The casualties of the Iraq and Afghanistan wars continue to fall far from the battlefields of Asia — although they die by their own hand.
“There’s always more that needs to be done because we have soldiers returning from Iraq and now Afghanistan who are dealing with this invisible injury, and that’s post-traumatic stress (disorder),” said Lt. Gov. Anthony Brown, himself a veteran of the Iraq war who deployed in 2004, serving in Baghdad, Fallujah, Kirkuk and Basra with the 353rd Civil Affairs Command.
Nationally, an estimated 18 veterans per day take their own lives, and the U.S. Department of Veterans Affairs announced in February an effort to do a better job of collecting states’ data and to provide more counseling services to help veterans.
The number of suicide casualties among veterans in Maryland was unknown, state officials said.
On Thursday, the University of Maryland and the state Department of Health and Mental Hygiene launched a partnership to help identify gaps in veterans’ services and better train professionals to treat vets.
Many veterans have returned home from multiple deployments in war zones with post-traumatic stress disorder, said psychologist Kathy Seifert, whose Eastern Shore counseling practice has treated many veterans.
Post-traumatic stress also can result in behavioral problems that can manifest themselves in alcoholism, depression and difficulty in adjusting to life, Seifert said.
A Rand Corp. study for the federal government found that nearly 20 percent of all returning Iraq and Afghanistan veterans showed signs of depression or PTSD, yet only half of them sought treatment.
The Rand study also found that exposure to combat led to an increase in depression and post-traumatic stress.
“People only cope with so much and you get beyond a person’s ability to cope, and then the body and the mind are going to break down and say, ‘Look, I’ve taken all I can take without a timeout here,’” Seifert said.
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In 2008, the General Assembly approved an initiative, Maryland’s Commitment to Veterans, through the state Department of Veterans Affairs and the Department of Health and Mental Hygiene, to link veterans to available services either at the state or federal level, said Laura Herrera, chief medical officer for the Department of Health and Mental Hygiene.
“We knew not only the risks of suicide were high, but also the risks of people falling through the cracks, not getting the behavioral health services they need,” said Jerry Boden, chief of staff of the Maryland Department of Veterans Affairs.
The state decided that even though the federal government has the primary responsibility to treat veterans, “the states have a responsibility as well because these are our neighbors, and we couldn’t let them slip through the cracks,” Brown said.
Upward of $6.4 million has been committed to the treatment of veterans through different state departments — from providing behavioral health services to offering transportation assistance to get them to treatment programs, Brown said.
The latest action by the state was the University of Maryland-Department of Health and Mental Hygiene partnership. Part of the effort will be to train mental health professionals, primary care doctors and clergy to better understand the needs of returning military personnel.
The Maryland Veterans Resilience Initiative will form an advisory council of veterans, family members, nonprofits and faith organizations.
The initiative, through the University of Maryland’s School of Public Health, also will conduct a statewide survey of medical and behavioral health professionals to assess their training needs and ability to assist veterans.
“Our goal is to address behavioral health problems early on and to prevent future problems through a coordinated network of training and peer support,” Herrera said.
Brown went through a post-deployment screening process when he finished his tour of duty in Iraq.
“I wanted to come home and get a clean bill of health that I could assure [my family] I was the same person that left them a year earlier,” he said.
Many veterans only discover after they have returned home that they still are coping with the war.
“Veterans returning have so many competing priorities — employment, stable housing, fitting back in with the family — the behavioral health issues get addressed second,” Herrera said. “Sometimes they don’t identify they need help. They haven’t been sleeping or are irritable, and they may equate that with their stress about needing work. So a certain amount of education is sometimes needed.”
The unemployment rate for veterans of Afghanistan and Iraq was 12.1 percent, according to a federal Bureau of Labor Statistics report released in March.
The state initiative created regional coordinators to intervene with the veterans. Figures were unavailable on how many veterans the coordinators have referred to counseling for depression or post-traumatic stress disorder, but the state’s Department of Veterans Affairs interacted with about 4,000 veterans in 2012, up from about 2,400 in 2007, according to state figures.
The number of veterans in the state from all wars peaked at 480,218 in fiscal 2008 due to the return of veterans serving in Afghanistan and Iraq. Since then, the returned military population has declined steadily to 465,727 in 2011, the most recent figures available.
Overall, the state budgets $22 million for the Maryland Department of Veterans Affairs, the bulk of which goes to a long-term health care facility for veterans, Charlotte Hall Veterans Home in St. Mary’s County.
The veterans affairs department budgeted $1.08 million in fiscal 2012 to provide direct services to veterans and another $190,000 on outreach and advocacy programs to ensure that veterans and their dependents are aware of the benefits available to them at the federal and state level.
“They talk to them to make sure they’re connected to the right counselor or VA resources available to veterans,” Boden said.
Linking the veterans to existing services that they might not be aware of, including mental health counseling and educational opportunities that can improve their employment lot, can reduce the suicide rate, he said.
“By helping them now, we can hopefully help prevent that,” Boden said.
Although he is proud of the state’s efforts, Brown said more can be done for those who served and sacrificed for the nation.
“Five years ago, we weren’t really talking about the state’s role and responsibility in addressing service members returning home with post traumatic stress,” said Brown, who is a colonel in the U.S. Army Reserves.
“What is true for the state is also true for the federal government, and that is we need to step up our efforts.”