Army’s vice chief of staff, Gen. Peter W. Chiarelli, gives closing words of advocacy

These days, he looks for glimmers of progress in statistics that others might see as deeply troubling. For example, the number of hospitalizations of troops who have suicidal thoughts has increased every year since he became vice chief of staff in 2008. “I look at that and say leaders are involved and are not ignoring things that they once ignored when it comes to this area,” he said.

Recently, Defense Secretary Leon E. Panetta asked Chiarelli to retire from the Army and serve as undersecretary of defense for personnel and readiness, one of the Pentagon’s most senior civilian jobs. The position would have allowed Chiarelli to remain involved in mental-health issues, but he turned it down to return to Washington state.

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“I have my mom on the West Coast all by herself,” he said. “She turns 90 on February 15th. I have a family responsibility after 40 years of service to be with her.”

He acknowledged that he leaves behind many problems, including a medical system that is poorly structured to treat the mental wounds of war. “Soldiers would tell me point blank that [the doctor] talks to me for five minutes and throws a bag of pills at me,” Chiarelli said. “We have some real issues right now with the shortage of behavioral-health experts and a business model that does not lend itself to taking care of these people in the most effective way.”

Throughout his military career, Chiarelli has had a reputation as an innovator. In Baghdad’s Sadr City, he launched a massive effort to employ young men to fix the slum’s dilapidated sewer system. His efforts helped shape the Army’s approach to counterinsurgency warfare, which stresses that winning the support of the people is as important as killing the enemy.

It’s unclear, however, whether another four-star general will continue his efforts to improve mental-health care for soldiers. “I think that anyone who looks at the numbers after a while is going to say, ‘Wow, we have got a problem here,’ ” he said. “That is how I got involved in it. . . . It is going to still need pushing.”