Hidden Wounds:
Military, community not ready for wave of damaged soldiers
http://www.fayobserver.com/articles/2010/09/30/1034698?sac=Home
Sep 30, 2010
By Jennifer Calhoun
Fort Bragg Spc. John Brack is broken.
He's a backwoods Georgia boy who joined the Army and became a combat
medic to save people.
Now, he's so swallowed up by post-traumatic stress disorder that he
has only one real emotion left for the world: anger. The rest, he
says, he fakes.
Brack is 30 years old and his third marriage is over. He's in a
custody fight over his children. A few weeks ago, he was in a
Cumberland County courtroom awaiting trial on an assault charge when
the case was dismissed because the alleged victim decided not to testify.
For more than a year, Brack has taken a cocktail of medications to
relieve PTSD, the anger and other problems that began after his time
in a region of Iraq known as the Triangle of Death.
"I have one pill to be this way, and one to be that way," Brack says.
"One to sleep, and one to wake up. One for no nightmares, and one for
the headaches and the migraines."
He sees a psychiatrist at Womack Army Medical Center once a month. He
sees a psychologist every two weeks. Two of his children needed
counseling, as well.
When his children weren't living with him, he says, he drank to pass
out and keep the nightmares at bay.
Now he takes enough pills to stay what he calls "comfortably numb"
while he waits for a medical discharge from the Army.
He doesn't look much beyond that. As he says, with PTSD "your
give-a-damn is shattered."
Brack is one of thousands of service members suffering from the
hidden wounds of the Iraq and Afghanistan wars. No one can say just
how many Fort Bragg soldiers are fighting their own battles with
PTSD, depression or other lingering effects of combat. No one knows
how many will stay in Fayetteville and the surrounding area after
their service.
What is clear is that the community - military and civilian - isn't
ready to provide all the resources that damaged soldiers and broken
families will need.
The Fayetteville Observer has spent months examining the handling of
mental health issues created by nine years of war. That reporting
shows that the Army, Fort Bragg, the veterans health system and the
civilian community are doing more than ever before to address the
problems that soldiers and their families face.
But the problem is growing; more soldiers are suffering.
"They were saying there'd be an epidemic of PTSD cases 10 years from
now," said Richard Varela. He's a Vietnam veteran turned counselor in
Fayetteville. "It's a problem which is still on the horizon and
getting bigger. What we have seen is the beginning of the worst of it."
And the worst of it, according to the studies of PTSD, is more crime,
drug and alcohol abuse, broken families and damaged children,
domestic violence, homelessness and suicide.
The response to the problem, the Observer's examination shows, can't
be left up to the military or veterans programs. Instead, evidence
suggests that addressing PTSD in a military community requires a
broad approach that includes:
An improved national commitment - demonstrated through federal
spending - to take care of soldiers who have volunteered for war and
come home broken.
A civilian community, including law enforcement and the court system,
engaged in understanding the mental health problems facing soldiers
and veterans and willing to explore creative responses.
A stronger commitment from the military to fight the stigma attached
to seeking mental health treatment.
As combat deployments have stretched to nine years, the military has
recognized the mental health problems the long wars have created. The
military has done more to understand and address those problems than
it has during any previous conflict.
The Army and the Department of Defense commissioned studies of their
own and gave outside researchers access to hundreds of thousands of
medical records to learn more about the problems associated with combat stress.
Hundreds of new programs are aimed at helping service members and
their families. Military commanders and installations provide troops
with information on suicide prevention, access to marriage workshops
and training on the signs of post-traumatic stress disorder.
Fort Bragg went from 38 behavioral health care providers in 2004 to 88 today.
Francisco Hernandez Jr. is an example of how the Army's new emphasis
on responding to combat stress can work.
When he broke down on his third tour of duty in Iraq, the Army took
action through the AW2 program for Wounded Warriors.
Hernandez was airlifted out of the country and given treatment
immediately. The assistance he received included medical care,
insurance, job training and help with obtaining veterans benefits
once he was given a medical discharge.
Hernandez is still struggling with PTSD, but he has a job, is in
school and is beginning to build a life.
While the military has made significant advances, the Army did come
under criticism this summer from its own task force studying
suicides. Basically, the task force found that the Army is not doing
an adequate job of collecting and reporting the statistics related to
such things as PTSD and prescription drug use, complicating the
identification of trends and issues.
As much as the military has done to respond to problems related to
combat stress, it isn't enough, according to military officials,
veterans advocates and community activists. What is needed, they say,
is a national effort to make sure that the money and programs are in
place to take care of the people who served.
That includes an infusion of funding into the military health care
system, an expansion of veterans programs and a reassessment of
reimbursement rates for civilian counselors who get the spillover of patients.
