Helping Veterans Cope with the Mental Scars of War – Op-Ed

Dr. Jeffrey Borenstein is the host of the national public television series Healthy Minds with Dr. Jeffrey Borenstein. The show aims to remove the stigma of mental illness, educate the public and offer a message of hope by humanizing common psychiatric conditions through inspiring personal stories, cutting-edge research on diagnosis and treatment, and interviews with well-known personalities. Borenstein contributed this article to Live Science's Expert Voices: Op-Ed & Insights.

When we think about the men and women in our military this Veterans Day, we should also think about their mental health.

In August, in the largest study to date on the topic, the Veterans Administration found that an average of 20 veterans died as a result of suicide every day in 2014. Some of these veterans may have had post-traumatic stress disorder (PTSD), a condition that affects people's ability to function and can lead to other psychiatric problems, alcoholism, drug addiction, self-medication and suicide.

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Though the statistics are grim, there are encouraging developments going on in the mental health community that will help to recognize, destigmatize and treat veterans who are suffering.

Suffering among veterans is not new. I recently spoke with Dr. Matthew Freedman, a senior adviser at the U.S. Department of Veteran Affairs National Center for PTSD, who recalled treating veterans during his medical residency in 1973. At that time, the VA was flooded with Vietnam vets who were depressed, hyper-vigilant, or in a state of constant alert, and suffering from flashbacks. The condition was named post-Vietnam syndrome. 

Psychiatrists eventually realized that the condition, which is now called PTSD, is the result of exposure to traumatic and potentially life-threatening events. In addition to veterans, other people are susceptible to PTSD, including victims of sexual violence, first responders, firefighters, ER doctors and mental health professionals who work with prisoners of war and refugees. In fact, more than half of all men and women in the United States have been exposed to at least one traumatic event; but 8 percent of people have been diagnosed with PTSD, according to the VA website. 

The good news is that the human mind is resilient. Most people don't forget the traumatic events that occur in their lives, but the majority can cope with them and move forward with their lives.   

Researchers desperately want to understand why some people experience a trauma and recover without lingering effects on their mental health, while for others, a traumatic event causes a long-term mental health condition.  One explanation may be findings that show the likelihood of developing PTSD increases with repeated exposure to trauma. 

But the links between trauma, PTSD and suicide are still unclear. Dr. Marianne Goodman, a psychiatrist at the Bronx VA and at Mount Sinai Medical Center in New York, recently told me about astudy that looked at 1,800 veteran suicides over the past 2.5 years.  Although many studies of suicide have found that a previous attempt is a significant risk factor,  of those 1,800 veterans who died by suicide, 70 percent  had never made any previous attempts. Psychiatrists don't know much about the veterans who die as a result of suicide without prior attempts, and the VA is trying to understand who is at risk and how to provide the help they need before they make that first attempt. 

The study also found that the vast majority of these veterans who died by suicide never saw a mental health professional. However, many had visited a primary-care physician in the month before they died as a result of suicide. [5 Myths About Suicide, Debunked]

The New York Psychiatric Association is now leading an effort to educate primary-care doctors about prescribing antidepressants in the hope of reducing the number of veterans who take their own lives.

We also need to educate the friends and families of veterans about how to better support the veterans in their lives, and to identify their signs of distress. It's rare that someone takes their own life without an underlying mental health condition, and PTSD, depression, substance abuse, agitation and insomnia can be a lethal combination. Many veterans who attempt suicide are unusually stressed and have legal, relationship or financial issues.

Unfortunately, suicide is often an irrational and spontaneous act, and isolation is a huge risk factor. Many people who are thinking about suicide often turn their phones off, won't answer texts or answer the door.

The VA's suicide prevention programs help veterans cope, manage their emotions and, most important, develop a safety plan that can be used when someone feels suicidal. It is also important to remove risks by securing any guns and emptying the medicine cabinet of pills.

New York State Sen. Thomas D. Croci, a veteran who served in Iraq and Afghanistan and is still in the Reserves, told me that for some soldiers, the hardest part of a deployment is coming home. Although deployments are stressful, many soldiers say they have never felt more productive or relevant than during their deployment. Coming home means facing pressure and expectations from work and family. 

He says a veteran's mission is not complete until he or she returns home, readjusts and reintegrates.

Our veterans have made great sacrifices. We hope they will not suffer in silence. We need to make them understand that with help, there is hope.

Originally published on Live Science.