Soldiers Not Getting Needed Help for PTSD

Anger and angst are the enemy now

by Mike Drummond

National Guard Sgt. Chuck Rice shows some classic symptoms of post-traumatic stress disorder. As a veteran, he's eligible for free counseling. But he hasn't gone.Rice, 37, just doesn't want to deal with the bureaucracy and the 40-minute drive to the nearest VA counseling center. His wife, April, said he views seeking help as a sign of weakness.

PTSD is one of the most common mental disorders arising from combat. With 1.5 million having served in Iraq and Afghanistan, as many as 300,000 could have some form of PTSD, health experts say.

The Observer found that the VA, the main agency responsible for treating veterans, is understaffed, underfunded and unprepared for the wave of returning service members.

Rice served on about 50 convoys as a turret gunner, one of the most exposed and dangerous duties in Iraq. Every car, dead dog, or cluster of trash could hide that bomb with his name on it. In his year in Iraq, Rice walked away from three roadside blasts. Such bombs account for 38 percent of the 3,466 U.S. casualties.

The danger "didn't bother me over there," he said, finishing a Bud Lite at Chili's in Gastonia. What bothers him now are crowds, traffic and noises — loud, sudden noises.

His buddies in the 505th Engineer Battalion nicknamed Rice "Angry Man." Now he's on edge and has a hair-trigger temper. His temper is worse since returning, his wife said. Typical PTSD symptoms include emotional numbness, sleeplessness, depression, anxiety and outbursts of anger.

Rice, who works as a prison guard, grows remorseful when talking about the time he swore at his wife, who had clapped her hands during an a-ha! moment in the car.

"Man, she ended up apologizing to me," he said, shaking his head. "And I'm the one who yelled `m———–!' at her."

"Everything we did over there had a consequence," he said, fists clenched white. "It was life and death. I'm bored all the time now. Nothing does it for me anymore. I want to go back. I, I don't know what I want."

Self-enforced isolation

Many in the National Guard face problems unique to serving in state militias.When Guard troops return home, they typically lose contact with fellow soldiers. They're also likely to be miles from treatment, sometimes a powerful deterrent to seek help. When Army troops return home, they are surrounded by comrades on bases and are often within walking distance of counseling centers — although the military has yet to rid itself of the stigma associated with PTSD.

"When you have lack of geographic access and you're already psychologically isolated, you tend to stay home, don't answer the phone and it becomes self-reinforcing," said Lawson Bernstein, a psychiatrist and professor at the University of Pittsburgh.

"In the Army, no one's allowed to just sit in the barracks. It's a lot easier to go under the radar as a civilian."

Geography is a bigger hurdle to treatment for the nation's 6 million rural veterans, who live an average of 63 miles from VA health centers. Nearly half the 231,500 National Guard members who have served in Afghanistan and Iraq live in rural America.

Regular Army soldiers are required to participate in mental-health sessions the first three months after returning from combat.

Research shows Guard troops usually don't answer post-deployment health surveys honestly. They fear it would delay their trip home. So, the Defense Department waits three to six months to ask about mental-health problems. In doing so, the government may be overlooking some service members when they need treatment most.

A call for help, too late

Guard Staff Sgt. Jeffrey Jerome Sloss of Union, S.C., returned from a year in Iraq in April 2004 a changed man.

The state trooper reported to work within about a week. His second day on the job, he arrived at a fender bender and forgot how to write up an incident report.

Sloss had trouble concentrating. He hardly slept. He didn't talk about the war.

His wife, Pamela, struggled to find him help. "I didn't have any resources to go to," she said. "I looked through all the paperwork (the Army) gave him and couldn't find anything."

She discovered Military OneSource on the Internet, which offers a directory of services.

On May 27, 2004, Jeffrey Sloss phoned for a counseling appointment. The same day — five weeks after his return from Iraq — he stood in the hall of his home and put his service revolver to his head. Pamela lunged for the gun just as he pulled the trigger.

Pamela said she believes lack of access to combat-related counseling was "a major factor" in his suicide.

Army says it's attentive

The Army says it does more to address PTSD than any military in history.It has placed counselors on the front lines. And the National Guard has experimented with dispatching PTSD counselors to training drills, which usually take place a few months after units return from combat.