Counselors at Fort Bragg and the Fayetteville Veterans Affairs
Medical Center often have long waiting periods for an initial
appointment. From October 2009 through August, Fort Bragg's hospital
referred 1,519 soldiers to civilian counselors because counselors at
Womack were so booked that the soldiers couldn't be seen within 28 days.
"If we didn't have more business than we can handle, we wouldn't be
sending people into the community," said Lt. Col. Jay Earles, who
runs Fort Bragg's behavioral health care division. "The demand
clearly has gone up, and I'm not anticipating it going down."
But some private counselors aren't enthusiastic about military
patients because they don't want to take payments from Tricare, the
military insurance plan. Thomas Harbin, a Fayetteville psychologist,
said reimbursements have actually dropped in the past 20 years.
Currently, counselors get $86 for an hour of psychological counseling.
The Fayetteville VA has its own burden. Since January, the VA has
served more than 5,000 Iraq and Afghanistan veterans with only four
case managers. The caseload is double what it was for the entire year
of 2006, officials said.
As the population of Afghanistan and Iraq veterans grows,
Fayetteville homeless advocates are more worried. They know that some
veterans struggling with problems such as PTSD will end up on the
streets, but shelter space is limited.
The city's shelters have a total of about 100 beds, said Denise
Giles, director of the Cumberland Interfaith Hospitality Network.
In 2008, Giles counted 40 veterans out of the city's almost 1,200
homeless people. That number more than doubled in 2009, she said.
Giles said the community has struggled for years to get the federal
grants necessary to build adequate shelters and housing for veterans.
But, so far, that hasn't happened, and the fallout could hit in a
year or two, she said.
"I think that any time you have war, you're going to have a
percentage of those soldiers unable to function on a day-to-day
basis," she said. "It's going to impact their ability to maintain housing."
Bridget Booth, a social work case manager for Afghanistan and Iraq
veterans at the VA, is already seeing those problems.
"Some are living in cars or shelters," Booth said. "The money from
the military has been cut off, and they can't hold down a job because
of PTSD or some other health problem."
Money is flowing to the problems. Over the past three years, for
instance, Congress has increased the budget of the Department of
Veterans Affairs by $23 billion, or 60 percent. The Department of
Defense has poured money into programs and additional counseling staff.
But those watching the problem grow are concerned that the response
isn't enough.
"We've got a lot of work yet to do," said U.S. Rep. Bob Etheridge,
whose district is home to thousands of soldiers and veterans.
Richard Allen Smith, a veterans advocate with VoteVets.org, said he
doesn't know how the public will react to hefty expenditures for veterans.
"I hope they say, 'We're glad to pay it,' " Smith said. "After all,
these are the people that volunteered to fight for their country when
it decided to go to war."
U.S. Sen. Richard Burr said the country needs to keep the promise it
has made to the military. That promise can be summed up simply: If a
soldier is damaged, physically or mentally, the country owes him its
best effort to put things right.
"You can't cut promises," Burr said.
In Fayetteville and other communities around Fort Bragg, officials
can't afford to wait for the military or federal government to
address the problems associated with stressed soldiers.
John Lesica, a child psychiatrist with the Cumberland County Mental
Health Center, believes an influx of troubled soldiers and veterans
is inevitable. He said civilian agencies need to gear up.
Part of that, he said, is better communication and coordination with
Fort Bragg about needs and resources.
"There is so little being done on the front end," he said. "We seem
to take care of things on the back end."
That back end can be the criminal justice system. Studies show that
PTSD can lead to crime such as drug abuse and domestic violence. But
Fayetteville police, the Cumberland County Sheriff's Office and the
county's court system don't keep track of whether offenders are
soldiers or veterans.
"We don't have the resources to do that," said Beth Keever, the
county's chief District Court judge. "That's a pat answer, but
sometimes pat answers are true."
Robert Stanulis, a psychologist who has testified as an expert
witness for soldiers with PTSD charged with crimes, believes such
tracking could expose trends and determine where more services are needed.
Debbie Tanna, a spokeswoman for the Cumberland County Sheriff's
Office, said the department has never tracked soldiers by criminal offense.
"It's simple," Tanna wrote in an e-mail. "Law enforcement deals
strictly with arresting those who commit crimes. We are not
interested in their employment status and do not track any employment
status for 'trends.'
"Additionally, we are not psychologists, so therefore the subject of
possible mental health conditions, as a result of war and
deployments, is far beyond our charge. We are cops - not doctors.''
Stanulis said that type of response is common from law enforcement
agencies across the country. But it's a mistake, he said.
He believes if officers start to identify veterans who have mental
health problems, they can head off trouble.
