MENTAL INSTABILITY
Healthcare treatment for returning troops proves troubling
BY DIANE M GRASSI

The ravages of war are hell. Collateral damage includes loss of life, permanent disability and war-related illness in both military and civilian populations. And too often, American soldiers are stung by the treatment they receive with respect to healthcare upon returning stateside. 

Unanticipated by the United States Department of Defense (DOD), healthcare services provided returning soldiers from the war in Vietnam and more recently the Gulf War were grossly underfunded. The criticism that endured thereafter was a lesson thought to be learned for future U.S. military engagements. Instead of fixing the problem, the U.S. military launched continual public-relations campaigns to project a more positive spin on the situation.

When it comes to the mental healthcare status of troops during deployment and upon their return to the U.S., funding is woefully lacking. There is no longer a shortage of laws and regulations in place like during Vietnam or the Gulf War with respect to mandated healthcare screenings for returning soldiers. Rather, a lack of political will by the Department of Veterans Affairs in concert with the DOD added to a lack of oversight by a lethargic U.S. Congress. This has made life extremely difficult for soldiers with acute mental health problems or those hoping to avoid them by seeking help.

Multiple administrative dilemmas have impacted the quality of life for returning troops. Immediately, due to a shortage of manpower, troops are now being re-deployed to battle as many as five times with less and less time to decompress between tours of duty. Were there not a need for so many bodies in the field, troops displaying emotional problems would be a liability and sent home for treatment. 

Colonel Elspeth Ritchie, an expert in psychiatry for the Army's Surgeon General, has insisted that the DOD still prioritizes the mental health of service members. But she admitted that, "Some practices, such as sending service members diagnosed with Post-Traumatic Stress Disorder (PTSD) back into combat had been driven in part by troop shortage." Absent any obvious symptoms of mental disorders such as PTSD, many troops fail to report their problems due to fear of retribution or are not aware there is a problem until they start acting out in other ways such as through drug or alcohol abuse.

A 1998 public law forced the DOD to comply with both pre-deployment health assessment and post-deployment health assessment. This stemmed from healthcare problems after the first Gulf War. The filing of forms 2795 and 2796 is meant to trigger physical as well as mental health evaluations of troops. However, oversight of such examinations is spotty, and the way in which the mental health assessment is recorded, if at all, is based upon the troops' own self-evaluation by way of answering four questions concerning PTSD symptoms.

The 1998 law requires evidence that face-to-face interviews are done upon demobilization, but the DOD has refused to turn over such documentation to Congress for the past four years, in order to verify that it has been adequately done.

And leaving the care of returning soldiers up to themselves or their families is hardly the system's intention. There are nearly 70 stories of soldiers who have committed suicide either in Iraq, Afghanistan or stateside since the inception of the War on Terror. There could be more, since suicides are considered part of non-combat-related casualties, and such statistics remain sketchy. And in most of these cases, either the families of these soldiers had pleaded for help for their loved ones, fellow soldiers had reported abnormal behaviors, or soldiers themselves had confided in their superiors about their troubles. Unfortunately, too many never came forward at all, fearing stigmatization.

The military subscribes to the "watchful waiting" concept with respect to mental health problems. But when it concerns PTSD, symptoms often take six months to a year to manifest, during which time a person may have already resorted to self-medication through illicit drugs or alcohol accompanied by violent or other self-destructive behaviors. Such symptoms present more need for preventative assessments, not less.

For those troops who have requested face-to-face evaluations, there are some areas of the country that have a waiting list up to a year, and then there is often the dispensing of anti-depressants, often by clinicians without any psychiatric training, without any accompanying counseling, therapy or follow-up. There is even a highly touted "telemental" therapy that troops can eventually utilize. This is basically counseling by e-mail or instant messaging - hardly adequate for a person experiencing severe anxiety, night sweats, flashbacks or bouts of paranoia.

To our soldiers: Thank you for serving. LW