Category Archives: Iraq

Invisible Wounds of War Report Available for Download

The Rand Corp. recently released a 499 page report titled “Invisible Wounds of War”.   This report was briefly summarized by numerous news articles and Internet reports, including my previous article. 

I’m happy to say that the entire report is available for free download online, or you can purchase a hard copy for $50 from the Rand Corporation through their online bookstore (link below).

Here is the link to the downloadable report which has details not reported elsewhere.  I strongly urge you to at least scan the entire report.   The subtitle is:

Psychological and Cognitive Injuries,

Their Consequences, and Services to Assist Recovery

 

 

TERRI TANIELIAN AND LISA H.  JAYCOX, EDITORS

 

 

Download here   (2.9 mb full report)

or here  (200KB summary).

You can find the Rand Bookstore with these links here  

Oldtimer

  

 

20% of Iraq, Afghanistan Soldiers Have Depression or PTSD

Veteranstoday.com

Half of Depression and PTSD affected troops untreated

A study published by the Rand Corporation shows that of the 300,000 troops affected by mental disorders of depression or PTSDless than half have been treated.   Yes, that is 150,000 untreated heroes on active dury or recently released to the streets without proper treatment according to this independent study.

Picture from Veterans Today site.  Find it Here

The sad news continues…  About one in five, about 20%, of our Iraq and Afghanistan active dury and veterans suffer from depression or PTSD.

The Rand study says that too many soldiers and Marines are still slipping through the cracks since the symptoms of depression and PTSD can appear months after an incident, and many mental problems that appear later may never be caught, the study said.

The RAND study interviewed 1,965 current and former service members and asked them how many had suffered from PTSD within the previous 30 days and suffered from depression within the previous two weeks.

  • “We have tried to generate this estimate across the entire deployed population,” said Terri Tanielian, one of the study’s authors. “We are looking at the scope of the problem now among the population back in the United States.”

The study shows that 19.5% of veterans had received a concussion or other traumatic brain injury during their combat tour.    The study found that some service members actively avoid a diagnosis of a mental health problem due to a fear of negative consequences of such a diagnosis.    The worry is that co-workers would have less confidence in them after a diagnosis and thus impact their career.

  • “When we asked folks what was limiting them from getting the help that they need, among the top barriers that were reported were really negative career repercussions,” Tanielian said.

Please read the rest of this article (paraphrased above) here:  Veterans Today.

You can get a different take at Medical News Today.  They report that 30% of our soldiers that are on their third or fourth tour have expressed emotional illnesses as gleaned from 2295 anonymous responses to the survey (11.9 % first tour soldiers, 18.5% second tour, 27.2% third tour).

And from the Associated Press at the Atlanta Journal Constitution website.

I encourage you to write the candidates at every government level and all of our current congressmen to encourage them to show their support by increasing the help for these wonderful men and women that have served our country.  Let’s serve them now!

Help our Heroes!

The ‘equal opportunity war’ bring equal opportunity trauma

Much of the information below was gleaned from a well written USA Today story entitled Mental toll of war hitting female servicemembers.   Early in the story the writer tells about Master Sgt. Cindy Rathbun who began losing hair in clumps within 3 weeks of arriving in Iraq.   She is now enrolled in the first group of a new Women’s Trauma Recovery Program which is a 60 to 90 day program for female warriors. 

Cindy is suffering from the stress and trauma of war, but also from sexual trauma from prior to her deployment by a military superior.

Some tidbits of information directly from the article cited:

More than 182,000 women have served in Iraq, Afghanistan and the surrounding region — about 11% of U.S. troops deployed, the Pentagon says.

That dwarfs the 7,500 who served mostly as nurses in Vietnam and the nearly 41,000 women deployed during the brief Gulf War.

Although some of those women suffered PTSD, few saw actual fighting or were subjected to the stress of multiple deployments.

In Iraq, “there are no lines, so anybody that deploys is in a war zone,” Rathbun says. “Females are combat veterans as well as guys.”

 To be sure, women are barred from ground jobs, technically assigned to support roles, but guess what?   Those support roles include guarding checkpoints, driving supply convoys and searching women in neighborhood patrols.   Dangerous duty just the same. 

