US Secretary of Defense Robert Gates has stressed the need to focus on the psychological injuries sustained by soldiers.
Addressing the mental health summit organized jointly by the Defense and Veterans Affairs Departments Monday, Mr. Gates noted that in the past "unseen injuries such as post-traumatic stress and Traumatic Brain Injury were not accorded the full attention they deserved."
These kinds of ailments, in one form or another, have been around as long as war itself. Historical examples date back to ancient Greece where the Spartans called it "fear shedding." After the American Civil War, the term "soldier's heart" was used; in World War I they called it "shell shock"; later "combat fatigue"; and in the 1970s, it was known simply as "Post-Vietnam syndrome."
But "the protracted military campaigns in Afghanistan and Iraq - and the repeated deployments of much of America's ground forces - have brought a new focus to the signature wounds of these wars and on the psychological health of the force and their families," Mr. Gates said.
He also regretted that paperwork for injured troops could still be frustrating, adversarial, and unnecessarily complex. "We need to continue refining roles and responsibilities between DoD and VA, and finding better ways to share information - a goal both Secretary Shinseki and I are committed to."
According to a RAND study last year, there could be more than 600,000 service members with TBI, PTSD, or similar illnesses. Some signs are apparent - severe depression, or even suicide. Others are more elusive and sometimes ill-defined, arriving in the form of nightmares, anxiety, or unexplained and uncontrollable anger. Other acts, seemingly unrelated, bear this enemy's indelible fingerprints: petty thefts, fights, spousal abuse, drug or alcohol abuse. Today, it is all too clear that TBI, post-traumatic stress, and numerous other related mental ailments are widespread, entrenched, and insidious.
Dwelling at length on the strain of repeated deployments, he said, "We know that parents, spouses, children, and caregivers are under compounded states of stress. During deployment, they run single-parent households all the while worrying about the safety of their loved one overseas - a situation made more difficult by constant updates on the television and the internet about attacks and losses - or the overdue daily e-mail from a spouse or parent. When the longed-for reunion happens, the stress simply moves to other facets of their lives. Military members who are irrevocably changed by what they have endured during their combat tour find themselves quickly reintegrated with families that have also evolved and changed during the time apart.
"The department and the services have committed substantial resources to alleviate these stresses on families - and good work is being done in programs such as DoD's Deployment Health Clinical Center. But I have also found from my visits to military posts that there is a real disconnect between the programs that exist and the awareness among the rank and file of the help that is available - and, as just mentioned, the availability of help. We must do a better job of understanding these dynamics, addressing them, and making sure that our people take advantage of new and existing programs."
He wanted military leaders to educate themselves about what resources were available locally, and then identify the most effective way to communicate with subordinates and reach families with that same information. For example, all the services have family-support or readiness groups - the primary avenue to communicate with those closest to the deployed service member.
"If you have recommendations that will improve the way we help or communicate with the troops and their families, I can assure you I will do everything in my power to get it done - whether that means more funding, new authorities, or cutting through bureaucratic barriers," Mr. Gates promised.
Starting with the budget: The Fiscal Year 2010 budget includes some $3.3 billion to support injured service members, which includes funding for:
• Additional case managers and mental health providers;
• Developing a streamlined Disability Evaluation System with the VA;
• Constructing a dozen more Army Warrior in Transition complexes; and
• A number of other initiatives to improve quality of life for the wounded, from increasing staff at Family Assistance Centers to enhancing severance disability pay.
The department has nearly doubled the budget for psychological health and TBI to almost $1.2 billion from last year, including $400 million specifically for research and development. Beginning in FY 10, many of the psychological health programs that had been funded through supplemental appropriations will become part of the services' base budget - so that funding and institutional support for these important programs do not go away when the wars do.
Besides, the uniformed services have made mental health a priority and initiated new programs with the support and advocacy of the highest ranks. The Army chief and vice chief of staff are spearheading the Army Campaign Plan for Health Promotion, Risk Reduction, and Suicide Prevention - which includes a five-year, $50 million study with the National Institutes of Mental Health, considered the largest study of suicide ever undertaken. The Army is putting renewed emphasis on garrison leadership and chain-of-command responsibilities. These include early recognition of warning signals and intervention - in the hope of preventing the kinds of tragedies that have destroyed careers, families, and lives.
Referring to the chronic shortage of mental health professionals in or near the biggest military installations - particularly in remote, and rural areas, the Defense Secretary said, "Even with our push to acquire more professionals, there is a significant lag between our elevation of this issue and qualified professionals arriving where they are needed. For example, the Army has added nearly 900 behavior health providers of all types since 2007, an almost 50 percent increase. That still leaves the service with a shortfall of more than 330 specialists based on current requirements - a gap that will grow to more than 500 if the Army follows through on recommendations to put uniformed providers in every brigade.
Since this is long-term problem, there must be an expansion of recruiting at medical schools around the country. All told, the department clearly needs more uniformed mental health experts, as well as greater access to outside professionals who understand the issues faced by service members and their families."
The humbling fact remains that there is so much we still don't know about post-traumatic stress and other psychological problems. Relapses can occur with little or no warning. Advances can come from both the research lab and the kitchen table, he hoped.
"This reality makes it imperative that we continue the work that has already begun. The military medical community, in the Department of Defense and in the Department of Veterans Affairs, is dedicated to this issue. Our attention will not flag, and our dedication will not falter, Mr. Robert Gates declared.