We rarely hear about the war in the news these days, but our nation’s servicemen and women continue to feel the effects. According to recent reports, mental health problems are now the top reason for military hospitalizations (surpassing pregnancy and childbirth). Other findings from the Pentagon include:

• Substance abuse, mood, anxiety, and adjustment disorders accounted for nearly half of all hospital bed days in 2011.
• Four out of every five non-combat medical disorders were mental health disorders.
• The number of active duty troops hospitalized for mental disorders rose 19 percent last year.

Some of the most common diagnoses, especially among active duty members, include post-traumatic stress disorder, major depression, and bipolar disorder, according to an Armed Forces Health Surveillance Center report. In addition to being of concern to military personnel and their families, mental illness has cost 622 person-years of lost duty. A System that Turns Its Back on Its Own These figures don’t account for the thousands of veterans who are too embarrassed or afraid to seek help or who don’t recognize the signs of mental illness. According to a recent survey, one in three U.S. military personnel with post-traumatic stress never seeks treatment, in most cases because of stigma. Some service people insist that there’s little motivation to seek help for mental health challenges because they are so often met with no response at all, accusations of lying, ridicule, or even being pushed out of the military. Between 2005 and 2009, the Army saw a 64 percent increase in the number of service people forced out due to mental illness. The Army is currently launching a probe of mental health cases from 2001 onward to determine whether mentally ill soldiers were denied appropriate medical retirement benefits. There is concern that many soldiers’ illnesses were downgraded during evaluations in order to minimize the benefits paid. Some soldiers report having been wrongly accused of faking post-traumatic stress disorder or having severe symptoms downgraded to adjustment or personality disorder. As a result of downgrading an illness, many service people are denied pensions, service-related disability and education benefits under the GI bill. Feeling that they have no recourse, some veterans’ conditions worsen or they may become suicidal. With so many military personnel suffering from mental health disorders, there is real concern that the costs of treatment, disability and retirement will bankrupt the system. A Growing Need for Mental Health Care Are military personnel at greater risk of mental illness than ever, or are they simply more willing to reach out for help? Researchers aren’t sure, but what is clear is that our servicemen and women need treatment. Repeated deployments, prolonged combat stress, and other traumatizing experiences likely play a role, in addition to improved awareness screening and identification of mental health disorders. Yet appropriate treatment isn’t easy to come by. Critics have long argued that the VA, which is subject to performance metrics, overstates how quickly it serves mentally ill veterans and emphasizes the quantity of veterans treated rather than the quality of treatment. A report by the Inspector General found that 49 percent of new patients received a mental health evaluation within the required 14 days, but the VA said 95 percent had been seen within that time frame. The VA also overstated the number of patients who began treatment within 14 days of their desired start date (95 percent, compared to a finding that 64 percent actually began treatment on time). Noting the need for improved mental health care, the VA recently announced that it will hire 1,900 mental health workers. Still, onlookers question whether access to treatment will actually improve. For years, veterans have been in court fighting what they call systematic delays and neglect in mental health care. They alleged that the VA essentially made mental health treatment unavailable to discharged soldiers through long waits and complex benefits processes. Citing Department of Veterans Affairs documents from a trial in 2008, they pointed out that:

• It took more than four years to review veterans’ health care claims.
• More than 1,400 veterans who had been denied coverage died in a six-month period while their appeals were pending.
• Eighteen veterans were committing suicide each day.

The appeals court recently ruled that courts lack authority to order such broad changes in veterans’ health care and referred the veterans to special tribunals created in 1988 to review veterans’ benefits. A dissenting judge argued that the decision left millions of veterans without redress.