Overstretched Military Lead to Mental Health Problems

Prolonged periods of deployment among Britain’s armed forces is associated with mental health problems, finds a study published on bmj.com.

Deployment is an essential ingredient of military life. However, research shows that an increase in the pace of military operations “operational tempo” may have an effect on health and place strain on families.

The UK armed forces have recommended deployment levels called the harmony guidelines, reflecting the need to balance rest and recuperation with deployment. In times of simultaneous major operations, such as those in Iraq and Afganistan, this tool is helpful for monitoring overstretch as a measure of over-commitment.

So a study carried by Professor Roberto Rona and colleagues at King’s College London, set out to assess whether deployments above these guidelines (calculated as 13 months or more in a three year period) have an effect on psychological health.

They studied the number and duration of deployments in the last three years of a random sample of 5,547 regular military personnel. Mental health and alcohol use were assessed using recognised scoring methods.

Other outcomes included intentions to stay in the military and problems at home during and after deployment.

All analyses were adjusted for factors such as age, gender, rank, marital status and service. Further adjustments were made for role in theatre (combat or support), type of deployment (war or peace enforcement operations), and time spent in a forward area in close contact with the enemy.

They found that those who were deployed for 13 months or more over a three year period were more likely to have symptoms of post traumatic stress disorder and problems at home during and after deployment. This was particularly apparent in those with direct combat exposure. The prevalence of severe alcohol problems also increased with longer deployment.

There was no association between duration of deployment and intention to stay in the military.

The relation between number of deployments and psychological symptoms was less consistent and there was no link between number of deployments and problems at home.


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ATF, U.S. Military Team To Defeat Roadside Bombs

The U.S. Bureau of Alcohol,Tobacco, Firearms and Explosives (ATF) announced that it has expanded its program to help the U.S. military combat the use of improvised explosives devices (IEDs) by terrorists in Iraq, Afghanistan and elsewhere. IEDs, or homemade, roadside bombs, are a top killer of U.S. troops in combat.

The expanded program, under a Department of Justice initiative, includes detailing an ATF special agent certified explosives specialist to the military's Joint Improvised Explosive Device DefeatOrganization (JIEDDO) Joint Center of Excellence (JCOE) at Ft. Irwin,Calif., and assisting in the training of military bomb technicians before they deploy overseas in post-blast explosives investigations and homemade explosives.

Under a memorandum of agreement signed late last year by ATF acting Director Michael Sullivan and JIEDDO Director Montgomery Meigs, the ATF detailee will be the Department of Justice's representative to JCOE and provide technical instruction for the roles ATF and other Justice Department components play in the Combined Explosives Exploitation Cell (CEXC) in Iraq and the Terrorist ExplosiveDevice Analytical Center (TEDAC) in the United States.

CEXC provides immediate, in-theater technical exploitation and operational analysis of the IEDs that insurgents have used againstmultinational forces, and assists in the development of measures and procedures to counter the insurgent bombing campaign. TEDAC exploits and analyzes the returning IED components, confirming the intelligence received by CEXC for assessment and eventual sharing with law enforcement and U.S.allies.

"This agreement and the military's decision to have ATF assist intraining its bomb techs further strengthens the collaboration essential to winning the war against terrorism," Sullivan said. "We're proud to be ableto share our well-established expertise in explosives training and investigations with our comrades in uniform."

Since 2001, ATF's National Center for Explosives Training and Researchhas trained almost 6,000 bomb technicians and investigators in explosivedisposal and investigative techniques. ATF also provides explosivestraining to the new Iraqi Police Service and at the International Law Enforcement Academies in Botswana, El Salvador, Hungary and Thailand.


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Newsweek Cover: Failing Our Wounded

Recent revelations about the decay and mismanagement at Walter Reed Army Medical Center in Washington, D.C., were especially shocking because it is one of the most prestigious U.S. military hospitals. But a Newsweek investigation--which focused not on one facility but on the services of the Department of Veterans Affairs, a sprawling 235,000-person bureaucracy--found that the VA system is unprepared for the scope of the task at hand and ahead.

Around 50,000 service members so far have been banged up or burned, lost limbs or sacrificed something less tangible inside them in the wars in Iraq and Afghanistan. And a new study projects that at least 700,000 moreveterans from the global war on terror will flood the system in the coming years. In the March 5 cover story, "Failing Our Wounded" (on newsstands Monday, February 26), national security correspondent Dan Ephron and Assistant Editor Sarah Childress paint a grim portrait of an overloaded bureaucracy cluttered with red tape; veterans having to wait weeks or months for mental-health care and other appointments; families sliding into debt as VA case managers study disability claims over many months, and the seriously wounded requiring help from outside experts just to understand the VA's arcane system of rights and benefits.

Tonia Sargent, whose husband, Kenneth--a Marine master sergeant who had been in the corps for nearly 18 years--nearly died in a sniper attack in Najaf in 2004, says no one ever sat her down and explained the benefits and how to access them. Her husband's brain injury made him often incapable of understanding his own care. Key decisions fell to her alone. It's a "don'task, don't tell system," she says. The Sargent's story, and the stories of many other veterans, is raising concerns that the United States is failing to meet its most basic obligations to those who fight its wars, Newsweek says.

