Mental Health and the Military, 20.12.2004 (Friedensratschlag)
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Experten warnen vor Hunderttausenden seelischen Wracks / Rising mental health toll from the Iraq war

Center for American Progress Highlights Hidden Cost of the War in Iraq: Mental Health and the Military

Eine steigende Anzahl von Selbstmord-Fällen unter US-Soldaten, die im Irak eingesetzt sind, ist nur der sichtbare Ausdruck der zunehmenden psychischen Erkrankungen, die von Kampfeinsätzen verursacht werden. Soldaten im Irak - dies zeigen Untersuchungen - leiden unter posttraumatischen Belastungsstörungen (PTSD-post traumatic stress disorder) und anderen psychischen Krankheiten. Seit dem Vietnam-Krieg hat es dies in dem Ausmaß nicht mehr gegeben.

Zu diesem Ergebnis kommt eine Studie, die im September 2004 vom Center for American Progress vorgelegt wurde. Die New York Times widmete dieser Studie einen umfassenden Bericht in ihrer Ausgabe vom 16. Dezember 2004 ("A Flood of Troubled Soldiers Is in the Offing, Experts Predict", By SCOTT SHANE). Spiegel-Online berichtet am 17. Dezember über den Artikel.

Im Vietnam-Krieg, so zitiert die Studie vorangegangene Untersuchungen, habe der Anteil der PTSD-Erkrankten unter den eingesetzten Soldaten zwischen 26 und 31 Prozent gelegen. Im Zweiten Golfkrieg 1991 litten etwa neun Prozent unter dieser Krankheit. Im gegenwärtigen Irakkrieg betrage der Anteil der PTSD-Geschädigten zwischen 15 und 17 Prozent. 100.000 Personen könnten schätzungsweise in den nächsten 35 Jahren auf ärztliche Behandlung angewiesen sein.

Dazu Spiegel-Online:
Dabei gehen Forscher inzwischen von Hunderttausenden seelisch kranker GIs aus. Im August hatte eine interne Untersuchung der US-Armee ergeben, dass über 17 Prozent der im Irak eingesetzten Fallschirmjäger an PTSD leiden. Zuvor hatten unabhängige Forscher die Zahl der PTSD-Kranken mit 13 Prozent berechnet - alle anderen schweren psychischen Kriegsfolgen mitgerechnet, hielten sie aber ein gutes Drittel der Soldaten für seelisch krank. Bei insgesamt einer Million US-Soldaten, die bisher im Irak und in Afghanistan im Einsatz waren, ergäbe dies eine erschreckend hohe Zahl Betroffener.

Die wichtigsten Erkenntnisse aus der Studie gehen dahin, die medizinische und psychologische Betreuung der Soldaten vor, während und nach Kampfeinsätzen grundlegend zu verbessern. Damit sind die Grenzen der Untersuchung benannt: Sie hinterfragt nicht den Krieg, sondern geht im Gegenteil von den neuen Anforderungen des Krieges im 21. Jahrhundert aus und versucht, die Truppen physisch und psychisch darauf vorzubereiten. Auf diese Weise sollten die immensen Kosten des Krieges reduziert werden.

Im Folgenden dokumentieren wir die Presseerklärung des Center for American Progress anlässlich der Veröffentlichung der Studie "Mental Health and the Military" sowie Auszüge aus dem Artikel in der New York Times vom 16. Dezember 2004.

Die Studie selbst ist hier herunterzuladen: Hidden Toll of the War In Iraq: Mental Health and the Military



Center for American Progress Highlights Hidden Cost of the War in Iraq: Mental Health and the Military

Washington, DC (September 7, 2004) -- The alarming number of suicides earlier this year among U.S. troops serving in Iraq has raised a red flag about the mental strain on our service men and women as they face grueling battles and a conflict with no clear end in sight. These suicides are only the most visible manifestation of the rising mental health toll from the Iraq war and other U.S. combat operations abroad. Studies indicate that troops who served in Iraq are suffering from post traumatic stress disorder and other problems brought on by their experiences on a scale not seen since Vietnam.

"It is time for the military to more effectively monitor and treat mental health needs before, during and after a combat deployment," said Lawrence Korb, senior fellow at the Center for American Progress. "The country owes every military member sent to fight and potentially die in combat access to proper mental health care while deployed, upon their return to the United States and after leaving active military service."

These figures have mental health professionals and veterans groups worried, and with good reason. At a time when our troops are working hard to answer the nation's call, their own needs remain unmet. Barriers to mental health care persist both in the field and at home, leaving mental health problems to fester or worsen.

The personal burden on troops affected by mental trauma and their families is enormous, and these mental health problems have consequences for communities and the nation as well. The full extent of this hidden cost of war will not be apparent for some years to come, but experts believe it may involve tens of thousands of service members. Preparing for the challenge at hand and extending the appropriate care and respect to our troops must be a top priority.

