updated: January 30, 2008
Summary
As early as the Civil War, terms like “soldier’s heart” and “nostalgia” were used
to describe the psychological injuries incurred by combat veterans. In later
wars, “shell shock” and “battle fatigue” described a similar array of symptoms.
It was only in the aftermath of the Vietnam War, however, that veterans’
mental health injuries were examined scientifically. A 1988 Congressionally mandated
study estimated that 15 percent of Vietnam veterans suffered
from Post-Traumatic Stress Disorder (PTSD) at the time of the conflict.
During the Iraq and Afghanistan wars, American troops’ mental health
injuries have been documented as they occur, and rates are already comparable
to Vietnam. Thanks to today’s understanding of mental health
screening and treatment, the battle for mental health care fought by the
Vietnam veterans need not be repeated. We have an unprecedented opportunity
to respond immediately and effectively to the veterans’ mental
health crisis.
Rates of mental health problems among new veterans are high and rising.
The best evidence to date suggests that about one in three Iraq veterans will
face a serious psychological injury, such as depression, anxiety, or PTSD.1
About 1.5 million people have served in Iraq and Afghanistan, so approximately
half a million troops are returning with combat-related psychological
wounds. And problems are likely to worsen. Multiple tours and inadequate
time between deployments increase rates of combat stress by 50 percent.
These psychological injuries exact a severe toll on military families. Rates
of marital stress, substance abuse, and suicide have all increased. Twenty
percent of married troops in Iraq say they are planning a divorce. Tens of
thousands of Iraq and Afghanistan veterans have been treated for drug or
alcohol abuse. And the current Army suicide rate is the highest it has been
in 26 years.
According to the American Psychological Association,
there are “significant barriers to receiving mental health
care in the Department of Defense (DOD) and Veterans
Affairs (VA) system.”
Instead of screening returning troops through a face-toface
interview with a mental health professional, the DOD
relies on an ineffective system of paperwork to conduct
mental health evaluations. There are significant disincentives
for troops to fill out the forms accurately, and those
who indicate they need care do not consistently get referrals.
In addition, access to mental health care is in short
supply. According to the Pentagon’s Task Force on Mental
Health, the military’s “current complement of mental
health professionals is woefully inadequate.” Moreover, 90
percent of military psychiatrists, psychologists and social
workers reported no formal training or supervision in the
recommended PTSD therapies.
Effective treatment is also scarce for veterans who have
left the military. As of May 2007, the VA has given preliminary
mental health diagnoses to over 100,000 Iraq and
Afghanistan veterans. The veterans’ mental health system
is simply overwhelmed by the influx; waiting lists now
render mental health and substance abuse care “virtually
inaccessible” at some clinics, according to the VA’s own
experts. The VA has exacerbated the shortage by consistently
underestimating the number of new veterans who
would need care, and by failing to spend millions earmarked
by Congress for mental health treatment.
No one comes home from war unchanged. But with
early screening and ready access to counseling, the mental
health effects of combat are treatable. In the military
and in the veterans’ community, however, psychologically
wounded troops are falling through the cracks.
Decisive action must be taken to fix the gaps in the mental
health system if we are to reach this generation of
combat veterans in time.
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