Correction to This Article
The article misstated the Army's suicide rate for 2008. The rate was 20.2 suicides per 100,000 soldiers on active duty.

Shootings at Iraq Stress Clinic Highlight Mental Health Challenges for Military

By Ann Scott Tyson
Washington Post Staff Writer
Sunday, May 17, 2009

Sgt. John M. Russell was near the end of his third tour in Iraq when he allegedly gunned down five fellow service members at a Baghdad combat stress clinic last week.

The incident cast a stark light on some of the military's biggest mental health challenges: the deepening psychological and personal toll of repeated combat deployments, the stigma that surrounds seeking help, and the growing indications that some hardened soldiers such as Russell are having trouble ever mentally departing the war zone.

Army leaders, alarmed by recent trends -- particularly a rise in suicides -- are working to provide training and care aimed at bolstering soldiers' resilience and preventing those who become distraught from harming themselves or others. But a slew of programs, including mandatory "Battlemind" training and a suicide-prevention campaign, have blunted but not reversed the decline in the Army's mental well-being.

Since 2001, nearly 1 million soldiers have deployed to Iraq and Afghanistan, and more than 300,000 of them have served multiple combat rotations, most lasting 12 to 15 months. Currently there are 160,000 soldiers in those war zones, and of those, nearly 30,000 are on at least their third or fourth tour, Pentagon data show.

An estimated 20 percent of service members return from the wars psychologically damaged, with depression or symptoms of post-traumatic stress disorder such as nightmares, hyper-vigilance and emotional numbing, according to a Rand Corp. study last year.

Adding to the stress is that, once home, soldiers know they have only a year -- much of it filled with combat drills -- before they must head back to Iraq or Afghanistan. "With only 12 months back at home, some people chose not to reconnect with their families," Gen. Peter W. Chiarelli, vice chief of staff of the Army, said in an interview. "It's too hard. They chose not to reintegrate."

Particularly at risk from rotations are enlisted soldiers -- from privates to staff sergeants -- who have few opportunities to serve outside of the combat units that go back and forth onto the battlefield.

The unprecedented strain on the all-volunteer Army is not expected to end anytime soon, largely because of the troop increases in Afghanistan, Chiarelli said.

"The next six to eight months is going to be very difficult for us," he said, estimating that the Army will not be able to begin increasing soldiers' time at home until the middle or fall of 2010. Demands on the Army are so high that 87 percent of the active-duty force is either deployed overseas, preparing to deploy, or in basic training or otherwise not available.

A 2007 Army survey of soldiers in Iraq and Afghanistan showed that soldiers' mental health deteriorates significantly each time they go to war. More than 27 percent of the noncommissioned officers surveyed on their third or fourth deployment reported depression, anxiety or acute stress -- compared with 18 percent of those on their second deployment and 11 percent on their first tour, according to Army data.

Psychological problems, work-related stress and plans to separate or divorce also increase with each additional month deployed, the survey found. Meanwhile, suicide rates for deployed soldiers were elevated, compared with historical norms, and the majority coincided with relationship problems.

Overall, the Army's suicide rate reached a record level in 2008, surpassing 20 percent and exceeding that for the U.S. population, when adjusted demographically. The number of soldiers on active duty who took their own lives rose steadily from 79 in 2003 to at least 128 last year. The increase continued during the first four months of 2009, when 64 soldiers on active duty were suspected of killing themselves, with about half the cases under investigation.

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