Suicide in the military - One is too many

 

 

You may remember that I posted a very informative paper written by Julia Dougherty Aten MSW (she is also my mentor)  a few months back but unfortunately I had to remove it. I have revised it here because I feel that her research on the data is very important to understand the complexity and the wide spread dilemma associated with suicide in the military and added some information I received from a former Social Worker who conducted the return briefs for Soldiers come back to the states through Joint Base Lewis-McChord, thank you both.

Increasing numbers of active duty military, reserves, and veterans are committing suicide. Smith (2011) stated that every 80 minutes, a military veteran will take his or her life.  The problem of military suicide is at epidemic proportions even though the Department of Defense and/or the Veterans Administration is not willing to define the current suicide rates as an epidemic (Smith).  Veterans and active duty military suicides account for 20% of all suicides in the Unites States even though only 1% of Americans have served or are currently serving in the military.  Suicidal ideation is associated with depression and PTSD, both of which often go unrecognized within the military and veteran communities (Smith).

            According to Braswell and Kushner (2010), military suicide is not a new problem. Official statistics from European countries during the 19th century detailed suicide rates were higher in the military than the general public.  This was a well-known fact and suicide experts of the time discussed suicide.  The first accounts of suicide in the military date back to Esquirol (1838), who was the leader of the French asylum movement (Braswell and Kushner).

Problem Overview

            Since 2001, the suicide rate among members of our military has increased exponentially (Braswell and Kushner, 2010). This increase has continued even with improving behavioral health care for service members serving in Iraq and Afghanistan.  The outcry in response to the increase in military and veteran suicide generally blames all the bad things within the military on the stress of repeated deployments, and the hardships of military life (Braswell and Kushner). Military analysts link the increase in suicide in the military to the stress of repeated deployments and combat.  In reality, Pentagon data shows that 70% of service members in the Army who committed suicide had never deployed or only had deployed one time.  The other branches detail comparable statistics (Braswell and Kushner).

Current Statistics

United States Army

                        The US Army began formulating suicide statistics in 1980 (Zoler, 2012).  In 1985, there were 15.8 suicides per 100,000 active duty soldiers.  In 2006, the Army surpassed this statistic with 17.5 suicides per 100,000 active duty soldiers (Zoler). In 2008, the suicide rate for active duty Army soldiers exceeded the civilian rate for the first time in history.  Since 2008, the suicide rate has continued to rise.  In 2009, 160 active duty soldiers committed suicide.  In 2010, 305 active duty Army, National Guard, and reserve soldiers took their own lives (Zoler).

            According to Zoler (2012), in 2011, the Army had the highest suicide rate in history with 164 confirmed cases of active duty soldiers committing suicide.  This was the seventh year in a row that suicide rates had steadily increased.  For the first three months of 2012 there appears to be no slowing of suicides within the Army (Department Of Defense, 2012). The DOD reported 45 potential suicides, 20 confirmed suicides, and another 25 cases still being investigated for active duty army personnel.  During the same period in 2011, the Army had reported 25 cases of potential suicide.  There has been a steady increase in suicides in the National Guard, especially in the Midwest states (Department Of Defense, 2012).  Soldiers in an active duty status and inactive status committed suicide at the rate of 25 per month in 2010 (Zoler).  Suicide doubled within the National Guard where were in an inactive status during 2010 (Zoler).  The increase in suicide rates reported by the Army among active duty soldiers is not limited to the Army.

United States Marine Corps

            According to the Department Of The Navy (2008), the Marine Corps started recording and reporting suicide statistics in 2002.  There were 26 confirmed suicides in 2003 (Department of the Navy).  There were 26 suicides in 2003, and by 2008 there were 42 suicides, and a record 52 suicides in 2009 (Marine Corps Community Services, 2009).  There was a decrease in 2010 to 37 suicides and in 2011 there were 33 suicides.  As of February 2012 there has been 8 confirmed cases of suicide within the Marine Corps (Marine Corps Community Services, 2012).  While statistics show a decrease in suicide, there were Marines attempting to take their own lives in 2012 than ever before.  The Marine Corps reported there were 146 attempted suicides in 2008, 164 in 2009, and 172 in 2010, and 186 in 2011(Marine Corps Community Services, 2012). The Marine Corps is a smaller branch and their suicide per 100,000 Marines outpaces the Army in most years since 2002

            The higher rates of suicide among the Army and Marines have been linked to these branches being significantly more involved in combat in Iraq and Afghanistan (Zoler, 2012). The DOD reports that there is an average of 10 failed suicide attempts for each Soldier or Marine that takes their own lives.  It is estimated that more than 1,600 active duty Army and Marine’s attempted suicide in 2011 (Zoler).

