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Published on Sunday, February 24, 2008 by The American Prospect

What Happened to Mental Health Care for Vets?

The debate over the subject of suicide, and the treatment of soldiers and veterans, continues in Washington. Meanwhile, veterans of the wars in Iraq and Afghanistan are killing themselves at an alarming rate.

by Tara McKelvey

Andreas-Georg ("Andrew") Pogany was trained at the U.S. Army Intelligence Center in Fort Huachuca, Arizona, to interrogate high-level terrorism suspects in Iraq. But one evening in September 2003 in Samarra, he fell apart. That night, he saw the corpse of an Iraqi man cut in half by a Bradley cannon during a battle. Afterward, Pogany began shaking, barely able to catch his breath. He sat for hours in a dark room in a military compound with his hand on a weapon. If someone opened the door, he was prepared to shoot.

The following day, he told a team sergeant he did not feel strong enough to work. "He took me outside, and he told me I was a fucking coward, and if it was up to him he would shoot me in the head," says Pogany, 36, on a December evening at a restaurant called Racine's in downtown Denver, four years after the incident. Pogany has broad shoulders and grey hair at the temples, and he wears heavy silver rings on both hands. He does not look like someone who is easily thrown off balance. When he talks about his conversation with the military officer, though, he stares into the distance. "He was like General Patton. Short of slapping me with his glove, he did it all," he says.

Pogany was soon facing charges of cowardice, a crime punishable by death in a military court. He told his less-than-supportive military attorney: "Go pound sand." Then he hired a Colorado Springs-based civilian lawyer and showed that he had been suffering from side effects of a military-issued, anti-malarial drug called Lariam while he was in Iraq.

On Nov. 6, 2003, less than six weeks after he experienced his "drug-induced, psychiatric breakdown," as he says, a CNN segment titled "Heroes and Cowards in War" appeared on television. Army Private Jessica Lynch was held up as a hero; Pogany was described as a coward. Yet things have changed over time. In April 2007, Lynch testified before the House Oversight and Government Reform Committee that the Army exaggerated her role in fighting off Iraqi insurgents, turning her into "little girl Rambo" in order to pump up enthusiasm for the war. Meanwhile, Pogany, though he's far from the battlefield in Iraq, has emerged as a hero. At Army posts and in military communities across the country, he is trying to help save people who have returned from the war with mental and emotional problems.

On July 15, 2004, the Army dropped the cowardice charges. At that point, Pogany became Exhibit A in the case against the military's treatment of mental illness among soldiers. He was featured in GQ ("The Coward," July 2004) and on PBS' Frontline ("The Soldier's Heart," March 2005), as well as in dozens of newspaper articles. "He was like a canary in a coal mine," explains Paul Rieckhoff, executive director of Iraq and Afghanistan Veterans of America. "Now, years later, we see more cases of the stress of war -- acute stress -- and the Army's inability to deal with it."

Over the past several years, Pogany has visited military installations, set up meetings between congressional leaders and soldiers, and examined ways the Army can improve its mental-health care. On Jan. 1, 2008, he was hired as an investigator for the National Veterans Legal Services Program, a Washington, D.C.-based nonprofit organization. Experts in the field of veterans' care say he is one of the most effective advocates in the country. "Congress tends to hear about the military from higher-ups, and there's an institutional response. They're making things look the best they can," says Charles Sheehan-Miles, former executive director of Veterans for Common Sense. Pogany has worked hard to ensure that people in Washington meet directly with individuals who have been through the military's mental-heath-care system -- "the folks on the ground," as Sheehan-Miles explains.

Pogany knows a great deal about the subject of mental-health care for veterans and soldiers, both through his research and from his own experience in the military. "I see this guy, and he's always pushing the meds," Pogany recalls, describing the mental-health treatment he had received. "'So I say, 'Let's just say I'm going to take this drug. What are the side effects?' He had to look them up. One of them, it turns out, is an inability to get an erection. I'm like, 'You think I'm depressed now?' He said, 'If that happens, we'll just give you a prescription for Viagra.' We both laugh. "Later, I find out people I know are on nine or ten meds. I felt like I was dealing with a M-A-S-H episode. There is this comedy of errors, and it culminates with this guy going home and blowing his brains out. And they say, 'Oh, well, he was depressed.'"

