Tag Archives: PTSD

Post Traumatic Stress Disorder (PTSD) Is Treatable

San Diego artists stop to appreciate one of the paintings featured in the Combat Arts exhibit in the Southwestern University art gallery, featuring art by Iraq and Afghanistan war veterans with post-traumatic stress. (Sgt. Ken Scar/Army)


“Warrior Care Network Academic Medical Center (AMC) partners at Emory University, Massachusetts General Hospital, Rush University, and UCLA Health use tailored combinations of evidence-based, complementary, and alternative therapies.

Veterans who are struggling to do a brave thing — seek care because PTSD is treatable and treatment works.”


“A recent study conducted by researchers at the New York University and published in the Journal of the American Medical Association (JAMA) has led many to believe the leading evidence-based psychotherapies for post-traumatic stress disorder do not work for up to two-thirds of patients.

Our findings at Wounded Warrior Project (WWP) show very different results for veterans participating in our two- and three-week intensive outpatient programs (IOP) provided by our Warrior Care Network Academic Medical Center (AMC) partners at Emory University, Massachusetts General Hospital, Rush University, and UCLA Health. They all use tailored combinations of evidence-based, complementary, and alternative therapies within their IOP.

Under our IOP, veterans receive upwards of 70 hours of direct clinical care — more than a year’s worth of traditional therapy.

For the almost 2,000 veterans who have completed IOP with the Warrior Care Network, the results are extremely promising.

Veterans completing IOP show a clinically significant reduction in PTSD symptoms (measured using the PCL-5), and these lower levels are relatively sustained 12 months following treatment.

This decreased symptomology tends to result in increased functioning — empowering veterans to more actively engage in life.

Remarkably, our IOP program has a greater than 90 percent completion rate — double the national average. We believe this is due to a variety of factors including the condensed time period (two to three weeks), our cohort model where small groups of veterans start the program together and graduate together, and the inclusion of evidence-based therapies with alternative and complimentary therapies.

While we appreciate the discussion generated by the JAMA article on the challenges of delivering mental health care and the need for future research and better treatment models, we are concerned about the researchers’ approach of collapsing veterans’ results within active-duty military and civilian results due to wide variations in cultural characteristics and treatment goals and methods.

While mental health care challenges are a global issue, it is important to remember that the military is a collectivist culture that places the group and mission over the needs of the individual. This dynamic, combined with the potential for increased and prolonged exposure to traumatic events, may increase service members’ risk for specific mental health challenges.

These cultural differences are compounded when military members leave active duty following inadequate transition assistance support programs and begin assimilating back into civilian culture. Many veterans may feel isolated during this period and struggle with their mental health as they attempt to find their new cultural identities and reengage in civilian life.

Even within the military community, treatment goals, results, and completion rates differ between the active-duty and veteran populations and the broader civilian population.

Our outcomes and results treating veterans seems to outpace other methods in clinical reduction of depression and PTSD, overall completion rates, and patient satisfaction scores.

Differences between active-duty service members and veterans may be driven by desired outcomes. For instance, active-duty members may be more interested in managing symptoms of PTSD so they can continue their careers effectively. Whereas, veterans may tend to be more interested in symptom reduction, thereby increasing functionality, and reducing the impact on their families.

Countless articles and studies in the multicultural psychology field have warned against comparing minority, veterans in this case, with majority groups, such as civilians, as results may serve to further normalize the majority group culture.

Comparing military and veteran to civilian results may only further highlight the differences in the smaller military population when compared with the larger U.S. population.

There exists a large body of research that indicates that evidence-based treatment does work, however the effect tends to vary at the individual level.

To better determine which therapies work best for individuals, WWP invested in and is promoting research into biomarkers for PTSD.

With better understanding of these biomarkers, medical experts will be better able to tailor current therapies to individual patients and develop new models of care.

Until we gain a better understanding of individual differences in reacting to and recovering from trauma, we advocate for combining evidence-based therapies with complementary and alternative methods in an intensive outpatient format.

In conclusion, we welcome and support the need for further dialogue, discussion, research and innovation in the field of PTSD treatment, but suggest caution in how findings are disseminated and interpreted.

It falls on researchers and community partners to ensure that the dissemination of results provide both realistic expectations of treatment and refrain from creating additional barriers to care.