                                                          United States Air Force

            The Air Force has fewer personnel in direct combat, but Air Force suicides were at a 17-year high in 2010 (Svan, 2010).  The Air Force reports that relationship problems are the number one reason Airmen take their own lives.  Chief Master Sergeant of the Air Force James Roy reported that 100 Airmen committed suicide in 2011 and the total for 2012 may surpass this figure (Ricks, 2012).  The numbers of Airmen who have committed suicide in 2012 are a 40% increase over the same time period in 2011. The Air Force has not released the numbers for 2012, but some sources think that there were at least 18 suicides in January alone (Ricks).  If this figure is repeated monthly the Air Force could reach 200 suicides in 2012, which could put them ahead of the active duty Army.   Few Air Force officials believe that suicides will reach this number, but it is clear that suicide in the Air Force is on the rise (Ricks).

United States Navy

The Navy started tracking suicides in 2001, and that year there were 40 suicides (Navy Personnel Command, 2012).  There were 45 suicides in 2002, 44 in 2003, 40 in 3004, 37 in 2005, 38 in 2006, 40 in 2007, 39 in 2008, 46 in 2009, 39 in 2010, and jumped to 51 in 2011.  Master Chief Petty Officer of the Navy Rick West stated financial issues were a big factor in suicide within the Navy.  39% of Sailors that committed suicide in 2011 were facing disciplinary actions (Navy Personnel Command).

The DOD reported that in 2009 service members with a history of Absent Without Leave (AWOL) was found in 10% of suicides, 15% were facing military disciplinary actions, 12% were facing civilian legal problems, and 27% had been experiencing difficulties in their job (Navy Personnel Command, 2012). The ability to find extrapolated statistics for suicides varied greatly for each branch of the military.   The Navy/Marine Corps had the most detailed statistics available that outlined number of suicides, attempted suicides, gender, race, age, marital status, pay grade, and years in service.  The Army and Air Force statistics found only stated number of suicides and were vague on attempted suicides.                

Glantz (2010) reported that suicide statistics for veterans may be understated.  The VA identifies veteran suicides by matching suicides that are recorded in the National Death Index with those veterans that are enrolled in the VA.  There is no nationwide tracking system that identifies all veterans who commit suicide.  Due to this lack of data the true numbers of veterans taking their own life is not known. There are only 6 million of the nation’s 22 million veterans enrolled in VA health services (Glantz). 

According to Harrell and Berglass (2012), the reports that an average of 18 veterans commit suicide every day is taken from the Centers for Disease Control’s National Violent Death Reporting System, which only gets data from 18 states.  By summer 2012, there should be better data on suicide rates for veterans because of a partnership between Veterans Affairs Secretary Eric Shinseki and 49 state governments.  These states have committed to furnish the statistics of veteran’s deaths within their states.  It is reported that 950 veterans that were enrolled in VA health care attempted suicide each month between 2008 and 2010 (Harrell and Berglass).

Stigma against mental health problems in the military and limitations for veterans to access confidential mental health care is one reason active duty and veterans are not getting mental health treatment.  Half of those with significant symptoms and do access treatment are only getting minimal care. (Tanelian & Jaycox, 2008).  According to the American Psychoanalytic Association (2009), the military, VA, and DOD have made attempts to remove the stigma of seeking mental health care.  Stigma against mental illness is permeated throughout society and not just within the military.  Reducing stigma has been a long-term effort, but service members speak out that stigma is still alive and well within the military (American Psychoanalytic Association).                                                                                                                          

Stigma of mental illness prevents people from seeking help and this leads to a greater risk of suicide.  Suicide can seem like the only option for a stigmatized person (American Psychoanalytic Association (2009).  In the military, stigma towards mental illness is strong and many military service members deny any form of mental health difficulty.  This puts the military population at greater risk of suicide.  A service member who admits to suicidal ideation is often perceived as weak, shameful, sinful, and selfish and this keeps them from seeking help early when treatment could possibly turn things around for the person (American Psychoanalytic Association). The military states that they are reducing the stigma of mental illness and that military leadership is leading the fight against stigma. It is only recently all active duty Army bases conducted a “stand-down” which stopped all normal duty day activities and required all soldiers and leaders to attend classes and activities that addressed suicide. According to Dreazen (2012), on January 18, 2012 Major General Dana Pittard whom is the commanding general of the Fort Bliss Army post wrote on his official blog:                                                                                                

