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Running Head: Veterans and the Mental Health System 1

Veterans and the Mental Health System

Jacob Vohlken

ANP 489

Michigan State University

Veterans and the Mental Health System 2

Abstract

In this paper, I would like to discuss aspects of the current Veterans Affairs Mental

Health System. The reason I chose this topic is because I to have had troubles with

reintegration, PTSD, and anxiety. I seek to understand more knowledge as a Veteran of the U.S.

Department of Veterans Affairs, to find a more productive outcome to prevent rates of

psychiatric disorders and suicide. There have been many rumors about recent statistics, such as

“22 Veterans die each day” and “128,000 suicides vs roughly 4,000 combat deaths have been

recorded since the beginning of the Afghan war.” These are rumors I read and hear about in

public conversations and media, but the point isn’t to study statistics, but to show what we as

Veterans experience from our perspective vs. what actually happens as a result of our

experiences. I would like to dig in depth and explain some of the personal tasks we had to do as

soldiers, that both were part of our job, but also brought us together. I will cover

reintegration/readjustment following post-war and post-conflict issues. Lastly I will talk about

underlying issues and what we can do to fix them to improve the mental health care system

here in the U.S.


Main Body

Firstly, I would like to introduce myself and why I wanted to study this topic in order to

connect with the rest of the paper. I am a U.S. Army Veteran, I served 4 years of active duty as a

weapons/artillery mechanic (MOS: 91F). I trained at Fort Bragg, NC for a period of about 3 years

with a 1 year deployment in Afghanistan. I primarily flew and fixed what we called an M777A2

howitzer that costs around $1.6 M each, I enjoyed my work overseas and would do it all over

again. I was Honorably Discharged in 2011, shortly after my deployment and returned back to

Michigan to my family and to attend this University. Like many other soldiers I long for the

return to whom I call my “Brothers” and had to go through my own rigorous phase of

readjusting back into modern society, and like many other Veterans I have had my rough

patches to say the least. But because I have been through this process I realize there are

loopholes or failures in the system which need to be addressed and is why I am writing about

the mental health system, to better understand it and be able to correct certain aspects of the

system in order to benefit future generations of soldiers, and to raise awareness. I have

presented this paper to reflect on key issues and concepts from my “participant observation” to

connect with the flaws from each step: Training, War, and Reintegration to support the

collective data from my articles to expose gaps that need to be addressed by our society.


Training

Most young men and women volunteering during the periods of OEF/OIF Operations

(Operation Enduring Freedom being Afghanistan, and Operation Iraqi Freedom taking place in

Iraq) were straight out of high school and probably had no real idea what they were doing, like

myself. I suppose I joined because I enjoyed helping people, it didn’t matter who, what race,

gender, or religion. Training is the time when a young man or woman, is progressively and

rapidly thrown into the real world and faced with decisions that could alter theirs, or someone

else’s life. We go from writing papers and talking math, to live grenades and hand-to-hand

combat, a very different change in pace. Basic Training is like the membrane that one must pass

through to transition into adulthood. But training is meant to weed out the mentally weak that

are unfit for combat, and to simultaneously incorporate teamwork, leadership and hard skills

into the soldiers minds. A lot of what is shown in the media about training is often

misinterpreted with what actually happens on the inside. Most would view training as a place

where we become familiar on how to use certain weapons, equipment, and how to do our

Military Occupation Specialty (MOS). But there is much more to it than that, it is as mental

game, as it is a physical one. We are taught to use teamwork or receive mass punishment as a

result of failure. We must learn how to give one of our own in our platoon an IV insertion,

piercing the vein of someone else in order to save their life, treat for trauma in case our friend

may lose a leg or arm, shock, dehydration, etc. We are taught to give total trust and confidence


in our fellow soldiers. One challenge which I will never forget was a tower without ladders, it

looked like a building which had several floors but no way to get up, or at least we thought. Our

fellow soldiers had to help each other up, the trick is to swing the person upside down, on the

way back down, using two other people to literally swing your whole body upside down. One of

the most nerve racking moments you could ever imagine, this is just one example of team

building. If we analyze the process by which it works, “fear is used as a channel to bring focus,”

as one of my counselors put it, while it is an effective method for combat, it is not so useful in

life outside of the military. Anger is the second tool that they teach us to channel, in Basic

training; it can be one of the most stressful situations in a young adult’s life, going from living

with their parents to soon be facing an enemy that does not fear death. That anger towards the

enemy is used to give us energy during training. In training we are shaped under the agenda of

the government to be trained into effective combatants or job specialists, but we are all

infantry first, your job comes second. This is the whole structure and backbone upon which the

overall concept of training in the modern U.S. military is built upon. While it fits the agenda of

the government, that doesn’t mean it always fits the agenda of the psyche of the individual,

leaving room for mental health issues to develop unaddressed. Anger and fear are the primary

emotions which the government uses to shape us, it works in combat, but not in our modern

society effectively.