Most importantly, we strongly urge veterans who are struggling to do a brave thing — seek care because PTSD is treatable and treatment works.


A Thank You And 4 Gifts from Ken Larson at “Smalltofeds”


October 2015 Promo


NOTE:  Although certain of the covers above are dated 2012 and 2014, the article links within the downloads have kept the content current and supplemented at the web site.

Approaching my 12th year in volunteer small business consulting, I appreciate the nearly 8,000 individuals who have contacted me for advice.

You have come from many venues through the Micro Mentor and SCORE Foundations, Linked In and other social media sites. It has been a pleasure serving small business.

My work with you has kept me active in retirement, in touch with my profession and engaged in a continuous learning mode as we follow the world’s largest consumer – The US Federal Government.

Please feel free to download any of the 4 free books available here:


Thank you and my best wishes for success to you all.

Ken Larson

Military Units To Reunite In New VA Pilot To Prevent Suicide


Military Units Reunite

Photo: Staff Sgt. Gabriela Garcia/Marine Corps


“The Veterans Health Administration this week announced a new pilot program with the advocacy group The Independence Fund which will reunite troops who experienced some of the toughest combat conditions in Iraq and Afghanistan. 

[The program is] for group therapy sessions, with the hopes of using those common bonds to better work through individual post-military struggles.”

“Mental health professionals in the past have touted the benefits of veterans meeting with peers for counseling sessions to discuss trauma and prevent suicide.

Now, Veterans Affairs officials are readying to take that idea one step further: Bringing whole military units back together for treatment.

“I had one guy tell me, ‘I literally went to hell with these men, so I can go on a yoga retreat or whatever you want if you think it will help them,’” said Sarah Verardo, chief executive officer of The Independence Fund. “They still want to support each other. And building on that trust is key to getting some of these veterans the help they need.”

The effort comes at a time when progress on preventing veterans suicide nationwide has remained stalled. About 20 veterans a day take their own lives, a figure that has held steady in recent years.

Most of those veterans have little or no contact with official VA programs, making outreach a key component of VA’s suicide prevention programs. Dr. Keita Franklin, executive director of the department’s suicide prevention efforts, said in a statement that programs like the new pilot dubbed Operation Resilience can help reach those who need it.

The first retreat will take place in April with members of Bravo Company, 2-508 Parachute Infantry Regiment, 82nd Airborne Division — the unit where Verardo’s husband, Mike, was serving when he was severely wounded by a roadside bomb in Afghanistan eight years ago.

Since his return, the couple has attended numerous funerals of his fellow soldiers. Some were combat deaths. Several others were suicides after the unit returned home.

“It got to the point where the only time they saw each other was funerals,” she said. “We needed to change these guys’ perspective on what it means to return home.”

Details of the first event are still being worked out, but Independence Fund officials have already heard from more than a dozen more units who want to participate in future retreats. The program will focus on groups who saw heavy casualties overseas or a significant number of suicides after they returned home.

Defense Department officials are working with VA to identify unit members and issue invites. VHA officials will handle mental health counseling presentations and interventions, and use the event as an opportunity to look for ways to better connect with all veterans.

A second event is already being planned for early summer, with another hard-hit unit. Verardo hopes to expand the program in years to come.

“These are men and women who went to war together, survived Iraq and Afghanistan,” she said. “We need to help them survive at home.”

More information on the program will be available on the Independence Fund site.

Veterans who are experiencing distress may contact the Veteran Crisis Line at 1-800-273-8255 and select option 1 for a VA staffer. Veterans, troops or their families members can also text 838255 or visit VeteransCrisisLine.net for support assistance.”


VA Researchers Named Most Influential People In Health Care By TIME Magazine


VA Researchers

Dr. Ann McKee of the VA Boston Healthcare System is one of two VA researchers named among the most influential people in healthcare by TIME magazine. (VA Boston Healthcare System)


“The two doctors — one of medicine, the other of philosophy — have been named to TIME magazine’s 2018 Health Care 50 list, topping the charts along with 48 other major influential industry leaders.

The list also includes Iraq veteran and Illinois Sen. Tammy Duckworth, an outspoken advocate for breastfeeding mothers who became the first U.S. senator to give birth while in office earlier this year.”