"We lost a Fort Bliss Soldier to an apparent self-inflicted gunshot wound. I heard the tragic news as I walked out of a memorial service for another one of our Soldiers who decided to kill himself at home on Christmas Day so that his family would find him. Christmas will never be the same for his two young daughters he left behind. I have now come to the conclusion that suicide is an absolutely selfish act. Soldiers who commit suicide leave their families, their buddies and their units to literally clean up their mess. There is nothing noble about suicide. I care about each and every one of our Soldiers, family members and civilians at Fort Bliss. I know there are a lot of people hurting out there, especially with the future Army personnel cuts on the horizon. If you are hurting mentally or emotionally, then seek and get help; but don’t resort to taking your own life. I am personally fed up with Soldiers who are choosing to take their own lives so that others can clean up their mess. Be an adult, act like an adult, and deal with your real-life problems like the rest of us. SEEK HELP! If you need help, please call 915-779-1800 or 800-273-TALK (8255). It is a confidential call. Please look after each other; please do not allow your buddy to make a rash decision that will have permanent life-ending consequences. Choose life.” (Dreazen, 2012).                                    

According to Dreazen (2012), what General Pittard wrote on his blog is pervasive inside the military and is just one example of how leaders feel about suicide.  He retracted his statement after public outrage within and outside of the military, but the damage was already done.  “Thanks to many of you and your feedback, I have learned that this was a hurtful statement.  I also realize that my statement was not in line with the Army’s guidance regarding sensitivity to suicide. With my deepest sincerity and respect towards those whom I have offended, I retract that statement” (Dreazen, 2012).  He wrote on his blog what many in the military think about suicide and his words perpetuate the already existing stigma inside the military (Dreazen). So many people in the military that are in distress do not seek help for the very reason that General Pittard wrote in his blog.  This stigma leaves with service members as they transition out of the military and reintegrate back into the civilian community (Dreazen). Attitudes like Pittard’s are pervasive in the military despite the push to reduce stigma, Barbara Van Dahlen, the founder of Give an Hour, an organization that matches troops with civilian mental-health providers stated:

"Soldiers who are thinking about suicide can't do what the general says: They can't suck it up, they can't let it go, they can't just move on.  They're not acting out of selfishness; they're acting because they believe they've become a burden to their loved ones and can only relieve that burden by taking their own lives. His statement -- whatever motivated it can do little good for those who are already on the edge." (Dreazen, 2012).                                       

Barnett (2012) stated destigmatisation should be addressed to mental illness as well as suicide.  General Peter Chiarelli, vice chief of staff of the Army, the service’s leading fighter against suicide, stated that the hardest part of reducing suicide is reducing the stigma.  “I’m not going to kid myself.  As hard as I try, and I brief every brigade combat team going out, both in the National Guard and in the active component…I see the head going up and down…In their mind, they really don’t believe these injuries are as serious as the injuries that they can see”  (Barnett, 2012).                      

            Dr. Jonathan Shay (2002) stated that unit cohesion is an essential tenant for military members in combat.  He detailed isolation and despair in veterans that he treated from the war in Vietnam because of the lack of unit cohesion.  Unit cohesion is essential for trust and trust is a main protective factor against suicide.  Shay stated that soldiers run a risk of moral injury from repeated combat tours.  Shay believes that a moral injury occurs when the concepts of trust and right and wrong are lost during combat.  A moral injury can result from believing that they failed while under fire, or from the failure of a commander that does not lead properly. When the soldier returns home he is hyper vigilant and does not trust anyone.  This leads to difficulty living life (Shay).

            According to Shay (2002), the moral injury would be lessened if soldiers were treated like a person instead of device with interchangeable parts to one of looking at the soldier in a holistic sense.  Shay repeatedly states that money is not the answer to the mental problems plaguing service members, but it is the shallow of how trauma affects a person who serve in combat. Shay proposes that what is missing is the buildup of trust, and insists that “competence is an ethical imperative” (Shay, p. 223) and the military must demand a high ethical standard for leadership and this will reduce the trauma in combat and the horrors of returning home (Shay).

