We live in a time in which nations are sending unprecedented numbers of allied troops to combat zones in the name of terrorism prevention, the full cost of which is staggering and unforeseen. Post Traumatic Stress Disorder (PTSD) has hit record numbers and garnered record attention, and it is the primary culprit for high suicide, homelessness, divorce and substance abuse in global combat veteran populations.
The here and now
Since 2000, the cost to allied nations for these military operations has surpassed 5 trillion dollars, and treating those injured both physically and mentally continues to hemorrhage billions more. It is approximated that 30% of combat veterans will return demonstrating either partial or full symptom expression of PTSD.
Combat veterans are glorified for having served their country in combat, focusing attention on this group, especially where the public sees combat veterans homeless and unsupported in the aftermath of their service. Military trauma is the largest statistical group for PTSD, as they are concentrated within organizations such as Veterans Administrations (VAs) and therefore easily studied.
There are far greater numbers of PTSD from childhood and sexual trauma than combat trauma, yet combat veterans have excessive rates of homelessness and suicide due to the lack of both governmental and social support systems available to adequately cater the currently astronomical influx of need.
Think of it like this: civilians with PTSD are naturally spread amongst a country, states, cities and towns. They often have a structure of family and friends around them. The military operates in large clusters. Soldiers often call their base locations home. VAs are normally established close to military bases, further isolating support for combat veterans.
At present there are billions of dollars spent on a multitude of programs and studies in an effort to find and solve the PTSD veteran crisis. With all this money spent, you might think progress is being made, yet the results don’t reflect the cost or effort to date. There are programs that work, and there are known factors with high success rates, yet these are often dismissed due to time requirements or, worse, funding, as funding keeps going to new trials and programs.
So what are the problems that need to be solved?
- Thousands of returning soldiers are suffering complex, treatment resistant trauma due to multiple operational tours.
- VAs are under-equipped to deal with the returning PTSD quantities.
- The efficacy of pharmaceuticals is inconsistent, causing more problems than they fix for the majority yet being used as the first line treatment protocol.
- There is a shortage of effective programs to first treat self-medication.
- There is a shortage of trauma therapists to effectively treat the number of those affected.
- Effective therapies require years, a decade even, to be truly effective per individual.
- Federal disability schemes are stretched to funding limits with PTSD sufferers.
- Stigmatization strains reintegration within society both socially and for employment.
- Collateral damage is done to the veteran’s family.
Problems are fairly easy to identify. The above list is far from exhaustive in presenting issues for combat veterans with PTSD. I’m an Australian combat veteran, and whilst the suggestions here are just that, I don’t speak for the entire world’s combat veteran community. I consider myself lucky, as Australia has quite an exceptional combat veteran support system and associated programs in place. I hope other combat veterans add their own comments to what they feel could be simple, effective solutions to the present issues.
By no means is the following discussion a total solution to the above problems, and some of the solutions address and intertwine several of our listed problem areas.
Repeated tours broaden PTSD complexity
Just like a child within a toxic home environment, surrounded by abuse with nowhere to go, a soldier resides in a similar situation when deployed within a combat zone. For six to twelve months, this is traumatic for many soldiers as an isolated tour, yet when compounded by multiple tours — such as six on, six off, six on, six off — the repeated exposure provides little relief towards re-adjustment or effective downtime following a combat tour. Most will remain in an activated and ready state, knowing they redeploy again, let alone that they will most likely start pre-deployment training within 3 months, further reducing downtime.
The simple solution to the entire problem? Stop sending troops into ridiculous wars that make little tactical sense. The deceit, lies and conflicting information from all the recent wars does little towards credibility to support troop deployments. Defend your country; don’t invade others. A simple solution to the entire problem!
Saying that, politicians and secret agencies can’t get enough deceit and power, so troop deployments need to be radically changed to curb repeated, extreme exposure to combat. A ratio of 1:3 should be used for all deployments. For every month deployed, you spend three months home, reintegrating in general duties, training, courses, social life, family and so forth.
Simply put, most deployments are six month in duration for economical and tactical reasons, making every rotation 18 months home. That leaves a minimum of 15 months to decompress, deal with any psychological issues that present, then begin pre-deployment again.
If militaries want to think long-term, then they need to get onboard such rotation intervals. Losing experienced combat veterans works against every military, so looking after them is in the best interest for all involved.
VAs are under-equipped
VAs are far under-equipped to deal with the present influx of PTSD combat veterans. Wait times can be many hours for what should be a one-hour appointment. Moreover, it can take months just to make that appointment.
Group therapy is failing to treat the individual traumatic components of each combat veteran. Whilst group therapy has merit, it also has outcome limitations.
VAs in the United States are under-funded, using over-worked, tired, frustrated employees. The solution is that funding should be focused on the problem, not wasted on diverse experimental options. The solutions are already present — effective therapies that provide 60 to 80% recovery, with more time needed for some.
Money could wisely be spent allowing combat veterans to seek Va-funded therapy through local, private trauma therapists who deliver approved trauma therapy techniques to treat the trauma. That may be hard to hear for some in the United States, as that is socialism vs capitalism. Is every man for themselves really helping the problem? No, no it’s not.
In Australia and the United Kingdom, it is helping the problem. Combat veterans are not abandoned to be homeless and ignored. Instead they have government support in place for treatment and disability funding while seeking treatment. Getting people healed and back to being productive members of society is in every country’s best long-term interest.
Pharmaceuticals are not the answer
Psychiatrists are using pharmaceuticals to treat PTSD with little evidence to support the efficacy of such a treatment regimen. Pharmaceuticals have an approximate 25% success rate, far less than trauma therapies. Sure, they’re cheaper than therapy, but they cause far more issues than they fix.