War

After training, the general idea is that most soldiers deploy to a combat zone. I call it

“war” because the media these days portrays what the United States is doing, is fighting an evil

force or that the country we invaded is in shambles, left to dry, and run by the Taliban with a

government that is nearly non-existent. The media debates everyday on operations in foreign

war countries, but once you are on the ground it may just change your view… what I mean by

this is there are certain expectancies of soldiers as to what they may encounter when deployed,

however that wasn’t the case in our situation. I wouldn’t call it war that we fought but more

guerilla style warfare, sporadic and random fighting, instead of largely offensive fighting as was

the case with the common 10 Day War during the first invasion of Iraq in the 1980’s, which was

your normal “blitzkrieg” style warfare. The type of war fought today is usually against an enemy

which does not fear death. They are bound by religious or familial ties which lead young men to

be recruited, often to support their families, even if it costs them their life.


War and deployment aren’t at all what the media portrays these days. As an

“unknowing” participant observer, and as my paper is directed towards, there is a certain

addiction to the country and to the brotherhood which is developed. Afghanistan was a

beautiful country, to me it was like being in Northern Michigan, with sand everywhere but tall,

grassy, large mountains in the Northern provinces, in the Southern provinces it became mostly

flat, desolate, and more desert. What becomes so addicting to us as soldiers is the

peacefulness, simplicity, and randomness during deployment. It is peaceful in the sense that

most of the time, we aren’t being attacked, and when you aren’t working for the day it is like

taking a vacation! Having less clutter everyday, no bills, no families to take care of, no

government to worry about and no drugs or alcohol when deployed either, coupled with the

beauty of the country and the locals showed us more compassion than we ever expected. We

played softball, soccer, baseball, ate the local food, bought from the local markets, and the

Afghani’s were an athletic and talented people. The randomness in deployment comes from

both the risk and the adventure at the same time. The risk is involved in the fighting, you never

know if it may be your time, but most look at it as “Better to die for something than for

nothing” which is an underlying ideology which drives us to the recruiters in the first place and

brings the brotherhood together. Lastly, you have brotherhood which is intensely developed

overseas. We work almost every single day together, no weekends off, and typically the

average work hours for a soldier overseas is anywhere between 8-12 hours a day. More time


spent with the men and women you work with, the more you get to know them. Overseas

environments are very limited in entertainment, most FOB’s (Forward Operating Bases) would

contain a computer center, pool tables, video games, movie room, and a fast food chow tent or

food trailer such as Green Bean (like Starbucks). The randomness is part of the entertainment,

not knowing where you could be tomorrow or what you might be doing, is the kind of

environment that soldier’s long for back in the states. We are molded back from soldiers to

citizens, whether we like it or not, which leads me to my main argument topic.

Reintegration and the Mental Health System

This seems to be one of the leading topics in modern media and I thought I would dig

into some facts to expose rumors in order to find out if there was in fact some truth to it. I have

always heard rumors such as, “There have been over 3,000 combat deaths in OEF/OIF

operations since the beginning and there have been 128,000 Veteran suicides since then…” or

“22 a day… 22 Veterans die each day” Whether these are legitimate or not is why I am writing

about this. There is no doubt that the reports have shown that suicide rates since the Vietnam

war have almost tripled since the war in Iraq and Afghanistan started. But we can’t deny that

there is an underlying problem in the system which needs to be addressed as pointed out in

this article, “The challenges of adjustment and transition, post-traumatic stress, traumatic brain

injuries, and physical disabilities, all need to be addressed especially as these things result in

barriers to education, employment, health care, and overall individual well-being.


Many of these needs are being met by a combination of different veteran-serving nonprofits

and VA support. Unfortunately, there are still gaps in the system.”

(http://taskandpurpose.com/truth-22-veteran-suicides-day/).

