Unanticipated by the United States Department of Defense (DOD), healthcare services provided returning soldiers from the War in Viet Nam and more recently the Gulf War were grossly under-funded, and the criticism that endured thereafter was a lesson thought to be learned for future U.S. military engagements. And in that effort, the U.S. military has been sure to launch continual public relations campaigns to project an image that active duty troops deployed to Operation Iraqi Freedom and Operation Enduring Freedom in Afghanistan receive the best healthcare that money can buy.
The Department of Defense's Deployment Health Clinical Center website reads, "Fostering a trusting partnership between military men and women, veterans, their families and their healthcare providers to ensure the highest quality care for those who make sacrifices in the world's most hazardous workplace." But when it comes to the mental healthcare status of troops during deployment and upon their return to the U.S., it is woefully lacking.
There is no longer a shortage of laws and regulations in place as existed during Viet Nam or during the Gulf War with respect to mandated healthcare screenings for returning soldiers. But 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, has made life extremely difficult for soldiers with acute mental health problems or those hoping to avoid them by seeking help.
Multiple administrative dilemmas at play at once have impacted the quality of life for troops serving in Iraq and Afghanistan and upon their return. 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 of outwardly exhibiting 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.
Public Law 105-85, Section 762-767 enacted as part of the 1998 Defense Authorization Act was presented in 1997 in order to force the DOD to comply with both pre-deployment health assessment and post-deployment health assessment for returning soldiers as the result of healthcare problems them after the Gulf War. Through the filing of forms 2795 and 2796 respectively, their purpose is 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 troop's own self-evaluation by way of answering 4 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 the Congress, for the past four years, in order to verify that it has been adequately done. Therefore, all of the regulations in the world are of little use unless there is implementation of said regulations.
And leaving the care of returning soldiers up to themselves or their families is hardly the way system was set up to work. 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 reported abnormal behaviors, or soldiers themselves 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 6 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 presents more need for preventative assessments, not less.
For those troops who have requested face-to-face evaluations there are some areas of the country which have a waiting list up to a year and then there is often dispensing of anti-depressants, often by clinicians without any psychiatric training, without any accompanying counseling or therapy of follow-up. There is even a highly touted "telemental" therapy which troops can eventually utilize which is basically counseling by e-mail or instant messaging on the internet. It is hardly adequate for a person experiencing severe anxiety, night sweats, flashbacks, or bouts of paranoia.
A May 2006 Government Accountability Office (GAO) report found that four of five returning troops, potentially at risk for PTSD, were not referred for further mental health evaluation. Half of those eventually got help on their own but less than 10% were referred through the military. A September 2006 GAO report highlighted that the VA underestimated the cost of serving veterans upon return from Iraq and Afghanistan due to pre-war budget figures, yet still failed to report such problems to the Congress.
In December 2006 the GAO released an additional report which shows that the funds allocated to the VA for mental health have not been spent on mental health care accordingly. The report discloses that the VA has no system in place to track spending on mental healthcare and that funds may have gone to other resources instead. But such an indictment of the VA does not alleviate lawmakers of their oversight responsibilities, either.
Dr. Frances Murphy, Undersecretary for Health Policy Coordination at the VA said in March 2006 that there is a need for improvement for mental healthcare for an increasing number of veterans seeking help. She said, "VA clinics do not provide mental health or substance abuse care, or if they do, waiting lists render that care virtually inaccessible." "The VA needs more capacity so that vets can get treatment and don't have to wait," according to Paul Sullivan, a former senior analyst at the VA prior to April 2006 and now Director of Programs for Veterans for America, an advocacy organization.
Furthermore, while waiting to see a VA doctor, veterans with severe symptoms of PTSD are often denied disability benefits should they turn to illegal substances as a way to cope. They are then vulnerable to the categorization of "willful misconduct" since the military has a zero tolerance policy for drug abuse. And those who have received benefits are subject to losing them should they be found abusing drugs. Ironically, the VA is tolerant of alcohol abuse, just not illicit drugs. But even then, only if a medical doctor finds that the veteran also has been diagnosed with PTSD may they then continue to receive their disability benefits.
Veterans from the present and ongoing wars have been the best advocates for those presently active duty soldiers, reservists still on call and those now discharged. Such organizations and grassroot efforts have successfully lobbied lawmakers, attended and testified in hearings on Capitol Hill and in doing so have unearthed the inadequate access to mental healthcare for troops. And as typical of U.S. medical insurance plans, mental healthcare always takes a back seat to physical medicine. And it continues to remain the biggest hidden cost as the result of the War on Terror.
Yet through their plight for their brethren in uniform, former brothers in arms have proven that it is not always just a matter of throwing money at a situation to solve a crisis, as inadequate access to mental healthcare presents a crisis of its own. Certainly the invisible front line and a deceptive enemy have made for a war unlike any other that the U.S. military has previously fought.
Yet, much like prior wars fought by the U.S. armed forces, present and future veterans of the Wars in Iraq and Afghanistan will have not only fought for their health and survival on the battlefield but many must continue to fight to an ineffectual government for their continued survival. Certainly, it was to suppose to have been better by now, but sadly it is but another testament to benign neglect by those with the power to affect change.
Copyright ©2006 Diane M. Grassi