Mental Health Care for Returning U.S. Military Veterans
The long wars in Iraq and Afghanistan have put considerable strain on members of the all-volunteer U.S. military. (09 October 2008)
Colonel Terry Walters, a doctor and commander of the WoundedWarrior program at one of the largest U.S. military bases, recentlysent a message to her bosses at the Army medical command. Colonel Terry Walters: "We're going to be short of psychiatrists. But we need even more thanour normal complement of psychiatrists to deal with this surge of need." Colonel Walters' "surge of need" at Fort Bragg, North Carolina iscoming because of the end of the surge in Iraq, as thousands of troopsdeployed to support the new counterinsurgency strategy last year returnto their home base. Colonel Terry Walters: "One of the lessons we've learned from Iraq is that there are no frontlines, that everybody is exposed to stress. What we're doing is we'resending perfectly normal individuals into combat, which is, bydefinition, an abnormal situation." Colonel Walters says the Army is sending her some extra psychiatristsand psychologists, but sometimes it is difficult to get soldiers toadmit they need counseling. Colonel Terry Walters: "There is a belief out there in our society and especially in themilitary that, 'Oh, just pull yourself together, pull your socks up,and rock on [i.e., get on with your life].' I think there aresignificant numbers of soldiers who are not seeking care because ofthis perceived stigma, which we're trying to do a lot to combat." U.S. Defense Secretary Robert Gates is among those trying to spread the word. Robert Gates: "You're tough and you go into the hospital when you receive a physicalwound. That doesn't mean you're weak in some way. And so why wouldn'tyou when you've received a psychological wound? It's the samedifference. They're all wounded." Secretary Gates has described a proposal to award Purple Heart medalsto troops diagnosed with Post-Traumatic Stress Disorder, or PTSD, as"an interesting idea". A Pentagon committee has rejected that proposalin the past, but it is taking another look at the issue. The PurpleHeart is awarded to troops wounded in combat, and several seniorofficers have been quoted as opposing the expansion of the criteria toinclude PTSD. But the Pentagon is fighting the idea that psychological wounds areless significant than physical ones. It has established a Center ofExcellence to spread understanding of the impact of combat stress andinformation on what commanders and doctors can do to help. Loree Sutton: "We work very hard to help our leaders as well as our service membersunderstand that treatment really works, and it's a sign of strength." Colonel Loree Sutton is the Director of the Center of Excellence. Loree Sutton: "Part of our challenge is to help families, help individuals, warriors,help communities understand what are the normal, what are the normalreactions, the human responses to stress. If we don't understand what'shappening, it's scary. You know, the flashbacks, perhaps thenightmares, the jumpiness. And so what we have to communicate to folksis to help them understand these are normal signs of healing fromtrauma. No, you're not going crazy." The experts also want the troops to understand that post-traumaticstress is not necessarily Post-Traumatic Stress Disorder. They say itis only a "disorder" if symptoms persist after treatment, and it isonly a disability if it prevents the sufferer from returning to work orresuming other aspects of their lives. But the Defense Department has come under criticism for not providingenough high-quality treatment to the troops who need it. A recent studyby the RAND Corporation says that 300-thousand of the one-and-a-halfmillion U.S. troops who have served in Iraq or Afghanistan havesymptoms of Post-Traumatic Stress Disorder or major depression. Thestudy also says that only about half of the Iraq and Afghanistan warveterans who have PTSD symptoms, depression or traumatic brain injuryhave sought treatment, and that only half of those veterans receivedadequate treatment. Terri Tanielian was co-leader of the study. Terri Tanielian: "Service members will report a number of barriers to getting care. Wefound that of the top five barriers, three of those were associatedwith concerns about the career repercussions of seeking mental healthcare." The Chairman of the Joint Chiefs of Staff, America's top militaryofficer, Admiral Mike Mullen, has joined the effort to convince troopsthat seeking counseling will not hurt their careers. Mullen: "I hear it everywhere I go -- the belief that admitting to the need forcounseling and assistance or the fact of having received it onlypenalizes you and stifles your career. Good people, many of whom haveseen combat up close and faced its grim reality, whose courage isabsolutely unquestionable and who deserve only the best physical andmental health care we can provide, are actually willing to denythemselves that care out of the fear that doing so hurts them and theirfamilies in the long run. Nothing could be further from the truth. Andit's time we got over that." But it is an uphill battle among commanders and ordinary troops. As part of the effort, the U.S. government recently stopped requiringpeople applying for security clearances, including members of themilitary, to state whether they have ever had psychological counselingfor combat stress. At Fort Bragg, North Carolina, Colonel Terry Walters is getting theextra psychologists she will need during the next few months. But, shesays, there is a broader issue to address. Colonel Terry Walters: "There's no easy answer to fix this. There is a significant lack ofbehavioral health providers across the United States, not just in themilitary. I would like to think we do a little bit better than generalsociety." And Colonel Walters says even with the extra staff on base, there willbe an added burden on civilian psychologists in her area this summer tohelp care for the returning soldiers.