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Monday, May 15, 2006

IRAQ: MENTALLY UNFIT, FORCED TO FIGHT---PART I

Despite a congressional order that the military assess the mental health of all deploying troops, fewer than 1 in 300 service members see a mental health professional before shipping out.

Once at war, some unstable troops are kept on the front lines while on potent antidepressants and anti-anxiety drugs, with little or no counseling or medical monitoring.

And some troops who developed post-traumatic-stress disorder after serving in Iraq are being sent back to the war zone, increasing the risk of their mental health.

These practices, which have received little public scrutiny and in some cases violate the military's own policies, have helped to fuel an increase in the suicide rate among troops serving in Iraq, which reached an all-time high in 2005 when 22 soldiers killed themselves---accounting for nearly one in five of all Army non-combat deaths.

The Courant's investigation found that at least 11 service members who committed suicide in Iraq in 2004 and 2005 were kept on duty despite signs if significant psychological distress. In at least seven of the cases, superiors were aware of the problems, military investigative records and interviews with families indicate.

Among the troops who plunged through the gaps in the mental health system was Army Spec. Jeffrey Henthom, a young father and third-generation soldier, whose death last year is still being mourned by his native Choctaw, Okla.

What his hometown does not know is that Henthom, 25, was sent back to Iraq for a second tour, even though his superiors knew that he was unstable and had threatened suicide at least twice, according to Army investigative reports and interviews. When he finally succeeded in killing himself on Feb. 8, 2005, at Camp Anaconda in Balad, Iraq, an Army report says, the work of the M-16 rifle was so thorough that fragments of his skull pierced the barracks ceiling.

In a case last July, a 20-year-old soldier who had written a suicide note to his mother was relieved of his own gun and referred for a psychological evaluation, but then was accused of faking his mental problems and warned he could be disciplined, according to what he told his family. Three weeks later, after his gun had been handed back, Pfc. Jason Scheuerman, of Lunchburg, Va., used it to end his life.

Also kept in the war zone was Army Pfc. David Potter, 22, of Johnson City, Temm., who was diagnosed with anxiety and depression while serving in Iraq in 2004. Potter remained with his unit in Baghdad despite a suicide attempt and a psychiatrist's recommendation that he be seperated from the Army, records show. Ten dys after the recommendation was signed, he slid a gun out from under another soldier's bed, climbed to the second floor of an abandoned building and shot himself through the mouth, the Army has concluded.

The spike in suicides among the all-volunteer force is a setback for military officials, who had pledged in late 2003 to improve mental health services, after expressing alarm that 11 soldiers and 2 Marines had killed themselves in Iraq in the first seven months of the war. When the number of suicides tumbled in 2004, top Army officials had credited their renewed prevention efforts.

But the Courant's review found that since 2003, the military has increasingly sent, kept and recycled troubled troops into combat---practices that undercut its assurances of improvements. Besides causing suicides, esperts say, gaps in mental health care can cause violence between soldiers and critical mistakes in judgement during combat operations.

Military experts and advocates point to recruiting shortfalls and intense wartime pressure to maintain troop levels as reasons more service members with psychiatric problems are being deployed to the war zone and kept there.

"What you have is a military stretched so thin, they've resorted to keeping psychologically unfit soldiers at the front," said Stephen Robinson, the former longtime director of the National Gulf War Resource Center. "It's a policy that can do an awful lot of damage over time."

Army officials confirmed that 22 soldiers killed themselves in Iraq, and three in Afghanastan, in 2005. The Army suicide rate was about 20 per 100,000 soldiers serving in Iraq---nearly double the 2004 rate, and higher than the 2003 rate that had prompted alarm. Three Marines also committed suicide in Iraq last year.

The military does not discuss or even identify individual suicide cases, which are grouped with other non-combat deaths. The Courant identified suicide victims through Army investigative reports and interviews with families.

Although the Courant determines that a spate of six suicides occurred within eight weeks last year, from late May to July, there is no indication that the military took steps to respond to the cluster.

While the 2005 jump in self-inflicted deaths was as pronounced as the 2003 spike that had stirred action, Army officials said last week that there was no immediate plans to change the approach or resources targeted to mental health. They said they have confidence in the initiatives put in place two years ago---additional combat stress teams to treat deployed troops and increased suicide prevention programs.

Col. Elspeth Ritchie, the top psychiatry expert for the Army surgeon general, said that while the Army is reviewing the 2005 suicides as way to gauge its mental health efforts, "suicide rates go up and down, and we expect some variation."

Ritchie said the mental health of troops remains a priority as the war enters its fourth year. But she also acknowledged that some practices, such as sending service members diagnosed with PTSD back into combat, have been driven in part by a troop shortage.

"The challenge for us...is that the Army has a mission to fight. And as you know, recruiting has been a challenge," she said. "And so we have to weigh the needs of the Army, the needs of the mission, with the soldiers' personal needs."

But the COurant's investigation shows that troubled soldiers are getting lost in the balance:

Under the military's pre-deployment screening process, troops with serious mental disorders are not being identified---and others whose mental illness is known are being deployed anyway.

A law passed in 1997 requires the military to conduct an "assessment of mental health" on all deploying troops. But the "assessment" now being used is a single mental health question on a pre-deployment form filled out by service members.