“Dr. Ann McKee studies the effects of traumatic brain injuries as chief of neuropathology at the the Veterans Affairs Healthcare System in Boston.

Tony Wyss-Coray uses mice to test his theories on aging and memory loss as a VA research scientist in northern California.

McKee also made this year’s TIME 100 most influential people list, a lineup that spans various talents, industries and levels of prominence — from Olympic athlete Chloe Kim to Kim Jong Un and President Donald Trump.

“Dr. Ann McKee and Dr. Wyss-Coray are key VA health care leaders who are performing groundbreaking research,” VA Sec. Robert Wilkie said in a news release. “I’m proud to have them in our ranks searching for new ways to improve the lives of our veterans.”

McKee, who is also the director of a partnership between the VA Boston Healthcare System, Boston University and the Concussion Legacy Foundation, has earned widespread recognition for her research on brain injuries within the NFL. According to TIME, “Since 2015, the ‘McKee criteria’ has been the definitive diagnostic for chronic traumatic encephalopathy (CTE), a degenerative brain disease usually found in patients with a history of repeated brain trauma, like football players. Her recent breakthrough study suggests that blows to the head themselves — not full concussions — may be the underlying cause of CTE.”

The condition has also been associated with repetitive, mild TBI in service members, the VA release states.

Of Wyss-Coray, a professor of neurology at Stanford University, TIME writes, “(He) found that stitching together young and old mice to join their blood systems improved the older mice’s cognition. Startups began offering unproven ‘fountain of youth’ blood-­plasma infusions, but Wyss-­Coray co-founded a company, Alkahest, to scientifically test the idea in people with early Alzheimer’s. Encouraged by early results, he now hopes to refine a blood-plasma treatment for aging brains.”

Wyss-Coray is also the associate director of the Center for Tissue Regeneration, Repair, and Restoration for the Palo Alto VA.

“We are proud of the amazing work Dr. Wyss-Coray has done to help people with Alzheimer’s,” said Thomas J. Fitzgerald III, director of the VA Palo Alto Health Care System that serves more than 272,000 veterans. “It is researchers like him that show how VA research not is only improves care for our veterans but helps to change medicine around the world.”

The winners of the health care category were nominated by a team of health editors and reporters who evaluated their work on key factors, including originality, impact and quality, according to the news release.”


New “Pay for Success” (PFS) Employment Program for Veterans With PTSD


Veteran unemployment predicts PTSD symptom severity, says a new study. How can we use this to help unemployed veterans who suffer combat PTSD? 


“The project is a partnership of Social Finance, the U.S. Department of Veterans Affairs, local governments, and impact investors.

Government partners will repay project investors if and only if the project demonstrates positive outcomes for Veterans.”

“The Veterans Coordinated Approach to Recovery and Employment (Veterans CARE) is a $5.1 million Pay for Success initiative that supports unemployed or underemployed Veterans with post-traumatic stress disorder (PTSD) in attaining competitive, compatible employment. The project is a partnership of Social Finance, the U.S. Department of Veterans Affairs, local governments, and impact investors.

Through Veterans CARE, local VA medical centers will deliver Individual Placement and Support (IPS), a personalized approach to supported employment, to up to 500 Veterans over three years.

The Veterans CARE project is the first PFS project in the United States to focus on improving employment and health outcomes for Veterans, and is the first multi-state project of its kind.


  • Support unemployed or underemployed Veterans with PTSD in attaining competitive, compatible employment
  • Expand high quality, evidence-based employment services to Veterans who can’t currently access these services
  • Serve as a demonstration project for the use of the Pay for Success model within the U.S. Department of Veterans Affairs

The U.S. Department of Veterans Affairs provided $3 million in outcomes payments for the project.

The Commonwealth of Massachusetts and the City of Boston serve as matching outcomes payors for this project.

The Tuscaloosa VA Medical Center will support local VA medical centers to offer Individual Placement and Support, an evidence-based employment service, for Veterans with PTSD.

Social Finance supported the design and financial structuring of the project, raised the capital, and will provide active performance management services for the duration of the project.

Westat will lead the evaluation of the project.

Jones Day is serving as legal counsel to Social Finance for this project.

Wilmington Trust is serving as fiscal agent and custodian for this project.

