Healing Hidden Wounds: The Mental Health Crisis of America's Veterans

Article excerpt

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From August 2004 to January 2005, and from January to September 2006, I commanded a Marine Corps logistics battalion of more than 1,100 Marines and Sailors in Iraq whose mission was to provide support for a Marine infantry regiment in combat. My men and women drove over a million miles through the worst of Iraq's "bad guy country"--western Anbar Province. During both deployments, battalion convoys were attacked with improvised explosive devices (IEDs) that resulted in loss of limbs, hearing damage, concussions, and other injuries--and on one occasion members of the battalion were victims of a suicide vehicle-borne IED that caused shattered limbs and permanent disfigurement from severe burns. Just as tragic, we lost Marines and Sailors to vehicular accidents in the line of duty. Even life in the base camp was not free of danger, as we frequently received rocket fire from a nearby town. This was life in our area of operations during the height of the insurgency.

After our return from the first deployment, I held roundtable discussions with my Marines and Sailors to talk about what we had seen, how each of us would characterize the deployment, what it was like being home, and how those feelings manifested themselves. Many of the participants in these discussions commented that the operational tempo of the deployment was incredibly demanding--and they liked it; that being back in garrison was slow, boring, and meaningless; that those who did not deploy with us "just didn't get it"; and that everyone missed those they served with. Although only a few admitted they had experienced symptoms of combat stress (for example, sleeplessness, anxiety, anger, and intrusive thoughts), most everyone's alcohol consumption had gone up exponentially, suggesting there were some issues my Marines and Sailors were not dealing with.

After these informal discussions, I realized how much my battalion would have benefitted from a formal combat operational stress control (COSC) program that could have provided some training and education before deployment. An established program also would have given me some tools as a commander to assist my personnel through the transition from war back to "normal" life. During my time in battalion command, I was not aware that such a program existed and wondered what was available to commanders in the other Services. With this in mind, as a Federal Executive Fellow this past year at the Brookings Institution, I have researched what psychological wellness programs are available for today's commanders. I talked with other commanders, psychologists, psychiatrists, licensed counselors, chaplains, and returning war veterans to gain insight on the topic of effective stress control and returning to optimal emotional health following combat. I also reviewed program briefings from each of the Service programs, interviewed people directly involved with these programs, surveyed Servicemembers who were about to deploy or had recently returned from a combat zone, and examined studies on combat stress.

During my research, I found that until recently there was a lack of investment in mental health care to prepare Servicemembers for combat and to help them reintegrate into life at home. I also found significant barriers to receiving mental health care, which include a lack of sufficient mental health care providers and the cultural stigma attached to self-reporting symptoms of combat stress response. A stigma can come from military culture itself, society in general, or the terminology used to describe and treat combat stress reactions. Thus, this article discusses barriers to care, provides a current model for mental health care, and examines each of the Services' programs to explain the progress made since my time in command and to highlight where improvements are needed. In addition, the article suggests recommendations for further program development. …