"In no way do I diminish the fact that there are veterans out there who are coming in who require treatment and maybe are not getting the treatment they need," White House Deputy Press Secretary Tony Fratto tells Newsweek. "It's real and it exists."

Dr. Michael Kussman, the VA's acting under secretary for health tells Newsweek that the department is trying to reach veterans earlier, as they approach their date of discharge, and that he does not believe Iraq and Afghanistan are straining resources severely.

"The impact on the VA so far has been relatively small," Kussman says. "It has not kicked the system over in our budget and in our ability to absorb it."

But the number of veterans has to grow and critics worry the VA is in a state of denial. In a broad sense, Newsweek reports, the situation at the VA seems to mirror the overall lack of planning for the war. "We know the VA doesn't have the capacity to process a large number of disability claims at the same time," says Linda Bilmes, a Harvard public-finance professor who last month released a 34-page study on the long-term cost of caring for veterans from Iraq and Afghanistan.

Veterans' support groups and even some former and current VA insiders believe there's a reluctance in the Bush administration to deal openly with the long-term costs of the war, Newsweek says.

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U.S. Troops, Vets Not Getting Care They Need, Playboy Says

American troops fighting in Iraq and Iraq war veterans are not receiving the mental health care they deserve, specifically when it comes to the diagnosis and treatment of post traumatic stress disorder (PTSD), according to an investigative report for Playboy magazine.

Journalist Mark Boal spoke with numerous mental health experts, government sources and former military personnel who paint adisturbing picture about the government's handling of PTSD, according to Playboy.

Boal found that the Department of Defense (DOD) diagnoses about 2,000 cases of PTSD a year. Yet according to a landmark study conducted by Army researchers and published in The New England Journal of Medicine, PTSD rates for soldiers in Iraq and Afghanistan are running between 10 and 15 percent. That means one would expect to see the military diagnosing 13,000 to 20,000 cases of PTSD, Playboy says.

Former government officials agree there is a problem, according to Playboy.

"PTSD is being underdiagnosed on a fairly wholesale level," Playboy quotes Dr. Robert Roswell, a former undersecretary at the U.S. Department of Veterans Affairs, as saying.

Sources in the Pentagon and former officials of the VA, doctors working for the VA and DOD are being pressured to limit diagnoses of PTSD in order to save the military money and manpower, reports Boal.

Budget pressures may be the motivation to discourage diagnoses of PTSD, according to the Playboy article, which reports that when the DOD submitted a war budget to Congress, the line item for mental health casualties was simply left blank.

"DOD never prepared for a long war; it never prepared for anoccupation," says one senior congressional staffer, according to Playboy. "Now we're seeing the third thing it didn't anticipate: what to do with the soldiers when they come home. Now they really don't have the money."

Boal discovered politics may also be a factor, Playboy says.

"The soldier has tremendous symbolic power in American politics. Healthy, happy soldiers bespeak a just war. Like the amputees and flag-draped coffins the administration hides from public view, such soldiers are antithetical to the hawkish goal of mitigating the costs of the conflict," writes Boal."The critical difference is that mental illness isn't always obvious and is therefore easier to sweep under the rug."

As one congressional staffer puts in the Playboy story, "It's much easier to deny the reality of mental illness than it is to deny the spinal cord injury of some guy sitting in a wheelchair."

When questioned for the piece, Pentagon and VA officials vigorously denied there is a policy to underdiagnose PTSD, Playboy says.

"That would be immoral and unethical," Playboy quotes Dr. Michael Kilpatrick, the assistant secretary of defense for troop readiness as saying.

Officials attribute the low rates of diagnosis to a reluctance on the part of military doctors to "stigmatize the person or bring harm to their careers" by labeling them with PTSD according to Lieutenant Colonel Dr. Charles Engel, the director of the deployment health clinic center at Walter Reed Medical Center. "It's out of respect for the patient that they don't make the diagnosis."

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Nearly 200,000 Veterans May Be Homeless Tonight

Americans say they want to "support the troops." But what about the veterans?

Nearly 200,000 veterans may be homeless on any given night and twice that many veterans experience homelessness during the year, according to a report released by a coalition of advocates for homeless persons.

The report released finds that affordable, permanent housing coupled with supportive services provides a powerful tool for preventing and ending homelessness among veterans, particularly thosewho confront chronic disabling health problems such as mental illness, substance addiction and HIV/AIDS.

Homeless male veterans are more likely to be homeless for an extended period of time than homeless male non-veterans, the report, titled "Ending Homelessness Among Veterans Through Permanent Supportive Housing," says.

The report notes that 32 percent of homeless male veterans reported that their last homeless episode lasted 13 or more months compared to 17 percent of male homeless non-veterans.

