As large numbers of military personnel return from Iraq and Afghanistan with serious mental health needs, the Department of Veterans Affairs is establishing a treatment and research center at the Durham VA Medical Center.
The Mental Illness Research, Education and Clinical Center will receive $2.8 million a year and be one of 10 centers nationwide that address the mental health needs of people returning from active duty.
"About a year ago, for the first time in five years, they came up with money for two more centers," said Dr. Harold Kudler, a psychiatrist who is co-director of the Durham VA's new center. "Our group was aware of what was developing in Afghanistan and what was developing in Iraq."
According to research published in July in the New England Journal of Medicine, as many as 17 percent of combat forces returning from Iraq showed signs of post traumatic stress disorder, depression or substance abuse, while about 11 percent of forces who fought in Afghanistan showed evidence of mental stress.
"The military does recognize the fact that there is a significant number of people needing services," Kudler said.
The deluge hasn't yet come to Durham, although other areas of the country have been overwhelmed with men and women returning from battle and needing help. Kudler said only 124 patients from the latest wars have sought services for any reason at the Durham VA hospital.
"There's just a trickle of patients coming in," Kudler said, noting that many of North Carolina's fighting forces are still in war zones. Until they are discharged from active duty, they are not eligible for VA services.
Nationwide, 85 percent of people who have served in Iraq or Afghanistan are still in the military, Kudler said.
"The wave will crest," he said, "but it's not quite here."
Still, preparation is under way. Kudler said he will hire administrators and other staff to get the mental health center running. He said the center's goal is to study post-deployment mental health problems, find treatments and apply them.
He said the hospital is building a network between it and military hospitals in North Carolina and Virginia, where people who were injured in battle are treated. VA liaisons assess whether the injured need mental health services when they are released, and then help arrange care.
Kudler said military officials hope the effort will reach the combat-weary sooner, rather than later. As part of that, veteran centers are preparing to counsel more people and steer those who need more intensive services to hospitals.
Greg Inman, a psychologist at the Raleigh Vet Center who served in the Army during the 1991 Persian Gulf War, said the efforts have not yet resulted in higher demand. His office is not seeing a huge influx of people asking for help.
"Whatever they're saying about 20 percent coming back with PTSD, we're not seeing that," he said. He doesn't doubt the rate of post traumatic stress disorder, he said, but fears that people who need help are not seeking care. That, he said, is a tragedy waiting to happen.
He said his office still has Vietnam veterans coming in for help for the first time after suffering depression, flashbacks, anger problems and substance abuse 30 years after combat.
"Our goal is to get these vets now," Inman said.
But veterans say there are impediments to seeking help. Active duty warriors perceive that the military brass frowns on disclosures of mental stress, so they try to stay tough. And mental assessments before discharge are considered half-hearted.
"We just call it the don't-beat-your-wife briefing," said Paul Rieckhoff, who served in Iraq and is executive director of the New York advocacy group Operation Truth. "It's really not intensive. It's check the box. No followup."
Rieckhoff said the problem is especially troubling for National Guard members or reservists, who must make an abrupt transition back to civilian jobs.
"We're going to have mental health issues, and they are going to be severe," Rieckhoff said. "Years from now, we're going to see homelessness, crime, alcoholism and family issues that are going to cost this country a lot of money."
Rieckhoff said he bases his opinion on the type of warfare being waged in Iraq, where there are no safety zones and the fighting is in urban settings among an enemy impossible to discern.
"If I had to predict the mental damage," he said, "it will be worse than Vietnam."
Staff writer Sarah Avery can be reached at 829-4882 or firstname.lastname@example.org.