Attacks come from IED’s, mortars, and suicide attacks on checkpoints as well as from enemy fighters.   The stress is there.  The fear is there.  The fatigue is there, the unknown is there, the worry about the home folks is there.  Death and destruction are evident every day.   More than 100 of our female warriors have died and almost 600 wounded.

 More from the article cited:

The ranks of psychologically wounded from this war are far larger. In 2006, nearly 3,800 women diagnosed with PTSD were treated by the VA. They accounted for 14% of a total 27,000 recent veterans treated for PTSD last year.

In June, the Defense Department’s Mental Health Task Force reported that the number of women suffering from combat trauma might be higher than reported. It cited “a potential barrier” for women needing mental-health treatment as “their need to show the emotional strength expected of military members.”

The report also said that after leaving the military, “many women no longer see themselves as veterans” and might not associate psychological symptoms with their time in the war zone.

Did you notice that?  Women represent 11% of the deployed but have 14% of the cases, even though the DoD thinks they are under reported.  Battle lines or not, they are being affected at a much higher rate than men, some possibly due to MST, Military Sexual Trauma that was being diagnosed and treated as PTSD.

Here is a link to Oldtimer’s PTSD Videos which includes a video on MST.

It is about time that this problem is being addressed early in the process for our returning heroes.   Our warriors are the best and deserve the best, black, white, male and female.    

Wear the uniform, deserve the best

Our programs should never be just about the men. 

It should be about our heroes.

Oldtimer

Surge Seen in Number of Homeless Veterans

Surge Seen in Number of Homeless Veterans

 Oldtimer’s Comment:  I’ve seen a number of these types of articles.   Although the estimates vary depending on the subject area from 400 to about 1500, the word on the street is that the returning soldiers from Iraq and Afghanistan are showing up in shelters much faster than in previous wars.  The problem stems from higher rates of PTSD and TBI (traumatic brain injury) which still take too long to diagnose, and which are resulting from the combined effect of IED’s and higher survival rates.    The VA has long under diagnosed these problems and only recently, after much heat, begun to actively pursue it. 

Photo by Jeff Swensen for The New York Times
Frederick Johnson, a veteran of the Iraq war, lives in temporary housing provided by the V.A. after spending a year on the streets.

By ERIK ECKHOLM

WASHINGTON, Nov. 7 – More than 400 veterans of the Iraq and Afghanistan wars have turned up homeless, and the Veterans Affairs Department and aid groups say they are bracing for a new surge in homeless veterans in the years ahead.

 

Photo by Brendan Smialowski for The New York Times
Joe Williams lives in a homeless shelter in Washington.

Experts who work with veterans say it often takes several years after leaving military service for veterans’ accumulating problems to push them into the streets. But some aid workers say the Iraq and Afghanistan veterans appear to be turning up sooner than the Vietnam veterans did.

“We’re beginning to see, across the country, the first trickle of this generation of warriors in homeless shelters,” said Phil Landis, chairman of Veterans Village of San Diego, a residence and counseling center. “But we anticipate that it’s going to be a tsunami.”

With more women serving in combat zones, the current wars are already resulting in a higher share of homeless women as well. They have an added risk factor: roughly 40 percent of the hundreds of homeless female veterans of recent wars have said they were sexually assaulted by American soldiers while in the military, officials said.

“Sexual abuse is a risk factor for homelessness,” Pete Dougherty, the V.A.’s director of homeless programs, said.

Special traits of the current wars may contribute to homelessness, including high rates of post-traumatic stress disorder, or PTSD, and traumatic brain injury, which can cause unstable behavior and substance abuse, and the long and repeated tours of duty, which can make the reintegration into families and work all the harder.

Frederick Johnson, 37, an Army reservist, slept in abandoned houses shortly after returning to Chester, Pa., from a year in Iraq, where he experienced daily mortar attacks and saw mangled bodies of soldiers and children. He started using crack cocaine and drinking, burning through $6,000 in savings.

“I cut myself off from my family and went from being a pleasant guy to wanting to rip your head off if you looked at me wrong,” Mr. Johnson said.

(…)  Read more about Fredrick at the link above

Poverty and high housing costs also contribute. The National Alliance to End Homelessness in Washington will release a report on Thursday saying that among one million veterans who served after the Sept. 11 attacks, 72,000 are paying more than half their incomes for rent, leaving them highly vulnerable.

