As it relates to Brownwood PTSD and "Military Support" !

Some troops headed back to Iraq are mentally ill
By Rick Rogers
STAFF WRITER

March 19, 2006

Besides bringing antibiotics and painkillers, military personnel nationwide are heading back to Iraq with a cache of antidepressant and anti-anxiety medications.
The psychotropic drugs are a bow to a little-discussed truth fraught with implications: Mentally ill service mem-bers are being returned to combat.
The redeployments are legal, and the service members are often eager to go. But veterans groups, lawmakers and mental-health professionals fear that the practice lacks adequate civilian oversight. They also worry that such redeployments are becoming more frequent as multiple combat tours become the norm and traumatized service members are retained out of loyalty or wartime pressures to maintain troop numbers.
Sen. Barbara Boxer hopes to address the controversy through the Department of Defense Task Force on Mental Health, which is expected to start work next month. The California Democrat wrote the legislation that created the panel. She wants the task force to examine deployment policies and the quality and availability of mental-health care for the military.
“We've also heard reports that doctors are being encouraged not to identify mental-health illness in our troops. I am asking for a lot of answers,” Boxer said during a March 8 telephone interview. “If people are suffering from mental-health problems, they should not be sent on the battlefield.”
Stress reduces a person's chances of functioning well in combat, said Frank M. Ochberg, a psychiatrist for 40 years and a founding member of the International Society for Traumatic Stress Studies.
“I have not seen anything that says this is a good thing to use these drugs in high-stress situations. But if you are going to be going (into combat) anyway, you are better off on the meds,” said Ochberg, a former consultant to the Secret Service and the National Security Council. “I would hope that those with major depression would not be sent.”
About 25,000 Marines and sailors based in San Diego County are undergoing a major combat rotation that began in January. Their deployments are expected to last seven months.
Officials from the Defense Department and Camp Pendleton, where some units have been to Iraq three times, said they don't track personnel deployed while taking mental-health medication or the number diagnosed with mental illness.
But medical officers for the Army and Marine Corps acknowledge that medicated service members – and those suffering combat-induced psychological problems – are returning to war. And anecdotal evidence, bolstered by the government's own studies, suggest that the number could be significant.
A 2004 Army report found that up to 17 percent of combat-seasoned infantrymen experienced major depression, anxiety or post-traumatic stress disorder after one combat tour to Iraq. Less than 40 percent of them had sought mental-health care.
A Pentagon survey released last month found that 35 percent of the troops returning from Iraq had received psychological counseling during their first year home.
That survey echoed statistics collected by the San Diego Veterans Affairs Healthcare System. The system has found that about 33 percent of Iraq and Afghanistan veterans suffer from schizophrenia, depression and post-traumatic stress disorder.
The various studies apparently didn't consider the effects of multiple combat tours, though psychiatrists agree that the greater people's exposure to combat, generally the higher their risk of suffering mental illness.
More than 435,000 U.S. personnel have served in Iraq and Afghanistan combined. It is unclear how many have served in that region more than once.
Joe Costello, a mental-health counselor at the Vista Veterans Center, said emotionally scarred troops are routinely redeployed and that most want to go back to the war zone.
“I see it every day,” said Costello, who mainly treats reservists.
Buttressing the idea that large numbers of service members are medicated, more than 200,000 prescriptions for the most common types of antidepressants were written in the past 14 months for service members and their families, said Sydney Hickey, a spokeswoman for the National Military Family Association.
Hicks said a Defense Department official gave her the information during a December briefing. She said the official did not distinguish between prescriptions for the troops and those for their family members.
In addition, the Defense Department has not provided prescription totals for such antidepressants from before and after the United States invaded Iraq in 2003.
The prescriptions were for selective serotonin reuptake inhibitors, commonly called SSRIs. These drugs are used to treat depression, anxiety disorders, some personality disorders and post-traumatic stress disorder. They include brand names such as Paxil, Cymbalta and Wellbutrin.
The antidepressants work by elevating the level of the neurotransmitter serotonin. Researchers believe that low serotonin levels in the brain could be a biological cause of depression and certain anxiety disorders.
Mental-health care for service members and the Defense Department's efforts to keep the mentally ill in uniform are becoming national issues, said Steve Robinson, director of the National Gulf War Resource Center in Silver Spring, Md.
Robinson said three Army doctors have told him about being pressured by their commanders not to identify mental conditions that would prevent personnel from being deployed.
“They are being told to diagnose combat-stress reaction instead of PTSD,” he said. “That does two things: It keeps the troops deployable and it makes it hard for them to collect disability claims once they get out of the military.”
Robinson contends that the Pentagon is trying to control its spending on mental-health disabilities.
Between 1999 and 2004, disability payments to veterans with post-traumatic stress disorder rose to $4.3 billion from $1.7 billion nationwide, according to a report by the Department of Veterans Affairs' inspector general.
Overall, service members' mental health is a hot-button subject because it goes to the cost of the war in dollars and lives, said Joy Ilem, an assistant national legislative director for the organization Disabled American Veterans.
“The (Department of Veterans Affairs) is very worried about the political implications of PTSD and other mental issues arising from the war,” Ilem said. “They are talking about early outreach and treatment, but they are really trying to tamp down the discussion.”
Cmdr. Paul S. Hammer deals with such issues daily.
Hammer, a psychiatrist, is responsible for the Marine Corps' mental-health programs during this deployment rotation. He confirmed that Marines with post-traumatic stress disorder and combat stress are returning to Iraq, though he would not say how many.
Hammer said deciding who is deployed is often anguishing.
Sometimes he has to tell Marine commanders that personnel they had counted on will not be deploying. In other instances, he said, “We'll hold some guy's feet to the fire and say, 'This is what you signed up for, and you have to go.' ”
Marines are “amazingly resilient,” Hammer added. “You've got people exposed to incredible violence, but they do entirely well.”
It's the tough calls that worry Adrian Atizado, a legislative director for Disabled American Veterans.
“Currently, the services will deploy a service member if the person is medically stable and it is determined that the deployment won't aggravate (his) condition,” Atizado said. “How does one gauge that?
“This a gray area; this is asking a medical provider to make a decision based on the future. The medical providers are human beings. I have no doubt that they are looking out for the best interest of the service members, but they are under pressure to check off on their deployment.”
Ultimately, much is unknown about the rates of post-traumatic stress disorder among Iraq veterans, especially those who have been through more than one combat tour, said Matt Friedman, executive director of the U.S. Department of Veterans Affairs National Center for PTSD in White River Junction, Vt.
Friedman said that with time, “one of the things we are going to find out is how well people function who might have been on medication (during combat). This is a very important question and has all kinds of implications.
“But remember, they are all volunteers. This isn't Vietnam, where people were drafted and sent to fight. Think of the ethical questions that would arise from sending draftees back to war on medications.”

