The Toll of War: Service Members With PTSD Get Help, but More Is Needed
The young man had served in the Middle East and now, home from a harrowing deployment, was stricken with the symptoms of post-traumatic stress disorder. He became a recluse, refusing to leave his house for months because of fears that he might suddenly snap. But then he was invited to a gathering of veterans who met regularly to work out. He went.
"He started exercising, and he started feeling better," Elaine Miller-Karas, a therapist and expert on PTSD in the military, told TakePart. "What if he didn't get to that [event]? Mental-health counseling is one portal to help people with PTSD, but it's not going to help everyone. There have to be different portals of care."
Karas, codirector of the Trauma Resource Institute in Santa Fe, NM, is among the experts who are strategizing ways to help military personnel and veterans get the care they need for PTSD. The problem is of growing significance as military and public health experts try to make do with limited resources. Between 13 percent to 20 percent of the 2.6 million U.S. service members who have been stationed in Iraq or Afghanistan since Sept. 11, 2001, have PTSD, according to a report released earlier this year from the Institute of Medicine.
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PTSD is triggered by a specific traumatic event. Service members with PTSD often relive the event and become easily startled or upset. They have nightmares or flashbacks in which they remember the trauma and the feelings associated with it. People with the disorder are often jittery and on edge. Others become emotionally numb, avoiding thoughts, feelings or people that are associated with the trauma. Symptoms of PTSD typically start soon after the trauma. But sometimes the problem begins months or years later, according to the Department of Veterans Affairs.
Other problems tend to go hand-in-hand with PTSD. Difficulties in relationships are common. Service members may have marriage troubles or are unable to get along with coworkers or supervisors at work. Depression, anxiety and feelings of hopelessness are common. Some service members drink heavily or use drugs. The risk of suicide rises dramatically.
Several new approaches, however, are aimed at getting more service members effective help. In April, the VA announced an addition of 1,600 mental health professionals as well as nearly 300 support staff to its existing workforce of 20,590 to help meet the increased demand for mental health services. Since 2007, the VA has seen a 35 percent increase in the number of veterans receiving mental health services.
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Also this year the Army issued a revision in the definition of PTSD in order to urge more veterans and service members to seek help. Under the traditional definition, PTSD was diagnosed with criteria that included a description of the patient as responding to the trauma with "helplessness, horror and fear." But mental health experts in the military argued that veterans and service members typically do not act helpless or afraid, although they may be suffering from PTSD. Under the new Army guidelines, members who are still functioning can still qualify for a diagnosis and get treatment.
And in June, the VA began a new online initiative called AboutFace to help veterans recognize PTSD symptoms and seek treatment. The AboutFace Web site has videos from veterans who talk about getting treated for PTSD.
"We want veterans to recognize themselves in these stories and to feel optimistic that they can overcome their challenges with proper treatment," Dr. Robert Petzel, VA’s under secretary for health, said in a news release announcing the program.
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Despite these efforts, it's going to take entire communities and legions of public-health experts to meet the demand for services, Miller-Karas says.
"Fortunately, there are many people working around the country in different avenues, such as the VA," she says. "But I think it's really important that it has to be a public-private partnership if we're going to try to impact the many men and women who need help."
For every service member or vet affected by PTSD, she adds, there are often family members who are suffering, too.
"That's a lot of people who are impacted," she says. "I don't think we have a enough mental health providers to meet the need for everyone."
A variety of treatments are used to treat PTSD. Medications, such as anti-anxiety drugs and antidepressants are often helpful. But the most effective treatment for the condition is cognitive behavioral therapy, which helps people cope with their symptoms and learn skills to change their thoughts and feelings.
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While that kind of therapy doesn't have to last for years, it still requires trained therapists. Instead, Miller-Karas favors greater use of programs that train peers to help each other.
"There's an access problem," she says. "They just hired 1,600 new therapists around the country, but that is a drop in the bucket."
And some service members simply won't go see a therapist. "They say, 'I don't want to be diagnosed as a nut case,' " she says. "The point is, not any one intervention is not going to help every service member."
Miller-Karas has created a program she calls trauma resiliency in San Bernardino County in Southern California that offers peer-to-peer counseling. Veterans learn wellness skills, such as exercise, meditation, prayer or yoga, that they can teach to peers who have PTSD. By using these techniques, people can learn to recognize the anger, anxiety and hostility that is part of the illness and can interrupt the symptoms and train their nervous systems to stabilize.
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"They may do a program like this when they may not go see a therapist," Miller-Karas says. "One thing they say unequivocally is that talking to someone else who has been through [combat] is so helpful because they get them and they know what they've been through."
Miller-Karas says she sees other promising alternatives to traditional PTSD counseling and therapy, such as complementary health practices. A study published last month in the journal Military Medicine found that healing touch and guided imagery reduced PTSD symptoms in combat-exposed active-duty service members. These complementary medicine strategies, when added to conventional therapy, seemed to improve the soldiers' quality of life and reduced feelings of depression.
"There has been a lot of great support and creativity" in the VA, she says. "There is an attempt to expand our knowledge about what—outside of the traditional box—may be helpful to our vets and our active duty service members."
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Still, some people are falling through the cracks. Service members and vets in small or rural communities do not have access to as many resources, Miller-Karas notes. And some people who seek a PTSD diagnosis and structured therapy may still have to wait too long for care. She recalls one patient who was suicidal. She was instructed to refer the patient to a VA medical facility for emergency care.
But, days later, the man's wife told Miller-Karas that the experience had been "dehumanizing." The couple waited for five hours to see a nurse-practitioner for a five-minute visit. The patient then had to wait three more days to get an appointment with a therapist.
"You sometimes have to wait a long time for care, and that is a real barrier for some of these young guys," she says. "It's up to us, as the wider community, to ask what can we do to help these people."
What more should communities do to help returning service members and veterans get mental-health care? Let us know in the comments.
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Shari Roan is an award-winning health writer based in Southern California. She is the author of three books on health and science subjects.
