When the fight is over, servicemembers must face the challenges of coming home. Now, a number of assistance programs are easing that transition.

By Don Vaughan

The soldier thought the worst was behind him when his commanding officer gave him the good news. During his nine months in Iraq as an infantry gunner he had seen things no man should ever see and done things no man should have to do, and he had lost a lot of good buddies along the way. But he dried his tears and put on a smile because he was finally going home.

His family and friends were waiting when the soldier stepped off the plane still dressed in desert fatigues. His first month home was heaven, but by the third he was drinking heavily in a desperate attempt to erase the terrifying images that tortured him in his sleep.

But it wasn’t until his wife took the children and moved out that the soldier picked up the phone and asked for help.

Military personnel returning from Iraq and Afghanistan often experience emotional and psychological problems on redeployment — but they don’t have to face them alone, say mental health professionals. DoD and the VA have joined forces to offer a wide variety of assistance programs that address postcombat challenges and make the transition easier.

Indeed, during no other conflict has the military placed such an emphasis on the emotional and psychological needs of American servicemembers. Specially trained combat stress teams (CSTs) made up of psychologists, psychiatrists, and other mental health professionals provide immediate care in theater, and several new programs quickly identify and treat those who experience problems on returning home.

“I can honestly say that the level of proactiveness [by the military] has been unprecedented in the area of early identification and early intervention to prevent posttraumatic stress disorder,” confirms Cmdr. Mark Russell, USN, staff clinical psychologist at Naval Hospital Bremerton in Bremerton, Wash.

Wages of war

Emotional and psychological problems resulting from combat are an expected side effect of war, but those problems faced by servicemembers in Iraq and Afghanistan are made worse by the fact that the enemy wears no official uniform and attacks can occur at any time. As a result, most military personnel are under almost constant stress their entire stay in theater.

Some servicemembers succumb to combat stress disorders while in theater, but many don’t feel the effects until after they’ve returned home. Sleep difficulties are one of the most commonly reported symptoms, says Lt. Col. Michael L. Russell, a licensed clinical psychologist and chief of the Psychology Department for the U.S. Army Medical Department Activity, Fort Hood, Texas. Depression, anxiety, irritability, hypervigilance, and fear of crowds also are common complaints.Understandably, the emotional and psychological problems experienced by many combat veterans can have a detrimental effect on their lives.

At work, they can become frustrated and angry at tasks they now consider insignificant. At home, they can have difficulty reconnecting with family and loved ones or find their stress compounded by marital or financial tensions.

“There has been a dramatic increase in divorces, particularly among officers,” notes Russell. “The latest Army statistics show that divorces among officers have gone up by 78 percent over a few years prior.” For enlisted personnel, the 7,152 divorces reported in 2004 were 28 percent more than the previous year and up 53 percent from 2000.

Many divorces are the result of the stress disorders experienced by returning combat veterans, but a growing number are triggered by the strain of repeated deployments. “The family system has to adjust to the absence of the servicemember and readjust when that person comes back,” observes Russell. “Some people are now undergoing their fourth deployment to Iraq or Afghanistan. That really takes a significant toll [on the family].”

On occasion, the stress of deployment can affect the youngest members of a military family. David L. Steele, a civilian clinical psychologist at the Wiesbaden Army Health Clinic in Wiesbaden, Germany, notes the case of a young boy who became severely depressed while his mother was deployed in Iraq. “His depression required more intensive treatment than was available in Germany, so we had to pursue getting his mother a compassionate reassignment to a duty station in the United States,” Steele reports. “It’s not just soldiers who have deployment-related mental health needs.”

The Army is aware of the strain on military families and has taken steps to alleviate the problem, says Army spokesperson Maj. Elizabeth Robbins. “We have implemented something called the Deployment Cycle Support Program, which follows soldiers from their initial mobilization through their deployment, redeployment, and afterward,” she says. “Soldiers are also briefed before, during, and after their deployment about how their absence and return may affect their family relationships and how they can cope with the inevitable challenges.”

In addition, the Army has instituted a two-week R & R program that brings some soldiers back to their families mid-tour, an initiative aimed at helping facilitate communication and family ties, Robbins says.

There’s also the Building Strong and Ready Families Program, which was initiated by Army chaplains in 1999 and includes two days of instruction, discussion, and role-playing, that helps couples develop better communication skills and learn how to relate more openly to each other. “The two days are followed by a weekend retreat for the couple at a hotel,” notes Robbins. “It’s kind of a romantic getaway, but there are also workshops and opportunities to get to know each other better. Sometimes the weekends conclude with a marriage vow renewal ceremony.”

Services and assistance

Having learned much from past conflicts, including the first Gulf War, DoD was ready with mental health assistance from the beginning of operations Enduring Freedom and Iraqi Freedom. CSTs were in Baghdad almost immediately after the city’s liberation and quickly spread wherever they were needed, says Lt. Col. Irma Cooper, USAR, former commander of the 113th Medical Company Combat Stress Control.

“Our prevention teams were right behind the combat soldiers,” Cooper says. “In theater, we supported the 3rd Armored Cavalry Regiment, the 82nd Airborne, the 101st Airborne, and the 3rd and 4th Infantry divisions. We also gave support to all DoD soldiers in the area. We didn’t turn away any soldier who needed mental health services.”

