Veterans’ mental health needs great; many don’t get care, study says

WASHINGTON – The latest and most comprehensive study of veterans of the Iraq and Afghanistan wars has concluded that nearly one in every five veterans is suffering from depression or stress disorders and that many are not getting adequate care.

The study shows that mental disorders are more prevalent and lasting than previously known, surfacing belatedly and lingering after troops have been discharged into civilian and family life.

An estimated 300,000 veterans among the nearly 1.7 million who have served in Iraq and Afghanistan are battling depression or post-traumatic stress disorder. More than half of those people, according to the study conducted by the Rand Corp., are slipping through the cracks in the bureaucratic system, going without necessary treatment.

The Rand study underscores one of the hard lessons of modern counterinsurgency conflicts: Such wars might kill fewer soldiers than traditional fights but can leave deeper psychological scars.

Screening techniques for stress disorders are vastly improved from previous wars, making comparisons with Vietnam, Korea or World War II difficult or impossible. But a chief difference is that in Iraq and Afghanistan, all service members, not just combat infantry, are regularly exposed to roadside bombs and civilian massacres. That distinction subjects a wider swath of military personnel to the stresses of war.

“We call it `360-365’ combat,” said Paul Sullivan, executive director of Veterans for Common Sense. “What that means is veterans are completely surrounded by combat for one year. Nearly all of our soldiers are under fire, or being subjected mortar rounds, or roadside bombs, or witnessing the deaths of civilians or fellow soldiers.”

Military officials praised the Rand study Thursday, arguing that its findings were consistent with their studies and said it would reinforce their efforts to try to improve mental health care. Veterans Affairs officials, while questioning the study’s methodology, said their department has intensified efforts to find discharged service members suffering from mental disorders.

The Rand study was undertaken for the California Community Foundation, which has funded other programs for returning veterans. Lt. Gen. Eric Schoomaker, the Army surgeon general, said the study would help draw the nation’s attention. “They are making this a national debate,” Schoomaker said.

The Army previously has said that an estimated 1 in 6 service members suffers from a form of post-traumatic stress disorder, or PTSD, a slightly lower rate than Rand’s study found. In addition to PTSD rates, the Rand study found that 19.5 percent of people who had served in Iraq or Afghanistan suffered a concussion or another traumatic brain injury during their combat tour, a number similar to Army estimates.

Taken together, the study shows that 31 percent of those who have served in combat have suffered brain injuries, stress disorders or both.

Combat-related mental ailments and stress can lead to suicide, homelessness and physical health problems. But more mundane disorders can have long-term social consequences.

“These conditions can impair relationships, disrupt marriages, aggravate the difficulties of parenting, and cause problems in children that may extend the consequences of combat trauma across generations,” the study says.

Failure to treat disorders adequately can cost the government billions of dollars, said Lisa H. Jaycox, another of the study’s authors.

“We make the case that investing in treatment early would prevent some of the negative consequences from unfolding and save money,” Jaycox said.

Some service members avoid a diagnosis of a mental health problem, fearing negative consequences, according to the study. These troops worry about damage to their military careers and relationships with co-workers. “When we asked folks what was limiting them from getting the help that they need, among the top barriers that were reported were really negative career repercussions,” said Terri Tanielian, one of the study’s authors.

The study suggests two key changes.

It suggests ways to allow service members to get mental health care “off the record” to avoid any stigma. And since some soldiers and Marines fear that seeking treatment will prevent their redeployment, the study recommends that fitness-for-duty reports not rely on decisions to seek mental health care.

Col. Loree Sutton, director of the Defense Department’s PTSD center, expressed concern about Rand’s finding that only half of service members with stress disorders seek help. Changing military culture to encourage troops to get help is difficult, she said at a news conference.

Service members who seek treatment face a dearth of health-care providers with expertise in war-related mental disorders, the study found. The shortage leads to long waits that discourage some people from obtaining help.

Thousands of additional mental health professionals – both in government hospitals and in civilian health-care systems – are needed, and current practitioners must be given extra training, according to the report.

“Since the dramatic increase in the need for services exists now, the required expansion in trained providers is already several years overdue,” the report said.

Gerald M. Cross, the VA’s principal deputy undersecretary for health, said his agency is stepping up outreach, expanding a program designed to contact all veterans, whether or not they have reported problems.

“We contact them by mail, we contact them in person, we call them on the phone,” Cross said. “We are even putting a segment on MTV.”