Military Mental Health

A 29-year-old veteran came to the ED complaining of headaches and uncontrolled pain in his upper quadrant. He had been discharged from the military after he sustained a blast injury during duty as a Marine in Iraq. His right arm had been amputated.

Alarmed by the rising suicide rate among soldiers returning from Iraq and Afghanistan and “wanting to help,” Matthew “Matt” Houseal, MD, a psychiatrist with the Texas Panhandle Mental Health Mental Retardation Center (TPMHMR), reenlisted as an Army Reservist and volunteered to serve in Iraq.

An array of military-related presentations were given at this year’s American Psychiatric Association (APA) conference, addressing the rise of psychiatric issues in returning veterans and their families.

Our returning military veterans remind us dramatically of the importance to consider traumatic brain injury (TBI) as a potential comorbid illness in cases of posttraumatic stress disorder (PTSD). The common causes of comorbid TBI and PTSD are assault and battery to the head, head trauma (personal or work-related injuries), civilian or military explosions, inflicted head trauma in children, motor vehicle accidents, and suicide attempts by jumping. Prevalence figures for comorbid TBI and PTSD historically have been lacking

Reports of 1 in 5 military service members returning from Iraq or Afghanistan with posttraumatic stress disorder (PTSD) and/or depression and rising suicide rates have led researchers and military leaders to warn civilian psychiatric care providers of a “gathering storm”1 headed their way.

Traumatic brain injury (TBI) is the major cause of death and disability among young adults. In spite of preventive measures, the incidence of a TBI associated with motor vehicle accidents, falls, assault, and high-contact sports continues to be alarmingly high and constitutes a major public health concern. In addition, the recent military operations in Iraq and Afghanistan have resulted in a large number of persons with blast injuries and brain trauma. Taking into account that cognitive and behavioral changes have a decisive influence in the recovery and community reintegration of patients with a TBI, there is a renewed interest in developing systematic studies of the frequency, mechanism, and treatment of the psychopathological alterations observed among these patients.

There have been nearly 1.5 million military deployments to the southwest Asian combat zone since the start of the Afghanistan operation and Iraq war in 2001 and 2003, respectively. There have been many casualties, some of which have been highly profiled, such as service members being killed in action, losing limbs, or suffering blast injuries to their brain.

Having grown up as a "military brat," I have been familiar for decades with how my family's friends coped with war experiences. I did not know the term "PTSD" in those days, but I could see the enduring, horrific marks that posttraumatic stress disorder had left on them. I learned early on that wars could keep killing soldiers long after the peace treaties had been signed and weapons had been rendered silent.

Department of Defense (DOD) medical centers, community hospitals, and clinics throughout the United States were tasked with hiring 44 "contract" psychiatrists over the summer as a response to growing concerns about inadequate mental health care for soldiers in Iraq and Afghanistan and those returning home.

Mental health screening and treatment plans for soldiers deployed to Iraq and Afghanistan are being scrutinized after criticisms of the program have appeared in print and Web publications.

Little attention has been paid to the prevalence of sexual assault and its sequelae among military men. The past-year prevalence of sexual assault among enlisted men ranges from 0.4% to 3.7%, a figure equal to or exceeding the lifetime prevalence among civilian men in some studies. Increased awareness and understanding of male sexual assault as well as routine screening of all patients, regardless of gender, for exposure to sexual victimization will enhance their recovery.

With the end of the Cold War, there is a new dimension to America's military entanglements. The demise of the Soviet bloc has opened the door for the U.S. military to take a more active role in political hot spots, with the result being an increasing willingness to engage in peacekeeping and humanitarian operations throughout the world.

What started out as a solitary quest for justice by a veteran Orange County, Calif., obstetrician who was terminated without cause from two HMO networks operated by Metropolitan Life Insurance, has now blossomed into a major policy debate that has physician groups lining up to plead their global causes to the Supreme Court. And though Louis Edgar Potvin, M.D., a former president of the Orange County Medical Association, never expected to become the standard bearer for the medical profession, the case has grown beyond a mere effort by one physician to restore his practice and life savings; it has become symbolic of the increasingly heated debate that has enveloped the delivery of health care.