Invisible Wounds

The expected withdrawal of American troops from Iraq by the end of the year promises to be a joyous event for the families of the hundreds of thousands of soldiers now stationed there

But for many families, that joy will quickly be tempered by a stark realization: the soldier who comes back is a very different person than the one who left them months or years ago.

Thousands of soldiers, particularly those who saw combat, are expected to return with mental health issues related to their service, including depression, anxiety and, in more severe cases, post-traumatic stress disorder.

The Veterans Administration has estimated that up to 20 percent of the 2.1 million soldiers deployed to Iraq/Afghanistan since 2001 will suffer from PTSD or some other mental health problem.

Other studies have pegged that number as high as 30 percent to 35 percent, said Patrick Bellon, executive director of Veterans for Common Sense, a nonprofit organization that advocates for improvements in veterans health care.

Bellon said there’s a growing concern among veterans groups whether the VA, which Bellon contends is already overwhelmed, will be able to handle the influx of cases once the Iraq and Afghanistan soldiers return home.

“The crisis is extremely significant at current levels of demand. Just try to imagine if more of the veterans who are eligible begin to use services,” Bellon said. “If a couple hundred thousand more show up on their doorstep they need to meet that demand.”

As of June 30 this year, 211,819 veterans of the Iraq and Afghanistan conflicts have been diagnosed as potentially having PTSD, according to a quarterly report issued by the Department of Veterans Affairs. That includes 1,376 veterans who have been seen at the Veterans Administration Medical Center in Plains Township or its outpatient clinics.

A study released in 2008 by the RAND Center for Military Health Policy Research entitled “Invisible Wounds of War” raised concerns regarding gaps in treatment for Iraq and Afghanistan veterans seeking care for PTSD and other mental health conditions.

The study found that roughly half of the veterans who have symptoms of PTSD or major depression seek treatment. Of those who did seek treatment, only slightly more than half got “minimally adequate care.”

Severe consequences

The consequences for veterans and their families are severe. Veterans suffering from untreated mental disorders are far more likely to have problems with substance abuse and are at higher risk to commit suicide.

There were a total of 2,293 suicides of active duty members from 2001 to September 2011, with 298 of those occurring in a war zone, according to statistics compiled by Veterans for Common Sense.

Former Marine Sgt. Stanley Laskowski of Carbondale is among those who returned from combat with the “invisible wounds” of war. The decorated Iraqi war vet suffers from severe PTSD brought on by his 5� month tour of duty in Iraq in 2003.

Laskowski, 33, maintains the VA’s failure to properly treat him when he first sought care in 2007 caused his condition to worsen to the point that he’s been declared 100 percent disabled and is unable to work.

Dr. Antonette Zeiss, chief consultant for the VA’s Office of Mental Health in Washington, D.C., said she’s aware of the concerns that have been raised, but believes the VA – which saw more than 1.28 million veterans for mental health issues in 2010 — provides exceptional care.

Zeiss said the VA, which operates the National Center for Post-Traumatic Stress Disorder, is the leading organization conducting research on PTSD. That’s resulted in significant advances in the treatment of the disorder in the past five years.

Those treatments focus on a combination of individual and group counseling, coupled with medications, said Zeiss and Dr. Matthew Dooley, a staff psychologist at the VA Medical Center in Plains Township.

“It starts off by educating patients so they can learn to identify and understand their symptoms and learn coping skills so they can manage them better,” Dooley said.

The VA is continually evaluating treatment options and modifies its approach as more information and data becomes available, Dooley said. There have been significant advances in treatments since 2006.

“As treatments evolve and become more effective, you adapt your system so that you can help patients recover more effectively,” he said.

Today the VA focuses treatment primarily on two evidence-based therapies, Cognitive Process Therapy and Prolonged Exposure Therapy. The therapies encourage veterans to talk about their trauma and teach them how to deal with anxiety and feelings of guilt they experience, Zeiss and Dooley said.

“Cognitive process therapy deals with self punishing distortions. Sometimes people can feel personally responsible for the death of a colleague in combat,” Zeiss said. “Cognitive process therapy deals with those distorted, self-critical thoughts.”

“Prolonged exposure therapy puts more of an emphasis on learning how to live again in the world even though you have negative memories,” Zeiss said.

Treatment issues

Bellon agreed the VA has made advances in therapies, but there remains significant concern regarding the availability of mental health services, he said.

An internal staff survey recently conducted by the Department of Veterans Affairs revealed that 70 percent of the 272 respondents don’t think the VA has the resources to handle the increasing demand for mental health services.

According to the survey, 37 percent of the respondents said they cannot schedule an appointment for a new patient within the 14-day standard the department mandates.

Zeiss acknowledged the concerns raised by staff, but said those feelings conflict with other data the VA collects.

“Our internal data shows that 95 percent of all patients new to mental health are seen within 14 days,” she said. “We track that carefully and think we are doing very well in that field.”

The VA has also taken significant steps to improve services, including the establishment of a suicide prevention program that includes a national hotline for veterans.

The hotline received more than 460,000 calls as of July 31, 2011 that resulted in 16,855 “rescues” of veterans who had attempted or were on the verge of attempting suicide, according to Veterans for Common Sense.

The VA has also significantly increased mental health staff in recent years, Zeiss said. Since 2005, the VA has hired an additional 7,500 mental health professionals, giving it a total of 21,000.

Bellon said those are positive steps, but he remains concerned that the efforts have come too late.

“They are beginning to add people. The problem is it’s the tip of a problem that’s been allowed to accumulate. It’s going to take a substantial amount of time,” Bellon said.

Zeiss said there are no immediate plans to hire more mental health professionals, but the department is continually monitoring the situation.

“We are thinking about … what happens when all the service members come back from Iraq. We are looking at models to ensure we are appropriately prepared for what may be ahead.”

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