Most combat veterans treated with pharmaceuticals will be on several medications. Why? Because one will cause other problems, so then psychiatrists are prescribing medications to treat the symptoms that another medication created. Seriously? This is a sign of just how bad pharmaceuticals are, in that the solution is giving a pill to a problem created by a pill. How is this okay? Pharmaceuticals are creating more problems than they solve.
Shortage of effective pre-treatment programs
Acceptance and Commitment Therapy is a foundational treatment protocol that has history to demonstrate and support efficacy in treating substance abuse with PTSD. Why are billions being spent on experimental, radical, obscure attempts to find other solutions for treating the veteran crisis when the solutions already exist? Put the billions of dollars toward training staff to deliver the techniques to the affected combat veterans. More will get solved in a shorter period than what is happening now.
Pre-treatment is not about stopping substance abuse but limiting its use to make therapy overall more effective. Hell, the effectiveness of pre-treatment can be used as a marker towards having full trauma treatment paid for at a physician local to the combat veteran.
Shortage of effective therapists
Therapists are not created equal. This focus on hiring therapists and tossing them within a VA is antiquated, to say the least. You limit a therapist’s potential to learn and treat trauma by exposing them to nothing other than combat trauma. Limits become imposed on their learning and techniques. They become desensitized and become less effective at treating their client.
The solution is not to create a military therapist but to support therapists in private practice, where they have a mix of clients and therefore have a mix of treatments they’re using and assessing for effectiveness. Furthermore, they aren’t becoming burnt out on the atrocities of combat trauma and aren’t being screwed into provide their service for next to nothing.
A happy therapist makes a good therapist. Pay them well. Treat them well. Ensure they have diversity of clientele, and ensure they have mandatory exposure to ongoing learning and techniques.
Effective therapies take time
Eye Movement Desensitization and Reprogramming (EMDR) took 20 years to develop and evolve into one of the most effective treatments for trauma. The billions being spent towards idiotic studies and programs by governments needs to stop, and we must repurpose this money towards actual available treatments that work.
I am advocating training more therapists in EMDR, Prolonged Exposure (PE), Trauma Focused Cognitive Behavioural Therapy (TF-CBT), ACT, and getting these treatments used as first line treatment for PTSD instead of tossing pharmaceuticals around. Using this money to fund the longevity treatment durations required to effectively change 60-80% of returning troops suffering PTSD to completely healed, functional civilians once again. This just makes sense.
Yes, this is socialism at work, but let’s be honest, it’s truly needed to treat the veteran crisis happening globally. The money is being spent already, but instead of being wasted, it can be used to truly treat the problem, not just look as though something is being done.
Federal disability stretched to the limits
Disability awarded to combat veterans has climbs to dizzying highs. Throwing money at veterans is not going to solve their problems nor the overall problem. Disability schemes will eventually break governments. This issue has far reaching economic impact for all countries concerned, as we are a global economy today.
Sure, money needs to be there to support veterans during treatment, but the problem is that money is not being equally used towards the treatment and the affected. To reduce the overall occurrence of disability, governments need to ensure money is being effectively spent on providing treatment to the affected. It’s quite simple really — to get your disability payments you must be attending therapy and actually partaking towards recovery. Once deemed recovered by the therapist, aid towards re-employment training and then full employment opportunities.
Disability is then used effectively, and those who are truly resistant after years of therapy then remain on disability. Keep providing them the support they need, and you have lessened the longevity burden by a minimum of 60% annual funding. Well… unless you keep sending troops into idiotic wars, that is.
Reintegration employment stigmatization
A more pressing problem for veterans, especially those who are functional, employable, have healed and are ready to transition to employment once again, is that PTSD awareness has now reached employers. These employers have inaccurate beliefs of PTSD sufferers and are now discriminating when learning of military history on resumes. Employers are now asking questions that are not allowed to be asked relating to mental health. They are passing over combat veterans on the premise that PTSD may become an issue for them as an employer.
If governments get their act together and do manage to change the present strategy of treating combat veteran PTSD, then an awareness media campaign would also need to be launched — or incentives to hire combat veterans, period — to thwart the inaccurate stigma associated with PTSD.
Families are collateral damage
Lastly, the forgotten in all of this is the family behind the veteran. They need access to government-assisted support in relation to combat veterans. Parents, siblings and spouses need help in how to best help their affected combat veteran. They need self-care support. They need access to educational tools to help get their combat veteran back on track in life, towards stability and employment.
Family play a larger role than therapists in assisting their loved one back to health, but they can’t do it alone. With an approximate 80% divorce rate for serving personnel, the PTSD divorce rate is much higher. Having combat veterans abandon their family, or vice versa, is not helping the veteran, family, community or economy. A snowball effect occurs with far reaching impact.
Whether online support structures are in place for education, access to free copies of popular PTSD relationship books, phone counseling support, even video conferencing and online support groups, all of these resources assist supporters to band together, help each other, and help themselves towards helping their veteran.
There are some rather large problems that presently are only getting worse. Things need to change as the current approach is a dismal failure. We have effective treatments available. They just need time, money and locality implementation for effectiveness: more official resources freely available online, campaigns targeting the stigma of PTSD and use the truth to blanket the myths that propagate the discrimination and maybe even incentives to employ combat veterans.
What can you add towards solving the veteran PTSD crisis? Do you feel there is a larger problem at play that we haven’t mentioned? Please share your thoughts and maybe, just maybe, someone that matters might take initiative and implement the change needed to fix the issue.
Written by Anthony, who founded MyPTSD in 2005. He is a veteran, writer, and web designer. He lives with his wife and two heinously cute puppies in Melbourne.
Edited by Simon, who earned her writing degree in 2011. She hopes to one day garner a doctorate in composition. You can find her on MyPTSD, where she talks (too much) about her dogs, life, the multiverse, and Everything.