Homeless housing and service providers reported that they are already serving returning Iraq and Afghanistan war veterans at local emergency shelters, U.S. Department of Veterans Affairs-financed transitional housing programs and local permanent supportive housingprojects. Participants noted that while it is too soon to have a complete picture, evidence suggests that unique risk factors for homelessness and mental illness will confront veterans of Iraq and Afghanistan.

These factors include a housing market that is far tighter and morecostly than it was in the Vietnam era. Expert observers also contend thatthe nature of the current conflicts, including the near-complete blurring of combat versus non-combat zones, will generate higher rates of Post Traumatic Stress Disorder (PTSD) and other mental health traumas. A recent study in the Journal of the American Medical Association documented that 19 percent of soldiers who served in Iraq screened positive for the signs and symptoms of a mental health disorder.

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Expert Back From Afghanistan: U.S. 'Cannot Afford To Lose 2 Wars'

The U.S. government must do more to deal with its less-publicized war -- the ongoing conflict against the Taliban and other forces in Afghanistan, according to a Washington expert who recently returned from Afghanistan.



The United States, which ousted Afghanistan's Taliban regime in 2001 following the Sept. 11 terrorist attacks, must, for instance, put the survival needs of the Afghan people ahead of drug eradication, says Anthony Cordesman of the Center for Strategic & International Studies in Washington.



If Afghanistan does not get more support from the United States, it is almost certain that the Taliban and hostile elements in Afghanistan will have a much more successful 2007 offensive than they had in 2006, Cordesman says. "And we really, to put it bluntly, cannot afford to lose two wars. And I think that is the path that we are headed on without urgent action," he says.



U.S. and NATO forces are winning tactically in Afghanistan, Cordesman says.



"The problem with that is we won tactically in Vietnam," he says. "We are winning tactically in Iraq. The problems are not tactical victory; the problems are, are you actually gaining control of the countryside? Are you actually winning political support? Are you reducing Taliban influence or are you watching it expand? Are you developing effective NATO forces or are you keeping what people in Afghanistan call stand-aside forces? Do you have enough U.S. forces? Can you take an aid mission, which now is limited by finance and manpower to what, in some ways, are projects, which, while important, are more showpiece than projects that reach into the field, and substitute for the lack of Afghan governance in the field until you can develop that Afghan governance?"

Afghanistan needs about $6 billion in aid, or roughly three times higher than what the U.S. government is spending, Cordesman says. "And depending on how you define this, this is either half of a month in Iraq, or it is a month in Iraq, depending on how you are doing the counting," he says.



Afghans living in the countryside of Afghanistan are without water, without power, who do not have roads to get to an area where they can function, where it will take time to get them basic clinics and schools, Cordesman says.



"You are talking about a society in which people have drug loans to start the year – essentially a sharecropping type system," he says. "To put eradication before survival is a disastrous aid to the Taliban. And we have to have a program which links this to an overall development program and to a counterinsurgency campaign."

Afghanistan is a producer and exporter of poppies from which heroin is made.

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Democrat Reid Challenges Bush On Various Security Threats

While he and House Speaker Nancy Pelosi challenge President Bush on Bush's course for U.S. involvement in Iraq, Senate Majority Leader Harry Reid also calls Bush's moves inadequate on several other security matters facing the United States.

"As much as we're convinced the president has chosen the wrong direction in Iraq, we're increasingly concerned he's headed in the wrong direction in Iran and Afghanistan," Reid, Democrat of Nevada, says. "Five years after we defeated the Taliban, the extremists are returning. Drug production is soaring. And attacks on U.S. and NATO forces are on the rise. By all measures, the country is at risk of slipping away; yet, some reports suggest the president will be moving some U.S. troops out of Afghanistan and into Iraq. This is a terrible mistake."

Bush must put more attention on the mission in Afghanistan, Reid says.

"Although time is short, there is still an opportunity to defeat our enemies in Afghanistan once and for all," he says. "The president must acknowledge what's at stake, and immediately take action to prevent the country from returning to what it was -- a haven for international terrorism."

President Bush will need explicit new authorization from Congress if Bush wants to pursue military action against Iran.

"Much has been made about President Bush's recent saber rattling toward Iran. This morning, I'd like to be clear: The president does not have the authority to launch military action in Iran without first seeking congressional authorization -- the current use of force resolution for Iraq does not give him such authorization," Reid says.

Reid also criticizes Bush's approach to the threat posed by the apparent nuclear ambitions of Iran, saying ultimately the best way to defang the regime in Iran to cut U.S. dependence on Middle East oil.

"Let there be no doubt, the Iranian regime poses one of the great threats of the new century, but the Iranian people -- two-thirds of which are under the age of 30 -- present a great opportunity for progress. Regrettably, this administration has no strategy for connecting with this generation of potential reformers.

"Iran sends millions of barrels of crude oil to theWestern world, and gets billions of dollars in return," Reid says. "Fortunately, we have the power to turn the tables on Iran. That power is energy independence. If the United States led the world in developing new alternative fuel technologies, we could create new jobs, export new products, slow global warming and reduce Iran's leverage on the international stage."

Democrats in Congress are advancing an energy bill that would shift priorities away from oil production to alternative sources.


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