According to Cooper, her teams provided education regarding the causes of combat stress and how to deal with it. They also worked with senior leaders regarding available mental health services. “That was key,” Cooper notes, “because there is still a stigma associated with mental health. A lot of soldiers would say, ‘There’s nothing wrong with me,’ which we used to initiate a conversation. And the more we talked with them, the more things came out.”

The CSTs worked as far forward as they could, Cooper says, because “we didn’t want the soldiers to think they were ill; what they had was a normal reaction to an abnormal situation. For example, we had one soldier who was upset because he shot a child who had a weapon. We wanted the soldiers to know they were responding the way anyone would respond in their situation [and help them cope with it]. Our return-to-duty rate was about 95 percent.”

Back home, returning servicemembers are monitored through a screening process called the Post Deployment Health Assessment. All service personnel are required to fill out a health questionnaire on returning home and are evaluated again after three, six, and nine months, says Col. Elspeth Cameron Ritchie, psychiatry consultant to the Army Surgeon General. “The assessment is conducted at specific intervals,” Ritchie explains, “because we realize that many people won’t have symptoms or won’t talk about symptoms right away.”

In addition, the VA has initiated a variety of assistance programs aimed at helping returning combat veterans and their families deal with the difficulties of readjustment, says Alfonso Batres, chief officer for Readjustment Counseling Services in Washington, D.C. “Our program by design is community-based,” Batres notes. “It originates out of the hospitals and is located in 206 sites nationwide, as well as Puerto Rico and Guam.

“More than 80 percent of the staff at these veterans’ centers are veterans themselves, and more than 60 percent have served in a combat zone, so we understand the military experience and the sacrifices that soldiers and their families make for their country.”

Among the multiple services available at most veterans’ centers are:

■ employment and education counseling services;

■ benefits counseling and referral;

■ medical screening and referral — “We are always an extension of the hospitals in that we have all the latest literature and are familiar with the types of services offered medically, as well as the requirements to get in,” explains Batres; and

■ psychological counseling with peer counselors — “Participants are seen in a confidential setting where we can address a lot of their issues and help them adjust, yet remain stable in their job and stay job-ready,” Batres says. “We provide the types of assistance that often keep them from having to go to a medical center for a more formal diagnosis.”

One of the most helpful services to returning combat veterans is a new outreach program staffed by soldiers who have served in Iraq and Afghanistan. “This is a unique program that does a lot,” says Batres. “First, it sensitizes my staff to the needs of a new cohort of veterans that we’ve not served before. Most of us are veterans, but I’m from the Vietnam era, and I might as well be from Mars to the new soldiers because I don’t understand their culture, their language, or their music. So I’m hiring members of their own in-group to promote the outreach.

“We’re educating returning personnel about the services available to them. A lot of them need assistance with getting their GI Bill, for example. There are also job issues, family issues, and communication issues. And we’re screening for those soldiers who might have [emotional] issues related to combat,” Batres says. “We want to intervene as early as possible in a nonjudgmental fashion, shore up the support systems, provide peer support, and assist them in a healthy readjustment.”

Stigma persists

Unfortunately, despite the best efforts of DoD and the VA, a stigma persists that keeps some from seeking help for emotional and psychological problems, say mental health professionals. In fact, according to an article in the July 1, 2004, issue of the New England Journal of Medicine, only 23 percent to 40 percent of those returning from Iraq and Afghanistan whose responses were positive for a mental disorder sought mental health care.

There are many reasons why soldiers and Marines are reluctant to seek help in dealing with emotional issues. Foremost is the warrior mentality that is ingrained in the military culture, says Carolyn Martin, a former Marine who now works as a federal contract investigator. Marines in particular are reluctant to show any kind of weakness, she says, and usually are encouraged to simply “tough it out.”

More significantly, however, many returning servicemembers remain quiet out of fear that their admissions will have an adverse effect on their military careers. “There is some evidence that such a fear is justified,” reports Russell. “A lot of times the myths or perceptions people have are based on some reality.”

Martin agrees, noting, “A lot of our troops, including officers, recognize they have a mental health problem and will go to extreme measures not to allow the military to learn about it because they will be ousted. Sure, the military offers medical assistance, but I can tell you right now that [the servicemember’s] career will probably be over.”

But there are efforts to change that. “I think the past two commandants of the Marine Corps have been good at addressing this issue with their officers and senior enlisted personnel,” observes Martin. “But you still have the old cavemen in there. It doesn’t matter what you train these people to say or see, they will believe what they want to believe.”

Part of the solution, Martin adds, is eliminating the prejudice caused by lack of knowledge. “To get rid of the zero-defect mentality, it should be taught throughout the military that we’re not dealing with robots, we’re dealing with human beings,” she says. “Much of it is a lack of awareness.”

The soldier was embarrassed at first to tell the psychologist about his persistent nightmares and other adjustment difficulties, but the more he talked, the better he felt. The psychologist, a Vietnam veteran, understood his problems and discussed several strategies to help the soldier cope.

A few months later, the soldier’s nightmares were all but gone, and his drinking had been reduced to a couple of beers on weekends. His wife and children rejoined him, and together they worked out the issues that had driven them apart. War was hell, and readjustment had been no picnic, but the soldier finally realized that no matter how bad things might get, there was always someone watching his back.

Just as there had been in Iraq.