Rick Rogers: (760) 476-8212; rick.rogers@uniontrib.com
source: The San Diego Union Tribune
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Ailing vets overwhelm system
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BY CRAIG GORDON
Newsday Washington Bureau

March 20, 2006

WASHINGTON -- At Ground Zero in lower Manhattan, Larry Provost said, he spent a week digging through the still-smoldering pile for survivors who weren't there.

His Army Reserve unit touched down in Afghanistan a year to the day after the Sept. 11, 2001 attacks. Then it was onto Iraq a year later, where every trip off base could be deadly, and Provost knew three fellow soldiers who died in a Baghdad roadside bomb attack.

It's why back home, he swerves to avoid a piece of trash in the road, or tries to avoid large crowds -- things that would have been danger signs in Iraq, a hiding place for a bomb, or a bomber. Some experiences, he just can't forget, no matter how hard he tries.

But when he sought counseling at a Veterans Affairs hospital near his home in Virginia Beach, Va., he said he felt like the message was, "Take a number." He said he's been waiting several weeks for a counseling appointment and was told by one doctor it could be two months before getting in.

"I say to them, 'Why?' And they say back to me that 'Unfortunately, it's because of all you guys coming back, and we just can't handle you. It's nothing personal. It's just the way it is,'" Provost, 27, recalled.

Provost's story illustrates the worst fears of military advocates and even some in the sprawling federal Department of Veterans Affairs itself -- that a health-care system already stretched to the limit in some key areas will be swamped by an influx of veterans straight off the plane from Iraq and Afghanistan.

One internal committee of VA experts on post-traumatic stress disorder raised the alarm last year, warning of several years of shrinking capacity and saying the system isn't big enough to deal with today's patients and make room for new ones.

"We can't do both jobs at once," the report said.

Nearly 150,000 Iraq and Afghanistan vets have shown up on the doorsteps of VA health centers since 2001 -- and about one third, 46,000, have been seen for mental health issues, the agency says. Veterans' advocates say those figures point to cost increases ahead, with two wars in progress.

VA officials and the White House insist they are ready to deal with this ongoing human cost of war, marked not by fatalities alone but also by those who survive.

They say President George W. Bush's budget proposal next year would mark a 69 percent increase in veterans health-care spending since he took office, to $34.3 billion. About $300 million in new spending in the past two years has shortened waiting times for care and largely erased the problems outlined by its post-traumatic stress disorder committee, the VA insists.

But many veterans groups -- from newcomers like the Iraq and Afghanistan Veterans of America to mainline stalwarts like the American Legion -- say Bush's spending still shortchanges the needs of veterans and leaves the VA ill-prepared to deal with what's still to come.

They point to proposed fee increases that would bump 200,000 higher-income veterans off the rolls, projections of $1 billion in management efficiencies that Congressional auditors call dubious and spending hikes they say fall short of what's needed to cut down wait times for specialty appointments, spotty care in rural areas and other problems.