The following are a number of concrete steps that the Department of Defense, the Administration and Congress can take to address current shortfalls and meet coming challenges in mental health care for our soldiers and veterans.
  • The Department of Defense should work to improve mental health care in the field of combat. Combat, particularly ground combat, produces a high-stress environment that can be corrosive to troops' mental health. DOD should take steps to implement fully the recommendations made by the Army Mental Health Advisory Team for improving mental health care in the field. In addition, similar follow-on studies in current and future military operations should become standard, so that troops' needs can be addressed and methods of care assessed and improved regularly.
  • The Department of Defense must ensure that all troops are given pre- and post deployment medical examinations. Medical examinations – including mental health assessments – to identify troops who should not be deployed or who need help after returning home are critical. They should be completed on all active duty and guard and reserve troops. Pre-deployment examinations should take place at an individual's home station before departure to the mobilization site. Troops with pre-existing conditions that prevent deployment should be rehabilitated, reclassified or seen before a medical evaluation board. Post deployment examinations should be required within a specified period after the units return to the United States. Questionnaires are not sufficient to establish physical and mental fitness.
  • The Department of Defense and the Department of Veterans Affairs should provide aggressive mental health counseling and outreach programs for returning troops and their families. Studies have shown that troops who need mental health services do not always seek or receive them because of stigma and other barriers to care. In order to address this challenge and prevent mental health problems from developing into severely debilitating conditions, the DOD and the VA should work with local civilian agencies, chaplains and family centers to reach out to active duty and guard and reserve troops and veterans and their families proactively and systematically.
  • The Department of Defense should launch a service-wide anti-stigma campaign. The stigma associated with seeking help for mental health problems will not decrease without a service-wide campaign to change perceptions and attitudes among troops and leadership. Training and education programs for military members and their families should be initiated. In addition, commercial ads similar to those currently targeting depression among civilians could be run in military newspapers and magazines as well as on Armed Forces Radio. The ads should give symptoms and descriptions of common combat-related and other mental health problems, publicize resources, encourage troops to come forward, and guarantee that seeking treatment will not be held against an individual's career.
  • The Department of Defense and the Department of Veterans Affairs must work as a team to provide proper and seamless care for our soldiers and veterans. No combat veteran leaving military service should fall through the bureaucratic cracks. The DOD and the VA should improve the system for handing over responsibility from the DOD to the VA for on-going medical care of those leaving the service. The hand-off should include a detailed history of care provided, including mental health, and an assessment of what each patient may require in the future.


New York Times, December 16, 2004

A Flood of Troubled Soldiers Is in the Offing, Experts Predict

By SCOTT SHANE (Abstracts)

WASHINGTON, Dec. 15 - The nation's hard-pressed health care system for veterans is facing a potential deluge of tens of thousands of soldiers returning from Iraq with serious mental health problems brought on by the stress and carnage of war, veterans' advocates and military doctors say.

An Army study shows that about one in six soldiers in Iraq report symptoms of major depression, serious anxiety or post-traumatic stress disorder, a proportion that some experts believe could eventually climb to one in three, the rate ultimately found in Vietnam veterans. Because about one million American troops have served so far in the conflicts in Iraq and Afghanistan, according to Pentagon figures, some experts predict that the number eventually requiring mental health treatment could exceed 100,000.

"There's a train coming that's packed with people who are going to need help for the next 35 years," said Stephen L. Robinson, a 20-year Army veteran who is now the executive director of the National Gulf War Resource Center, an advocacy group. Mr. Robinson wrote a report in September on the psychological toll of the war for the Center for American Progress, a Washington research group.

"I have a very strong sense that the mental health consequences are going to be the medical story of this war," said Dr. Stephen C. Joseph, who served as the assistant secretary of defense for health affairs from 1994 to 1997.

What was planned as a short and decisive intervention in Iraq has become a grueling counterinsurgency that has put American troops into sustained close-quarters combat on a scale not seen since the Vietnam War. Psychiatrists say the kind of fighting seen in the recent retaking of Falluja - spooky urban settings with unlimited hiding places; the impossibility of telling Iraqi friend from Iraqi foe; the knowledge that every stretch of road may conceal an explosive device - is tailored to produce the adrenaline-gone-haywire reactions that leave lasting emotional scars.

And in no recent conflict have so many soldiers faced such uncertainty about how long they will be deployed. Veterans say the repeated extensions of duty in Iraq are emotionally battering, even for the most stoical of warriors.

Military and Department of Veterans Affairs officials say most military personnel will survive the war without serious mental issues and note that the one million troops include many who have not participated in ground combat, including sailors on ships. By comparison with troops in Vietnam, the officials said, soldiers in Iraq get far more mental health support and are likely to return to a more understanding public.

But the duration and intensity of the war have doctors at veterans hospitals across the country worried about the coming caseload.

"We're seeing an increasing number of guys with classic post-traumatic stress symptoms," said Dr. Evan Kanter, a psychiatrist at the Puget Sound veterans hospital in Seattle. "We're all anxiously waiting for a flood that we expect is coming. And I feel stretched right now."
(...)


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