By Sandra G. Boodman
Washington Post Staff Writer
Tuesday, November 6, 2007
They are the other casualties of the wars in Iraq and Afghanistan: spouses -- mostly wives -- of military personnel as well as their children, parents and even siblings struggling with the fear that accompanies combat separations or the wrenching readjustment that often marks the return home. Some are troops themselves, home for good or for a while between deployments, trying to cope with depression, anxiety, alcoholism or reentry.
Pincered by financial concerns and worries that seeking psychological counseling, especially through official channels, could jeopardize a loved one's military career, many relatives are reluctant to seek help. Others don't know where to find it.
Now a new nonprofit group called Give an Hour, launched by Washington area clinical psychologist Barbara V. Romberg, is providing free counseling for soldiers and their families, as well as their unmarried partners. More than 720 licensed psychologists, social workers and other counselors from 40 states and the District have volunteered to donate an hour a week of therapy time for a minimum of one year to those affected by the twin conflicts.
So far about 50 clients, including one soldier on active duty in Iraq, have contacted the program to find a therapist -- a trickle Romberg hopes will turn into a steady stream as word of the program spreads.
The pro bono effort is underwritten by several grants, including one from the Coalition to Salute America's Heroes, a nonprofit group based in Ossining, N.Y., that assists severely wounded soldiers. Romberg's group also has forged partnerships with several military family organizations, including the Silver Star Families of America and the Washington-based Tragedy Assistance Program for Survivors, or TAPS, which aids relatives of those who die while on duty.
The goal, Romberg said, is not to supplant the psychological services the military offers but to supplement them.
"We provide help to people they don't," among them parents and siblings of troops, she said. Because it operates independently of the Department of Defense and VA health systems, the program hopes to remove a key obstacle confronting those who need help.
Sometimes troops return home utterly changed or obviously damaged by what they have experienced but resist seeking help, leaving it to their families to cope with the aftermath.
A 2004 study published in the New England Journal of Medicine of 6,000 soldiers and Marines involved in ground combat operations in Iraq and Afghanistan found that of those whose responses indicated a mental disorder, only 23 to 40 percent sought psychiatric help. Many who did not cited fear of being stigmatized as a reason.
"In the military, there are unique factors that contribute to resistance to seeking such help, particularly concern about how a soldier will be perceived by peers and by the leadership," concluded the research team, headed by psychiatrist Charles W. Hoge of the Walter Reed Army Institute of Research in Silver Spring.
In June, top Bush administration and military officials, acknowledging "shortfalls" in mental health treatment, pledged to improve psychiatric care for military personnel. Among the improvements mentioned is a program to reduce stigma.
"It was just very clear to me that there was going to be a tidal wave of [psychologically] damaged folks coming back," said Romberg, who founded Give an Hour in 2005 and is its president. The military is trying to cope, "but it was clear to me they weren't going to be able to stay ahead" of the accelerating demand for psychological services.
Last year, a study co-written by Hoge of 300,000 returning troops found that one in three of those who served in Iraq later sought help for mental health problems. The Iraq veterans consistently reported more psychological distress than those returning from Afghanistan, Bosnia or Kosovo.
The repercussions of that suffering can hit families hard.
Bonnie Carroll, executive director of TAPS, said her group has referred relatives struggling with the death of a service member to Give an Hour.
"It's a wonderful resource," said Carroll, who adds that counseling services available through the military to eligible spouses and children are typically limited to a few sessions and are not offered to other relatives.
Although the Department of Veterans Affairs operates 207 specialized Vet Centers around the country that offer counseling, not everyone who needs help lives near one, Carroll said.
Researchers affiliated with Harvard reported last week that 1.8 million veterans and 3.8 million people who live in their households lacked health insurance in 2004.
The match between therapist and client is made online through the group's Web site, http://www.giveanhour.org. Potential clients search for practitioners on the basis of their location. Listings include information about specialty or expertise, such as grief counseling, marital therapy or substance abuse, as well as a willingness to participate in telephone sessions in the event that in-person meetings are not feasible.
Give an Hour does not screen therapists, Romberg said, but it does verify they have a license in good standing.
To protect confidentiality, the Web site contains no "cookies" that could identify people seeking help, Romberg said. The site also includes information for patients about what to expect during therapy sessions and how to choose a counselor. For therapists, there is information about the unique culture of the military.
Demand for counselors, many of whom are social workers, has been slow in the Washington area where more than 100 therapists have signed on, but brisk in other parts of the country that have large military populations, including the Southwest, Romberg said.
Dawn Beatty, a licensed professional counselor in Mesa, Ariz., a suburb of Phoenix, said she has treated two clients this year through Give an Hour and talked by phone to a third. For the past two months she has been meeting with the wife of a National Guard member who recently returned from Iraq and may face a second deployment.
The couple had been married only a few weeks when the husband shipped out. Recently returned after 18 months, his wife describes him as "a different person." He has refused to discuss his experiences overseas and is having trouble coping with being married and with her two children from a previous marriage who live with them.
Beatty said the woman has said her husband is "upset with her for coming in. He thinks they should be able to work it out. There's a lot of anger and frustration."
One young soldier, recently returned from multiple tours in Iraq and Afghanistan, kept his first appointment with Beatty but did not return for a second, she said. "He had a lot of PTSD" and was drinking heavily, she said.
Beatty, who said her usual fee is $115 per hour, said that she volunteered for Give an Hour and plans to provide free treatment beyond the one-year minimum for as long as it takes for those who seek her help. "No matter what a financial struggle it is for me I'll do it," she said. "I'm a strong Christian, and I believe God will provide."
Among military clients, she said, "there is a real pride issue. They feel very guilty about coming in and accepting free counseling," but often their insurance won't cover it. "They're so grateful."
Clients seeking to give back are encouraged to volunteer at local organizations listed on the program's Web site.
Romberg said the group reflects her experience as the daughter of a World War II veteran who grew up in a small town in California and watched as her neighbors went off to fight in Vietnam.
"We were the rural kids who didn't have resources," she said.
Several years ago she was mulling over what she could do after hearing a radio report about the number of Americans who have not been personally touched by the war.
Her resolve to do something, she said, was strengthened when her then-9-year-old daughter asked her about a homeless veteran dressed in camouflage fatigues.
"I could not look at her and say we knew but didn't do anything," Romberg said. "It seemed to me if the mental health community had an easy way to participate, they would." ¿