Suicide among veterans and soldiers has been occurring with a disturbing frequency in recent years. Approximately 1,000 individuals receiving care through the Veterans Health Administration (VHA) kill themselves each year, according to VHA records. In August, the Army Surgeon General's Office reported that 99 active-duty soldiers killed themselves in 2006, the highest number since 1991, the year of the Gulf War.

In August 2007, a psychiatry consultant to the Army Surgeon General, Col. Elspeth Cameron Ritchie reported that the suicides had been caused by financial woes, troubled relationships, and other issues - and had not been caused by the war. But some experts disagree with that assessment, saying that the military has determined there is no direct relationship between the rate of suicides and deployments in order to avoid additional, wartime costs that might be required to treat or prevent suicides. "There are various possible explanations for the Pentagon's refusal to accept that connection," said Penny Coleman, author of Flashback: Posttraumatic Stress Disorder, Suicide, and the Lessons of War, before the House Committee on Veterans Affairs in December 2007. "But one of the most compelling is budgetary." In other words, treating soldiers and veterans with mental-health problems is expensive -- and refusing to draw a connection between war and suicide may simply be a way of saving money.

Col. Ritchie says that is not an accurate assessment of their position. In fact, she says in an email on February 21, "We do believe that the frequent deployments were straining marriages and other relationships." In addition, she says, "Failed intimate relationships are a definite risk factor for suicide. Other risk factors for our soldiers include legal and occupational difficulties, and the availability of firearms in theater. As time has gone on, we continue to see the effects of deployment on relationships. We also need to acknowledge the connection between PTSD, substance abuse, and suicide. To date, few of our suicides have had diagnosed PTSD."

The debate over the subject of suicide, and the treatment of soldiers and veterans, continues in Washington. Meanwhile, Pogany is traveling around the country to investigate mental-health care at Army posts so he can help soldiers who may need legal assistance or aid in obtaining proper health care. Several weeks ago, he arrived in Syracuse, New York, in the midst of a blizzard. The mental-health facilities at nearby Fort Drum have been taxed with visits up 200 percent above prewar levels, and an additional clinic, Mountain Community Tricare Behavioral Health, was added to Fort Drum in June to meet the demand. (Tricare is a managed-care company.) Assistant Secretary of Defense S. Ward Casscells told the House Armed Services Subcommittee on Military Personnel in July 2007 that the clinic is "a model for other installations."

Yet a soldier at Fort Drum still must wait six to eight weeks before he can see a mental-health worker, says Pogany. "The [mental-health-care] providers say, 'Hey, we're doing this, we're doing that,'" he says. "And on paper, they're seeing people. On paper, they have a PTSD group. On paper, they have someone coming in for an appointment. But when you pull that apart, it's all coffeehouse crap."

It is after 5 p.m. at Racine's restaurant, and Pogany is checking his watch. He has recently come back from another trip -- this time to Anchorage, Alaska, where 3,700 troops recently returned to Fort Richardson from Iraq. They have arrived home, he says, during the dark winter months in a place known for clinical depression, suicide, and crystal meth. "How many psychiatrists they have there? Zero," Pogany says. (Maj. Vanessa Venezia, the chief of the community mental-health division at Bassett Army Community Hospital, Fort Wainwright, who oversees Fort Richardson's mental-health services, says they are currently hiring a psychiatrist. In the meantime, she explains, soldiers are being treated in a full-service clinic at nearby Elmendorf Air Force Base.)

Pogany says the need for expanded mental-health services for soldiers at Fort Richardson is urgent. "If they don't address this problem now, the roof will cave in," he says. "All we have to do is sit back and wait ninety to one hundred days and see how many suicides and DUIs there are, and then separate out how many are combat-related."

Tara McKelvey, a senior editor at the Prospect, is a research fellow at NYU School of Law's Center on Law and Security and the author of Monstering: Inside America's Policy on Secret Interrogations and Torture in the Terror War.

© 2008 by The American Prospect, Inc.

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