The project’s funders include:

BNP Paribas
Northern Trust
The Dakota Foundation
Deutsche Bank
Robin Hood Foundation”


VA Offering Alternatives To Drugs For Pain, PTSD And Other Ills


Vets and Tai Chi

Image: Blake Farmer/Nashville Public Radio

Tai Chi, Yoga, Mindfulness Training and Art Therapy


“Zibin Guo guides veterans in wheelchairs through slow-motion tai chi poses as a Bluetooth speaker plays soothing instrumental music.

The U.S. Department of Veterans Affairs has given $120,000 in grant money to Guo to spread his special wheelchair tai chi curriculum.”

“Cloudy hands to the right, cloudy hands to the left,” he tells them. “Now we’re going to open your arms, grab the wheels and 180-degree turn.”

The participants swivel about-face and continue to the next pose. Guo, a medical anthropologist at the University of Tennessee at Chattanooga, has modified his tai chi to work from a seated position. Even though many of the participants are not wheelchair-bound, using the mobile chairs makes it easier for them to get through a half-hour of movement.  He started in Chattanooga, and has expanded his class offerings to Murfreesboro.

his idea of going beyond prescriptions — and especially beyond opioids — in dealing with different sorts of pain and trauma has become a focus of the VA nationally.

In Tennessee, nearly a quarter of all VA patients with an active medical prescription were on opioids in 2012. That number is now down to 15 percent, but that’s still higher than in most other parts of the country.

According to a national survey from 2015, nearly every VA hospital now offers some kind of alternative health treatment — like yoga, mindfulness and art therapy.

Guo is teaching people in a half dozen VA hospitals in Florida, Texas, Utah and Arizona to use his version of tai chi. He believes the focus on breathing and mindfulness — paired with manageable physical activity — can help ease a variety of ailments.

“When you have a good amount of body harmony, people tend to engage in proactive life,” he says, “so that helps with all kinds of symptoms.”

In addition to making a vet feel better physically, the VA also hopes these alternative therapies might help ease symptoms of conditions like post-traumatic stress disorder.

Medical anthropologist Zibin Guo (center) adapted tai chi for people with limited mobility. Though there’s little research evidence confirming that tai chi eases drug cravings or symptoms of post-traumatic stress, the veterans in Guo’s class say the program helps them.

Blake Farmer/Nashville Public Radio

Thomas Sales, of Nashville, Tenn., says his latest panic attack caught him by surprise. “Night before last, when we had the thunderstorm,” he says. “The thunder is a big trigger for some people.”

It’s been 25 years after Sales fought in the first Gulf War with the Navy Special Warfare Command, and he still has panic attacks regularly.

“You’ll find yourself flashing back to being out there with the fellas, and you’ll just kind of snap,” he says. “And I found myself, for some reason, thinking about doing the breathing techniques [from tai chi], and doing the ‘heaven and earth,’ and then breathing deep and slow.”

Sales says he knows it must look crazy to some people when he reaches to the sky and then sweeps his arms to the ground. There was a time when he would have agreed. Most of the patients in this class had some skepticism going into the tai chi program. But Vietnam veteran Jim Berry of Spring Hill, Tenn., says he’s now convinced of its value.

“My daughter sent me a t-shirt that sums it up,” he says. “Tai chi is more than old folks chasing trees.”

Berry credits meditation and tai chi with helping him quit smoking. “No cigarettes for three months now,” he says.

Zarita Croney, a veteran with the National Guard, says tai chi has helped her with chemical dependency. She now makes the nearly two-hour drive from Hopkinsville, Ky., to Murfreesboro each week, and has reduced her use of pills for pain.

“My whole life … revolved around, ‘Oh shoot, when can I take my next pill?’ ” Croney recalls. “I’ve gone from about 90 percent of my day being on my bed to being able to come out and be social.”

The VA has been aggressively trying to wean vets off high-powered opioids — using prescription data as a key measurement to judge how its hospitals across the country are doing with that goal.

The VA acknowledges that there’s little evidence at this point that tai chi or mindfulness therapy or acupuncture will ease PTSD or addiction, though recently there has been research into the quality of life benefits of tai chi among the elderly.

But physicians say they suspect many of the opioisa aren’t always helping veterans either, and the drugs carry more risks.

Aaron Grobengieser, who oversees alternative medicine at the VA hospital in Murfreesboro, says tai chi won’t replace medication. But it might help reduce prescriptions, and the agency plans to start measuring that.

