Fla. shooting raises question about vets' mental-health care

The deadly shooting spree by a military veteran who dealt with mental health problems has reignited debate about services for vets with post-traumatic stress disorder.

Esteban Santiago, 26, who is suspected of killing five people at Fort Lauderdaule-Hollywood International Airport on Friday, told FBI agents in November that the Islamic State terrorist group had gained control of his mind and commanded him to commit acts of violence on its behalf, the FBI said Friday.

His erratic behavior led the FBI to conduct a background check — which found no connection to terror groups — and conclude he required a mental health evaluation. It is not clear whether Santiago received treatment following the incident, which the FBI reported to local authorities.

It is unclear whether Santiago's issues emerged while he was on active duty.

Authorities in Alaska who last year referred Santiago for mental evaluation said Saturday he was allowed to retrieve his 9mm pistol in early December. Santiago could not be denied his weapon because he was not declared "adjudicated mentally ill," Alaska U.S. Attorney Karen Loeffler said during a press conference. Federal law prohibits the mentally ill from possessing weapons, but only if they've been formally declared adjudicated.

Florida airport shooting suspect charged; could face death penalty

Late Saturday, federal prosecutors filed charges against Santiago that could bring the death penalty if he is convicted. The Miami U.S. attorney's office accused Santiago of an act of violence at an international airport resulting in death. He was also charged with two firearms offenses.

The airport shooting Friday was the latest deadly reminder of the plight veterans face when they return to civilian life. Yulee Newsome, founder of CivCom, which assists veterans and their families, told KTVU-TV in Oakland, Calif., that many young people enlist in the military straight out of school with little knowledge of the outside world. The jolting experience deepens upon their return home.

"The civilian world is completely different from the military world," Newsome told KTVU. "That's why we have boot camp. It takes a very long time to figure out how to be a military person."

Diagnosing and treating the root cause of what leads some veterans to violent acts is far from agreed-upon, however.

In a random sample of 1,000 post-9/11 veterans, the University of North Carolina-Chapel Hill School of Medicine in 2015 found one-third reported being involved in an incident of physical aggression the previous year and 11% engaged in acts of severe or lethal violence. Eric Elbogen, an associate professor at the school, called PTSD "the risk factor most consistently associated with violence."

But researchers with the National Center for PTSD have found that while post-traumatic stress disorder is associated with an increased risk of violence, the majority of veterans suffering from the condition have never engaged in violence. The center is part of the Department of Veterans Affairs.

According to a 2008 study by the RAND Corp., nearly 20% of American service members returning from Afghanistan and Iraq suffered from post-traumatic stress disorder. Yet only about half of those who need treatment for PTSD seek it. Estimates of depression in returning troops who served in Irag or Afghanistan vary widely, from 3% to 25%.

Veterans advocates say there are a number of barriers to treatment, including stigma and shame surrounding mental health problems and long wait times to receive care.

Santiago was discharged from the Alaska National Guard in August for "unsatisfactory performance," a spokeswoman for the Alaska Guard said.

Earlier, he was stationed in Balad, Iraq, with the 130th Engineer Battalion in 2010 where his job was to clear roads of improvised explosive devices and secure bridges. He was awarded a Meritorious Unit Commendation. At least two soldiers from Santiago's company were killed in insurgent attacks.

Back in Alaska, Santiago apparently had a rough time acclimating to home.

Anchorage police responded to a series of calls about him last year, said Anchorage Police Chief Christopher Tolley. Santiago was arrested and charged with criminal mischief after police received a call about a physical disturbance in January. He was ordered as a condition of his release to stay away from his girlfriend and the apartment they lived in, but was arrested again in February when police found him there during a routine check, Tolley said.

In March, police received another physical disturbance call, but officers "were not able to establish probable cause for an arrest" of Santiago, Tolley said.

Police receive another domestic violence call on Oct. 15 concerning Santiago, but officers were told by a municipal prosecutor not to arrest him, Tolley said. On Oct. 21, police received a call accusing Santiago of strangulation, but officers could not establish probable cause for an arrest, Tolley said.

Tolley did not identify who called police about Santiago or who accused him. Court records show Santiago's girlfriend was the victim in the January incident.

Follow USA TODAY San Francisco Bureau Chief Jon Swartz @jswartz on Twitter.

Contributing: Carol McAlice Currie in Anchorage, Ala., (Salem, Ore.) Statesman Journal.