FORT HOOD, Texas - Nine months after an Army psychiatrist was charged with fatally shooting 13 soldiers and wounding 30, the nation's largest Army post can measure the toll of war in the more than 10,000 mental health evaluations, referrals or therapy sessions held every month.

Col. Steven Braverman, head of the Carl R. Darnall Army Medical Center, says mental health counselors' schedules are filled. "We are full to the brim," he says. (Erich Schlegel for USA TODAY About every fourth soldier here, where 48,000 troops and their families are based, has been in counseling during the past year, according to the service's medical statistics. And the number of soldiers seeking help for combat stress, substance abuse, broken marriages or other emotional problems keeps increasing.

A common refrain by the Army's vice chief of staff, Gen. Peter Chiarelli, is that far more soldiers suffer mental health issues than the Army anticipated. Nowhere is this more evident than at Fort Hood, where emotional problems among the soldiers threaten to overwhelm the system in place to help them.

Counselors are booked. The 12-bed inpatient psychiatric ward is full more often than not. Overflow patient-soldiers are sent to private local clinics that stay open for 10 hours a day, six days a week to meet the demand.

"We are full to the brim," says Col. Steve Braverman, commander of the Carl R. Darnall Army Medical Center on the post.

That doesn't even count those soldiers reluctant to seek care because they are ashamed to admit they need help or the hundreds who find therapy outside the Army medical system, Braverman and other medical officials say.

Officials worry the problems may worsen - for the military and the country.

"If Fort Hood is representative of the Army - and 10% of the Army is assigned to Fort Hood - then if you follow the logic, our numbers should be scalable to any other post in the country," says acting base commander Maj. Gen. William Grimsley.

"I worry that if we don't see this through the right way over the long haul ... we're going to grow a generation of people 10 or 15 years from now who are going to be a burden on our own society," he says. "And that's not a good thing for the Army. That's not a good thing for the United States."

Statistics provided to USA TODAY by Fort Hood commanders show the explosion of mental health issues here:

• Fort Hood counselors meet with more than 4,000 mental health patients a month.
• Last year, 2,445 soldiers were diagnosed with post-traumatic stress disorder (PTSD), up from 310 in 2004.
• Every month, an average of 585 soldiers are sent to nearby private clinics contracted through the Pentagon's TRICARE health system because Army counselors cannot handle more patients. That is up from 15 per month in 2004.
• Hundreds more see therapists "off the network" because they want their psychological problems kept secret from the Army. A free clinic in Killeen offering total discretion treated 2,000 soldiers or family members this year, many of them officers.
• Last year, 6,000 soldiers here were on anti-depressant medications and an additional 1,400 received anti-psychotic drugs.

"I don't think we fully understand the total effect of nine years of continuous conflict on a force this size," Chiarelli says, reacting to those statistics.

"Those numbers are pretty staggering," says Kathy Beasley, a health care executive with the Military Officers Association of America. She wonders what will happen when those soldiers leave the military. "Do we have the supply and the people in our systems to take care of that?"

Every time more counselors are hired here, their schedules immediately fill up with patients. "It's almost like a Field of Dreams," Braverman says, referring to the famous line from the 1989 film about a baseball field on an Iowa farm that spontaneously draws crowds. "If you build it, they will come."

'Life can slowly slip away'

Staff Sgt. Josh Rivera came back from his third tour in Iraq this year eager to save his marriage.

"When a soldier is constantly gone and actually fighting, not just deploying and sitting in an office, life can slowly slip away," says Rivera, 32, a native of the Bronx, N.Y.

Thirty-nine cumulative months of war had left him distant from his family and confused about his role in their lives, Rivera says. All that made sense was the infantry, which he loves. Rivera resisted seeing a counselor until his marriage was in real trouble, he says.

The Army therapist who met with Rivera and his wife, Julie, gently guided them back to basics - what brought them together 10 years before, why each mattered to the other and what they wanted out of life, the couple say.

Chaplains provide marriage counseling, but for soldiers who want to see a licensed marriage counselor, the base's social work department has two, each with a caseload of 60 couples, says Lt. Col. Nancy Ruffin, department director.

She has to refer some troubled marriages to private clinics, and not all the soldiers are willing to do that, Ruffin says.

The demand for other types of counseling also far exceeds supply. There are not enough social workers to treat soldiers suffering the emotional effect of sexual assault. Ruffin says she has one social worker, who is handling 50 cases.

Fort Hood has an intensive, three-week therapy program, followed by eight weeks of group therapy, for soldiers suffering stress-related issues, including post-traumatic stress disorder. It has a waiting list of 80 soldiers.

The child and adolescent psychiatric services at Fort Hood handle more than 1,000 visits, assessments or counseling sessions with military children each month, up from about 800 in 2004. It refers about 30 overflow cases off base each month, up from zero in 2004, the base statistics show.

Fort Hood has one of the most robust mental health programs in the Army. It has 171 behavioral health providers and 28 new hires are on the way, says Lt. Col. B. Kirk Phillips, a psychiatrist and director of mental health care at the Darnall medical center. This is up from about 50 mental health workers in 2004.

Because of war and deployments, not only are there more soldiers suffering emotional problems, they are sicker than ever and require more counseling sessions, Phillips says. Even after the latest round of hiring, Phillips says, a recent internal analysis showed the mental health staff will need an additional 58 counselors to meet the demand.