“I believe this is going to be an avenue,” he says, “to really help address that group of folks [who are] looking for ways to manage those types of conditions without popping another pill.”




Afghanistan Veteran Awarded Medal of Honor Explains Beating PTSD and Finding Peace and Hope


Afghanistan Medal of Honor Explains

The author, Florent Groberg, is seen here as an Army lieutenant flying over Afghanistan’s Konar province in 2012. He was awarded a Medal of Honor, the nation’s highest combat valor award, after risking his life to minimize the fallout from a deadly suicide attack. (Photo by Staff Sgt. Alexis Ramos)

“WASHINGTON POST” By Florent Gronberg

“I realized sitting in my own hospital bed, having been injured by a suicide bomber, that no Taliban, no al-Qaeda, and no foreign fighter ever truly scared me.

What frightened me were the demons in my head left behind after that traumatic attack, and their relentless work to destroy my inner spirits and finish me off.”

“The longest war in American history turns 16 years old Saturday — the anniversary of the first deployment of elite special operators to Afghanistan just weeks after the worst terrorist attack in our nation’s history.

Back then our mission was clear, and the call to war was simple: We were going to take out Osama bin Laden, and shut down al-Qaeda’s safe haven for good.

For most American teenagers, a 16th birthday is a huge milestone, a joyful transition into the independence, freedom and opportunities that come with adulthood. But in war, these milestones operate in reverse. The longer they stretch on, the murkier our mission feels, the greater the sacrifice becomes, and the farther into the distance our original goals fade.

Most Americans, glad to be hitting back after being attacked on 9/11, never imagined how expansive this war would become, how many millions would ultimately deploy to fight it, that bin Laden would prove such an elusive target, or that this conflict would morph from a massive manhunt to an even greater struggle for Afghanistan’s nationhood and soul.

And no one would have believed 2,500 American lives — and even more Afghan allies — would be lost.

Americans look at these questions differently and from many perspectives — across our dining room tables and our political divides. Some think we have been there too long, some that victory is just around the corner. Some think we have a responsibility to put Afghanistan back together, others that we are doing more harm than good.

I’ve been a part of these conversations, and I’ve been one of the many confused about our mission. Until I deployed myself.

On the ground in Afghanistan, walking through the silvery moon dust that layers the mountain ridgelines and among ancient societies who carve their homes out of some of the world’s most unforgiving terrain, this war looks very different.

Instead of hostile barbarians, I found myself among hungry and hopeful people. Instead of hunting a terrorist, we hunted for a nation’s future.

Yes, we fought the Taliban, and we used overwhelming American strength to fight those who engaged us with hostility. But we spent much more time working to improve the living conditions for ordinary Afghans, to clear paths for children to safely go to school, to deliver electricity, clean water and basic human security.

I saw the best of humanity at work in Afghanistan through the sacrifices and bravery of the people we worked alongside.

I also saw the depths of evil. Acts of barbaric cruelty, Afghan against Afghan, and brother against brother. The Taliban are a merciless enemy, happy to kill scores of their own people if it was worth one American life.

What hits hardest from my time in Afghanistan is how many of us came home with wounds — physical and emotional.

I nearly became a statistic, one of the 20 veterans who takes his or her life every single day. But like my time in combat, I relied on my brothers and sisters around me. They never quit on me, they pushed me and guided me. They saved my life once in the mountains of Afghanistan and again in the hospital room of Walter Reed National Military Medical Center.

Today, I work with the Boeing Co. to help veterans and their families land careers where they can use their rare and unique skills. Part of that process involves providing our veterans with the resources they need when they, too, are struggling, physically or emotionally. To me, the continuing legacy of this war resides in every job offered to a veteran, in every family reunited with their service member, and in every opportunity for peace that we create.”


Florent Groberg is a retired Army captain, Medal of Honor recipient and author of “8 Seconds of Courage: A Soldier’s Story from Immigrant to the Medal of Honor,” to be released Nov. 7. He works at Boeing Co. as director of veterans outreach and defense, space and security strategy. On Twitter: @FlorentGroberg



Revising U.S. PTSD Treatment Guidelines




“Post-traumatic stress disorder is arguably the most challenging problem combat veterans face.

