CLARKSVILLE, Tenn. — On the outside, Spc. Carl McCoy seemed to be the perfect soldier, his personnel file highlighted with praise from his officers like "great man" and "could not have asked for a better mechanic."
But McCoy's personal life was unraveling after he returned from his second tour in Iraq in December. He was drinking so much that he often passed out. He was losing a custody battle with his ex-wife and was in marriage counseling with his new wife, who worried he was suffering from post-traumatic stress disorder, or PTSD.
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The 23-year-old McCoy took a hard step for a battle-tested soldier and made an appointment with a mental health counselor at Fort Campbell. At the last minute, his appointment was canceled because the counselor was sick.
That night, McCoy put a gun in his mouth, pulled the trigger and died instantly at his home in Clarksville, Tenn.
An Army investigation into his July 11 suicide says McCoy's superiors didn't realize how much emotional pain he was in until it was too late. McCoy's family wonders why, when he did reach out, that he didn't get better care from the Army, including the canceled appointment.
"I feel now that this was Carl's last cry for help and his voice went unheard," Sgt. Maggie McCoy, his widow, said in a letter she sent to the Army inspector general and members of Congress asking for better mental health treatment for soldiers.
Although the Army has revamped and ramped up its health system to treat troops for PTSD and other emotional problems, officials say the first hurdle is being able to identify soldiers who are really struggling, whether they ask for help or not.
One indicator of the problem is the suicide rate among soldiers, which has risen for five straight years and could surpass the national rate this year.
The Army has begun trying to raise awareness of the problem, and Fort Campbell, where 10 soldiers have killed themselves in the past two years, is the first stateside base to have a suicide prevention program manager.
Military officials often describe an ingrained stigma among service members against reporting emotional or mental problems. McCoy's family said he reached out for help several times but was repeatedly ignored, culminating in the canceled appointment.
Maggie McCoy said their marriage counselor knew the details of her husband's drinking but never referred him to the Army's Alcohol and Substance Abuse Program. She said officers refused to excuse him from an out-of-town recruiting assignment even though he told them it would scuttle a long-planned visit with his 3-year-old son.
The Army has implemented health screenings designed to identify symptoms of war stress and injury, but a 2007 American Psychological Association report found no evidence of "a well-coordinated or well-disseminated approach to providing behavioral health care to service members and their families."
Maggie McCoy, who is now being treated for PTSD following her husband's death, said soldiers aren't given the right opportunities to reach out for assistance for relationship problems, depression, substance abuse or legal issues — factors the Army has cited as reasons soldiers kill themselves.
The Army has started using survey forms to screen soldiers for behavioral health issues twice after they return from deployments.
But the American Psychological Association review found that identification of potential problems doesn't necessarily lead to needed treatment. A different 2006 study led by Army Col. Charles Hoge found that about 23 percent of troops who served in Iraq and only about 18 percent of troops who served in Afghanistan who screened positive for mental health concerns were actually referred for treatment.
"It's a joke," Maggie McCoy said of the screenings she and her husband went through after their return from Iraq.
Her screening was in a room with about 50 other soldiers, and she spoke for only a few minutes to someone who might not have been a doctor.
"That is what they are calling mental health screenings," she said. "That is not conducive. No soldier is going to talk about this stuff when they don't feel comfortable."
What soldiers need is face-to-face interviews with specialists who can diagnose symptoms of PTSD, she said.
Blanchfield Army Community Hospital at Fort Campbell, where McCoy was seeking treatment, has increased the number of mental health providers since last year and now has 50 who specialize in psychiatry, psychology, social work, substance abuse, and marriage and family counseling.
Fort Campbell spokeswoman Cathy Gramling said she couldn't comment directly on McCoy's case but said officers should be aware of soldiers' personal lives outside of work, including family obligations or concerns.
"We recruit soldiers, but we retain families," Gramling said. "So if we can't help a soldier's family, we're failing both the soldier and the family."
Hospital officials declined to release information regarding McCoy's treatment, citing privacy laws. Laura Boyd, a spokeswoman for the hospital, said McCoy's death was "a tragic loss."
The Army's investigation of his death, obtained by a Freedom of Information Act request by The Associated Press, found that McCoy had a history of suicidal thoughts that he expressed to family members and a history of alcohol abuse.
It said the custody fight contributed to his death. But the report concluded, "There were no obvious warning signs that would have been seen by his spouse or his unit personnel."
Maggie McCoy, who keeps a photo of her and Carl taped on the dashboard of her car, is haunted by the "ifs."
"What if he would have been sent to the Army substance and abuse program? What if his appointment had not been canceled?" she said. "What if everyone had paid just a little more attention?"