Homeland Psychiatry

War veterans are coming home in worse mental shape than anybody expected.
August 1, 2007 AT 3:00 AM
Donald F. Kettl
By Donald F. Kettl  |  Columnist
Sid Richardson Professor at the LBJ School of Public Affairs at the University of Texas at Austin

For Army Specialist Eugene Cherry, the turning point in Iraq came when a demolition team destroyed a minivan full of propane tanks, then took down a nearby three-story apartment building. Cherry, an Army medic, ran to help the injured civilians, but the horror he saw stuck with him in nightmares, weight loss and depression.

When he returned from Iraq to his post at Fort Drum, New York, Cherry tried to get help but couldn't find it anywhere on the post. During a visit to his home in Chicago, he went AWOL and sought relief from clinical psychologist Hannah Frisch, who treated him for a year. Frisch diagnosed him with post-traumatic stress disorder and major depression. "This is not a borderline case," she told one reporter. After a year in treatment, Cherry returned to Fort Drum and turned himself in. Early this year, the Army brought him up on charges for a court-martial.

The case was a nightmare for everyone. Cherry risked a bad-conduct discharge, which would make him ineligible for any future veterans' benefits, including health care. The military was inviting fresh questions about its care of veterans following reports in the Washington Post on appalling conditions at Walter Reed Army Medical Center. For the Department of Veterans Affairs, there was the ominous reminder of health care that a whole generation of vets will need over many decades.

The fact is, no one was prepared for the flood of post-traumatic stress disorder cases that has developed among Iraq war veterans. According to a study published in the New England Journal of Medicine, 15 to 17 percent of these vets have suffered from PTSD, compared with 11 percent of vets who served in Afghanistan. Of those suffering from the disorder, for which researchers have found both psychological and physiological roots, fewer than 40 percent had sought care.

This whole mess has turned veterans' health care into a costly unfunded mandate for state and local governments. Medical, psychological and social problems that spill out of the military often end up in the state and local social service system.

States are already beginning to reckon with the costs. Soon after the Army announced its plans to court-martial Cherry, New York Governor Eliot Spitzer visited Fort Drum to pledge the state's support for mental health counseling. He laid out projects totaling more than $750,000 to provide counseling for family support and prevention of alcohol abuse.

But that is a token amount of money. The states currently spend $3.5 billion per year on veterans and their families. With the federal government struggling to deal with the unexpected issues of returning vets, and the high cost of their care, the state and local burden is sure to grow.

In part that is because states such as New York are stepping forward to plug the gap in federal programs. Many vets do not live close to a VA hospital or other federal facility. And as time goes on, the problems will ripple further through the system, much as troubled Vietnam vets helped fill homeless shelters. Dealing with Specialist Cherry and tens of thousands of his fellow soldiers will surely become one of the major social service issues for state and local governments for decades to come.

Research shows that vets tend to avoid treatment because they fear that they would be seen as weak and that their colleagues would have less confidence in them. But those who don't seek treatment often struggle for years with the consequences. The syndrome pushes many into depression, alcoholism and conflict with their families. "If I would have stayed and did the Army thing, it would have been that much worse," Cherry told a local television reporter. "I would have ended up getting in lots of trouble."

Defense Department officials believe that in all, 100,000 combat vets from Iraq and Afghanistan may eventually need psychological help. One certainty is that neither the military nor veterans hospitals are ready. That leaves states and localities no choice but to prepare themselves as best they can.