OK

Some of the greatest legacies, costs and tragedies of war often go unseen and unexamined.  Every day hundreds of thousands of homeless veterans sleep on the streets.  PTSD and other maladies go untreated and lead to breakdowns of individuals and families.  And now, a report from as psychiatric researcher suggests that you can double the deaths from Iraq and Afghanistan if our pathetic record on mental health care continues.

The number of suicides among veterans of wars in Iraq and Afghanistan may exceed the combat death toll because of inadequate mental health care, the U.S. government's top psychiatric researcher said.

It's a problem of access and a problem of lack of consideration of mental health as a serious challenge.

Community mental health centers, hobbled by financial limits, haven't provided enough scientifically sound care, especially in rural areas, said Thomas Insel, director of the National Institute of Mental Health in Bethesda, Maryland. He briefed reporters today at the American Psychiatric Association's annual meeting in Washington.

Insel echoed a Rand Corporation study published last month that found about 20 percent of returning U.S. soldiers have post- traumatic stress disorder or depression, and only half of them receive treatment. About 1.6 million U.S. troops have fought in the two wars since October 2001, the report said. About 4,560 soldiers had died in the conflicts as of today, the Defense Department reported on its Web site.

You're talking about 4,500 Americans who have served their country susceptible to pain and suffering and death from self-inflicted wounds.  And the Pentagon did NOT dispute the figures.

And look, the future for those with untreated PTSD is not bright even if they don't commit suicide.  The disorder makes it hard to hold a job, relate to family and friends, and generally lead a normal life.  Maybe 300,000 returning soldiers are at risk.

Hilzoy has more.

Some things in life are hard. But getting the number of vets who get minimally adequate treatment over 50% is not one of them. You train the doctors. If those treatments cost more, you provide the money. You do what you need to do to make sure that when someone walks in the door looking for help, s/he finds it.

It's also not that hard to think of ways of raising the number of vets who actually seek help above 50% of those who need it. I think there are good reasons why soldiers should not have the same expectations of confidentiality as civilians, especially during wartime. (We really, really do not want soldiers who are actively psychotic, for instance. Likewise, soldiers with persistent homicidal fantasies.) But as of now, if they are still in the military, they have to deal with the knowledge that their command will find out that they have sought counseling, unless they seek counseling outside normal military structures, which is (I believe) forbidden. Many of them believe that this will affect their careers, and while I'm sure some of them are wrong, I'm equally sure that others are right.

We know how to treat people suffering from PTSD, too.  There is research in the area that needs to be advanced.  I don't need to tell you - Ilona Meagher has told this story repeatedly.  What's lacking is the political awareness of the severity of the issue.  And Thomas Insel has provided it.

Moreover, this must be factored into the costs of future wars.  When we head 10, 20, 30 years down the road and have another generation of homeless and mentally ill veterans on our streets, and the question is raised of another pre-emptive war where the evidence is sketchy and the rationale suspect, will anyone add to the debate "You're consigning tens of thousands, maybe hundreds of thousands of our sons and daughters to a life of endless suffering, even suicide" without expanding our commitment to mental health treatment, which could be part of a more expansive health care system in general, one that would pay for itself and cover our citizens at far higher levels than we currently do.  We're conditioned to think about the defense budget as only weapons systems and private contractors.  THIS is the defense budget too.  In fact, it's the only unfunded part.

Will anyone raise this?  Or will this be another forgotten cost, played out in scattered headlines in newspapers for years to come?

There's almost nothing left in this country that isn't in crisis, but veteran's mental health care most certainly is.  This demands immediate attention.

Originally posted to dday on Mon May 05, 2008 at 07:51 PM PDT.

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