            Currently there are two methods for conducting pre and post deployment health assessments they are:

1.         Telehealth- this is the main way they do these screenings overseas -Most of the troops give the standard answer- I’m fine. They know how to cheat on the exams given and they know what to say to get out of that office fast. They deny anything wrong even when you see it clear on their face and are pulled away before you can investigate further. Since you are not on site you as the therapist are at the mercy of the assistants. You can’t even give them your information and ask they return as you are at a completely different site.

2.         The 2nd method seen on CONUS (Continental United States) bases consist of the providers breaking into teams one team did a “briefing “the others did an “interview”. Buses- of troops are brought over to a building. Each troop is handed a questionnaire to fill out- they are given these by cadre in uniform, the Soldiers’ command is in the room with them. They are allowed to talk- the scoring mechanism is on the sheet- they are told- high scores go to see therapist, medium go to see therapist , low scores go to a mass briefing and can re-board the bus.  (Here’s a Caveat, these soldiers are NOT from this base (seen with many National Guard Units who do the screening at bases outside their respective states) - if they do not pass redeployment assessment they stay for treatment- you are just coming off a long deployment and are told that if you have an issue it will be even longer before you get home.) The tests are scored right there in front of the troop and they are broken into groups. Some escorted to the next building – EVERYONE KNOWS the next building has the counselors in it. The rest are taken into rooms and given a 5-10 minute brief on PTSD and resources then dismissed. This brief is VERY short- if the providers go to long they are reminded of time constraints. Now….remember that bus- the troops are taken back to the bus. However, their fellow Soldiers who were taken to the other building have to meet with a therapist- everyone is waiting on the bus for those people to finish. EVERYONE now knows as the troop walks back to the bus that he scored “moderate to high” for issues. The worse you are often the longer it takes- each person meets with the therapists for 15-20 minutes unless they are so severe they require full escort to the impatient ward.

The problem with this method is: The troops share how to pass the exam- they opening tell each other how to answer to avoid having to talk to someone- The cadre does not stop this and the command encourages this. Even stating they need to hurry up so we can get home. There is no privacy- if you have an issue EVERYONE knows it the moment you are taken next door, or placed in “that” group.  They are hostage to their test- admit issue and you are delayed in going home- answer that you are fine and you are headed home.

            While the military continues to address suicide with “stand-downs” and numerous PowerPoint briefs to commanders at all levels the biggest population that must be addressed is the lower enlisted ranks. When Soldiers, Marines, Airmen and Sailors understand the complexity and the severity of suicide and the wounds that many military and active duty members face then will the acceptance of seeking help be successful.

 

A decision is made..what now?

Well I finally received a decision concerning my multiple medical claims through the VA and only after I got my state Senator involved. This is irritating enough in itself because you would think think that a organization would not need 22 months to make a determination about compensation.
So here it is I received a 70% disability rating for PTSD. When I read the findings I found it was pretty spot on in description. But then my brain starting going and I started thinking

1) Do I tell anybody I have a "disability".

2) As a soon to be Clinical Social Worker how will it affect my career as well as the thoughts that my professional peers may have?

3) Do I tell people that I have PTSD and if I do are they going to think that I might "explode" or go off and kill people (I was a sniper for a majority of my career).

4) and last but not least why can't I get my retirement pay and compensation pay at the same time? That is BS because I worked for 21 years to be able to receive that money every month the compensation is just that compensation for the crap you have to endure.

5) So I have a 70% rating, what does that mean? What entitlements are out there for those with a rating like this?

So I ask you all what did you do or think when you got your rating? Tell me what you think about my questions are the valid or am I just being pessimistic about the whole thing.

Finally....

So after 15 months of waiting I am finally being seen and scheduled for appoinments through the VA. This has been a long year, with some good and some bad twists. But more to follow on that I have an appoinmnet to get too!!

Need some research help from you!!!

I am currently conducting research on a question regarding the effectiveness of pre / post deployment psychological assessments performed by the military for one of my graduate classes at the University of Southern California and I could use some help from those voices tat have gone through it like myself. I want to make sure that my experiences are similar or different from your. The last post deployment brief I went through was in June 2011 so I know some things may have changed since my retirement, which is why I am asking for your help.

My question is:

"Are the current pre-deployment / post-deployment psychological screenings effective in identifying mental health problems in Soldiers?"

