Published: 12:00 AM, Sun Sep 23, 2012
The Last Battle: Is the Army doing enough to help soldiers suffering from mental health problems?
By Greg Barnes
Staff writer
Lt. Gen. Frank Helmick stood in front of 14,000 soldiers on Fort Bragg in February with a message:
"We have got to stop the violence."
Just weeks before, Helmick had closed out the combat mission in Iraq
and brought the troops home. Now, as he congratulated them for a job
well done, he could not ignore some disturbing numbers. In just the past
six weeks, he knew of six suicides and 25 accusations of spousal abuse.
Since Helmick retired in May, the violence at home has only gotten worse.
The Army has rolled out program after program aimed at identifying
and helping soldiers suffering from mental health problems related to a
decade of war.
Despite those efforts, figures show that soldiers and veterans
continue to commit crimes and take their own lives in record numbers.
Through July, Fort Bragg had reported 13 suspected or confirmed cases
of soldiers who committed suicide this year, the most of any military
installation and on pace to far outstrip the 15 suicides recorded in
2011. Another 40 Fort Bragg soldiers tried to kill themselves between
January and June of this year.
Nationwide, the 38 soldiers confirmed or suspected of killing themselves in July was the highest monthly total on record.
The figures are far worse for the nation's veterans, who are taking
their own lives at a rate of 18 a day, according to the Department of
Veterans Affairs.
Suicides are only one barometer of the mental health of soldiers and
veterans. Years of research indicate that multiple deployments and the
stress of combat are leading to a dramatic increase in soldiers
suffering from post-traumatic stress disorder, traumatic brain injury
and substance abuse problems. These soldiers often end up in trouble -
in their units, at home or with the law.
Magazines and newspapers - including The Fayetteville Observer - have
written extensively about these "hidden wounds" of war. Again and
again, mental health professionals have warned that the problems are
growing. Two years ago, one Fayetteville advocate put it this way:
"We're already seeing the tropical storm is here, and the tsunami is
coming because of the 10 years of war and the impact that it's had on
military members and their families."
That prediction appears to be more accurate than ever in 2012, and
perhaps nowhere can the wars' effects be seen more clearly than in
Fayetteville.
Late last year, McClatchy Newspapers analyzed cities nationwide by
zip code and found that few places outside of Fayetteville and
surrounding communities had more families dealing with the human costs
of war in 2010.
According to the findings, which only include veterans registered with the VA, the Fayetteville area had:
The country's second-highest number of veterans on disability rolls- 26,797.
The third most Iraq-era vets on disability - 7,283.
The third-highest number of traumatic brain injuries - 251.
The fourth-highest number of PTSD cases - 920.
The third-highest number of people suffering from major depressive disorder - 503.
Fayetteville police say the number of soldiers and veterans
struggling with mental health problems is partly to blame for a rise in
the city's domestic abuse cases and other crimes.
The year was only 13 days old when Joshua Eisenhauer, a Fort Bragg
staff sergeant suffering from severe PTSD and other mental health
problems, began shooting at police and firefighters from his
Fayetteville apartment.
Eisenhauer's parents say their son, who had watched two of his
buddies die in a firefight in Afghanistan, was having flashbacks and
thought he was shooting at enemy insurgents. Police shot Eisenhauer, who
is now awaiting trial on 15 counts of attempted murder and other
charges. No one else was seriously injured.
Three days later, Fort Bragg Sgt. Taylor B. Self became the first
soldier this year to kill himself in Fayetteville. Police said Self, 25,
of Oneonta Ala., died of a self-inflicted gunshot wound at his home.
Two weeks later, Fort Bragg paratrooper Pete Peterson, 32, of North
Las Vegas, Nev., committed suicide a month after returning home from his
fourth deployment.
In June, Spc. Ricky Elder shot and killed his commanding officer, Lt.
Col. Roy Tisdale, during a safety briefing on a Fort Bragg field.
Elder, who friends say suffered from TBI, then killed himself. Elder had
been in trouble since childhood.
Despite all the programs, all the studies, all the conferences, the
mental health issues appear to be growing at Fort Bragg and across the
military.
The rising suicide rate and the increasing numbers of service members
and veterans dealing with post-combat stress or substance abuse show
that the military's mental health programs are not getting the job done.
That leaves mental health advocates - both those in uniform and those
in the civilian world - with a question: What should be done
differently?
In an exclusive interview with The Fayetteville Observer, Defense
Secretary Leon Panetta acknowledged that the problems won't be easily
solved.
"It's only going to be solved by a fundamental and deep commitment on
the part of everybody to address this issue," Panetta said. "We owe it
to the people who serve in our military. People who are willing to put
their lives on the line to protect our country. Surely we owe it to them
to do everything we can to protect them."
In May, Maj. Gen. Dana Pittard, commander of Fort Bliss, Texas, posted on his blog that suicide is an "absolutely selfish act."
"I am personally fed up with soldiers who are choosing to take their
own lives so that others can clean up their mess," Pittard wrote. "Be an
adult, act like an adult, and deal with your real-life problems like
the rest of us."