The VA says it sends representatives to brief Guard units before they go to war. After they return, Guard members are sequestered on bases for a few days, and VA representatives explain what PTSD treatment is available.

Sloss had filled out the mental-health questionnaire the Defense Department requires.

Those who note they have signs of mental problems can be detained for a lengthy psychological evaluation.

"When we came off of orders, we were just so glad to be home," says Sloss' best friend Daniel Seaford. "The last thing you want to do is listen to problems you'll have down the road."

VA documents show this is common. In 2005, the VA's committee on PTSD found no official "seems to expect them to answer (the questionnaire) truthfully."

Efforts in Charlotte

The Charlotte Vet Center on South Brevard Street is one of 209 storefront counseling outposts specializing in PTSD.

More than 5,130 patients sought treatment last year, up 35 percent since 2002. Almost all were National Guard members. The center has three mental-health staffers — the same number it had in 2000. The VA said it's adding another counselor in June.

"We're not overwhelmed," said Loretta Deaton, the center's team leader. "We're handling our caseload. … We have not requested any additional resources."

Because no one at the center is a psychiatrist, no one can write prescriptions.

"Medication should be a consideration for any patient with PTSD," said Dr. Spencer Eth, a psychiatrist who helped write national PTSD treatment guidelines.

The Charlotte VA clinic on West W.T. Harris Boulevard has two psychiatrists. But that office is so overwhelmed it sends patients to the VA hospital in Salisbury, about 40 miles north.

VA medical center officials around the country reported in 2004 that follow-up PTSD appointments may be delayed up to three months. VA spokeswoman Adrien Creecy-Starks said such waits "have now been eliminated."

She echoed top VA officials, who say the system is working.

"There's a myth that we're drowning in patients," said Ira Katz, deputy chief of mental health services.

Such statements clash with the VA's own data. The VA estimated 2,900 new PTSD cases nationwide for 2006, but got 34,000.

The VA based those estimates on the number seeking treatment shortly after the 2003 Iraq invasion, VA spokeswoman Karen Fedele e-mailed the Observer. "It did not correct for the increasing number of returning veterans…"

Last week, the VA said it will hire 100 employees to provide readjustment counseling nationwide.

Mental-health money returned

Congress authorized the VA to expand PTSD services in 2005 and 2006 — including staff for clinics in outlying areas.The VA was supposed to spend $158 million last year but returned $46 million because it was unable to hire enough people. The Government Accountability Office said the VA couldn't account for how it spent the remaining $112 million.

"The likelihood it got spent on these mental-health initiatives is not high," said Laurie Ekstrand of the GAO. She acknowledged it takes time to recruit and run background checks on mental-health providers. "These aren't people you hire in three days," Ekstrand said, "assuming you can find them and they want to work for the VA."

Katz said the GAO should have emphasized "VA services in mental health didn't happen as fast as desired. I think they put the spin the wrong way."

`We're still suffering from this'

In Gastonia, Rice's wife, April, talked about the stress of war with a reporter at a restaurant.

"I think he's getting better," she said. The two have sat, side-by-side on their bed, to talk about his anger, and how they're in this together.

"When I slapped my hands that one time and he, well, he did that thing, I realized this wasn't just B.S. It was the first time I saw that reaction in him.

"We're still suffering from this."

April knows she can never understand the blend of fear and adrenaline buzz her husband experienced in Iraq. Although she calls Chuck "nearly perfect," she also realizes something else.

"All of them," she said, "in some shape or form, have come back different."

PTSD

Post-traumatic stress disorder, officially recognized as a mental illness in 1980, can develop after exposure to terrifying or traumatic events. It can affect family members, as well. More than twice as many women as men experience PTSD following exposure to trauma. Depression, alcohol or other substance abuse, or other anxiety disorders frequently occur.Those with PTSD often experience flashbacks or nightmares. Symptoms include emotional numbness and sleeplessness, depression, anxiety and outbursts of anger. Feelings of intense guilt are also common. Most people try to avoid reminders or thoughts of the ordeal.

WHERE TO GET HELP

Iraq War Veterans Organization
www.iraqwarveterans.org

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