Mr. Dougherty of the V.A. said outreach officers, who visit shelters, soup kitchens and parks, had located about 1,500 returnees from Iraq or Afghanistan who seemed at high risk, though many had jobs. More than 400 have entered agency-supported residential programs around the country. No one knows how many others have not made contact with aid agencies.

More than 11 percent of the newly homeless veterans are women, Mr. Dougherty said, compared with 4 percent enrolled in such programs over all.

Veterans have long accounted for a high share of the nation’s homeless. Although they make up 11 percent of the adult population, they make up 26 percent of the homeless on any given day, the National Alliance report calculated.

Oldtimer’s comment:   My studies show that homeless male veterans make up 43% of the homeless male population, far in excess of what would be expected.

According to the V.A., some 196,000 veterans of all ages were homeless on any given night in 2006. That represents a decline from about 250,000 a decade back, Mr. Dougherty said, as housing and medical programs grew and older veterans died.

Oldtimer’s comment:  Oops!  That is a deliberately misleading statement.   A GAO report states that the drop from 250,000 a decade ago was due to a major change in how homeless veterans are counted.   While it is true that our older veterans are dieing off, many more veterans are joining the ranks of the homeless and make up for it.  There has been no real decline, and actually there has been a steady increase in the percentage of homeless veterans vs the overall population of veterans.

The most troubling face of homelessness has been the chronic cases, those who live in the streets or shelters for more than year. Some 44,000 to 64,000 veterans fit that category, according to the National Alliance study.

On Wednesday, the Bush administration announced what it described as “remarkable progress” for the chronic homeless. Alphonso R. Jackson, the secretary of housing and urban development, said a new policy of bringing the long-term homeless directly into housing, backed by supporting services, had put more than 20,000, or about 12 percent, into permanent or transitional homes.

Oldtimer’s comment:  I’m not sure where these numbers come from.  It appears the HUD secretary is talking about all chronic homeless, not just veterans.   20,000 is 12% of 166,000, which is about right for the chronic homeless for the entire homeless population. To get a feel for progress among veterans, see the following two paragraphs.

Veterans have been among the beneficiaries, but Mary Cunningham, director of the research institute of the National Alliance and chief author of their report, said the share of supported housing marked for veterans was low.

A collaborative program of the Department of Housing and Urban Development and the V.A. has developed 1,780 such units. The National Alliance said the number needed to grow by 25,000.

Mr. Dougherty described the large and growing efforts the V.A. was making to prevent homelessness including offering two years of free medical care and identifying psychological and substance abuse problems early.

Oldtimer’s Comment:  ‘Bout Time!

(…)

PTSD vets soon coming like tsunami

There is a scary article in the San Francisco Chronicle.  The article predicts a flood of new stressed out veterans as they return form Iraq and Afghanistan, many of whom are on the fast track to PTSD, depression, and other mental health disorders compared to previous wars.   I’ve reprinted a little of it below, but you can find the rest at this link where it is reproduced in SGate.com.   

A flood of stressed vets is expected

C.W. Nevius

Sunday, December 9, 2007

(…) omitted illustrative story about a vet (Tim Chapman) contemplating suicide, find it at the link. 

First a few facts. Bobby Rosenthal, regional manager for homeless programs at the Department of Veterans Affairs, estimates that one third of the more than 6,000 homeless people – about 2,100 – in San Francisco are veterans.

And no wonder the number is so high. California leads the nation in homeless veterans by a mile, according to the National Coalition for Homeless Veterans. The 2006 numbers showed 49,724 homeless vets in California. The next nearest state was New York with 21,147.

Now here’s the scary part. Compared with what’s coming, that’s nothing.

Roughly 750,000 troops served in the wars in Iraq and Afghanistan, often with multiple tours of duty. Many are only now returning home. But unlike Vietnam veterans, who didn’t begin to demonstrate post-war trauma until five or 10 years after they left the war, this group seems to be on a fast track.

“Everything is speeded up,” said Michael Blecker, executive director of San Francisco’s Swords to Ploughshares program. “What we’re seeing in San Francisco is guys in their 20s with the kind of stress and trauma that makes it impossible to go on with their lives.”

