I have always had the utmost respect for anyone who has served our country as a participant in our nation’s armed forces. As far as I’m concerned, American War Veterans should be given a free ride in almost every aspect of their lives upon returning home. Unfortunately mental health services for returning servicemen have not been prioritized and funding for these services continues to be cut. One hundred thousand (and counting) of our soldiers have returned or are returning home as operations in Iraq and Afghanistan continue. Consequently the number of Iraq and Afghanistan war veterans seeking treatment for mental health services continues to increase exponentially.

Recent studies indicate that as many as 35% of all returning American soldiers from Iraq are experiencing some form of mental illness. This number is up almost 70% over a 12 month period and differs vastly from the 10% that the government had previously projected. The study was based on findings compiled from the Post Deployment Health Assessment which is a mandatory survey for all returning soldiers since May of 2003 — two months after the invasion of Iraq. Answers provided by soldiers in the post-deployment survey show that 19.1% of those returning from Iraq had immediately reported mental problems, compared with 11.3% of those returning from Afghanistan and 8.5% of those returning from other overseas postings mostly in noncombat areas. By the end of the first year, a collective 35% had eventually sought mental health treatment.

Veterans turn to the VA for mental health services and sadly their needs are not being met. Recent increase in demand coupled with the underestimation of the need for services has left the government unprepared to serve our returning veterans. In some communities VA clinics don’t provide mental health services or substance abuse care. Even if these VA clinics offer mental health services, waiting lists often render that care inaccessible.

There are many potential reasons why previous attempts at determining the rate of mental illness have been unsuccessful. Active soldiers and veterans alike have generally been reluctant to admit to having a mental illness. Several factors contribute to why soldiers and vets aren’t readily willing to admit that they are experiencing any psychological problems. Stigmatization and the consequent potential for singling out that individual are obvious deterrents for admission. A general fear of the potential for jeopardizing career advancement is another reason that is often cited. Most soldiers and veterans feel that information obtained through mental health services will be shared with their unit commanders and consequently are reluctant to seek services.

Several opportunities are presently available that would improve the identification and treatment of mental illness in active military personnel and Veterans alike. DSM labeling is commonplace in the treatment methods of the VA and other related facilities. This is a problem itself as the labeling process reinforces the “sick role” of the patient. The labeling effect could potentially delay the soldiers return to his or her unit, or even home, which is especially true in the early care of the soldier or veteran. In order to avoid legitimate concerns about possible “pathologization” of common symptoms, treating professionals should consider avoiding labeling and instead focus on symptoms and behaviors. Some evidence suggests that returning to work with one’s fellow unit or group during wartime can facilitate improvement of symptoms.

Incorporating what has been learned from Vietnam Veterans with chronic PTSD, attention should be focused on several vital areas of life functioning. Preventing family breakdown is a key element to treatment. Oftentimes soldiers have some panacea impression of home life, and when they eventually return home, they may have difficulty adjusting when that is not the case. Families themselves have experienced stress and problems related to deployment. Mental health providers need to be able to focus on the family unit in order to anticipate potential problems.

Preventing social withdrawal and isolation is another key factor to successful re-entry into today’s society. PTSD specifically inhibits individuals from returning to previously exiting relationships with colleagues and relatives. Specific attention should focus on skill training and linking individuals with others with PTSD in order to facilitate social networks. Special attention should focus on vocational rehabilitation for veterans, as steady employment is often difficult to maintain due to irritability, difficulties with PTSD symptoms, and substance abuse. Steady employment acts on many levels as it alleviates financial stress, provides a source of meaningful activity as well as an opportunity to meet friends. Finally, efforts must be made to slow the combined occurrence of substance abuse and PTSD. More education needs to be focused on the relationship between traumatic stress reactions and substance abuse.

The government is attempting to alleviate the mounting demand for mental health services by placing more psychiatrists, psychologists and social workers within primary care clinics. This action alone is simply not enough. We need to expand services into the warzone itself, and place additional effort into initial identification of symptomatic behavior. I can only hope that the government increases its efforts for treating veterans so that they may be able to re-adjust to everyday life. It only seems fair to give these individuals every opportunity for successful repatriation as they have given us so much already.