The prolonged war experiences and multiple deployments of men and women to Iraq and Afghanistan have created emotional as well as physical casualties of war. While more than 4,000 U.S. soldiers have lost their lives in the recent conflicts, multitudes of others have experienced life-altering consequences. Traumatic Brain Injury, often described as the signature wound of this war, has impacted many soldiers exposed to countless blast injuries. The war experience has left many soldiers suffering from depression, anxiety, post-traumatic stress disorder, chemical dependency and other issues. These sometimes-invisible injuries of war may go undetected until the veteran returns home. As the soldiers readjust to home life, other problems may arise in the form of sexual assault and domestic violence.
It has been estimated that as many as 20% of active duty military and perhaps 40% of reserve soldiers returning from combat may have a mental illness. In addition, many soldiers and their families will face post-deployment adjustment problems and challenges. Understanding and addressing these normal stressors can perhaps prevent or decrease the likelihood of more serious mental health issues. In addition to learning more about TBI, PTSD and other sequela of war, helping these soldiers cope can help us better understand aspects of resilience and recovery.
The American Psychiatric Association is committed to assisting in the care of veterans and their families as well as advocating for their mental health needs in Washington. The APA has supported the caucus of psychiatrists who work within the VA system, in addition to forming numerous work groups such as the Committee on Mental Healthcare for Veterans, Military Personnel and their Families. APA members have been encouraged to participate in “Give an Hour,” a volunteer program to match mental health providers with post deployed military members and their families. In addition, both the American Psychiatric Association as well as the APA Foundation has supported research efforts to better understand the barriers that military members face in seeking mental health care as well as looking at use of evidence-based therapies in treating PTSD.
There exists a spectrum of stressors in the cycle of predeployment, deployment, reunion, and readjustment. Preparation for war or deployment can impact families as they anticipate differing roles and responsibilities, manage uncertainty, and experience anticipatory anxiety. Positive emotions may also exist in terms of pride and patriotism. Post deployment, with much anticipated reunions, can come with its own set of stressors and adjustments.
Whether we look at the spectrum of symptoms of distress or disorder, it is clear that the mental health consequences of the war are substantial. The systems of care, whether through the military, Veterans Health Administration or civilian treatment facilities, must include family in the treatment process. Ideally treatment should be integrated, involving community resources such as schools, churches, and employers. Issues of stigma must be overcome so that both veterans and their family have access to care without fear of repercussions in terms of their career, employment, or future insurability.
A recent American Psychiatric Association survey of military service members who had served in a war zone or in support of a war zone in the previous five years believed that stigma continues in the military. About 3 in 5 military members said seeking help for mental health concerns would have a negative impact on their career. More than half of the spouses said seeking help for their own mental health concerns could impact their spouse’s career.
The Department of Veterans Affairs reports that only 40% of returning veterans eligible for services seek treatment through the VA. Furthermore, the VA traditionally has not extended care to families and children. The APA survey showed military spouses, who experience their own stressors from repeated deployments and homecomings, believe it’s harder for them to get mental health care within the military system than in civilian life. Clearly there are numerous areas of unmet needs, with much of treatment occurring in the community. Community providers may need training to understand military culture and to learn about the resources that are available to help military members and their families cope with the anticipated stressors of deployment and reunion. Approximately 40 states offer a 211 number to help individuals locate appropriate health and human services.
On the advocacy front, the APA has testified at congressional hearings supporting the validity of Post-Traumatic Stress Disorder as a diagnosis, recognizing the effectiveness of treatment, providing information on the problems of co-occurring and substance use disorders, lobbying for more funding for research and supporting of workforce issues and access to quality care. In the 110th Congress, there were nearly one hundred bills introduced with veterans and health in their title. Although limited legislation has passed, there have been significant funding increases regarding veterans’ health. The level of national attention has brought substantial change in the delivery of care and the efforts to create a continuum of care. This level of national attention and concern must be followed with action to address access to care issues and to bring effective and evidence-based treatment to our veterans in the communities in which they live.
Mental health treatment has historically been underfunded. It usually takes a crisis to bring attention to the deficits in mental health delivery systems in order to spark an interest in demanding adequate funding (take for example the state of Virginia expanding funding for mental illness in the aftermath of the deadly shooting at Virginia Tech in 2007). Hopefully, recognition of the public health crisis created by the current war and the attention drawn to mental health issues will be a stimulus to providing adequate mental health care for all.
Dr. Davis is the Director of Behavioral Oncology at the Norton Cancer Institute in Louisville, Kentucky. She is a member of the American Psychiatric Association’s Board of Trustees and serves on the APA’s Committee on Mental Health of Veterans, Active Duty Military and Their Families.
PTSD Internet Resources
American Psychiatric Association’s Healthy Minds: www.healthyminds.org
The Center for the Study of Traumatic Stress: www.centerforthestudyoftraumaticstress.org
Sesame Street Workshops: www.sesameworkshop.org
Military OneSource: www.MilitaryOneSource.com
United States Department of Veterans Affairs: www.va.gov
The National Center for Posttraumatic Stress Disorder: www.ncptsd.va.gov
Give an Hour: www.giveanhour.org