I would like your opinion and what you think should be changed to make it better. If you know or have access to any empirical research / or any research on the subject PLEASE forward it too me.

 

Thank you all and I will post this research after I complete it on the blog.

 

 

A Letter Home



CPT John Hallett Afghanistan 2009

 

SPC Dennis Williams, Driver Afghanistan 2009

I wanted to share with all of you a letter I wrote to Cynthia on 18 September 2009. About three weeks after the death of my Company Commander Captain John Hallett, his driver SPC Dennis Williams, our Battalion Physicians Assistant CPT Cory Jenkins and our Battalion Senior Medic SFC Ronald Sawyer.

SFC Sawyer with his niece Emma and his 20 month old son Daniel
picture courtesy of Iraqiwarheros.com

    "Just wanted to write you a letter and say I love you and miss you very much. Things are going good here and I don't want you to worry. I remember you told me I could write you about things here that were happening and how I felt during the situation and the things I did. Well I figured that now would be a good time to tell you about something. It is therapeutic right?

I have been reading a lot going to bed around 0100 or 0130. It is funny how when I am home I never really buy anything for myself and now that I am in Afghanistan I am Amazon biggest customer. I always have that feeling that I should read all the books I can in case, well, you know.

I wanted to write you and tell you about what happened on 25 August. This is probably the hardest thing I have had to do, actually write to you about it.

The patrol we were on went to the Shah Wali Kot district center to do a Key Leader Engagement with he leaders then conduct an assessment of the medical clinic in the village. We left that morning at 0800. I had two medics in my MRAPand cross loaded CPT Jenkins and SFC Sawyer into CPT Hallett's Stryker. We departed the FOB and headed north to Shah Wali Kot. When we got there I got out with CPT Hallett and we talked a little bit (he was sick) as we walked up to the district center to meet with the police chief and ask about the clinic that was about 1/2 mile away. We left and went to the clinic and we were there for about hour. During this time CPT Jenkins and SFC Sawyer look at the facility and even treated a few people that were there.

CPT Cory Jenkins

As we mounted back up to head to the Forward Operating Base (FOB) I had move forward in my MRAP and got onto the road. We had 2 Mortar vehicles, the HHC commander, my vehicle and CPT Halletts vehicle so five total vehicles. 51 was already ont he road and pushed forward, the road was very narrow and the strykers could not pass me so I called CPT Hallett and said the order of movement would be 51, me, HHC 6, A66 9CPT Hallet's vehicle and 52 picking up the rear. We left and headed to the OB. As we were driving I heard a big "Boom" and the radio came to life. HHC 6 called me and said "IED hit" I immediately looked in the rear view mirror and saw a huge pillar of smoke rising in the air. I immediately told my driver to turn around and drove past HHC 6 towards the the vehicle that was hit by the IED. I saw it was A66. The scene was horrific the vehicle was flipped over and the back end now faced the direction we were traveling.

Out of the back door I could see a leg hanging out like someone was lying down in the back. I dismounted and ran to the vehicle. I did not know if anybody was with me but I knew we had little time if we were going to save anyone. My biggest fear was that it was going to explode. In retrospect I should have been worried about the enemy ambushing us with small arms fire. But I did not think about it. I ran up to the vehicle and the fire inside was spreading and the smoke was rolling out of the vehicle. I got inside and someone was yelling for help. I could not see any further than about 2 inches in front of my face. I was choking from the smoke and could feel the fire on my face. I heard someone yelling and could see SPC Pannel crawling through the smoke towards me his head was bleeding so I grabbed his vest handle and pull him out of the stryker. At this time SPC Chaney (my company medic) and SSG Banuelos (my HQ PSG) took care of him and began to take off his gear. I went back to the stryker to find my friend and commander CPT Hallett.

I saw an arm under the back part of the Stryker and knew that was CPT Jenkins. I got back into the Stryker now with SSG Banuelos with me and the .50 cal rounds were now starting to cook off and we could hear them exploding outside the Stryker. SSG Banuelos and I tried to get SFC Sawyer out of the vehicle but the fire was intensifying and I knew that it would be only minuets before the AT-4 (Anti-Tank Missile) would explode causing in effect more casualties. So I pulled everyone back away from the vehicle. I was mad because I could not find CPT Hallett............

SPC Pannell was air medevac'd I I helped carry him to the bird shielding his face from the flying debre and placed him on the bird.

