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Unfortunately, the mental health system responsible for serving these men and women is already stretched to the breaking point, even as many thousands are returning to civilian life or are between multiple deployments. In a survey of its members by the National Council for Community Behavioral Healthcare, a nonprofit association of 1,600 behavioral healthcare organizations, nearly two-thirds of the respondents said that veterans and their families, even when in crisis, report long delays and excessive wait times before they get to see a mental health provider. In addition, it often takes veterans living in rural America as long as five hours to travel to a Veterans Affairs (VA) office or a military base for an appointment. Some don't have access to a vehicle or public transportation, or may be unable to drive or take public transportation because of combat-related physical and mental limitations. Civilian agencies already take up some of the slack: about 22 percent of veterans seek mental healthcare outside the VA system.
Most clinical interventions, including cognitive-behavioral therapy, exposure therapy, EMDR, and exposure therapy using virtual reality, are delivered in standard clinical formats: one-on-one or group therapy sessions provided by professional psychotherapists. These interventions are expensive, time-consuming, and often unavailable outside urban areas, and there aren't enough trained therapists to deliver them to the many thousands of troops and veterans suffering from PTSD and the array of other war-related symptoms.
In addition, there's a growing chasm between the number of military personnel who need mental health services and who actually try to get them. Many of those who are experiencing the unseen wounds of war frequently avoid seeking help, fearing that they'll be stigmatized as "weak" or "crazy" by their peers and superiors—that they'll be, in effect, abandoning the fight and "letting down" their battle buddies because they can't take the pressures of war. One sergeant (who did finally get help for his PTSD from a private nonprofit counseling agency), interviewed anonymously in a recent issue of Stars and Stripes, said, "People are going to call you psycho. Even if people just see you going into the mental health offices, they're going to think you're crazy." Many active-duty troops fear that if they admit they've got "problems," they'll lose the chance at promotion—or may even be discharged and separated from their combat-experienced peers.
Added to that, many will shun help because they don't want to stir up intense and, at times, overwhelming memories of their war experiences. Many bolt from intake interviews because standard clinical procedures raise too many emotions. Even if they do muster the courage, dogged persistence, and time it takes to get the help they need from overloaded facilities, the usual therapy models may not be appropriate for the complex physical, spiritual, and emotional wounds resulting from the unique circumstances of these seemingly interminable wars. The way our therapy establishment—military and civilian—is organized isn't necessarily effective with the kinds of chronic trauma resulting from protracted and repeated deployments to war zones. Nor do therapeutic models—with their focus on treating the individual—mesh well with the realities of military culture and its communal values.