Medications need to be identified as “second-line” treatments. They should only be used if an effective talk therapy is not available.

Estimates vary, but experts believe that between 10 and 20 percent of Iraq and Afghanistan veterans suffer from the disorder. This puts the actual number of men and women affected in the hundreds of thousands.

Considering that PTSD wreaks havoc on the veteran and their loved ones, and costs billions of dollars each year, finding and using the most effective treatments are critical.

Historically, medications and talk therapy have been considered “first-line treatments.” This basically means they should be used first, and if they fail, then you try something else.  In fact, the joint treatment guidelines published by the Department of Defense and Veterans Affairs Department puts medications and psychotherapy on equaling footing. The same is true for the American Psychiatric Association.

Not all agree.

Organizations from the United Kingdom and Australia and the World Health Organization take the position that trauma-focused psychotherapies such as prolonged exposure, cognitive processing therapy, and eye movement desensitization and reprocessing are most effective when it comes to PTSD treatment. Basically, their stance is that the evidence for meds is just not as strong. A recent study carried out by military and VA researchers, and published in the journal Depression and Anxiety, supports this position.

After weeding through more than 60,000 possibilities, the researchers identified 55 psychotherapy and medication studies for PTSD. This added up to around 6,300 total study participants.

What did they find? Trauma-focused psychotherapies outperformed psychotherapies that do not specifically discuss the trauma. They also beat out medications.

This does not mean other psychotherapies are useless. For example, the researchers noted that stress inoculation training is effective for PTSD. SIT is a credible talk therapy that has been around for decades. It just may not be as effective as the trauma-focused therapies.

The same is true for medications. Zoloft and Effexor are commonly used for PTSD, and they do work for some people. But again, they may not be as useful as certain psychotherapies.

The results of this study challenge the current status quo with regard to treating our combat veterans. It is time to take a close look at how we prioritize PTSD treatments and make adjustments to our national treatment guidelines as necessary.”



Military’s PTSD and Depression Care Falls Short




“The military’s health program falls significantly short in providing mental-health care to service members, according to a Rand study published last week.

The study focuses on depression and post-traumatic stress disorder, the two most common mental-health conditions experienced in the armed services.

It finds some good news: The Military Health System, which is operated by the Defense Department, is effective at contacting active-duty personnel diagnosed with one of the conditions. In addition, a vast majority of those diagnosed with PTSD or depression receive at least one session of talk therapy, the study finds. In that regard, the military system outperforms civilian health services.

But the system faces difficulties ensuring that patients continue with treatment, either by continuing to see a psychotherapist or following up with a doctor after being prescribed medication.

“It’s essential to provide excellent care for these service members because of how much we ask of them,” said Kimberly Hepner, the study’s lead author and a senior behavioral scientist at Rand.

The study examined medical records for service members diagnosed with one of the two conditions between January and June 2012. About 15,000 had PTSD, and about 30,000 had depression. About 6,000 had both.

About 1 in 3 patients newly diagnosed with PTSD got the appropriate follow-up care — typically, that’s at least four visits to a psychotherapist within two months. For those with depression, less than a quarter completed those four visits.

Only about 40 percent of patients who were prescribed medication followed up with a doctor afterward. Those visits are essential, Hepner said, because the physician can make sure patients take their medication and help them manage side effects. A physician’s involvement also ensures that medication doesn’t counteract other drugs being taken.

“Service members received a tremendous amount of medical treatment,” she said. “That’s why it’s even more critical to make sure that it’s a successful experience.”

Combat can contribute to mental health problems, according to the Department of Veterans Affairs. Meanwhile, research has found that suicide attempts seem to be more common in service members than in civilians, though it can be difficult to make such comparisons.

The study is the first part of an overarching project to assess mental-health care in the military. The research, which was commissioned by Defense, hasn’t yet delved into such questions as why patients stop their therapy and medication.

Potential explanations could include insufficient access to mental-health professionals, said Joe Davis, a spokesman for the Veterans of Foreign Wars. Many service members might also fear judgment from their peers for asking for help.

“It’s very easy for senior leaders to say there is no stigma, but far different on the ground at the small-unit level, where everyone relies on their buddy . . . and vice versa,” he said in an email.

Service members might also have been unhappy with the care they got, he added, and therefore chose not to return.