When I got back I started to think about what happened and that CPT Hallet's vehicle was in the spot of the convoy I was supposed to be in. I feel bad like maybe I had something to do with this tragic event and was the cause of many deaths that day. I gathered the company and told them the news as I fought to hold back my tears. After things had settled down I sat and watched while members of the company started to pack up CPT Hallet's belongings, my thoughts went to his new born daughter that he was talking about at dinner the night before.

I can't explain how I felt losing my friend. How helpless I felt watching that Stryker burn and knowing my friend and other Soldiers were in it. I still think about this at night went it is quiet and I know that I could not have saved them without jeopardizing the lives of even more Soldiers. Did I do the right thing? Did I do EVERYTHING I could? I have held my feelings in for this long and try to remain strong and focused for the Soldiers and the leaders of the company, but I never thought it would be this hard again. After Iraq and all the fighting we did in Mosul I thought I had become hardened by battle but the feelings just resurface with every death.

But I am doing it baby and I could not have asked for a better group of Soldiers and Leaders. I just wanted to write you and let you know what happens and courage our young men display every day they are here. The impossible tasks that they are asked to perform everyday. But they put there fears aside and continue the mission.

Even through this ugliness goes on I still know that I have an angel waiting for me at home. I want you to know that I WILL be home soon and give hugs and many kisses.

Gene

This is a letter I know that there were many hero's that day and I write this a tribute to all of those involved. Thank you all for letting me tell you about an event I still think of everyday.

LT Kim XO, me, and CPT Hallett NTC

   

The first of many but a life time of memories

In December of 2008 I was given the privilege to be promoted to First Sergeant and given the equal privilege to be placed as an Infantry First Sergeant to my friend Captain John Hallett In A Company 1st battalion, 17th Infantry. Being the new "kids on the block" to some other seasoned command teams we shared a command vision that helped us become successful in combat and to overcome some very trying times in our deployment.
I remember John calling me on a Saturday and asking me to meet him at a Denny's in Lakewood for breakfast so that we could discuss our plans for training and to share our philosophy of leadership. I will talk more about John later. In this post I just wanted to share a remembrance of SGT Troy O. Tom.


SGT Tom was one the first Soldiers I met when I toured the company my first day and I just remember his huge smile. A soft spoken leader who rarely raised his voice because his actions spoke even louder. He led by example and touched many of us with his genuine concern and love of his Soldiers and the respect of his leaders.

SGT Tom was killed on August 18, 2009, he would be the first Soldier that A Company 1-17th would lose during the deployment. 3rd Platoon "Dirty Pirates" were attached to another company in the Arghandab Valley. I rememeber sitting down to write his mother a letter, one of the hardest things I have had to do.

SGT Tom thank you for you service and you will never be forgotten...Attu 7

Xavier Mascare–as/The Daily Times; Army Sgt. Troy Orion Tom's mother accepts the flag that was covering his casket from Brig. Gen. Kurt Story on Wednesday at the burial at Farmington's Greenlawn Cemetery following his memorial at the Farmington Civic Center.

Xavier Mascare–as/The Daily Times



SGT Tom being carried to his final resting site.Xavier Mascare–as/The Daily Times

Military bonds draw veterans to mental health jobs

As a graduate student working towards my Masters Degree in Social Work degree I can honestly say that I truely want to help Veterans and their families. I also believe that it is important that a Vet help a Vet because there is a common bond between the two "SERVICE". I am reminded of a saying that "For those who fought for it, freedom has a taste the protected will never know." 

1SG Gene Hicks Helmand, Afghanistan

 By Maria LaMagna, Special to CNN

(CNN) -- Things probably should have turned out differently for Samantha Schilling.  The stories she tells have dark beginnings and could have had, under different circumstances, dark endings -- as so many stories for those in the military do. Schilling, now 31, served in the U.S. Navy from 1999 to 2003. She was never deployed but worked as an information systems technician at Naval Station Norfolk in Virginia.

Several of her friends were killed during the 2000 al Qaeda bombing of the USS Cole in Yemen, which left 17 dead and at least 37 injured. Some of the injured were transferred to her base in Norfolk. Many of the survivors suffered from mental trauma after the bombing. One of them, a man who had been aboard the ship, attacked Schilling and attempted to rape her. That assault drove home the impact that active duty had on her colleagues' mental state. "I experienced military sexual trauma, and that just inspired me," she said. "Coming back into civilian life, you're not the same person you were in the military. ... You carry with you all these burdens, all these stressors."  