Suicides outpacing 2009

Despite the increase in mental health resources, there have been 14 confirmed or suspected suicides among Fort Hood soldiers this year. That figure outpaces 2009 and matched each of the three worst years for suicides in recent base history, 2006-2008. In June, the Army recorded 32 suicides overall, the highest monthly total since it began keeping records.

Army Sgt. Douglas Hale Jr., 26, was one of the most recent Fort Hood suicides.

On July, 6, Glenda Moss received this text message from Hale, her son: "i love u mom im so sorry i hope u and the family and god can forgive me."

Her son had tried to kill himself in May. She feared he might try again. She immediately called the Army and then drove the 90 minutes from her home in King, Texas, to the base.

It was too late. Hale had walked into a restaurant across Highway 190 from Fort Hood, asked to use the bathroom, locked the door and shot himself in the head with a newly purchased handgun, according to a police report. He was removed from life support a few days later.

Moss knew her son was very troubled. When his second combat tour to Iraq ended in 2007 after 15 months, he was diagnosed with PTSD and severe depression, began drinking heavily, saw his marriage disintegrate and, finally, left the base without permission last year.

He was brought back to Fort Hood in May after being taken into custody by police in King for being absent without leave, his mother said. He attempted suicide in his barracks that month.

The Army sent him to a psychiatric hospital in Denton, Texas. Army doctors told him "we don't have enough people here (at Fort Hood) to help you," his mother recalls.

A statement released by Fort Hood in response to questions about Hale's case says, "Space and staff shortages prevent us from treating all our patients on post. While it is our intent to treat patients within our facilities, the reality is we cannot at the present time."

Base officials declined to discuss the specifics of Hale's case while an Army investigation continues.

Moss says her son seemed to be in good spirits after leaving the Denton hospital following a month of treatment in June. He spent the July 4th weekend at his mother's home before she drove him back to Fort Hood on July 5.

Moss says the Army can do more to watch over troubled soldiers like her son. "They need to do as much as they can to stop this, because if they don't, the Army's going to be responsible for a lot more (suicides)," she says. "I don't want another family to have to deal with what I went through.

'Stigma was still a problem'

After the mass killings in November, Fort Hood launched a campaign to gauge the psychological health in the community. The goal was to see how many people needed help, whether they were getting it and how many counselors were needed. Part of the effort was an online, confidential survey in February to get soldiers' views. Troops were offered incentives such as a day off from work to participate. More than 5,000 responded.

One in four said they would be viewed as weak, treated differently or harm their careers if they admitted suffering emotional issues, says Col. William Rabena, who led the campaign. The attitude was particularly strong among majors, lieutenant colonels and full colonels.

"Stigma was still a problem," Rabena says.

For those soldiers afraid to seek help, who decline to go to Army therapists or private clinics that contract with the military, there are alternatives.

A Pentagon program offers soldiers a limited number of counseling sessions with private therapists that will remain off their medical records. The program is called Military OneSource, and it provides up to 12 free and confidential therapy sessions when soldiers call a toll-free hotline. From May 2009 to May 2010, there was a 72% increase in sessions provided by the program in the Fort Hood area, from 822 to 1,412, says Air Force Maj. April Cunningham, a Pentagon spokeswoman.

Another option for Fort Hood soldiers who want to keep their psychological problems secret from the Army is a free clinic in Killeen called Scott & White Military Homefront Services. The therapy provided at this clinic does not show up as a mental health diagnosis on a soldier's medical record.

The five therapists at the project are booked solid, says the director, Maxine Trent, a psychotherapist and the wife of a retired Navy SEAL.

The clinic has seen 7,117 soldiers, spouses and their children since it opened in 2008, says Matthew Wright, a director with Scott & White Healthcare of Temple, Texas, which operates the project.

Soldiers, many of them officers, come into the clinic seeking therapy for the first time in their careers, Trent says.

"Generally, you have the parade rest," she says, demonstrating how they sit with backs straight, arms outstretched and palms on knees. The tension in their bodies, she says, is palpable.

"Those who have been back-to-back deployed vibrate. ... There's different energy. There's hyper-vigilance that you won't see anywhere else," Trent says. "They walk in here not sleeping. They walk in here having mood disruptions, angry driving, explosions at wife and/or husband and kids."

When her offices opened, Trent canvassed the wives of Fort Hood commanders to get a sense of what she was facing. "They told us basically, 'We know everything we need to know about deployment. Please don't set up any programs to teach us about deployment,' " Trent recalls. " 'What we don't know how to do is to keep doing it (deployments). We're tired. We're exhausted.' "

Even this program struggles to cope with all those needing help and getting the money to pay for it.

A $750,000 grant from the Dallas Foundation and the Association of the U.S. Army for the project is nearly gone and officials are trying to secure more funding, Wright says.

Adam Borah, who runs the outpatient psychiatric clinic at Fort Hood, sees progress in the many soldiers stepping forward to seek help. "The bad news is that there are a lot of people out there who need behavioral heath care," he says.

Braverman worries that if the number of patients keeps climbing, soldiers will give up waiting to see someone and avoid seeking help. Private clinics that contract with the military to handle overflow patients are overworked, says Chuck Lauer, a senior administrator at Darnall Hospital. "These guys (local private therapists) are putting in six days a week. Some of them have their practices open 10 hours a day," Lauer says.

Staff Sgt. Rivera, who got the marital help, worries for the soldiers. "The military needs to know that they are losing very good soldiers and squads and platoons to multiple deployments," he says. "The amount of help needed is actually overwhelming."