Even using that limited tool, troops who self-report psychological problems are rarely refferred for evaluations by mental health professionals, DoD records obtained by The Courant indicate. From March 2003 to October 2005, only 6.5% of deploying service members who indicated a mental health problem were referred for evaluations; overall, fewer than 1 in 300 deploying troops, or 0.3%, were referred.

That rate of referral is dramatically lower than the more than 9% of deploying troops that the Army itself acknowledges in studies have serious psychiatric disorders.

In addition, despite its pledges in 2004 to improve mental health care, the military was more likely to deploy troops who indicated psychological problems in 2005 than it was during the first year of the war, the data shows.

The Courant found that at least 7, or about one-third, of the 22 soldiers who killed themselves in Iraq in 2005 had been deployed less than 3 months, raising questions bout the adequacy of pre-deployment screening. Some of them had exhibited earlier signs of distress.

Also, at least 3 soldiers who killed themselves since the war began were deployed despite serious mental conditions, including bipolar disorder and schizophrenia.

The military relies increasingly on antidepressants, some with potentially dangerous side effects, to keep troops with known psychological problems in the war zone.

Military investigative reports and interviews with family members indicate that some service members who committed suicide in 2004 and 2005 were kept on duty despite clear signs of mental distress, sometimes after being prescribed antidepressants, including a class of drugs known as SSRIs.

In one case, a 26-year-old Marine who was having trouble sleeping was put on a strong dose of Zoloft, an SSRI that carries a warning urging doctors to closely monitor new patients for suicidal urges. Last April, within 2 months of starting the drug, the Marine killed himself in Iraq.

Some serve members who experienced depression or stress before or during deployments to Iraq described being placed on Zoloft, Wellbutrin and other antidepressants, with little or no mental health counseling or monitoring. Some of the drugs carry warnings of an increased risk in suicide, within the first weeks of their use.

These anecdotal findings conflict with regulations adopted last year by the Army cautioning that antidepressants for cases of moderate or severe depression, "Are not usually suitable for extended deployments."

Also, the military's top health official, Assistant Defense Secretary William Winkenwerder Jr., indicated in testimony to Congress last sumer that service members were being allowed to deploy on psychotropic medications only when their conditions had "fully resolved."

The use of psychiatric drugs has alarmed some medical experts and ethicists, who say the medications cannot be properly monitored in a war zone. The Army's own reports indicate that the availability and use of such medications in Iraq and Kuwait have increased since mid-2004, when a team of psychiatrists approved making Prozac, Zoloft, Trazadone, Ambien and other drugs more widely available throughout the combat zone.

"I can't imagine something more irresponsible than putting a soldier suffering from stress on SSRIs, when you know these drugs can cause people to become suicidal and homicidal," said Vera Sharav, preseident of the Alliance for Human Research Protection, a patient advocacy group. "You're creating chemically activated time bombs."

The military is sending troops back into combat for second and third tours despite diagnoses of PTSD or other combat-related psychological problems---a practice that some metal health experts fear will fuel incidents of suicide and violence among troops abroad and at home.

Although Department of Defense standards for enlistment in the armed forces disqualify recruits who suffer from PTSD, the military is deploying service members to Iraq who fit that criteria. The practice which military experts concede is driven partly by pressure to maintain troop levels, runs counter to accepted medical doctrine and research, which cautions that re-exposure to trauma increases the risk of psychological problems.

At least 7 troops who are beleived to have committed suicide in 2005 and early 2006, and one who has been charged with killing a fellow soldier, were serving second or third tours in Iraq. Some of them had exhibited signs of combat stress after their first deployments, according to family members and friends.

Some soldiers now serving second tours in Iraq say they are wrestling with debilitating PTSD symptoms, despite being placed on the medications.

Jason Sedotal, a 21-year-old military policeman from Pierre Part, La., returned home in March 2005 after 7 months in Iraq, during which a Humvee he was driving rolled over a land mine, badly injuring his sergeant. After completing his tour, Sedotal was diagnosed with PTSD and placed on Prozac, he said.

Last October, after being transferred to a new unit, he was shipped back to Iraq for a one-year tour. During a short visit home last week, he described being wracked by nightmares and depression and convinced that "somebody's following me." When he conveyed his symptoms to a doctor at Fort Polk in Louisiana last Tuesday, he said, he was given a higher dose of medication and the sleeping pill Ambien and was told that he was going to go back to Iraq.

"I can't keep going through this mentally. All they do is fill me up on medicine and send me back," he said. "What's this going to do to me in the future? I'm going to be 60 years old, hiding under my kitchen table? I'm real scared."

Mor than 378,000 active-duty, Reserve and National Guard troops have served more than one tour in Iraq and Afghanastan, representing nearly one-third of the 1.3 million troops who have been deployed, according to the DoD statistics. That repeat exposure to combat could dramatically increase the percentage of soldiers and Marines who experience PTSD, major depression or other disorders, some experts say.

Recent studies have estimated that at least 18% of returning Iraq veterans are at risk of developing PTSD after just one combat tour.

"The [Department of Defense] is in the business of keeping people deployable," said Cathleen Wiblemo, deputy director for health care for the American Legion. "What the consequences of that are, we haven't begun to see."

"This is uncharted territory. You're looking at guys being extended or sent back multiple times into an extremely stressful situation, which is different than past wars...I think the number of troops that will be affected, it will be a huge number."

*This is the end of PART I. Watch for PART II.

Source: The Hartford Courant
Story By: Lisa Chedekel and Matthew Kauffman
May 14, 2006

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