CQ WEEKLY - IN FOCUS
July 21, 2008 - Page 1964

By Matthew M. Johnson, CQ Staff

Most Americans say they're looking forward to a significant drawdown of the U.S. occupation forces in Iraq starting next year, no matter who's elected president. But at the same time, the Veterans Affairs Department is scrambling to address the prospect that a mass demobilization of troops - bringing home a combined 186,000 from Iraq and Afghanistan - will badly overstretch the VA's already-frayed mental health screening program. And that, in turn, could lead to all manner of undiagnosed and inadequately treated maladies in the returning vet population, from depression and post-traumatic stress disorder (PTSD) to suicidal tendencies.

Suicide is the grimmest indicator of insufficient mental health support for the military and its veterans. And even before a massive wave of soldiers and Marines come home from the wars and start their emotionally complicated transitions to their lives back home, the armed forces has reported a sharp rise in active-duty suicides. The Army has documented 115 soldier suicides last year, up 13 percent from the year before. The Pentagon pegs the suicide rate among male members of all branches of service at 26.9 for every 100,000 in uniform - significantly higher than the rate of 19.4 for every 100,000 American men in 2005.

‘ENDING THE PAIN': Patrick Campbell of Iraq and Afghanistan Veterans of America calls for greater attention from the VA to the suicide threat. (CQ / RYAN KELLY )

Not surprisingly, many of the mental ailments that can be precursors to suicide are also alarmingly frequent. A study released by the Rand Corp. in April found that nearly 20 percent of the 1.6 million troops sent to Afghanistan or Iraq since 2001 now suffer from PTSD or major depression. Nineteen percent have suffered traumatic brain injuries, which often have debilitating mental and physical side effects. That adds up, experts say, to a formidable challenge for the VA, the government's helper in moving people out of the military and into civilian life: Without adequate treatment, these post-combat conditions can easily prompt distressed vets to take their own lives.

Returning vets are mindful of the spread of suicides in their ranks, as well, but are sometimes reticent about making an issue out of it. "I talk to veterans all the time and when you bring up this issue, everybody holds their heads low; it is just a reality," said Patrick Campbell, an Army National Guard medic in the Iraq War who is now legislative director for the Iraq and Afghanistan Veterans of America. "There are a lot of people who are coming home and ending the pain."

A Paucity of Data

The VA, too, isn't exactly out in front of the problem, critics say. When journalists and members of Congress have pressed the department on the suicide threat, it has been largely unresponsive, saying it lacks comprehensive data on suicides by veterans who were in Iraq or Afghanistan. Bob Filner, the California Democrat who chairs the House Veterans' Affairs Committee, is pressing the VA to drastically ramp up its mental health operations, in part by starting to draft legislation that would require all war-zone soldiers to undergo psychiatric evaluation as soon as their regiments return stateside.

As matters stand, before they are discharged, troops who have been in combat are required to answer a health questionnaire with fewer than 10 entries pertaining to mental health. The paucity of data, Filner and other critics of the system say, means these soldiers and Marines rarely get the full-scale psychological evaluations from which many might benefit.

Suicide Among Veterans: a Partial View: Click Here to View Chart

Indeed, some returning troops say the manner in which the surveys are conducted is far from conducive to psychological introspection. "You get off the plane; you go to a big gym or a theater or something like that," recalled Brian McGough, a veterans' advocate with the anti-war group Votevets.org, who was an Army staff sergeant in both Afghanistan and Iraq and suffers from PTSD. "While you are on the bus to the gym, they make you fill out this survey saying, ‘Do you feel different?' or ‘Do you feel angry?'They tell you if you put ‘yes' to any of these, you won't be able to go see your family; you have to go straight to see the doc. Who in their right mind, after spending a year in Iraq, is going to put ‘yes' on there?"