Reintegration seems to be more of a key issue in affecting the overall mental trends and

stability of a Veteran when returning home. As it stands, the Veterans Affairs has a somewhat

“moderate” health care system. The process of transition is not as smooth or as straight

forward as you would expect, speaking from personal experience the first couple of years of

reintegration were the roughest, I couldn’t sleep, couldn’t eat right, family wasn’t the same

anymore, I was back to chasing employers and school, etc. a lot of symptoms of separation

from the environment we lived in for a year. The problem persists in the research as pointed

out in this article, “First, many prevalence studies are based primarily or exclusively on samples

of active-duty Army personnel and therefore do not provide information about other types of

service members, including activated National Guard and reserve troops, who may face unique

circumstances during and after their deployment. Second, most studies describing rates of

psychiatric symptomatology have assessed service members within the year after returning

from their deployment, leaving unexamined their long-term adjustment problems. Third,

because most prior studies have focused on psychiatric disorders, we know relatively little

about the functional problems that Iraq-Afghanistan veterans face as they attempt to

reintegrate into their home communities.

http://taskandpurpose.com/truth-22-veteran-suicides-day/


Veterans may perceive problems functioning at home, school, or work to be as important as or

more important than symptom resolution. Last, the treatment preference of this new

generation of veterans, which differs from earlier cohorts of veterans in terms of age,

education, and comfort with technology, is understudied.”

(http://ps.psychiatryonline.org/doi/full/10.1176/ps.2010.61.6.589, 2010) As I talked about in

the Training and War topics, there are drastic mental and lifestyle changes made to young

individuals within a short period of time, without a proper transition process these can lead to

chronic conditions. Fear and anger used as a tool in training does not work well in the

workplace outside the military. Again, the War topic points toward drastic cultural and

workplace changes which effect individuals after leaving combat environments. Well I have

noticed some interesting “trends” which match with my hypothetical approach as an

Anthropologist that I have been talking with my counselor about to urge the VA Health Care

System to change, notice the letters I have highlighted in the “conclusions section” of each

article.

http://ps.psychiatryonline.org/doi/full/10.1176/ps.2010.61.6.589


First Article (2006 from BMJ.com)

Objectives: To assess the risk of mortality from suicide among male veteran participants in a

large population-based health survey.

Design and setting: A prospective follow-up study in the US. Data were obtained from the US

National Health Interview Surveys 1986–94 and linked to the Multiple Cause of Death file

(1986–97) through the National Death Index.

Participants: The sample comprised 320,890 men, aged ≥18 years at baseline. The participants

were followed up with respect to mortality for 12 years.

Results: Cox proportional hazards analysis showed that veterans who were white, those with

≥12 years of education and those with activity limitations (after adjusting for medical and

psychiatric morbidity) were at a greater risk for completing suicide. Veterans were twice as

likely (adjusted hazard ratio 2.04, 95% CI 1.10 to 3.80) to die of suicide compared with non-

veterans in the general population. The risk of death from “natural” causes (diseases) and the

risk of death from “external” causes did not differ between the veterans and the non-veterans.

Interestingly, male veterans who were overweight had a significantly lower risk of completing

suicide than those who were of normal weight.


Conclusions: Veterans in the general US population, whether or not they are affiliated with the

Department of Veterans Affairs (VA), are at an increased risk of suicide. With a projected rise in

the incidence of functional impairment and psychiatric morbidity among veterans of the

conflicts in Afghanistan and Iraq, clinical and community interventions that are directed

towards patients in both VA and non-VA healthcare facilities are needed.”

Second Article (2007 from Jamanetwork.com)

Background: Veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) have

endured high combat stress and are eligible for 2 years of free military service–related health

care through the Department of Veterans Affairs (VA) health care system, yet little is known

about the burden and clinical circumstances of mental health diagnoses among OEF/OIF

veterans seen at VA facilities.

Methods: US veterans separated from OEF/OIF military service and first seen at VA health care

facilities between September 30, 2001 (US invasion of Afghanistan), and September 30, 2005,

were included. Mental health diagnoses and psychosocial problems were assessed

using International Classification of Diseases, Ninth Revision, Clinical Modification codes. The

prevalence and clinical circumstances of and subgroups at greatest risk for mental health

disorders are described herein.


Results: Of 103,788 OEF/OIF veterans seen at VA health care facilities, 25, 658 (25%) received

mental health diagnosis(es); 56% of whom had 2 or more distinct mental health diagnoses.

