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Invisible Wounds

Psychological and Neurological Injuries Confront a New Generation of Veterans
By Vanessa Williamson and Erin Mulhall

Executive Summary

As early as 1919, doctors began to track a psychological condition among combat veterans of World War I known as “shell shock.” Veterans were suffering from symptoms such as fatigue and anxiety, but science could offer little in the way of effective treatment. Although there remains much more to learn, our understanding of war’s invisible wounds has dramatically improved. Thanks to modern screening and treatment, we have an unprecedented opportunity to respond immediately and effectively to the veterans’ mental health crisis.

Among Iraq and Afghanistan veterans, rates of psychological and neurological injuries are high and rising. According to a landmark 2008 RAND study, nearly 20 percent of Iraq and Afghanistan veterans screen positive for Post Traumatic Stress Disorder or depression.

Troops in Iraq and Afghanistan are also facing neurological damage. Traumatic Brain Injury, or TBI, has become the signature wound of the Iraq War. The Department of Defense is tracking about 5,500 troops who have suffered TBIs, but many veterans with TBI are not being diagnosed. According to the RAND study, about 19 percent of troops surveyed report a probable TBI during deployment.

These milder injuries are difficult to identify and are often not easily distinguished from Post Traumatic Stress Disorder or depression. In fact, tens of thousands of troops are suffering from either two or all three of these conditions. Although these statistics are troubling, we have yet to see the full extent of troops’ psychological and neurological injuries. Service members are still deploying on long and repeated combat tours, which increases the risk of blast injuries and combat stress. Rates of marital stress, substance abuse, and suicide are all increasing.

The annual divorce rate among female Marines is 9.2%, almost three times the national average. During the Iraq War, the Army suicide rate has increased every year, and the rate for 2008 is likely to hit a 27-year high. Untreated psychological injuries are also a risk factor for homelessness; almost 2,000 Iraq and Afghanistan veterans have already been seen in the Department of Veterans Affairs’ homeless outreach program.

Because of these long-term effects, the economic cost of the new veterans’ mental health crisis has been estimated in the billions of dollars.

PTSD, TBI and major depression are treatable conditions, particularly when the symptoms are recognized early. Unfortunately, many troops and veterans have not been screened for neurological and psychological injuries and do not have access to high-quality health care. According to RAND, about 57 percent of those reporting a probable TBI had not been evaluated for a brain injury, only about half of troops screening positive for PTSD or major depression had sought help, and only half of those troops received “minimally adequate care.”

The Department of Defense (DOD) has taken significant steps to expand research into psychological and neurological injuries. But inadequate screening and shortages of mental health professionals in the military are still keeping troops from getting the care they need.

Instead of screening troops through a face-to-face interview with a qualified mental health professional, the DOD relies on an ineffective system of paperwork to conduct mental health evaluations. As a result, there are serious concerns about the psychological wellness of many deploying troops.

In surveys of troops redeploying to Iraq, 20 to 40 percent still suffered symptoms of past concussions, and among troops who experience high levels of combat, about 12 percent in Iraq and 17 percent in Afghanistan are taking prescription anti- depressants or sleeping medications. Access to mental health care for these troops is in dangerously short supply.

According to the Pentagon’s Task Force on Mental Health, the military’s “current complement of mental health professionals is woefully inadequate.” Only about 1 in 3 soldiers and Marines who screened positive for PTSD once they got home reported receiving mental health care in theatre. Mental health support for troops in Iraq is actually declining; the ratio of behavioral health workers deployed to troops deployed dropped from 1 in 387 in 2004 to 1 in 734 in 2007.

Effective treatment is also scarce for those who have left the military. The Department of Veterans Affairs (VA) has given preliminary mental health diagnoses to more than 178,000 Iraq and Afghanistan veterans, almost 45 percent of new veterans who had visited the VA for any reason. In the early years of the war, the veterans’ mental health system was simply overwhelmed by the influx, and these problems were exacerbated by disastrous VA mistakes, including a failure to project that veterans returning from the war in Iraq would increase the demand for VA mental health care.

But in recent years, the VA has made major improvements. With the help of a mental health budget that has doubled since 2001, the VA has taken key steps to aid veterans in need of mental health care, including placing mental health

professionals in primary care facilities, hiring thousands of new mental health care workers, opening a suicide hotline, and screening all new veterans seeking health care at a VA facility for Traumatic Brain Injury. Many veterans, particularly those in rural areas, still have difficulty accessing VA care, however. Ensuring these veterans have reasonable access to VA facilities, and fully integrating the many new VA staff, programs and centers will be a major challenge for the new Secretary of Veterans Affairs.

No one comes home from war unchanged. But with early screening and adequate access to counseling, the psychological and neurological effects of combat are treatable. In the military and in the veterans’ community, however, those suffering from the invisible wounds of war are still falling through the cracks. We must take action now to protect this generation of combat veterans from the struggles faced by those returning from the Vietnam War.

Please show your support for our Minnesota troops and help PetsLoyal2Vets by making a generous tax deductible donation today so we can provide those soldiers returning with a trained companion or therapy dog.  Too often, wounds go untreated when all it takes is a helping hand and loving new companion.

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