The mental toll
Coming home. While the efficacy of those battlefield programs is yet to be determined, the more critical mental-health need may involve the transition from the battlefield to civilian life. Post-deployment debriefings typically include information about mental-health services available through the VA and a health assessment questionnaire with questions intended to identify service members at risk for PTSD. But many vets report absorbing little of the information and even fudging responses to mental-health questions in an attempt to expedite their return. Says Batres: "The philosophy [at the debriefings] is pretty much, 'Don't let anything get in my way of getting home.' "
Still, the medical world's understanding of PTSD and services available to veterans facing mental disorders have seen enormous strides since Vietnam, when tens of thousands of vets descended into homelessness, often because of untreated PTSD and substance abuse. For veterans of Afghanistan and Iraq, the VA has established a 24-hour hotline that deals with readjustment issues, sent out hundred of thousands of letters with information about service-related mental illnesses, and hired 50 recent veterans to do outreach for vets trying to reintegrate into civilian society.
Those efforts appear to be paying off. In a 12-month period ending last September, 1 in 5 Iraq and Afghanistan vets who sought out care in VA hospitals--more than 6,000 people in all--was diagnosed with a mental illness, usually PTSD, depression, or a substance abuse problem. A Government Accountability Office report released in September questioned whether the VA can meet the increased demand for these services, however. And meanwhile, fear of stigma is most likely preventing many from seeking care. According to the Walter Reed study, troops whose survey responses suggested they had a mental disorder were twice as likely to be concerned about being stigmatized or about other barriers to care as those without mental disorders.
In addition, many experts say symptoms of PTSD may take months, even years, to surface; the free healthcare offered to Guard and Reserve troops deployed to Iraq and Afghanistan expires after two years. And part-timers are more likely to rely on private healthcare providers who are less familiar with service-related mental issues than are military or VA doctors. Indeed, some PTSD symptoms--aggressive behavior, for example--can be difficult even for vets to recognize, because they're common reactions to combat. "In order to function [in war] you kind of have to desensitize yourself. . . . [the troops] really have to flip some switches in order to operate," says Lt. Cmdr. Steven Unger, a chaplain who recently returned from a six-month tour in Iraq. The challenge now, for many vets, will be flipping those switches back.
COMBAT TRAUMA
Battlefield experiences reported by a sample of roughly 1,700 members of the U.S. Army and Marine Corps after deployment to Iraq
Being attacked or ambushed 92 pct.
Causing the death of an enemy combatant 55.7 pct.
Seeing dead bodies or human remains 94.5 pct.
Knowing someone killed or seriously injured 86.2 pct.
Source: Walter Reed Army Institute of Research
Graphic by USN&WR
With Susan Brink, Angie Cannon, Nancy E. Shute, Marianne Szegedy-Maszak, Carol Susan Hook, Jennifer L. Jack, Nancy L. Bentrup, Allegra Moothart, Ann M. Wakefield, Jill Konieczko and Monica M. Ekman
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