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Editorial: Finally, military lifts stigma of stress illness

Tue., Jan. 12, 2010

The wars in Iraq and Afghanistan have created nearly 1 million veterans and about 20 percent of them are being treated or have been treated for mental health conditions. But the suicide rate continues to climb, with the latest increase at 26 percent for males between ages 18 and 29.

One in five Americans who kill themselves each year served in the military, according to Veterans Affairs Secretary Eric Shinseki.

The military has come a long way in recognizing and reacting to the stresses of combat in the United States, but as these data from 2005 to 2007 show, there is a long struggle ahead. The prevalence of suicide is alarming: In 2005, the rate per 100,000 veterans among this age group was 44.99. Two years later, it was 56.77, the VA reports.

The silver lining is that the rate is lower for those veterans who seek VA care. So the challenge is to make sure mental health services are readily available and effective. The data do not capture the effects of increased staffing and other changes at VA centers in the past two years. The VA has hired thousands more caregivers and established a hot line that it credits with about 6,000 “rescues.”

That is a welcome turnaround from the longtime implicit message to troops to “suck it up.” The horrifying injuries and random nature of violence from roadside bombs and other unconventional attacks forced the military to reassess its culture, remove the mental health care stigma and directly confront the psychological effects on troops.

Because of those efforts, patient load soon overwhelmed VA centers. At the Spokane facility, mental health professionals declared a caseload crisis in August. They’ve gotten some relief since then.

Another complicating factor is that psychological trauma can take a few years to emerge, which limits the effectiveness of “exit interviews.” VA studies have shown that most veterans who seek care have only one or two visits. They may seem fine initially, but that is no guarantee that mental health issues won’t arise later.

The military is also reassessing its mandatory post-deployment survey, which had a poor record of predicting likely candidates of post-traumatic stress disorder because the definition was too constrained.

Whether this increased sensitivity pays off remains to be seen, but this latest data confirm that substantial changes were called for and that the issue requires persistent attention.