Even so, many of the symptoms of PTSD and service-related depression don't surface for months after a soldier leaves the theater of combat. "Most of this stuff hits people at different times; for me it took about three months before I realized that I had a problem," said Campbell. "I was acting out, and it took me losing three of my best friends" - who became estranged, he says, over his erratic and destructive behavior - "before I knew what was happening."

What's more, the culture of military service has long stigmatized mental illness; many soldiers view it as a sign of weakness, and they fear that seeking treatment would stymie their career progress, either in the military or in civilian life. Indeed, the Rand study found only 10 percent of veterans from the Iraq and Afghanistan wars seek psychological services from the VA, and many in that group received treatment that Rand researchers categorized as "minimally adequate."

In May the VA said it would try to boost those numbers by, at first, telephoning all soldiers returned from Iraq and Afghanistan to describe the department's mental health services, including a 24-hour suicide hotline. But VA critics such as Filner say that's too little, too late. The legislation he's writing would instead institute a "heroes homecoming camp," in which all troops coming home from the war would spend eight weeks or more decompressing at a domestic military base, with physicians and psychological professionals monitoring their health, in conjunction with members of their families.

Veterans Affairs Secretary James B. Peake, whom Filner approached in the initial phases of developing the proposal, remains skeptical. "I am just not sure the soldiers will like that," Peake said. "I don't want to say anything to have them keep away from their homes."

A Brewing Crisis?

Whatever treatment course the Defense Department or the VA adopt, most involved in the debate agree that the coming wave of returning troops spur more mental health maladies in the veterans population - with suicides and attempted suicides being the most distressing sign of trouble.

The VA has started to discuss suicide statistics, albeit with some outside prodding from lawmakers and journalists. In May, Peake went before the House Veterans' Affairs Committee and said attempted suicides among veterans of all U.S. conflicts could top 1,000 a month. But he offered up that figure only after Filner and the other witnesses he'd summoned from veterans' advocacy groups asserted that the department has been seeking to hide what it knows about the rising suicide rate among Iraq and Afghanistan veterans.

Based on figures collected from 45 states, CBS News reported in November that more than 6,200 veterans attempted suicide in 2005. Ira Katz, the VA's deputy chief mental health care services officer, disputed the accuracy of the figure on camera. But three days after the story aired, Katz e-mailed Michael J. Kussman, the undersecretary for health at the Veterans Health Administration, and essentially confirmed the CBS figure, according to a copy of the e-mail obtained by the network.

And when Katz was also summoned before the House panel in May, he testified that he agreed with the estimate of the federal Centers for Disease Control and Prevention of 18 suicides daily among the 25 million Americans who have served in military conflicts - which would generate an annual figure of 6,570.

Lawmakers contend that the information on suicides by veterans should be more readily available. In April, Democrat Tom Harkin of Iowa introduced a Senate bill that would require the VA to conduct a study on suicides among veterans.  A month later, Democrat Daniel K. Akaka of Hawaii used his authority as chairman of the Senate Veterans' Affairs Committee to request VA quality assurance reviews related to veterans' suicides - research that would otherwise not be available to Congress.

Meanwhile, the House's fiscal 2009 military construction and veterans' affairs spending bill would set aside $58 million for medical research in trauma, mental health and other areas. (There's no comparable figure specified in the companion Senate bill.) The House measure would also increase the authority of the House Military Construction-VA Appropriations Subcommittee to oversee care given to veterans who develop mental illnesses, post-traumatic stress disorder, substance abuse problems or suicidal tendencies.

"We will not know the true cost of war until we know the true rate of suicides among veterans," Akaka said. "Until the VA mental health care system meets the needs of those who have served, we will continue to see the tragic consequence of veteran suicides."

FOR FURTHER READING: Fiscal 2009 VA appropriations, p. 1990, CQ Weekly, p. 1780; VA substance abuse benefits (HR 5554), p. 1116; veterans' suicide prevention (HR 327), 2007 CQ Weekly, p. 3179; Filner, p. 1260; VA's overstretched health system, p. 1256; the Harkin bill is S 2899.

Source: CQ Weekly
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