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One day in 2005 Barbara V. Romberg, PhD, a clinical psychologist working near Washington, D.C., and her two young daughters drove by a roadside beggar. He wore a military uniform and held a placard reading HOMELESS VETERAN. CAN YOU HELP? Gracie, then 9, asked what the sign meant.
In deciding how to answer Gracie and little sister Mira, then 5, Dr. Romberg had an epiphany: "I realized that he probably needed help from a mental-health provider, and that I could make it possible for such professionals to get involved." She took action, founding the not-for-profit Give an Hour (GAH) and asking psychologists, psychiatrists, and family counselors across the country to donate sessions to veterans and their families.
One thousand volunteer providers have signed on since 2005, and the roster is still growing. "Whether people are for or against the war, they want to help," Dr. Romberg says. The professionals generally offer far more than 60 minutes. After an initial contact, the provider or GAH arranges for additional sessions or referrals, as needed. "Her program is outstanding," says U.S. Army Brigadier General (Ret.) Stephen N. Xenakis, MD.
"The military does what it can, but the number of people requesting mental-health help is overwhelming," explains Dr. Romberg. "I've heard that at some bases the wait is three months." During that time, says a 2007 American Psychological Association presidential task force, the soldier may lose interest in getting care. In the case of severe problems, the task force warns, "a treatment delay may have serious or even catastrophic results, including ... substance abuse and suicide."
The military mental-health system is under strain, says a 2007 Department of Defense report. The reasons include the difficulty of adapting a peacetime mental-health system to wartime and too few caregivers. In addition, today's signature combat injuries, traumatic brain injuries (TBI) and post-traumatic stress disorder (PTSD), cause long-term psychological issues for soldiers, who then require extended treatment, says the Defense Department.
According to Dr. Xenakis, TBI is prevalent because soldiers in Iraq may be exposed to innumerable blasts from improvised explosive devices. In contrast, he says, typical wounds in past wars were the result of gunshots and were resolved more readily. PTSD is widespread, he says, because in this war, unlike past conflicts, there's no secure base in which soldiers can recuperate from the stress of missions. "They are always in a protective posture. They can only rest when they return home," Dr. Xenakis explains.
Longer deployments mean more time before troops get that much-needed break, however. In early 2007 Army tours of duty increased from 12 to 15 months. At that time, of the 1.5 million troops who'd been deployed since September 11, 2001, 500,000 have gone at least twice, 70,000 have served three times, and 20,000 at least five times. In contrast, Dr. Romberg notes, once a draftee returned from World War II or Vietnam, his combat obligation was generally finished. "The open-ended involvement has a tremendous impact on mental health," she says.
In 2006, the Army announced, its suicide rate had risen to 17.3 per 100,000 troops -- the highest in 26 years of record keeping. The Defense Department reports that 20 percent of married soldiers were planning to separate or divorce in 2006, a 5 percent increase from 2005. The divorce rate had already nearly doubled from 2001, when about 5,600 unions ended, to 2004, with about 10,500 divorces.
"But don't think soldiers are somehow flawed," Dr. Romberg cautions. "If we send people to war, they'll have issues."
Unfortunately, military personnel may avoid psychological care as they fear looking weak, the Defense Department finds. Troops also worry that seeking help will hurt their careers, says the presidential task force, which claimed that anecdotal evidence "appears to support this concern." Whether a record of mental-health treatment affects eventual employment is uncertain, says Dr. Xenakis, who feels this may depend on what an employer asks during an application for any given job.
The military's required demobilization questionnaire seems not to provide a solution. Departing soldiers who feel they need mental-health care may deny this on the form, Dr. Romberg claims. "To get out quickly they answer 'no.'" Once home, though, if they change their minds, GAH stands ready to assist. Since it started offering services, in mid-2007, about 120 military clients have requested help.
Running GAH in her spare time is no small feat for Dr. Romberg, a single mother. "It's taken over my life in a good way," she says. "I'm energized. And my kids love what I'm doing. I see them developing both compassion and patriotism." For more, go to www.giveanhour.org.
Art imitates life for Kimberly Peirce, who cowrote and directed the movie Stop-Loss after hearing stories from her then-18-year-old brother about his life as a soldier in Iraq. Ryan Phillippe stars as Sergeant Brandon King, a squad leader who fights to maintain his comrades' emotional well-being after an ambush during which three of the 10 are killed just before they are to return home. Once stateside, despite war heroes' welcomes, the veterans struggle with nightmares, hallucinations, alcohol abuse, rage, and crumbling marriages -- the same mental-health problems that some clients of Give an Hour might experience. King is eventually called back into the Army under the military's "stop-loss" measure, which allows involuntary extensions of service in wartime. The remainder of the movie follows King as he wrestles over whether to comply with the order. Peirce, who directed the Oscar-winning Boys Don't Cry, had her brother screen the movie for authenticity. Stop-Loss opens nationwide on March 28.
Originally published in Ladies' Home Journal, April 2008.