In a growing number of communities, officials are trying to help
veterans who get in trouble through courts set up to address their needs.
Studies have shown the veterans courts, which have popped up in more
than 40 places across the country, have cut down on repeat offenders
and jail time.
"It's been remarkable," said Robert Russell Jr., a judge in Buffalo,
N.Y., who presides over veterans court sessions. "Lives have been
stabilized and gotten back on track. Those who were homeless now have
stable housing. Those that were having challenges with families and
children are getting help."
Cumberland County doesn't have such a court, but officials from the
courts, the VA, the Mental Health Center and Fayetteville police met
recently to discuss a similar program, Keever said.
She favors a "mental health court" that would handle veterans and
others with mental health problems. County officials, with the help
of the VA, are looking for grant money to establish the program.
"I think a mental health court is an excellent idea because we have
folks who are consistently in and out of the jail because they have
mental health issues that are not being treated," Keever said.
Jessie Garner is a minister who reaches out to the homeless. He is
worried that those ranks will swell as more veterans struggle to cope
with the trauma of war.
As he sees it, local government and local agencies have an obligation
to step up to help with the problems of veterans, who are, after all,
members of the community themselves.
Otherwise, he said, the sign in downtown Fayetteville that designates
the city as a "Soldier Sanctuary" is just a sign.
"What are you giving them besides this sign and this park?" Garner
asked, referring to the state veterans park under construction
downtown. "You've got to help them. They need a real sanctuary."
Soldiers also need to seek help when they have problems. But the
Army's push to reach its troops with problems continues to be
undermined by the stigma associated with seeking mental health treatment.
Sgt. Dany Cavalier, a soldier who has served three tours of duty in
Iraq, faced nightmares and emotional numbness after his second
deployment. But he chose to battle his demons on his own.
After all, he thought, a soldier should be able to control his emotions.
The military's emphasis on personal toughness and the concern that a
mental health problem could harm a career keep as many as half of the
soldiers with problems from seeking help, an Army task force said.
That task force, which studied suicide prevention, released a report
in July calling the stigma associated with seeking care the biggest
deterrent to soldiers getting help. And, the report said, the
soldiers who needed help most were the least likely to seek it.
Fort Bragg officials said they have worked to remove that stigma.
Larry Holland, a retired chaplain who runs the suicide prevention
program at Fort Bragg, said the culture has changed from the days
when speaking about mental health problems was discouraged.
"I can guarantee you that now, (officers) know the culture," Holland
said. "Fire would rain down on them if they're not taking care of
their soldiers."
But some enlisted soldiers interviewed for this story still worry
that speaking to a therapist would jeopardize their careers or make
them seem weak among their peers.
The fear remains that a promotion or security clearance could be held
up merely because of a past decision to visit a counselor, despite
the Army's assurances otherwise.
Two staff sergeants interviewed while eating lunch in Spring Lake
said they would never use the Army's mental health system. They
refused to speak to a reporter about the subject unless their names
were withheld.
There's what the Army leadership says, and then there's reality, one
of the soldiers said.
"The truth is, it can close some doors for you," he said.
His lunch partner said she's constantly angry since returning from
nearly 18 months in Iraq. She has a hard time enjoying life.
She said she knows she needs help. But would she speak to an Army counselor?
"Not on my life," she said. "I want to finish my career."
Barbara Black, a substance abuse counselor at Alternative Care
Treatment Systems in Fayetteville and a former soldier, said problems
that aren't addressed now will only get worse with time.
"But it takes the soldiers buying into it," she said.
Jim Johnson was a chaplain in Vietnam. He lived horrors. Thirty years
later, after he retired from the military and became a counselor, the
inescapable memories of war broke him.
He had to retire from counseling other veterans and deal with his own PTSD.
Johnson says the traumas of the current wars won't be any easier to shake.
The nightmares that built up in patrols in Kandahar or missions in
Baghdad will continue to haunt some soldiers for years, even decades.
Capt. Dan Urquhart, a chaplain with the 82nd Combat Aviation Brigade
who has seen deployment firsthand, says that no one comes back from
war unchanged.
Most readjust readily to life at home; some seem unable to leave the
war behind.
Johnson and Urquhart have seen for themselves what the studies of
combat trauma point out: Sometimes the damage to a soldier's psyche
can't be fixed. As long as the country sends men and women off to
fight, some will come home irrevocably damaged.
But Urquhart and Johnson, counselors and commanders, veterans
advocates and soldiers' spouses agree on one point: All of the men
and women who served deserve an Army that is open to helping them, a
community that is willing to work with them and a country that
doesn't count the cost of giving them their best chance at healing.
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Staff writer Jennifer Calhouncan be reached at
calhounj@fayobserver.com or486-3595.
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