Pittard later said the media took his comments out of context. He
posted a retraction, but the message, intended or not, had been sent:
toughness trumps compassion.
That same mentality appears to exist at Fort Bragg.
During a recent interview about whether soldiers'' mental health
problems cause misconduct, Fort Bragg spokesman Tom McCollum said, "a
lot of people have to grow up and accept responsibility. ... Just
because you have these problems is not a get-out-of-jail free card."
Military culture demands that soldiers be tough. Many soldiers worry
that revealing they have PTSD or other mental health problems would be
seen as a sign of weakness that could cost them rank, acceptance among
their peers or even their careers.
Despite military programs aimed at eliminating the stigma of seeking
help, it remains a major block to effective care for soldiers.
A recent study shows that what should be the key identifier of
problems - the mental health screening process when a soldier goes on
deployment or returns from one - is ineffective. The stigma attached to
admitting something is wrong plays a major role in that ineffectiveness.
The screenings are supposed to detect depression, post-traumatic
stress disorder and other mental health problems confronted by as many
as one in five returning soldiers.
Former Army Capt. Michael Cummings, who now writes a blog on his war
experiences and foreign affairs, said the mandatory screenings are
ineffective because soldiers regard the battery of questions as little
more than a minor annoyance.
After a long deployment, Cummings said, most soldiers just want to go home and get on with their lives.
"Redeploying soldiers check the mental health block for a variety of
reasons - to get back to drinking, to protect their careers, or to avoid
more questions," he wrote in a email.
After returning from his first deployment to Afghanistan, Cummings
said, he filled out his paperwork and was led to a small cubicle that
offered little privacy.
"The evaluator (psychiatrist?) asked me a series of questions off a
checklist," Cummings wrote. " 'Do you have trouble sleeping? Do you have
bad dreams? And so forth. Like most soldiers, I wanted to finish my
checklist and return to my hotel room. As soon as I finished, I would
join the battalion on block leave. So I answered, honestly, "No" to all
the questions and left."
Two years ago, on his return to Fort Campbell from a deployment to Iraq, Cummings faced the same battery of questions.
"I sat down with a counselor for about five minutes," said Cummings,
now a member of the Army Individual Ready Reserve. "Again, I answered,
honestly, "No" to all of the questions, but I couldn't believe that a
post with one of the highest suicide/discipline problems in the Army,
this was all the Army had for mental health."
Army leaders acknowledge that the mental health screenings are only
as good as the truthfulness of the soldiers who complete them.
A study published in the Archives of General Psychology in October
backs that up. Researchers found that soldiers who completed the
screening anonymously were two to four times more likely to acknowledge
thoughts of suicide or symptoms of PTSD and depression than were
soldiers who identified themselves during the process.
"This study indicates that the Post-Deployment Health Assessment
screening process misses most soldiers with significant mental health
problems," the researchers found. "Further efforts are required to
reduce the stigma of reporting and improve willingness to receive care
for mental health problems."
The picture isn't much better for service members who do screen positive for PTSD.
In July, the Institute of Medicine released a study by a panel of top
scientists that found that only 40 percent of troops who screen
positive receive a referral for additional evaluation or treatment, and
only 65 percent of those go on to get the treatment.
The study also found that the Department of Defense and the VA aren't
tracking which treatments are being used or evaluating how well they
work in the long term.
"In addition, DOD has no information on the effectiveness of its
programs to prevent PTSD," said Sandro Galea, a professor and department
chairman at Columbia University who headed the panel of scientists.
In a June speech at the 113th National Convention of the Veterans of
Foreign Wars in Nevada, President Obama called PTSD an epidemic.
Bill Birnes, a best-selling author who is co-writing a book about
military mental health problems called "Injured Minds," agrees with
Obama's assessment and takes it a step further.
"This is going to be an epidemic of mental illness that is going to
be beyond the public safety and public health system unless the Army
does something to triage the soldiers before they leave the system,"
Birnes said. "It's that bad."
The wars in Iraq and Afghanistan seem to be fading from America's
consciousness. Unemployment and a poor economy have overshadowed the war
on this year's campaign trail. Last month, Mitt Romney became the first
Republican presidential candidate since 1952 who didn't mention war in
his acceptance speech. Defense Secretary Pannetta talked to a CBS
reporter about the absence of the war in Afghanistan from the political
dialogue.
"I'm concerned that, you know, in the middle of the presidential
campaign, that not enough attention is being paid to the sacrifices that
are being made," Panetta said. "We have men and women that are fighting
and dying every day in Afghanistan. And they're making tremendous
sacrifices in order to protect this country. There's a war going on."
Even the struggles of thousands of veterans back home dealing with the lingering effects of combat are little noted.
The Associated Press reported in May that 45 percent of the 1.6
million Americans who fought in Iraq or Afghanistan are now seeking VA
compensation for war-related injuries. That makes them, by far, the most
medically and mentally troubled generation of veterans the nation has
ever seen.
The future looks even more bleak.
With the wars winding down, and the military calling for a large
reduction of troops, Panetta told Congress in July that the ability to
care for veterans will be strained even more.