Schilling was released from service with an honorable medical discharge in 2003. Since that time, she has taken on a personal mission to help others who need counseling after military service. She's nearly completed a masters in a joint military psychology and neuropsychology program at the Adler School of Professional Psychology in Chicago and plans to finish her doctorate degree in 2015.
"I'm determined to be able to be helpful to others," she said. "Helping others helps me. ... I think therapy can help people adapt to civilian life again instead of maladapt. People who have PTSD and other (issues) can maladapt and cause trouble in the civilian world."

It's no secret the U.S. military has struggled to adequately support its troops after they leave active duty.

A large number of service members suffer from post-traumatic stress disorder (PTSD). An estimated 11% to 20% of veterans returning from the Iraq and Afghanistan wars suffer from the condition, according to the U.S. Department of Veterans Affairs.

That's between 220,000 and 400,000 of the 2 million troops deployed since the September 11 terrorist attacks.

A new study shows that only about half of U.S. service members deployed to Iraq and Afghanistan diagnosed with PTSD received any treatment for it.

And statistics from the U.S. Department of Veterans Affairs show that about 18 veterans commit suicide every day.

The VA has stepped up efforts to expand care and recently announced plans to hire 1,600 more mental health professionals and 300 support staff members to help meet the increasing demand for services.
But some former active-duty service members aren't waiting for help to arrive. Veterans have turned to psychology to become mental health professionals, and they're filling in gaps in veteran care that government and civilian efforts have left open. And while they are still rare, programs to train them are slowly emerging at universities and nonprofit organizations around the United States.
                                           "It's just going to increase and increase"

Born a year ago with funding from the Department of Veteran Services in Massachusetts, a program through the Massachusetts School of Professional Psychology called Train Vets to Treat Vets has recently picked up steam. It has several goals: mentoring new veterans, providing services to at-risk and homeless veterans, and educating the public about ways they can help.

"As the stigma (of seeking professional mental health treatment) breaks down more and more, and more veterans are willing to come into treatment, (the need) is just going to increase and increase," said Robert Chester, 25, who served in the National Guard for six years and became a student at the Massachusetts School of Professional Psychology.

"That's why we want to get more veterans into mental health, both to break down the stigma and get more clinicians out there."

Chester is now an admissions assistant at Train Vets to Treat Vets.

Starting the program was a joint effort between the Massachusetts Department of Veterans' Services and veterans (Chester and colleagues Greg Matos and Norman Tippens) who are also students at at the school.

"We, as the veteran students, wanted to see that we could create more of a military cohort at our school," Chester said. "We really wanted to put something together where we can help our fellow veterans by providing mental health services in that specific way."

Since the program's start, Chester has fielded e-mails every day from veterans who want to get involved. Six will enroll in the school's fall class.

Massachusetts School of Professional Psychology President Nick Covino says the idea for the program came from a Latino mental health program the school began about eight years ago.

"It was clear that folks who wanted to talk about emotional issues ... want to talk about emotional issues with somebody that understands their culture and probably want to do it with somebody that's from their culture," Covino said. "It was a natural extension to think about returning veterans."

Having student veterans in the program has been beneficial not only to the veterans it has helped but to non-veteran graduate students who want to specialize in veteran care.

From casual conversations to exchanging papers and working on doctoral projects together, a collaboration between veteran and non-veteran students is "radically changing the academic culture of our learning community," Covino said.

                                                            Laptop battlefield

Leaning over an occasionally beeping laptop in a downtown Chicago office building, Robert Kyle rolls up the sleeves of a blue button-down shirt to reveal heavily tattooed forearms. On one, a drawing that looks like the Grim Reaper. On the other, columns of initials. There are so many, his arm is more ink than skin. He explains that they're the initials of friends who died alongside him while deployed in Afghanistan and Iraq. There are 53, he says. But there are more to add he hasn't gotten around to yet.

Kyle, who goes by his first and middle name online for security reasons, has his own set of challenges. At 26, he has survived three deployments and sustained a traumatic brain injury. He enlisted in the Army when he was 17 and served from 2003 to 2009.

Although he still carries burdens from his deployment, since his return, he hasn't forgotten about his military family. Some, he knows personally; others, he's only met through that beeping laptop. He has dedicated his life to helping veterans connect to one another and improve their mental health.

