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By Ami Albernaz
Reports of severe psychological distress experienced by soldiers
returning from Iraq and Afghanistan have focused attention on the
resources in place for these soldiers. Psychologists and Veterans
Administration officials in New England say they are equipped to
help the region's returning troops, but that more needs to be done
to encourage them to seek out mental health services.
The Boston VA Medical Center, which houses the nation's premiere
treatment center for posttraumatic stress disorder (PTSD), has so
far seen more than 50 returned soldiers for evaluation for psychological
problems including PTSD, says Terence Keane, Ph.D., chief of psychology
service at the Boston VA and a scholar in PTSD treatment. Representatives
of VA hospitals elsewhere in New England say they are seeing returning
troops as well and that they expect to see more in the coming months.
"We're prepared to handle psychiatric and psychological disorders,"
Keane says. "There are excellent VA resources throughout New England,
and many psychologists trained to deal with returned soldiers' issues."
(The VA New England Healthcare System provides up to two years of
mental health coverage to veterans at no cost).
This preparedness comes at an important time. According to a recently-published
national study of more than 6,000 Marines and Army soldiers, about
one out of six soldiers returning from Iraq met the criteria for
combat-related psychiatric disorder, primarily PTSD but also depression
or anxiety.
The study, which was conducted by Walter Reed Army Institute and
published in the July 1 New England Journal of Medicine, also stated
that 11 percent of soldiers returning from Afghanistan have experienced
some form of combat-related distress. The rate of PTSD among the
U.S. adult population as a whole is around three to four percent.
As disturbing as the incidence of combat-related distress outlined
in the report was the low percentage of afflicted soldiers who seek
out treatment. Only 38 to 45 percent of the soldiers meeting the
criteria for a mental disturbance said they wanted to receive help.
"Part of the nature of PTSD is avoidance of traumatic material,"
Keane says, in explaining the low percentage. "Then there's the
stigma of seeking mental health services. Many people feel that
in time they can manage it on their own, that they can recover.
Unfortunately for some people, this is not possible. The fear and
sadness grow."
Keane adds that members of the Reserves and (National) Guard -
who are not discharged from service - might fear that seeking out
psychological treatment would compromise their job or prevent them
from getting security clearance.
Some returning soldiers do not recognize how their tours of duty
have affected them, says Susan Hill, CISW, a licensed social worker
and coordinator of the PTSD clinic at the VA Connecticut's West
Haven campus. "A lot of times, guys don't realize that they're different
from when they went away," she says. "It's wives and family members
who call us."
Mental health services within the military branches and the identification
of psychological distress have improved tremendously over the past
few decades, says one federal official associated with the military
who asked not to be identified.
The Army, through its One Source program, employs more than 500
contractors who provide mental health services throughout the United
States and Europe. Any active duty soldier or member of the Guard
or Reserves may receive six face-to-face counseling sessions free
of charge. After the six, the soldier must pay. Unlimited telephone
and Internet-based counseling services are also available.
The federal official says that it is more difficult for a soldier
in need of counseling to go without help than it is for people working
in other fields.
"Your performance [in the military] is constantly being challenged,"
she says. "It's more difficult for a soldier to hide PTSD than it
is for someone in the typical workplace. The military is more likely
to encourage soldiers to get help."
Keane acknowledges that while mental health treatment for soldiers
has improved by leaps and bounds since the Vietnam era, the impact
of combat is just as detrimental. "We have many more people trained,
and we're in a different place," he says. "In many ways, though,
this current conflict bears similarities to Vietnam, in that it's
unclear who the enemy is and it's not clear when you're safe or
when you're in danger. Of course, the length of Vietnam is different.
But the prolonged lack of safety - that long period of stress -
is very worrisome from a psychological point of view."
And as more troops come home, the efforts of community-based VA
clinics to increase awareness of mental health services, combined
with contact between VA health centers and military bases to improve
understanding of what soldiers are facing, are reasons for guarded
optimism. "I'm hopeful," says Hill. "We're having some success."
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