"This system is going to be overwhelmed," Panetta said. "Let's not
kid anybody. We are looking at a system that is already overwhelmed."
According to the VA's website, more than 820,000 VA claims for
compensation related to injuries or illnesses suffered in military
service were pending as of Sept 15 Two thirds of those pending claims -
554,839 - were more than 125 days old.
Claims at the VA in Fayetteville are processed through the Veterans
Benefits Administration in Winston-Salem, which serves most of North
Carolina.
According to that agency, it had 33,606 pending claims in September,
including 21,744 that were more than 125 days old. Of those, 3,170 were
from veterans living in Fayetteville.
The VA has pledged to eliminate the backlog by 2015, including a 60
percent reduction by the end of this year. Congress signed a bill in
late July aimed at reducing the backlog.
But VA officials acknowledge that a significant reduction won't be
easy. The number of veterans filing claims is rising dramatically, and
the VA has been fighting the backlog for decades with an antiquated
system that still relies on paper rather than computers.
Compounding the problem is a lack of communication and coordination
between Veterans Affairs and the Department of Defense. The Defense
Department doesn't readily share information concerning the mental
health of a retiring soldier with the VA.
Veterans Affairs Secretary Eric Shinseki voiced his frustration in
June, at the Defense Department's fourth-annual suicide prevention
conference in Washington, D.C.
Shinseki told the story of a soldier who, realizing he was having
mental problems, asked to retire rather than serve a second tour of
combat. The Army denied the request, Shinseki said, and the soldier was
again deployed to Iraq.
After returning from his second tour, the soldier retired with 26
years of military service. When he entered the VA system, Shinseki said,
neither his military records nor his enrollment in the VA mentioned
depression, PTSD, TBI, or any mental illness.
About three years after his retirement, Shinseki said, the soldier
committed suicide. Only afterward, he said, did the VA learn about his
mental health problems.
"There was no hand-off between our departments that would have
enabled us to track and treat this veteran, or any other veteran today,"
Shinseki said.
Shinseki said he and Panetta met in May to reaffirm their commitment
to a fully operational health records system that would allow the VA and
the DOD to share medical records of soldiers and veterans
electronically.
President Obama requested the system in 2009. It isn't expected to
become fully operational for another five years, and that could be a
stretch.
The lack of such a system confounds some congressmen. In July, they
lashed out at Shinseki and Panetta, who made a joint appearance on
Capitol Hill.
"Another five years is unacceptable," U.S. Rep. Bill Johnson, a
Republican from Ohio, told Shinseki. "It's unacceptable to me, and
gentlemen, it should be unacceptable to you."
In July, U.S. Sen. Patty Murray criticized the military and the VA
while introducing a bill aimed at ensuring that the nation's service
members and veterans have access to quality health care. Murray, a
Democrat, represents Washington state.
"The Department of Defense and the VA are losing the battle against
the mental and behavioral wounds of these wars," said Murray, chairwoman
of the U.S. Senate Committee on Veterans' Affairs. "To see that you
don't need to look any further than the tragic fact that already this
year over 150 active-duty service members have taken their own lives, or
the fact that one veteran commits suicide every 80 minutes."
The ineffectiveness of Army programs to reduce stigma, screen
soldiers for PTSD and provide timely and appropriate treatment of
veterans is taking its toll in Fayetteville.
In nearly 30 years as a licensed social worker and addiction
specialist, Cindi Brooks of Fayetteville said she had lost only four
patients to suicide or accidental death caused by behavioral problems.
In the last three months, Brooks said, she has lost three soldiers -
two to suspected suicides and one to either suicide or an accidental
overdose.
Brooks, an Army veteran herself, said she has seen a significant
increase in Fort Bragg soldiers being charged with rape, drunken driving
and assault.
Many, she said, are being dishonorably discharged, excluding them
from VA benefits. Many return home to rural communities where they have
no support systems. Others remain in Fayetteville, where violence
increasingly extends to spouses and children, Brooks said.
Other mental health professionals in the Fayetteville area say they,
too, are seeing an increase in soldiers and veterans with mental health
problems.
Wayne Cannon, who coordinates the Crisis Intervention Team for the
Cumberland County Mental Health Center, said it's no longer just
soldiers having trouble; entire families are struggling.
"We're starting to learn about families that are just completely overwhelmed," Cannon said.
In 2009, Fayetteville police recorded 985 cases of domestic violence.
Two years later, that number had nearly doubled to 1,693. Through
August of this year, 1,111 cases had already been filed. The figures
include all cases, not just those involving soldiers and veterans
because police and the court system don't track them separately.
Cannon and police Lt. Randy Podobinski said they expect the domestic
violence numbers to escalate even more because the entire 82nd Airborne
Division will be home by the end of this month.
That means an even greater strain on a city facing a dire shortage of
psychiatrists, psychologists, counselors and services for the mentally
ill.
"I don't want to fault the military,'' Brooks said, "but we are just not addressing this issue."
Staff writer Greg Barnes can be reached at barnesg@fayobserver.com or 486-3525.
