Sometimes the news makes me very, very angry:
"The number of suicides among veterans of wars in Iraq and Afghanistan may exceed the combat death toll because of inadequate mental health care, the U.S. government's top psychiatric researcher said.
Community mental health centers, hobbled by financial limits, haven't provided enough scientifically sound care, especially in rural areas, said Thomas Insel, director of the National Institute of Mental Health in Bethesda, Maryland. He briefed reporters today at the American Psychiatric Association's annual meeting in Washington.
Insel echoed a Rand Corporation study published last month that found about 20 percent of returning U.S. soldiers have post- traumatic stress disorder or depression, and only half of them receive treatment. About 1.6 million U.S. troops have fought in the two wars since October 2001, the report said. About 4,560 soldiers had died in the conflicts as of today, the Defense Department reported on its Web site.
Based on those figures and established suicide rates for similar patients who commonly develop substance abuse and other complications of post-traumatic stress disorder, "it's quite possible that the suicides and psychiatric mortality of this war could trump the combat deaths,'' Insel said."
The Rand study (pdf) also found that of the roughly half of Iraq and Afghanistan veterans who had PTSD, major depression, or a probable traumatic brain injury and who sought treatment, "just over half received a minimally adequate treatment." (p. xxii)
Some things in life are hard. But getting the number of vets who get minimally adequate treatment over 50% is not one of them. You train the doctors. If those treatments cost more, you provide the money. You do what you need to do to make sure that when someone walks in the door looking for help, s/he finds it.
It's also not that hard to think of ways of raising the number of vets who actually seek help above 50% of those who need it. I think there are good reasons why soldiers should not have the same expectations of confidentiality as civilians, especially during wartime. (We really, really do not want soldiers who are actively psychotic, for instance. Likewise, soldiers with persistent homicidal fantasies.) But as of now, if they are still in the military, they have to deal with the knowledge that their command will find out that they have sought counseling, unless they seek counseling outside normal military structures, which is (I believe) forbidden. Many of them believe that this will affect their careers, and while I'm sure some of them are wrong, I'm equally sure that others are right.
As I said, I think it's right that active duty soldiers should not enjoy the same level of confidentiality as civilians. But they ought to be able to seek counseling with the expectation that that fact will not be revealed to their command unless it's necessary. This would be better for the soldiers, and also better for the military: untreated major depression or PTSD is not exactly a prescription for fun on the battlefield.
So imagine a soldier, just back from his third or fourth tour in Iraq (or worse: in Bob Herbert's last column, he cites an obituary for a soldier who was killed in Afghanistan: "As I read his obituary, I noticed that he had been deployed to Afghanistan and Iraq seven times.") Imagine that he is suffering from PTSD or major depression. He knows she needs help. Heck, he needed help after the first tour, and the second. He hasn't gone in before because he's worried about his career. But this time, he knows he needs help too badly to worry about that. He's stressed all the time; he snaps at his kids, and worries that he might lose it altogether; he spends nights just crying and crying; he has begun to feel like killing himself. He finally gets up his nerve and goes in for treatment, and guess what? His counselor doesn't now what appropriate treatment is, so he doesn't get any.
Or maybe it's more like this:
"Soldier Tyler Jennings says that when he came home from Iraq last year, he felt so depressed and desperate that he decided to kill himself. Late one night in the middle of May, his wife was out of town, and he felt more scared than he'd felt in gunfights in Iraq. Jennings says he opened the window, tied a noose around his neck and started drinking vodka, "trying to get drunk enough to either slip or just make that decision."
Five months before, Jennings had gone to the medical center at Ft. Carson, where a staff member typed up his symptoms: "Crying spells... hopelessness... helplessness... worthlessness." Jennings says that when the sergeants who ran his platoon found out he was having a breakdown and taking drugs, they started to haze him. He decided to attempt suicide when they said that they would eject him from the Army."
You can imagine it. I can imagine it. It's not too much to ask that someone in the Pentagon imagine it before they send good people off to war, and that they then do something about it.
We owe our soldiers better.