders accounted for more hospitalizations of servicemembers than any other illness and more outpatient care than all illnesses except musculoskeletal injuries and routine medical care. Between 2001 and 2011, the rate of mental health diagnoses among active duty servicemembers increased approximately 65%. A total of 936,283 servicemembers, or former servicemembers during their period of service, have been diagnosed with at least one mental disorder over this time period (see Figure 1 ). Nearly 49% of these servicemembers were diagnosed with more than one mental disorder. Between 2000 and 2011, diagnoses of adjustment disorders, depression, and anxiety disorders (excluding PTSD) made up 26%, 17%, and 10% of all diagnoses of mental disorder diagnoses. Alcohol abuse and dependence disorders, and substance abuse and dependence disorders made up 13% and 4%, respectively. PTSD represented approximately 6% of mental disorder diagnoses over this time period. (See Figure 2 .) The rates of specific mental disorders have also changed dramatically between 2000 and 2011. The reported incidence of PTSD has increased approximately 650%, from about 170 diagnoses per 100,000 person years in 2000, to approximately 1,110 diagnoses per 100,000 person years in 2011. The incidence of anxiety, adjustment disorders, and depression diagnoses has also increased. By contrast, the incidence of alcohol abuse/dependence, schizophrenia, and personality disorders fell. (See Table 1 , Figure 3 .) Among the services, the Army, followed by the Marine Corps, has consistently had the highest incidence rates for PTSD, major depression, alcohol dependence, and substance dependence between 2007 and 2010, followed by the Navy and the Air Force. (See Figure 4 .) Hospitalizations for mental health mental disorders were steady between 2000 and 2006, before increasing more than 50% from 2006 through 2009, from 10,262 to 15,328. This increase in hospitalizations was driven by sharp increases in hospitalization for PTSD, depression, and substance abuse. Calculated by lost duty time, the Army has been the service most affected by hospitalizations of active duty servicemembers for mental disorders, followed by the Marine Corps. (See Figure 5 .) TBI has been considered a "signature injury" of the conflicts in Iraq and Afghanistan. However, approximately 80% of servicemember TBIs occur in a non-deployed setting. Common causes of TBI include vehicle crashes, falls, sports and recreation activities, and military training. Since 2001, it is reported that servicemembers have experienced about 255,852 TBIs, including approximately 212,741 incidences of mild TBI, approximately 20,168 incidences of moderate TBI, approximately 6,472 incidences of severe TBI/penetrating head injuries, and 16,471 unclassifiable TBIs. Incidents of mild TBI rose sharply between 2005 and 2007, due in part to more aggressive screening measures for mild TBI instituted in 2006. (See Figure 7 .) Diagnoses of TBI in deployed settings nearly doubled between 2010 and 2011, due in part to a greater focus on identifying and treating TBIs among deployed servicemembers. Beginning in 2010, suicide has been the second-leading cause of death for active duty servicemembers, behind only war injuries. Researchers have suggested that, similar to suicides among civilians, suicides by servicemembers are often impulsive acts triggered by various stressors, including relationship problems and financial or legal problems. Suicides among the active duty forces have increased between 1998 and 2012, rising from approximately 200 deaths by suicide in 1998 to 349 in 2012. Between 1998 and 2011, the incidence rate of deaths by suicide for active duty servicemembers overall was approximately 14 per 100,000 person years. Most of the increase in suicide rates between 2000 and 2011 has been concentrated in the Army and Marine Corps. Between 2005 and 2009, the incidence of suicide has nearly doubled for Army and Marine personnel, while remaining approximately level for Navy and Air Force personnel. In 2011, the suicide rate for Army personnel was approximately 23 per 100,000, while the rates for the Navy and Marine Corps were approximately 15 per 100,000 and the rate for the Air Force was approximately 13 per 100,000. While the rates of suicide in the Armed Forces overall have increased between 1998 and 2011, the rates for active duty servicemembers overall remain lower than for comparable civilian populations. Lower suicide rates among the Armed Forces have been attributed to a variety of factors, including the servicemember's full-time employment; "healthy-worker" effects, including a sense of belonging and purpose among active duty servicemembers; and universal access to health care among the military population. Accession into the uniformed services provides an opportunity to screen potential servicemembers for potential behavioral health issues. Certain learning, behavioral, and psychological conditions are considered disqualifying for military service. However, there is no required battery of psychological tests for accessions into the military other than the learning and behavioral questions on the Armed Services Vocational Aptitude Battery (ASVAB). During the course of the history and physical that every recruit is required to complete, specific questions and other methods are utilized to evoke potential markers of psychological and behavioral dysfunction potentially incompatible with military service. Since 2009, the Supplemental Health Screening Questionnaire has augmented the standard Report of Medical History (DD 2807-2). This form includes 12 queries regarding past history of psychiatric, psychological, or behavioral issues as well as questions regarding substance abuse. Any condition reported or elucidated during the examination that does not meet the Department of Defense Instruction (DODI) 6130.03: Accession Medical Standard is considered disqualifying. Each service has the authority to waive the standard on a case by case basis. According to data provided by DOD from the U.S. Military Entrance Processing Command's database, out of 296,000 accessions in fiscal year 2009, a total of 11,845 accessions with medical waivers were granted. Of these, 1,178 were accessions with mental health conditions, of which 127 were for anxiety, 32 for depression, 182 for personality disorder, and 19 for PTSD. In addition, during the physical examination portion of accession medical evaluation, evidence of self-harm, mutilation, or excessive or otherwise inappropriate tattooing or piercings, among other physical findings, would lead the examiner to evaluate the recruit further for psychological problems or maladaptive behavior. In any of the above situations, reasonable suspicion on the part of the examiner that the recruit may manifest psychological or behavior health conditions incompatible with service would be referred for further psychological evaluation and if found unfit, would be subjected to the decision of the individual service to exercise its waiver authority. The study of the effects of prior psychological and behavioral health issues on successful military service is ongoing. Multiple forms of additional screening tools have and are being piloted, however, to date, the requisite data to determine if these tools have any predictive value in determining the ability of a recruit to complete a successful tour of duty are still outstanding. Servicemembers are required to receive an annual physical examination known as a periodic health assessment (PHA). The PHA is intended to identify changes in health status, including mental health changes, especially those that could impact a member's ability to perform military duties. Servicemembers who are deployed in connection with a contingency operation are required to receive face-to-face mental health assessments conducted by mental health professionals . Separate assessments are required at four separate times: within 120 days before the estimated date of deployment, between 90 and 180 days after return from deployment, between 181 days and 18 months after return from deployment, and between 18 and 30 months after return from deployment. Assessments must be administered at least 90 days apart.