Wednesday, September 23, 2015

The Hidden Enemy

In Unit Stalked by Suicide, Veterans Try To Help One Another:

Beginning in 2005, suicide rates among Iraq and Afghanistan veterans started to climb sharply, and the military and Veterans Affairs created a number of programs to fight the problem. Despite spending hundreds of millions on research, the department and the military still know little about how combat experience affects suicide risk, according to suicide researchers focused on the military.

Many recent studies have focused on whether deployment was a risk factor for suicide, and found that it was not.

The results appeared to show something paradoxical: Those deployed to war were actually less likely to commit suicide. But critics of the studies say most people deployed in war zones do not face enemy fire. The risk for true combat veterans is hidden in the larger results, and has never been properly examined, they assert.

“They may have 10 times the risk, they may have 100 times, and we don’t know, because no one has looked,” said Michael Schoenbaum, an epidemiologist at the Centers for Disease Control and Prevention.
Which is what I've said several times on this blog over the years. Deployment and combat are not synonymous. To assert that if those deployed don't have a higher risk of suicide than those who weren't deployed, then deployment is a non-factor in suicide risk, is absurd. One can be deployed to a combat zone, work KP for 18 months, and never see or hear an explosion.

Killing people and seeing people all around you killed is a very different experience than running supply lines out of range.
The men of the 2/7 overwhelmingly see a tie between combat and their suicide problem. Not only were all of the men who committed suicide young infantrymen who struggled with experiences of killing and loss, they say, but it is possible to trace one traumatic moment forward and see how those involved are now struggling.

No one knows whether the battalion’s suicide rate is abnormally high or a common trait of fighting units hit hard by combat, because no one monitors troops over time. In an era of Big Data, when algorithms can predict human patterns in startling detail, suicide data for veterans is incomplete and years old by the time it is available. The most recent data is from 2011.

The Department of Veterans Affairs and the Pentagon say they have introduced a new system, called the Suicide Data Repository, that is faster and more complete.
But Dr. Harold Kudler, chief mental health consultant to the department, said the military and V.A. did not share information that could allow the monitoring of combat units over time.
“Might that be a good idea? It might be a good idea,” he said. “But it’s not in our ability to achieve. It’s not our mission.”
The V.A. has two missions: one is to take care of veteran's physical health, the other, their mental health. If the military is less than forthcoming with the data, the V.A. should force their hand on it. This isn't some feel-good, white paper kind of idea...this is literally a matter of life and death.
A 2014 study of 204,000 veterans, in The Journal of the American Psychiatric Association, found nearly two-thirds of Iraq and Afghanistan veterans stopped Veterans Affairs therapy for PTSD within a year, before completing the treatment. A smaller study from the same year found about 90 percent dropped out of therapy.
The therapies, considered by the department to be the gold standard of evidence-based treatments, rely on having patients repeatedly revisit traumatic memories — remembrances that seem to cause many to quit. Evaluations of the effectiveness of the programs often do not account for the large number of patients who find the process disturbing and drop out.

Dr. Kudler of the Department of Veterans Affairs said data showed that 28 percent of patients drop out of PTSD therapy, but that most veterans stay in treatment and report improvements.
He added that dropout is an issue in all mental health care, not just among veterans, and that the department was constantly trying to provide alternative types of therapy, like meditation.

Craig J. Bryan, a psychologist and an Iraq war veteran, said that “the V.A. has done more to try to prevent suicide than anyone has done in the history of the human race.” Mr. Bryan, who runs the National Center for Veterans Studies at the University of Utah, added: “But most veterans who kill themselves do not go to treatment or give up. They are not interested. That is the challenge.”
Part of this is true, part of it isn't. While the V.A. has made tremendous strides in working on prevention, they're still not reaching those most desperately in need, and part of that is because of the disconnect between the military itself and the V.A. (for the umpteenth time: the V.A. and the branches of service are NOT connected whatsoever). 

It's also because of the backlog of cases, the incredibly long time it takes to get in to see someone (still 6 months, according the article, which is what it was a decade ago), and the lack of funding to expand services (the chest thumpers who want to send kids off to war never seem to want to pay the costs involved).

I'll let you read the rest of the astonishingly well-written piece that is alternately moving and enraging.

I'm out of ways to express exasperation over this, after 8+ years of writing about it. How many ways can you say, it's an astonishing ignominy for these men and women to have been put through the hell that they have, only to ignore them and drop the ball when making sure they get the help they need? To survive the horrors of the battlefield, only to die in your apartment, alone, at home is the ultimate disgrace.

Thank goodness they have each other. They certainly can't count on the clueless dolts who sent them off to this war to begin with. 

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