A glance at the statistics leaves no doubt that the United States’ all-volunteer military, after more than a decade of war that often has involved multiple individual deployments, is showing signs of strain. In addition to fatalities and physical injuries, psychological and cognitive injuries – what the RAND Corporation, in its award-winning 2008 study, called the “Invisible Wounds of War” – continue to pile up:

• The Department of Veterans Affairs (VA) estimates that 11 to 20 percent of Iraq and Afghanistan veterans experience post-traumatic stress (PTS).
• According to a July 2012 report from the Armed Forces Health Surveillance Center, the military has identified 43,299 service members who suffered some form of traumatic brain injury (TBI) after being deployed to Iraq or Afghanistan. Overall, the Pentagon estimates that more than 244,000 U.S. service members have been diagnosed with some form of brain injury over the past 12 years. Together, PTS and TBI are considered the “signature injuries” of the Iraq and Afghanistan conflicts, and are often the root causes of other problems or disorders, including depression and substance abuse.
• In a study requested by the Defense Department (DoD), a panel assembled by the Institute of Medicine concluded in September 2012 that increasing rates of alcohol and prescription drug abuse by troops constituted a “public health crisis.” Nearly 5 million prescriptions for pain medication, tranquilizers, muscle relaxants, stimulants, and barbiturates were provided to service members in 2011, compared with fewer than 1 million in 2001. The panel also reported that binge drinking – consuming five drinks or more in one setting – is 50 percent higher among service members aged 18 to 35 than among civilians. The number of veterans who received specialized treatment for substance abuse at VA facilities in 2011 – 160,223 – marked a 43 percent increase from 2006.
• In 2011, the VA provided more than 640,000 military sexual trauma (MST) mental health encounters to service members who had been positively screened for MST.
• In the first half of 2012, 154 active-duty service members killed themselves – nearly one a day. The VA estimates that about 18 veterans commit suicide every day.

 

While these statistics indicate deepening and worrying trends, they have not caught the DoD and the VA by surprise; the two agencies have been working together for several years to improve the quality of, and access to, mental health services to active-duty personnel and veterans – devising, for example, a 28-part Integrated Mental Health Strategy, and jointly administering initiatives such as the Defense and Veterans Brain Injury Center.

In many ways, the Pentagon and the VA are transforming clinical approaches to mental health in all categories: research, prevention, diagnosis, intervention, and treatment. In part, the Defense Centers of Excellence (DCoE) for Psychological Health and Traumatic Brain Injuries has done this with the fundraising assistance of the private nonprofit Intrepid Fallen Heroes Fund, which helped to establish the National Intrepid Center of Excellence (NICoE), a 72,000-square-foot facility located at the Walter Reed National Military Medical Center in Bethesda, Md. Through short, intensive inpatient sessions, the NICoE hopes to export the best practices, technologies, and innovations in mild traumatic brain injury (mTBI) and PTS care to other military medical facilities.

In the summer of 2012, the NICoE broke ground on two satellite centers at the Army’s Fort Belvoir in Virginia and Marine Corps Base Camp Lejeune in North Carolina – the first of what the DoD and Intrepid Fallen Heroes Fund hope will be several NICoE satellite centers throughout the country.

The interdisciplinary approach used by NICoE clinicians is a model that, to an extent, mirrors that of the VA’s mental health professionals. With its Patient Aligned Care Teams (PACTs), the VA has pioneered a continuum of care involving integrated specialists; it’s also setting the standard for evidence-based suicide prevention policies and procedures, such as safety planning, that are gaining traction among clinicians.