Kyle works as a peer coach at Vets Prevail, a free online forum and multistep mental health program. It was founded in 2009 by a small group of professionals, almost all of them veterans.

While working as a peer coach, Kyle is pursuing a graduate degree in psychology from DePaul University.

Six salaried professionals work at Vets Prevail, as well as three peer coaches who directly interact with veterans online. Although the peer coaches are not doctors, they complete a training process, and most important, Kyle says, they have all served on active duty.

"When they hear that you have done what they've done, (veterans) tend to open up more than someone that has never been in a combat zone. That opens a little more trust," Kyle says. "Veterans are doing this for veterans."

Kyle retired from service in 2009 after his injury and went back to school, earning a degree in psychology from Lees-McRae College in North Carolina.

Since that time, he has worked to develop Vets Prevail. Now, more than 8,000 veterans from about 5,000 ZIP codes turn to the site to chat and learn coping mechanisms, and membership is rapidly increasing.

Justin Savage, a 32-year-old Army veteran who works as the head of program development for Vets Prevail, says a large part of that success is the users' assurance that the experts on the other side of the computer screen are speaking their language.

"We live and breathe accountability," said Savage, who returned from Iraq in 2005. "Having vets do it really brings a new level."

                                                                         "A really good fit"

It makes sense that veterans would want to become mental health professionals, psychologist Joe Troiani says. In a military culture built on camaraderie, the desire to help a fellow veteran is natural and powerful.

Troiani, an associate professor at the Adler School of Professional Psychology, where Schilling is a student, is also a retired Navy commander and is determined to ensure that veterans get the help they need.

"If I was in trouble, I could pick up the phone and call some of my veteran friends," Troiani said. "You and I could have served together, and I have your back, you have my back. If something happens to you, I'm going to make sure that your family is taken care of."

The Adler School offers training for a new post-doctorate specialty called "military clinical psychology" and since the program's start two years ago has trained about 20 students per class. The need is greater, but 20 is the cutoff to ensure the best training, Troiani says.

Entering the mental health field can be "a really good fit personality-wise" for veterans, says Bret Moore, a former active-duty Army psychologist who completed two tours in Iraq.

"(Service members) want to protect and help people get through difficult times," Moore said. "That's really what a psychologist does: helps people who are more vulnerable, or not as strong in a certain sense, get through difficult times."

Taking responsibility for another human life is a familiar duty for veterans, Covino says.

"To have been in situations where they've needed to rely on judgment and develop a capacity for reflection, an ability to act autonomously and courageously. ... Those are qualities of character you can't teach," Covino said.
                                                               "They haven't experienced it"

Jon Neely, a 45-year-old living in Springfield, Illinois, has been using Vets Prevail for several months and says he logs on for about an hour every week, though when he first began using it, he logged on every day. Neely served in Kosovo from 1999 to 2000 and retired from the military in 2005.

"All too often, you go seek help from somebody that is book-learned, but they don't understand," he said. "They don't know. To me, getting help or seeking help from a non-veteran is like going to a marriage counselor that has never been married. They know all the book knowledge, but they haven't experienced it."

Sarah Bonner, 31, an Air Force veteran who was medically discharged from Ramstein Air Base in Germany in 2006, is an active user of Vets Prevail. She says that talking to a "like-minded" person is what has kept her coming back to the site.

She has bonded with the peer coaches, to whom she refers by their first names like friends, in a way she did not expect.

"There were a couple times recently, I was at a really low point," she said. "I was angry, and I wasn't holding back with what I said. They don't care. If I want to cuss out and threaten to punch something, they might say, 'Let's think of softer things than the wall to punch.' ... They let you talk about the stuff that's ugly."

                                                              "Why did all of us serve?"

Training veterans to treat other veterans does involve some risk, Chester says. If veterans are not stable themselves, they should not treat others as mental health professionals. For that reason, it can be a good idea for them to work with a psychologist even while they administer care to others.

There is so much training and hands-on experience involved in a post-doctorate program that it is highly unlikely a veteran who is still feeling unstable would make it all the way through, Troiani says. Rarely, but occasionally, a veteran will say, "This program is not a good fit for me," he says.

But if it is a good fit, the results can be rewarding.

"Why did all of us serve if not for each other?" Kyle asked. "Just because we're not in the military any more, it doesn't mean we are no longer brother and sister. It's a bond we'll have for the rest of our lives."