Overall, 32,010 (31%) received mental health and/or psychosocial diagnoses. Mental health

diagnoses were detected soon after the first VA clinic visit (median of 13 days), and most initial

mental health diagnoses (60%) were made in nonmental health clinics, mostly primary care

settings. The youngest group of OEF/OIF veterans (age, 18-24 years) were at greatest risk for

receiving mental health or posttraumatic stress disorder diagnoses compared with veterans 40

years or older.

Conclusions: Co-occurring mental health diagnoses and psychosocial problems were detected

early and in primary care medical settings in a substantial proportion of OEF/OIF veterans seen

at VA facilities. Targeted early detection and intervention beginning in primary care settings

are needed to prevent chronic mental illness and disability.

Third Article (2008 from the American Journal of Public Health)

Objectives: We sought to investigate longitudinal trends and risk factors for mental health

diagnoses among Iraq and Afghanistan veterans.

Methods: We determined the prevalence and predictors of mental health diagnoses among 289

328 Iraq and Afghanistan veterans entering Veterans Affairs (VA) health care from 2002 to 2008

using national VA data.


Results: Of 289,328 Iraq and Afghanistan veterans, 106,726 (36.9%) received mental health

diagnoses; 62,929 (21.8%) were diagnosed with posttraumatic stress disorder (PTSD) and

50,432 (17.4%) with depression. Adjusted 2-year prevalence rates of PTSD increased 4 to 7

times after the invasion of Iraq. Active duty veterans younger than 25 years had higher rates of

PTSD and alcohol and drug use disorder diagnoses compared with active duty veterans older

than 40 years (adjusted relative risk = 2.0 and 4.9, respectively). Women were at higher risk for

depression than were men, but men had over twice the risk for drug use disorders. Greater

combat exposure was associated with higher risk for PTSD.

Conclusions: Mental health diagnoses increased substantially after the start of the Iraq War

among specific subgroups of returned veterans entering VA health care. Early targeted

interventions may prevent chronic mental illness.


Conclusion

As pointed out in my last article, “The funding and attention paid to suicide prevention

within the departments of defense and veterans affairs over the past several years represent an

unprecedented effort to reduce risk for self-directed harm. However, effective treatments and

prevention initiatives may still be years away. In the meantime, clinicians, researchers, and

policy experts must work together to identify emerging risk populations and promising

approaches to reducing deaths from suicide.” (http://publications.amsus.org/) As you can see

there is a trend here for the VA Health Care System to implement an early detection system for

Veterans in order to prevent chronic mental illness from beginning in the first place. Due to our

training, our experience together at war, and the separation from the completely different

impacts on different individuals, but the current system is heavily reliant on the fact that if

Veterans need help, they can find it. What we need is a system to seek out those individuals

before they are put at risk of suicide or psychiatric problems. We need to explore the impacts of

mental health more on the lifestyle and workforce impacts as well as the effect on the psyche

of the individual. We have an active system for helping individuals who want to seek help, but

not a system for prevention. Therefore, I propose that we open a third party system which will

target Veterans who have recently have transitioned back from soldiers to civilians, in order to

understand how reintegration effects their work, social and environmental interactions.

http://publications.amsus.org/


Using this information we can build more personal and tailored profiles of the history of the

individuals to detect mental disorder patterns. Then, use these profiles or personal history to

detect and prevent mental health issues before a veteran steps foot in a hospital. We need a

better prevention system to focus on veterans before serious mental health disorders develop. I

don’t believe that it is ethical for the government to train us into tailored tools for their agenda,

then leave soldiers to rot after they are used for their worth. We are fighting a new type of war,

politics are changing, and so is society. Each of the articles conclusions (stated in last section) is

drawn from different sources and different years, but yet each reach the same conclusion…

Soldiers need an intervention system both in the VA and Non-VA health care systems to detect

early problems and prevent them before causing drastic changes to their lifestyle. I hope that

this paper will inspire people to understand the soldier’s life, the process by which we are

reintegrated back into society, and the changes that need to be made in the current Veterans

Affairs Health Care System to prevent and reduce the alarming amount of Veteran suicides and

psychiatric issues nationwide every year.


References



http://jech.bmj.com/content/61/7/619.short

http://archinte.jamanetwork.com/article.aspx?articleid=769661

http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2008.150284

http://publications.amsus.org/doi/pdf/10.7205/MILMED-D-10-00050

http://publications.amsus.org/doi/pdf/10.7205/MILMED-D-10-00050

http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2008.150284

http://archinte.jamanetwork.com/article.aspx?articleid=769661

http://jech.bmj.com/content/61/7/619.short



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