"The White House is playing Enron games with the numbers," said Paul Rieckhoff, an Iraq war vet who runs Iraq and Afghanistan Veterans of America. "These guys are not projecting the true cost. It should have been part of the original Iraq war planning but now there's no excuse."

Pentagon officials fret that a doubling of costs in its retiree health-care program is eating into money they'd rather be spending on wars today, already costing $1 out of every $12 in defense spending. They've proposed a fee hike critics say will push 600,000 retirees out of the program.

Working the numbers

Even the VA is trying to make its numbers look good by building in fee increases likely to be rolled back in Congress and projecting a decrease in medical-services spending in 2008 -- something even Bush budget officials admit isn't realistic.

For one thing, more soldiers are surviving wounds that once might have killed them, thanks to improvements in soldier protection and battlefield medicine. Of the 17,000 wounded in Iraq, for instance, more than 380 are amputees -- saved by body armor that protected their torsos even as it left limbs exposed.

Also, the nature of combat in Iraq -- urban and up-close, with dangers approaching from any side, at any time -- seems a fertile breeding ground for the mental health disorders now showing up in its veterans, particularly post-traumatic stress disorder, or PTSD. Once commonly known as "shell shock," it is marked by symptoms such as anxiety, irritability, sleeplessness and "hyper-vigilance," being ever alert for danger even outside the war zone.

Today, it is the fastest-growing disability condition among VA clients, with cases up 80 percent in five years, to 215,871 in 2004, at a cost of $4.3 billion in benefits. Those numbers don't account for Iraq and Afghanistan but are mostly Vietnam veterans seeking treatment.

Mental health help sought

Of the 46,000 veterans of current wars seen for mental disorders, 20,638 of those veterans have received a possible diagnosis of PTSD that requires follow-up monitoring, the VA said.

On Long Island, about 1,000 Iraq veterans have sought services at the Northport Veterans Affairs Medical Center since the conflict began, said chief psychiatrist Charlene Thomesen. Of them, 255 have been treated for various mental disorders, including about 100 who have been diagnosed with PTSD.

She said although Northport has not had to turn anyone away so far, her staff case loads are full. And because PTSD often does not show its symptoms for months or years, doctors at Northport said caseloads there could grow even more.

Thomesen said Northport will receive an additional $800,000 this year to hire another psychiatrist, three more psychologists, two social workers and an addiction therapist. The additions would bring the staff totals to eight psychiatrists, five psychologists and four social workers.

Still, some advocates are accusing the VA of seeking to publicly downplay the prevalence of PTSD out of worries over making an already unpopular war in Iraq seem even more harmful.

"It seems to be such a political hot potato right now," said Joy Ilem, a national legislative director of Disabled American Veterans. "We want to make sure people don't fall through the cracks."

The VA staunchly denies any political motives but is quick to point out shortcomings in a recent study showing that one-third of war-on-terror vets sought mental-health services upon returning home. Dr. Matthew Friedman, the head of the VA's National Center for PTSD, suggested that by asking the questions so soon after deployment ends, researchers might have skewed the numbers higher.

"If I hurt my knee in Iraq, and there's a question about knee problems, it might not have occurred to me to report a problem if someone hadn't asked," Friedman said.

And the agency's top leaders have drawn fire from an internal committee studying PTSD care, which reported that the system was struggling to keep up even before the Iraq war -- with fewer visits per patient every year. One in five centers reported in a survey that they couldn't handle any new patients.

Dr. Antonette Zeiss, deputy chief of VA mental health services, said the infusion of cash -- plus another $339 million proposed for next year -- is eliminating those issues. She also cautioned that the early possible diagnosis among some patients doesn't mean they ultimately will be diagnosed with mental-health disorders but that the VA is committed to spending what it takes to confront the issue.

"We feel like there's been a real recognition of those needs and real funding," Zeiss said.

And to some extent, even Provost doesn't disagree.

Provost was receiving VA counseling while living in Syracuse and was surprised to find difficulties getting it in a timely way when he moved to Virginia Beach, where the Hampton VA hospital serves an area more populated with veterans.

Hampton VA officials said they couldn't discuss any individual cases, due to patient privacy laws, but questioned why anyone would tell Provost of a possible two-month delay, when they are striving to see high-priority Iraq veterans within a week.

Provost, who speaks occasionally at IAVA college forums, admits that he has found his readjustment to life in the States difficult at times. After months of being on constant alert, it's hard to turn off those instincts.

"You're very much on guard while you're driving, you're very much on guard while you're walking in public place, you're looking around, you don't let people get too close to you," he said.

"I've obviously trained my mind to realize there is a difference between overseas and back home, and that's where the difficulty lies" for many veterans, Provost said. "It's very difficult for them to make that adjustment, and what if they can't? That's something we have an obligation to take care of."

Staff writer Martin C. Evans contributed to this story.

Copyright (c) 2006, Newsday, Inc.

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This article originally appeared at:
http://www.newsday.com/news/nationworld/nation/ny-usvets0320,0,2166439.story