The shortage of providers is one of the biggest barriers to continuous mental-health care, said Elspeth Cameron Ritchie, a former military psychiatrist. As the number of service members deployed to Iraq and Afghanistan has increased, she added, the need for doctors has grown.

It may also be true that appointments are not available at convenient times, Hepner said. “We ask a lot of service members, and they have a lot of demands on their jobs.”

Because they travel a lot, it can be difficult for them to keep up good, continuous access to care, Ritchie said. That difficulty can compound reluctance to keep up with mental-health care. Many, she added, worry about others’ perception if they are seen regularly visiting a psychiatrist.

“If you need to go to the doctor all the time, people will think, ‘Oh, what’s wrong with that person?’ ” Ritchie said. “There’s a lot of talk about how we should treat this as a broken leg, and there shouldn’t be a stigma. But there is a stigma.”

The Defense Department’s commissioning of the study is encouraging, Hepner said, because it suggests an interest in trying to improve mental-health care and access to it. DOD could build on efforts to publicly measure how good its providers are, she said. The department has begun doing that, but Hepner said the public needs more information about quality of care.

The Rand findings may have understated the difficulty of obtaining mental-health care, Hepner added. The study focused on patients who had been diagnosed, but it probably missed some who either hadn’t seen a doctor at all or who had but hadn’t been diagnosed.

Even when they go to the best doctors, service members must ask for help, which can be difficult, Davis noted.

For instance, everyone in the Rand study had been identified as needing help. That makes it easier to connect them with care, which may have influenced the high proportion who had an initial visit, Hepner said.

“The real risk here is the people we are not addressing,” she added.”


What is Learned About PTSD from A SEAL Suicide


Navy SEAL Cmdr Job W. Price

Navy SEAL Cmdr Job W. Price


“Several dozen members of the Special Operations community have killed themselves over the last several years.

In looking into the suicide of a Navy SEAL team commander, Job W. Price, during a deployment in late 2012, Times reporters learned more about the stresses on elite Special Operations troops.

Christopher Drew, one of the reporters who worked on the story, discusses these issues.

Why did The Times look into Commander Price’s suicide?

When we researched stories about SEAL Team 6 andallegations of detainee abuse involving members of SEAL Team 2, several SEAL team members mentioned that much about Commander Price’s death in December 2012 remained a mystery even to other SEALs. We spoke with his father and sister, and they were not satisfied with the explanations the Navy had provided in ruling his death a suicide and still had many questions about it.

What about your findings surprised you most?

Most of the movies and books about Navy SEALs portray them as warriors who remain resilient in the face of any difficulties, and it was almost unfathomable that a veteran commander would kill himself in the middle of a deployment. But as we studied the Navy’s investigative documents and talked to Commander Price’s friends, it became clear that he was haunted by the deaths of two soldiers and two SEALs under him. The losses seemed to burden him even more because they came after the United States had started to pull out of Afghanistan.

How common is traumatic stress within the Special Operations forces?

Medical researchers have found that the nation’s Special Operations forces — which include Navy SEALs and the Army’s Delta Force, Green Berets, and Rangers, as well as special Marine and Air Force units — are suffering just as much, or more, than regular troops from post-traumatic stress disorder and brain injuries. Most of these special operators have had multiple deployments in Iraq or Afghanistan, and the stresses and brain injuries they experience — some stemming from exposure to explosive blasts in breaching enemy compounds — have been linked to depression. Several dozen members of the Special Operations community have killed themselves over the last several years, usually after they have returned home or gotten out of the military.

Within these elite forces, is there still a stigma attached to seeking help on mental health issues

The Pentagon and the Department of Veterans Affairs now have many programs to teach service members to recognize the signs that they are suffering from stress disorders and brain injuries. The Special Operations Command has created a task force, Preservation of the Force and Family,to address the mental, emotional and physical needs of its troops and their families. It encourages all types of mental health counseling as well as meditation, acupuncture and physical therapy.

What was general reader response to your story?

Whether they opposed or supported United States involvement in the recent wars, readers said they were saddened by Comander Price’s death. Civilians as well as many who served in the SEALs and other units expressed concern that the military is overusing its most elite troops. “A country that believes you can send men and women back into war time after time without that force breaking is fooling itself,” one reader, Bill from Boston, wrote on our site. “My heart breaks for this and the many other families left behind.”