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The Military’s Invisible Wounds

By: Partnership for a Secure America

Yesterday I was a panelist on a television program talking about the rising number of suicides and suicide attempts in the American military.

Being a veteran myself, and having acted as a veteran’s advocate in my undergraduate days vets issues have always been of special interest to me. So let me summarize some of the facts that you may be unfamiliar with.

Currently, many veterans who served in Iraq and Afghanistan are suffering from invisible wounds. As in previous wars, service members can leave a war zone, but the war often follows them in their minds.

Numbers are always iffy but according to a RAND study released in April, nearly one in five Iraq and Afghanistan veterans report symptoms of post traumatic stress disorder (PTSD) or major depression. It estimated that 830,000 veterans - 300,000 of whom served in Iraq or Afghanistan - suffer from depression or PTSD symptoms.

Further, the study found that the stigma associated with mental healthcare, and concerns that admitting a problem will harm one’s career, continues to prevent many service members and veterans from seeking care.

The study found that only half are seeking treatment, and only half of these “receive treatment that researchers consider ‘minimally adequate’ for their illnesses.”

The study estimates that PTSD and depression disorders among veterans cost the nation as much as $6.2 billion in the two years following deployment—an amount that includes both direct medical care and costs for lost productivity and suicide. Investing in more high-quality treatment could save close to $2 billion within two years, RAND estimates.

The study emphasized the high risks of PTSD and depression, especially among service members sent on multiple deployments, and among National Guard and reservists.

A study released May 27 by Army Surgeon General Eric B. Schoomaker shows that the number of troops diagnosed with the illness jumped nearly 50 percent last year and that 40,000 soldiers have been identified as PTSD sufferers since 2003.

In May the public learned of a “suggestion” made by a VA psychologist, Dr. Norma Perez, in Texas in an email that her colleagues sent suggesting that clinicians “refrain from giving a diagnosis of PTSD straight out” because of “more compensation-seeking veterans.” That seems like a pretty clear case of medical malpractice to me, but then again, I’m not a lawyer.

This e-mail followed an earlier publicized e-mail from Dr. Ira Katz, deputy chief patient care services officer at the VA, who sought to suppress data on veteran suicides. It read “Our suicide prevention coordinators are identifying about 1,000 suicide attempts per month among the veterans we see…. Is this something we should address ourselves in some sort of release before someone stumbles on it?”

I am not quite sure what this means – possibly, if you can’t hide or spin something you try to misclassify it – but I’m sure it is nothing good.

Or how about the fact that for the first time in history, a large and growing number of U.S. combat troops are taking daily doses of antidepressants to calm nerves strained by repeated and lengthy tours in Iraq and Afghanistan. The medicines are intended not only to help troops keep their fighting edge but also to enable the already strapped Army to preserve its most precious resource: soldiers on the front lines.

Data contained in the Army’s fifth Mental Health Advisory Team report indicate that, according to a survey of U.S. troops taken last fall, about 12% of combat troops in Iraq and 17% of those in Afghanistan are taking prescription antidepressants or sleeping pills to help them cope.

The Army said on May 29 that at least 115 soldiers killed themselves in 2007 –which works out to 18.8 per 100,000 soldiers– including 36 in Iraq and Afghanistan. That’s up 13 percent from the year before. That’s the highest toll since it started keeping such records in 1980. As of late May there have been as many as 50 more Army suicides since January. If that rate continues, 2008 will be as bad as 2007.

And suicide attempts, according to the Army figures, are skyrocketing from 375 back in 2002, to more than 2,100 last year.

And no longer is the typical victim a young male. Now we are seeing more women killing themselves, and we’re also seeing older soldiers killing themselves.

We’ve actually reached the point where, according to Dr. Thomas Insel, director of the National Institute of Mental Health, “It’s quite possible that the suicides and psychiatric mortality of this war could trump the combat deaths.”

The Army says more than half of the suicides are among troops who are never deployed or who have been home from the war zones for more than a year. So the problem is bigger than just exposure to the trauma of conflict

Nearly 40% of Army suicide victims in 2006 and 2007 took psychotropic drugs like Prozac and Zoloft.

Why might troops be medicating themselves? Well, consider that repeated deployments to the war zones also contribute to the onset of mental-health problems. Nearly 30% of troops on their third deployment suffer from serious mental-health problems, a top Army psychiatrist told Congress in March. The doctor, said that recent research has shown the current 12 months between combat tours “is insufficient time” for soldiers “to reset” and recover from the stress of a combat tour before heading back to war.

Of course, true to the American tradition of talking about supporting our boys, and girls, after the horse has bolted the barn the Pentagon and Department of Health and Human Services in June announced a psychological health mission, in which they will dispatch hundreds of psychiatrists, social workers and other mental health care providers to military facilities across the U.S. to treat the growing number of war veterans returning from Iraq and Afghanistan who are diagnosed with post-traumatic stress disorder.

Military officials say the biggest problem is that victims don’t seek help. To my mind that sounds a lot like blaming the victim. The effects of combat stress have been well documented for at least decades.

The government chose to put military personnel in harm’s way. It is the government’s responsibility, not that of the veteran or his or her family, to ensure they have the support networks needed to ensure mental and emotional health.