As early as the Civil War, terms like "soldier's heart" and "nostalgia" were used to describe the psychological injuries incurred by combat veterans. In later wars, "shell shock" and "battle fatigue" described a similar array of symptoms. It was only in the aftermath of the Vietnam War, however, that veterans' mental health injuries were examined scientifically. A 1988 Congressionally mandated study estimated that 15 percent of Vietnam veterans suffered from Post-Traumatic Stress Disorder (PTSD) at the time of the conflict.
During the Iraq and Afghanistan wars, American troops' mental health injuries have been documented as they occur, and rates are already comparable to Vietnam. Thanks to today's understanding of mental health screening and treatment, the battle for mental health care fought by the Vietnam veterans need not be repeated. We have an unprecedented opportunity to respond immediately and effectively to the veterans' mental health crisis.
Rates of mental health problems among new veterans are high and rising. The best evidence to date suggests that about one in three Iraq veterans will face a serious psychological injury, such as depression, anxiety, or PTSD.1 About 1.5 million people have served in Iraq and Afghanistan, so approximately half a million troops are returning with combat-related psychological wounds. And problems are likely to worsen. Multiple tours and inadequate time between deployments increase rates of combat stress by 50 percent.
These psychological injuries exact a severe toll on military families. Rates of marital stress, substance abuse, and suicide have all increased. Twenty percent of married troops in Iraq say they are planning a divorce. Tens of thousands of Iraq and Afghanistan veterans have been treated for drug or alcohol abuse. And the current Army suicide rate is the highest it has been in 26 years.
According to the American Psychological Association, there are "significant barriers to receiving mental health care in the Department of Defense (DOD) and Veterans Affairs (VA) system."
Instead of screening returning troops through a face-toface interview with a mental health professional, the DOD relies on an ineffective system of paperwork to conduct mental health evaluations. There are significant disincentives for troops to fill out the forms accurately, and those who indicate they need care do not consistently get referrals. In addition, access to mental health care is in short supply. According to the Pentagon's Task Force on Mental Health, the military's "current complement of mental health professionals is woefully inadequate." Moreover, 90 percent of military psychiatrists, psychologists and social workers reported no formal training or supervision in the recommended PTSD therapies.
Effective treatment is also scarce for veterans who have left the military. As of May 2007, the VA has given preliminary mental health diagnoses to over 100,000 Iraq and Afghanistan veterans. The veterans' mental health system is simply overwhelmed by the influx; waiting lists now render mental health and substance abuse care "virtually inaccessible" at some clinics, according to the VA's own experts. The VA has exacerbated the shortage by consistently underestimating the number of new veterans who would need care, and by failing to spend millions earmarked by Congress for mental health treatment.
No one comes home from war unchanged. But with early screening and ready access to counseling, the mental health effects of combat are treatable. In the military and in the veterans' community, however, psychologically wounded troops are falling through the cracks. Decisive action must be taken to fix the gaps in the mental health system if we are to reach this generation of combat veterans in time.