Health

Half the Afghanistan and Iraq veterans treated by VA receive mental health care

This is the eighth story in an ongoing series.

Slightly more than half of all Afghanistan and Iraq war veterans treated by the Veterans Affairs Department received care for mental health problems, roughly four times the rate of the general population, according to statistics compiled by the advocacy group Veterans for Common Sense based on data obtained under the Freedom of Information Act.

The data show that among the 625,834 Afghanistan and Iraq war veterans enrolled in the VA health care system as of December 2010, 313,670 were treated for mental health conditions.

Lee Igel, a psychologist and assistant professor at New York University, said the numbers were "staggering" when compared to the general population.

The National Institute of Mental Health reported in 2008, the latest data available, that 13.4 percent of adults in the United States received treatment for mental health problems.

Read the entire Broken Warriors series.Sonja Batten, assistant deputy chief patient care services officer for mental health at the Veterans Health Administration, agreed the data obtained by Veterans for Common Sense showed that a "significant number" of veterans from the current wars were receiving mental health care. She told Nextgov these were provisional diagnoses that could be revised downward by as much as one-third.

Data VA subsequently provided to Nextgov showed that the department cared for 386,497 Afghanistan and Iraq war veterans in fiscal 2010, and out of that number, 161,794 -- or 41.9 percent -- received a primary diagnosis of a mental health condition, a rate three times higher than that of the general population. Data compiled by Veterans for Common Sense included Afghanistan and Iraq veterans treated at VA facilities from 2002 through 2010, whereas the numbers VA provided Nextgov reflect 2010 data only.

Paul Sullivan, executive director of Veterans for Common Sense, said VA is trying to downplay the mental health problems of Afghanistan and Iraq war veterans.

The data Sullivan's group obtained under the FOIA request were categorized according to diagnostic codes used by VA clinicians, Sullivan said. The numbers showed that 122,175 veterans were diagnosed with depression, 102,767 with neurotic disorders and another 72,952 with a combination of depression, anxiety and mood swings. More than 78,000 were diagnosed with a variety of other conditions, including alcoholism and drug abuse.

The data also showed that 182,147, or 29 percent of all Afghanistan and Iraq veterans treated by VA, sought care for post-traumatic stress disorder, Sullivan said. This is almost double the rate of PTSD for Vietnam War veterans, which is 15.2 percent, and more than double the rate of PTSD among Gulf War veterans, which is 12.1 percent, according to a fact sheet from VA's National Center for PTSD.

The data Veterans for Common Sense obtained from VA does not include any information on veterans who sought help from clinicians outside the Veterans Health Administration, Sullivan said. As such, he believes Iraq and Afghanistan war veterans' mental health problems actually are underreported.

Barbara Van Dahlen, founder and president of Give an Hour, a Bethesda, Md.-based nonprofit that arranges free counseling services with private practitioners for veterans, agreed. She said 67 percent of Vietnam veterans sought help outside VA, and expects many current veterans to do so, particularly in areas that do not have a VA hospital or clinic.

Tom Vande Burgt, an Army National Guard veteran who served in Iraq and runs the Lest We Forget PTSD peer-support group in Charleston, W.Va., with his wife, Diane, also believes the data obtained by Veterans for Common Sense likely underreports mental health problems because many veterans do not fully understand their benefits.

In addition, Vande Burgt said many veterans do not seek mental health care, preferring to "hide out in the basement, playing video games until there is some sort of triggering event."

Effects of Multiple Deployments

VA's Batten, mental health professionals outside the department and veteran advocates all agree the large numbers of Afghanistan and Iraq veterans seeking mental health care reflects the cumulative effects of multiple deployments during the past decade. As deployments increase, "the population in need grows," she said.

Rep. Jeff Miller, R-Fla., said he is concerned that troop cuts recently proposed by Defense Secretary Robert Gates "will only increase the burden of deployment on an increasingly smaller force." Miller, in an e-mail statement, added that the Defense Department "must ensure that our soldiers have adequate dwell time between deployments and that we are not relying too heavily on a fewer number of troops."

Miller, who serves on the House Armed Services Committee, said Defense needs to demonstrate that "the number and length of deployments are not having an effect on the mental health of service members."

Diane Vande Burgt, echoing the views of mental health experts interviewed by Nextgov, said, "There is no doubt in my mind that multiple deployments are the biggest reason for the high numbers. Stress levels are probably through the roof. When someone is overloaded on stress and gets no relief they begin to suffer both mentally and physically."

The fact that so many Afghanistan and Iraq veterans have sought help from VA for their mental health problems stands out as good news among otherwise grim statistics, experts and advocates agreed. Igel said the data show the current crop of veterans have overcome the stigma that felt by Vietnam veterans.

Miller agreed. "We're doing a much better job encouraging service members to come forward and seek treatment than at any other time in our nation's history, and that is one of many reasons for the high numbers. Some of our service members and veterans have experienced severe mental anguish, and I am thankful that they are seeking treatment," he said.

But Margaret Stone, co-founder and chairwoman of the Veterans Healing Initiative, which provides funding to treat veterans who suffer from substance abuse and PTSD in nongovernment facilities, said, "The stigma associated with mental health [and] substance abuse remains pervasive throughout the military and society and so we still see a lag time between the time a vet returns and when he or she ultimately receives care."

Miller said a number of factors could explain the increase in the number of recent veterans seeking mental health care from VA. "Better education on mental health and reducing stigma associated with asking for help are contributors. I also believe this increase can be attributed to outreach by VHA and increased access to VA health care enrollment.... Health care professionals are also better now at diagnosing mental health conditions both in the field and in VA and DoD medical facilities," he said.

The data on the mental health treatment of Afghanistan and Iraq veterans indicate that more resources are needed to treat these veterans, Stone said. In particular, she said VA must do a better job serving veterans who don't live or work near the department's hospitals and clinics.

Vande Burgt agreed, and noted National Guard and reserve troops have been hit hard by multiple deployments and are more likely to live in rural communities poorly served by VA.

Veterans Affairs should consider opening more rural clinics and contracting with outside services to reach underserved areas, she said.

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