It’s been called a health care tsunami. Because not only are the Iraq vets prone to post-traumatic stress disorder (something Chapman has battled) but with improved battlefield health care, far more are surviving traumatic injury. On one hand, that’s good news, but it also means many more vets who are severely disabled, having lost arms and legs. Both factors increase the chances that the returning troops will join the sad ranks of homeless veterans.

Cities all over the country are bracing themselves, although some, like San Francisco, are bound to be hit harder. Mayor Gavin Newsom says that at a recent conference of mayors, the group passed a resolution asking the VA “to tell us what you are going to do.”   “It’s great lip service,” Newsom said, “but show me the money.”

If history holds, the mayors shouldn’t hold their breath. If anything, benefits for veterans have been restricted. To take one example, many of us think of the World War II G.I. Bill as a shining example of a reward for service, paying for college for vets. But Blecker, of Swords for Ploughshares, says the current version “is in no way, shape, or form near enough” to pay for a degree.

As Newsom says, “Yeah, support the troops – as long as they are young, healthy and a great photo op.”

For San Francisco, the potential impact could be huge. An influx of traumatized, battle-scarred veterans presents a scary future. Consider the case of Scott Kehler, a veteran of the first Gulf War, who needed years to work through his demons. He recalls passing burned bodies and the constant fear that an explosion would suddenly erupt in the street.

“It was the things I didn’t want to see at night when I closed my eyes,” Kehler said. “I didn’t know what PTSD was. I only knew my dreams, my shame, my guilt, was all coming together.”

(…) omitted a few details, go to link to get the rest.

Kehler, who is mentoring Chapman, is testimony to the effectiveness of the Ploughshares slogan – “veterans helping veterans.”

“Especially now that we’ve got our veterans coming home from Iraq,” said Ploughshares counselor Tyrone Boyd, “we’re going to need people that have been in combat so they know what they are talking about.”

The challenges are unique. Wanda Heffernon, a program and clinical counselor for Ploughshares, said they had a new inductee who slept in the closet. It was the only place he felt safe.

It’s the sudden transition that gets them.  “One day they are fighting in a war,” said Kehler. “The next day they are sitting at their mother’s kitchen table.”

Is it any wonder they end up on the street? Kehler battled alcohol abuse, but Chapman is part of the new breed, who turn to methamphetamine. Married when he returned, he lost his wife and all contact with his parents. Eventually he ended up sleeping in an alley.Now drug-free, living at Treasure Island housing, holding down a full-time job, and reconnected with his mother, he is testimony to the idea that peer counseling seems to work. Ploughshares has earned support from Sens. Dianne Feinstein and Barbara Boxer and House Speaker Nancy Pelosi.

Imagine the impact it would have on the San Francisco homeless problem if one third of those on street were able to get help and housing.

But what the vets don’t have is funding.

“Why isn’t the federal government doing something about this? Why isn’t the Veterans Administration doing something?” Blecker asks. “The irresponsibility of our leaders, not to address this, makes me want to tear my hair out.”

The VA’s Rosenthal – who gets high marks from local leaders – says the problem is not being ignored.

“It’s a whole new set of challenges,” she said. “The VA is looking at it. Let’s hope we’ve learned our lesson from Vietnam.”

We can only hope.

“You know what scares me?” asks Boyd. “I haven’t heard a plan (from the federal government) about what they are going to do when the troops come home. What’s the plan?”

Well?

C.W. Nevius’ column appears Tuesday, Thursday, and Sunday. His blog C.W. Nevius.blog can be found at SFGate.com. E-mail him at cwnevius@sfchronicle.com.

Oldtimer’s comment:  This story illustrates what I’ve said all along.  PTSD and TBI are leading causes of homelessness among veterans.  It is a rapidly growing problem, approaching flash flood conditions for our heroes returning from Iraq and Afghanistan.   A tsunamis of real people, not just numbers, real people with real names.  Somebody’s sons and daughters, husbands and wives, fathers and mothers, brothers and sisters.  Real people, all in serious trouble, heroes in despair  … we should be crying.  We should be helping, we should be calling on congress, questioning our candidates. 

Where is your voice, America?

