The military and its critics agree on one thing -- there are not enough therapists to treat all the soldiers who return from Iraq and Afghanistan traumatized by the experience.
The 10th Mountain Division's 2nd Brigade Combat Team (2BCT) is the most-deployed brigade in the U.S. army since 2001. It served two tours in Afghanistan, totaling 11 months, and was sent to Iraq twice for tours of 12 and 15 months.
"They're kind of a canary in a coal mine," said Paul Rieckhoff, a former Army captain who founded the advocacy group Iraq and Afghanistan Veterans of America. "They're a good barometer to understand the human cost of the war."
A report by advocacy group Veterans for America said the mental healthcare system at Fort Drum was not meeting the demands placed on it and had prepared inadequately for the return of more than 3,500 soldiers from Iraq late last year.
"Even though we knew this group were coming back from their 4th deployment and there would be these problems, we still had massive waits of two months (for appointments)," Veterans for America spokeswoman Adrienne Willis said.
The report, released in February, said there were not enough counselors, psychologists and psychiatrists, there was too much reliance on group therapy over individual care and there was a lack of continuity in care. The lack of a hospital on base was also a problem.
It said commanding officer Gen. Michael Oates deserved "commendation" for setting the tone that psychological wounds were legitimate combat wounds. Nevertheless, the stigma of mental problems kept many soldiers from speaking up, it said.
Todd Benham, head of Fort Drum's behavioral health department, attributed long wait times to a lack of staff. He said the unit had plans to expand but it takes time to recruit, particularly in a rural area such as Fort Drum.
"It's definitely a crunch, it's difficult recruiting and certainly it's more difficult up here," Benham said.
"I don't think anybody is pretending the stigma has gone away or we didn't have significant wait times for a while," Benham said. "We understand there was an issue."
"Yes, we recognize Fort Drum needs some help, but that's something we've been working on for a year or more," he said.
GROWING CASE LOAD
Benham said visits to the clinic have risen from about 14,000 in 2001 to 26,000 expected this year. There was a big jump from 2004 to 2005 when the unit started screening all returning soldiers for mental health problems.
Post-traumatic stress disorder, or PTSD, can result from wartime trauma such as wounds or witnessing others being hurt. Symptoms include irritability or outbursts of anger, sleep difficulties, trouble concentrating, extreme vigilance and an exaggerated startle response.
Christopher Smith, 23, a tank mechanic who served in Ramadi, returned from Iraq in January 2006 and left the army. In the following six months, he grew increasingly withdrawn and isolated and was unable to hold down a job.
Despite what his wife Cara says were clear signs of PTSD, he managed to re-enlist in December 2006 without the recruiter noticing a problem. Sent to Fort Drum, he was diagnosed with PTSD and judged undeployable. He has been on a string of different medications, none of which he says have worked.
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"It's so frustrating," Cara Smith said, describing the base as unfriendly and depressing.
"The doctors up there, they say 'Come to group therapy, we'll help you.' But because of his duty and his orders and stuff he has to do, he missed two group therapy sessions and got kicked out of group therapy," she said.
Now, she said, he has a 30-minute individual therapy session around every six weeks. "It's not really therapy, it's more of a medication appointment," she said.
About 300,000 troops returning from Iraq and Afghanistan suffer PTSD or depression, or one in five of the more than 1.5 million who have deployed, according to a report by RAND Corp.
Around 17,000 troops are based at Fort Drum, a sprawling base near the Canadian border that endures bitter winters. Around 4,000 of those are in Iraq.
Most soldiers in the 2nd brigade will not have served all four tours, but some senior non-commissioned officers have deployed three or four times. Military studies show those on repeat deployments are more prone to PTSD.
Benham said his department has 35 staff in its three clinics, which cover mental health services, social work and substance abuse. Three more positions will be filled within a month and there are 16 vacancies.
Several soldiers interviewed by Reuters said the first weeks back for many younger soldiers was devoted to drinking.
"The first month back, everybody got drunk, pretty much," said William Buehler, 23, adding that as a married soldier he did not participate in such drinking. "You've been gone 15 months, that's what everybody wants to do," he said.
Among a series of incidents fueling concern about drinking, a Fort Drum soldier was arrested in March and charged with vehicular assault while intoxicated after ploughing his car into a crowd outside a nightclub, injuring seven soldiers.
In an effort to shame those who go too far, Gen. Oates decided in March to print the names and photographs of soldiers arrested for drink driving in the base newspaper.
Several soldiers interviewed on base praised the move as a good deterrent, but Willis of Veterans for America said many of those named were in the brigade that just came back from Iraq.
She said while nobody would justify drink driving, it was important to examine the link to combat stress. "They're making it the full responsibility of the soldier when the rest of the world has come to realize alcohol is a symptom of PTSD."
Tom Berger, chairman of a PTSD committee at the Vietnam Veterans of America, said alcohol abuse was typical.
"A lot of these folks, all indications are they're self-medicating. They come home and they try to deal with this stuff with a 12-pack (of beer)," he said.
Reporting by Claudia Parsons; Editing by Eddie Evans
© 2008 Reuters