Thousands of private counselors are offering free services to troops returning from Iraq and Afghanistan with mental health problems, jumping in to help because the military is short on therapists.
On this Memorial Day, America's armed forces and its veterans are coping with depression, suicide, family, marital and job problems on a scale not seen since Vietnam. The government has been in beg-borrow-and-steal mode, trying to hire psychiatrists and other professionals, recruit them with incentives or borrow them from other agencies.
Among those volunteering an hour a week to help is Brenna Chirby, a psychologist with a private practice in McLean, Va.
"It's only an hour of your time," said Chirby, who counsels a family member of a man deployed multiple times. "How can you not give that to these men and women that ... are going oversees and fighting for us?"
About 20,000 more full- and part-time professionals provide health care services for the Veterans Administration and the Pentagon. They include psychiatrists, psychologists, psychiatric nurses, social workers and substance abuse counselors.
According to veterans groups and health care experts, that is not enough for a mental health crisis emerging among troops and their families.
"Honestly, much is being done by the Department of Defense and the Department of Veterans Affairs," said retired Army Brig. Gen. Stephen Xenakis, a psychiatrist. "But the need to help these men and women goes far beyond whatever any government agency can do."
300,000 suffer mental health problems
About 300,000 of those who have served in Iraq and Afghanistan are estimated to have anxiety or post-traumatic stress, a recent private study said. Add in spouses left home to manage families and households without their partner as well as children deprived of parents during long or repeated tours of duty, and the number with problems balloons to 1 million, Xenakis said.
The VA says it has seen 120,000 Iraq and Afghanistan veterans who have symptoms of mental health problems, half with post-traumatic stress disorder. Although rates are high from those two wars, most of the 400,000 patients seen in VA last year for PTSD were Vietnam-era veterans, officials said.
Civilian groups are trying to step in for troops from the current conflicts.
"There are over 400,000 mental health professionals in our great country," said Barbara V. Romberg, a clinical psychologist who practices in Washington. "Clearly, we have the resources to meet this challenge."
Romberg founded Give An Hour, a group of 1,200 mental health professionals donating one hour of free care a week to troops, veterans or family members. They have to commit to doing it for a year.
Romberg, in cooperation with the American Psychiatric Foundation, hopes to find 40,000 volunteers over the next three years, or about 10 percent of available civilian professionals. The effort to get the word out to those who need the help and to recruit and train volunteers is being backed by a $1 million grant from the Lilly Foundation.
Romberg's group is the largest of a number across the nation.
Nearly 200 also have volunteered for the Soldiers Project, started by psychiatrists at the Ernest S. Lawrence Trauma Center of the Los Angeles Institute and Society for Psychoanalytic Studies — and now operating in Chicago, Seattle and New York.
The Coming Home Project in the San Francisco area has dozens of volunteers. A group of veterans, psychotherapists and interfaith leaders, it offers everything from retreats and workshops to yoga and other stress management programs as well as the counseling.
"Thousands of therapists across the country are donating their time to give vital treatment and support to our soldiers, sailors, airmen, Marines, veterans and families," Xenakis said at a recent news conference announcing the Lilly grant. "These young men and women volunteered to defend our nation, and now our nation can volunteer to serve them."
Private care might ease crisis
The government acknowledges there might be a place for such groups.
"While the military health system does not endorse volunteer health care organizations, we recognize that groups such as this one offer more options for our warriors and their families," said the Pentagon's Jones.
"If these mental health caregivers are willing to give and learn about our warriors, they may be more willing to become TRICARE providers," he said, referring to the network of more than 300,000 physicians and specialists and 55,000 pharmacies that support the department's military medical facilities and uniformed medical corps.
The military health care system serves about 9.2 million people — active duty, and guard and reserve components for all the services, as well as their families and retirees and their families.
Jones said there are 3,000 mental health professionals available under TRICARE in addition to the 1,431 in uniform. The VA said it has 17,000 full- and part-time mental health workers, 3,800 of which it has hired in the past few years.
The services are trying to hire about 575 more. Also, about 200 mental health officers from the U.S. Public Health Service will be detailed temporarily to the Pentagon to work in military facilities, Jones said. An agreement between the Pentagon and the Health and Human Services Department is to be signed in the coming weeks to finalize the arrangement.
The Pentagon has made a special effort to hire since a yearlong task force last year found it had neither enough money nor staff to support the military and family mental health needs during peacetime, let along during war.
Overcoming stigma an obstacle
Staffing was not the only issue. Officials have worked to change the military culture in which there is a stigma in seeking help and a fear doing so will harm careers.
They have tried to make mental health care more accessible, embedding more workers with troops, offering suicide prevention training and advising troops how to recognize mental problems in themselves and others.
The military also is working to assess mental health among troops, screening them before and after deployments and sending mental health teams to the front each year to measure morale, the amount of mental health problems, availability of care and related matters.
Programs to help families with housing, child care and other issues have been bolstered. Troops get mental-health training in a program called "Battlemind" that teaches about common problems to expect at home as they readjust to domestic life.
Still, some emotional difficulties are a normal reaction to war.
"No one who goes to war comes home the same person," said Patrick Campbell, a medic for an infantry unit who served in Iraq in 2004-2005. "There are things you have to unlearn to emotionally feel again."