Oldtimer  

News Flash! Army Reports on Delayed PTSD

Delayed PTSD, Depression,

Family Conflict Data Revealed

Picture by AlyssaAS

Picture by icolman (Creative Commons License – Find it Here)

This study reported in Army.Mil/News found that out of 88,000 returning Iraq war soldiers given Post-Deployment Health Assessments (PDHA), only 4 to 5% of the soldiers assessed in the 18 months prior to Dec 2006 were found to have PTSD, but 3 to 6 months later that number jumped to 20.3 % for active duty soldiers and to an alarming 42.4% for reserve-component soldiers.

We are talking about the same soldiers, delayed PTSD symptoms.   There were other delayed complications/symptoms.  Reported depression symptoms doubled and family conflicts rose from 3.5 to 14 % active duty and from 4.2 to 21.2 % for reserve-component soldiers.

Here is the report:

Army Study Finds Delayed Combat Stress Reporting

Nov 14, 2007
BY Elizabeth M. Lorge

WASHINGTON (Army News Service, Nov. 14, 2007) – In a study that will appear in the “Journal of the American Medical Association” Wednesday, Army medical officials examined increased Soldier-reported mental-health concerns in mandatory post-deployment health screenings.

Cols. Charles Milliken, M.D. and Charles W. Hoge, M.D., two of the study’s authors, found that between the initial Post-Deployment Health Assessment and the Post-Deployment Health Re-assessment three to six months later, Soldiers are more likely to report signs of post-combat stress and Post Traumatic Stress Disorder.

“These efforts are about taking better care of Soldiers,”said Col. Milliken, the principal investigator at Walter Reed Army Institute of Research’s Division of Psychiatry and Neuroscience during a media roundtable at the Pentagon Friday. “What we’re hoping to do with the screenings is detect mental health problems while they are still small, simple and temporary. When these problems get bigger and more complicated, they are much harder to treat and it increases the likelihood that they will become a chronic, long-term problem.”

The study examined the assessments of 88,235 Iraq veterans completed between June 1, 2005 and December 31, 2006, and found that while only 4 to 5 percent of Soldiers were referred for mental healthcare on the PDHA, three to six months later that number jumped to 20.3 percent for active-duty Soldiers and 42.4 percent for reserve-component Soldiers.

The second set of numbers encompasses the PDHA, PDHRA and Soldiers who were under mental-health care because of self-referral or employee-assistance referrals. According to Col. Milliken, these Soldiers were not necessarily diagnosed with PTSD, but they were exhibiting symptoms that were serious enough that a medical provider wanted to have them evaluated.

Similarly, symptoms of depression reported on the PDHA rose from 5 percent to 10 percent on the PDHRA.

The highest jump the study found between the PDHA and PDHRA were reports of conflict with family and friends. This rose from 3.5 to 14 percent for active-duty Soldiers and 4.2 to 21.1 percent for reserve-component Soldiers.

Although the study didn’t examine causes and effects, Brig. Gen. Stephen L. Jones, assistant surgeon general for force protection, who has deployed twice, suggested Friday that the PDHA numbers may simply be skewed because Soldiers are so happy to go home and haven’t yet interacted with their families.

“When you come back, you’re feeling great, almost euphoric. You don’t have any problems in the world. You’re just glad to be home. And then over the next three-four weeks, you re-establish relationships with your family and the normal stress everybody feels when they return home starts to surface. This is a normal, adaptive response and we would expect the stress levels at home to go up,” he said.

The disparity between active and Army Reserve and National Guard Soldiers was a bit more challenging for the study’s authors, especially because they determined that combat exposure for Reserve and National Guard Soldiers was virtually identical to that of active-duty Soldiers, and they reported more physical health concerns as well.

Col. Milliken believes this may be due to the differences in health coverage for reserve-component and active-duty Soldiers. Active-duty Soldiers can go to sick call any time, so he said they may not feel as pressed to report every little concern, but Reserve and National Guard Soldiers only have six months of TRICARE coverage when they return and two years of Department of Veterans Affairs benefits. After that, the VA will pay for service-related injuries or illnesses, if they are documented on forms like the PDHRA.

The PDHRA adds a question about alcohol use, and while 11.8 percent of Soldiers admitted that they might be misusing it, only 0.2 percent of these were referred for a treatment program and still fewer were seen within 90 days.

