Changing Attitudes About Mental Health

I just got back from Afghanistan, where 17 percent of troops are taking antidepressants or sleeping pills. Is that good news or bad news?

I spent a month there on a reporting assignment, embedded with the Marines of 2nd Battalion, 7th Marine Regiment in Helmand Province. Most of their forward operating bases, or FOBs, are pretty basic: no running water, no A/C or heat, a lot of prepackaged meals. They were there to train Afghan police. But Afghanistan produces more than 90 percent of the world's heroin, and most of it comes from Helmand, so they also had their hands full with drug lords and insurgents. The Marines at one outpost came under fire every single day for two solid months.
Yet, as they neared the end of their deployment, most of the Marines I talked to were feeling pretty good about what they'd accomplished -- they'd stayed alive and they'd made at least a small difference for the Afghan people.

But all that combat stress still takes a toll. A Navy medical corpsman, who was giving the Marines their post deployment health assessments, told me that about one-quarter were reporting mental health problems, and one-third were reporting physical problems. Among that third, 30 percent were concussions from improvised explosive devices.

Those who've experienced concussions may have a traumatic brain injury, or TBI. (For the latest on TBI visit Military.com's TBI overview.) Since many TBI symptoms and mental health problems don't surface until months after a deployment, the percentage of Marines reporting problems will probably go up after they get home. Studies have shown that multiple tours, long tours, and not enough time between tours all push the numbers even higher.

The same is true for Soldiers. Fort Campbell is doubling its psychological health staff to prepare for the return of the 101st Airborne from Iraq and Afghanistan. That's in addition to the psychiatrists, psychologists, and social workers the Army already deploys downrange.

Even so, in Iraq and Afghanistan, if you're not on a big base, mental health services are hard to come by. When Marines on the FOBs in Helmand had trouble coping with combat stress, they had only two choices: they could go to the surgeon or they could turn to the circuit-riding chaplain, who flew in every couple months.
So pills are often the easiest solution. The researchers on the Army's fifth Mental Health Advisory Team were the ones who discovered that 17 percent of troops in Afghanistan are on antidepressants or sleeping pills. I'm not about to bash antidepressants -- I know people whose lives have literally been saved by drugs like Zoloft and Prozac. And from time to time I've had to rely on sleeping pills myself, especially while my husband was deployed. But taking pills without pairing it up with counseling only treats the problem halfway.

Still, I think there's a silver lining in that 17 percent statistic. To get a prescription, you have to go to a doctor. That means all those warfighters have either admitted they need help, or someone who knows them has talked them into getting help. Either way, it's a sign that the stigma may not be as bad as it used to be.
That was the case with one Marine sergeant I met. He'd done a tour in Iraq, followed by this one in Afghanistan. One night he woke up and thought he was having a heart attack. It turned out to be a panic attack. Then his squad's medical corpsman came to him and pointed out other symptoms he'd noticed in the sergeant.

That really opened the sergeant's eyes. He agreed to get help and was medevaced to a larger base that had mental health staf. They diagnosed his post-traumatic stress disorder, or PTSD. (For more on PTSD, visit http://www.ncptsd.org). He began treatment, which included both counseling and medication while he remained in the rear -- but still in theater, where he felt supported by his unit.

"I'm doing well," he told me a month later during his treatment. "I'm recovering. Based on what I've learned, I realize I was showing symptoms after Iraq already." He didn't seem embarrassed about his situation. He just seemed glad he was getting better and was more than willing to talk about it. And that's the way it should be.

Attitudes are changing for a couple reasons. Troops are learning about combat stress and mental health first aid earlier in their training. The earlier they learn it, the less likely they are to believe the old lie that strong people never have trouble coping.

Another reason for the change in attitude is people like Army Maj. Gen. David Blackledge. He came home from two Iraq tours with PTSD and received psychiatric counseling. Then he talked about it publicly at a medical conference.
"It's part of our profession ... nobody wants to admit that they've got a weakness in this area," Gen. Blackledge told the Associated Press. "We need to be able to talk about it."

As attitudes change, more people will learn they can get help from more resources, both inside and outside the military system.

Some examples:

A more comprehensive list of resources is on my website.

When it comes to keeping our warfighters mentally healthy, our military and our society have both come a long way. But we still have a long way to go. Our warfighters on the frontlines don't have enough access to counseling and other forms of treatment. And there's still an amazing amount of ignorance. A recent survey of civilians revealed that only 24 percent knew what the term "PTSD" stands for. Worse, more than two-thirds had never even heard of it.

In a democracy, the military works for the people. Civilians need to know how to take care of the warfighters who defend them. So it's up to those of us who have heard of PTSD and TBI to spread the word. Like the general and the sergeant, we can make a difference by talking about it. If that 17 percent statistic motivates more changes for the better, then it really is good news.

If you or a loved one suffers from PTSD or TBI, visit Military.com's Benefits Channel to learn more about treatment.