ADDRESSING THE MENTAL AND BEHAVIORAL HEALTH NEEDS OF OUR NATION'S SERVICE MEMBERS

For many U.S. military personnel, the fighting does not end on the battlefield.  Many returning service members face sleepless nights, heightened anxiety, and sudden flashbacks that seem to transport them instantly back to the horrors and dangers of combat.  Thousands of returning soldiers are struggling with depression, substance abuse, social withdrawal, and unemployment, at the same time when there is a critical need to increase mental and behavioral health services.

• Once called shell shock or combat fatigue, Post-Traumatic Stress Disorder (PTSD) often develops after a soldier witnesses or experiences a traumatic event.  In 2004, over 5000 soldiers who fought in Iraq or Afghanistan sought treatment in VA clinics for PTSD.  This figure is expected to triple in 2005.¹



• Veterans suffer serious psychological trauma from an urban battlefield where they often can't distinguish Iraqi friend from Iraqi foe, or where they are faced with handling human remains of civilians, enemy soldiers, US or allied personnel, after an attack. ²



• Soldiers diagnosed with PTSD often suffer clinical depression, hyper-vigilance, insomnia, emotional numbing, recurring nightmares, and intrusive thoughts.  In many cases, the symptoms worsen with time, leaving the victims at higher risk for alcohol and drug abuse, unemployment, homelessness and suicide.¹



• Overwhelming feelings of guilt and sorrow surrounding personal actions or inactions, and feelings of shame and disgust, often prevent or compromise soldiers ability to function.²



• Studies show that reservists and National Guard soldiers are particularly vulnerable to PTSD. 3    In addition, female soldiers are more at risk for PTSD than male soldiers (i.e., about 20 to 25 percent of the women who served in the Vietnam War and the Gulf War developed PTSD; and psychologists are expecting figures to be at least as high for Iraq).⁴



• According to the National Center for PTSD, the pairing of PTSD with alcohol and drug problems in veterans is not uncommon.  Thus it is important to initiate preventive psychological and behavioral interventions to reduce drinking or prevent acceleration of alcohol consumption as a response to PTSD symptoms. ⁵



• The long-term medical costs to VA associated with chronic PTSD are staggering.  These stem from the symptoms of PTSD, itself, from mental health problems frequently associated with PTSD, from the increased medical morbidity associated with chronic PTSD, from the significantly higher medical care utilization among veterans with chronic PTSD, and from the cost of disability compensation to veterans with chronic PTSD. ⁶

• Homecoming and subsequent interpersonal functioning is often difficult for the veteran, especially if he/she was physically wounded during deployment. Younger families may be particularly less prepared to deal with the added stress of recovery, rehabilitation and/or adjustment to a chronic physical disability.²



• Some families of returning veterans may be at risk for domestic violence.  A report from the Miles Foundation Hotline for Domestic-Violence in the Military notes that calls have jumped from 50 to more than 500 a month since the start of the war in Iraq.¹

• The nation's health care system for veterans is facing a potential deluge of tens of thousands of soldiers returning from Iraq with serious mental health problems brought on by the stress and carnage of war.  According to Pentagon figures, some experts predict that the number of returning soldiers eventually requiring mental health treatment could exceed 100,000. ⁷     



• An estimated 40% of American casualties returning from recent war efforts in the Middle East by way of Walter Reed Army Medical Center report symptoms consistent with PTSD. ⁶



• A recent GAO report (February 2005) found that officials at six of seven Veterans Affairs medical facilities surveyed said they "may not be able to meet" increased demand for treatment of PTSD.  Officers who served in Iraq say the unrelenting tension of the counterinsurgency will produce that demand.⁷



• The GAO Report further states that if returning military do not have access to PTSD services, the chance may be missed for early identification and treatment to lessen the severity of the symptoms and improve the quality of life of those returning from combat. ⁸



• A survey published by the Army Surgeon General noted there is approximately one behavioral health provider for every 900 solders.  This could explain why only 27 percent of soldiers who screened positive for depression, anxiety, or traumatic stress said they had received any services from a mental health provider during their deployment. ⁹



• Dr. William Winkenwerder, Assistant Secretary of Defense for Health Affairs, discusses the effects of PTSD on returning soldiers in an interview with National Public Radio.  He claims that while 15% of returning troops suffer from PTSD, only 3% admit to it upon initial re-entry.  He suspects this discrepancy is due to the fear that if the soldiers report experiencing psychological stress, it would delay their return to their families.¹⁰



• A longitudinal study of Gulf War vets suggests that the prevalence of PTSD increases during the first two years after the soldiers' return.  Furthermore, a study of military peacekeepers who served in Somalia found that exposure to the war zone and how meaningful the mission was to the soldier was related to the course of PTSD symptoms over 18 months. ¹¹

• According to U.S. Army reports, the suicide rate for American soldiers in Iraq is five times (or 500%) the rate for the Gulf War and 11 percent higher than for Vietnam.¹²

1. Tyre, P. (2004, December). Battling the effects of war. Newsweek. Retrieved December 23, 2004, from http://www.msnbc.msn.com/id/6597101/site/newsweek/


2. National Center for Post-Traumatic Stress Disorder. (2004). The returning veteran of the Iraq war: Background issues and assessment guidelines. In P. Schnurr & COL S. Cozza (Eds.), Iraq War Clinician Guide (pp. 21-29). US Department of Veterans Affairs.
3. Lyke, M. (2004, August). The unseen cost of war: American minds. Seattle Post. Retrieved December 23, 2004, from http://seattlepi.nwsource.com/local/188143_ptsd27.html


4. Spitz, K. (2004, June). Female veterans deal with postwar trauma. Knight Ridder News. Retrieved December 23, 2004, from http://www.healthyplace.com/Communities/Anxiety/news/ptsd_female_veterans.asp


5. National Center for Post-Traumatic Stress Disorder. (2004). Treatment of the returning Iraq war veteran. In P. Schnurr & COL S. Cozza (Eds.), Iraq War Clinician Guide (pp. 33-35). US Department of Veterans Affairs.


6. U.S. Department of Veterans Affairs.  (2004).  Under Secretary for Health’s Special Committee On Post-traumatic Stress Disorder.  Kudler, H & Hamme, P.


7. Shane, S. (2004, December). A flood of troubled soldiers is in the offing, experts predict [Electronic Version]. New York Times. Retrieved December 29, 2004, from  http://www.truthout.org/docs_04/121704X.shtml


8. U.S. Government Accountability Office. (2005, February). Recommendations to improve VA PTSD services.  (GAO-05-287).  Washington, DC.


9. Daw Holloway, J. (2004, July/August). Army uncovers mental health-service gap. APA Monitor on Psychology, 35(7), 36-37.


10. Montagne, Renee. (2005, February 11). "Tests Will Examine Returning Troops for Stress Disorder." National Public Radio, Morning Edition.


11. Wolfe, J., Erickson, D., Sharkansky, E., King, D., & King, L.  (1999).  Course and predictors of posttraumatic stress disorder among Gulf War Veterans: A prospective analysis.  Journal of Consulting and Clinical Psychology, 67, 520-528.


12. Caplan, P. (2004, September). For anguished vets, the listening cure [Electronic Version]. Washington Post. Retrieved December 29, 2004, from http://tricare.osd.mil/eenews/downloads/090704anguishedvets.doc

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