While acknowledging the Army has a long way to go when it comes to alcohol treatment, and sight the lack of confidentiality as a real roadblock, both Brig. Gen. Jones and Col. Milliken said they were encouraged that so many Soldiers were even willing to report that they had a problem, because the PDHRA becomes part of a Soldier’s permanent medical record.

They also believe that the Army’s efforts to reduce the stigma around PTSD and seeking mental-health assistance, including the chain-teaching and Battlemind programs, are working.

“I think this study shows that we’ve done a pretty good job of reducing the stigma,” said Brig. Gen. Jones. “There’s several factors. Number one: the fact that over half the Soldiers who seek behavioral-health counseling do so within 30 days of the survey and do so on their own. They go in on their own and ask for the counseling. I think the response we’ve gotten to our Soldiers stepping up and saying yeah, I’d like some help is another indication that we’ve helped reduce that stigma.”

Oldtimer’s note:  The picture above is not part of the article.  Taken at the Korean War Memorial, it was released under creative commons license by icolman

Returning Vets: GI Bill Failing Them

Returning Veterans:

GI Bill Earns Dunce Cap 

GI Bill earns dunce capGI Bill earns Dunce Cap 

 I found this story in today’s @issue section of the Atlanta Journal- Constitution.   The author is Ellis Henican who is a columnist for Newsday.   He makes a point that returning veterans from Iraq and Afghanistan arrive to an ugly surprise – the highly touted education they were promised is still limping along essentially at World War II rates of funding compared to actual costs of an education.   The GI Bill is failing them and failing us for the promises we make for our heroes that go off to war.

He says what too many of us have been saying for it not to be true:  Our members of Congress from both parties are constantly saying how much they support our troops, yet once again, they shortchange our warriors when they come home.    Read the excerpts and then go back to the link above and read the entire article:

Returning Vets find GI Bill earns dunce cap

by Ellis Henican 

Newsday

Published on: 11/30/07

They’re coming home, the lucky ones are, pulling their lives back together after harrowing times in the war zone.   And the GI Bill is there to help them, same as it was for “the greatest generation,” who returned to civilian society after World War II.

Um, well, not exactly.

American vets now coming back from the wars in Afghanistan and Iraq are facing an ugly surprise — and I don’t just mean the iffy health care at their local VA hospital. The educational benefits that sounded so alluring in those upbeat recruiting ads? They don’t come close to covering the real costs of college.

“Four hundred dollars? Are you kidding?” Army Reserve Spc. Sheila Pion said of her monthly stipend. “Just my textbooks cost $410.”

A seven-year reservist back home in Long Island City, N.Y., and attending John Jay College of Criminal Justice, Pion served at an Army hospital in Kuwait, tending to wounded soldiers. “It was important duty,” said Pion, 24. “I was happy to do it. But the whole point of me joining the military was to pay for my education. And the educational benefits are nothing like they lead you to believe.”

(…)

Under today’s GI Bill, regular-service combat vets get $1,101 a month, far less for fighting members of the National Guard and Reserve. No one’s going to Harvard or Columbia on that kind of money. And even to qualify, today’s soldiers are required to deposit $100 a month into their own education fund, months or years before they ever get a nickel back.

“A combat tax,” the troops have starting calling these paycheck deductions.

(…)  Read the rest at the link, please.

 “Supporting the troops”

should be more than just a slogan!

______________________________________________________

Note:  After posting this an hour or so ago, I came across this related information. 

Did you know that the “No Child Left Behind” act now carries a provision that requires primary schools (your child’s high school for example) to provide detailed contact information for every child in the school to military recruiters?

Military recruiters can blitz youngsters with uninvited phone calls to their homes and on-campus pitches replete with video war games. This is all possible under a little noted part of the law that requires schools to provide the names, addresses (campus addresses, too) and phone numbers of students or risk losing federal aid. The law provides an option to block the hard-sell recruitment – but only if parents demand in writing that the school deny this information to the military.

It is in the recruitment of lower middle class students, focused on minority blacks and Hispanics, where the education card is pushed hardest in order to meet the recruitment goals to fill the ranks of our military.  These are the kids most likely to see an educational opportunity as a blessing and also the most unlikely to realize that it will not be enough to get them a real education.  It is these recruits that are in most need that later find the GI Bill failing them most dramatically.

Oldtimer