Report chronicles the rising burden of military mental health care

A study comparing the military’s health care burden during the wars in Afghanistan and Iraq with its prewar burden found that hospitalization of active-duty troops for mental disorders accounted for 63 percent of the increases in hospitalization rates during those wars.

The report Friday by the Armed Forces Health Surveillance Center calculated the difference between the total health care delivered to military members during wartime (October 2001 through June 2012) with that which would have been delivered if prewar rates had persisted during the conflicts. It found that relative to the prewar experience, mental disorders accounted for excesses of more than 6 million ambulatory visits, 42,000 hospitalizations and 300,000 hospital bed days -- increases of 35 percent, 63 percent and 48 percent, respectively.

The center, which conducts epidemiological and health surveillance studies for the Defense Department, analyzed treatment for 25 illness or injury categories for active-duty military personnel since Jan. 1, 1988. The study, “Costs of War: Excess Health Care Burdens During the Wars in Afghanistan and Iraq (Relative to the Health Care Experience Pre-War),” was published in the November issue of the Medical Surveillance Monthly Report released Dec. 7.

AFHSC pulled the data from the Defense Medical Surveillance System , which documents military and medical experiences of service members throughout their careers. The study included records for all active-duty servicemen and women -- but not members of the National Guard or reserves -- in fixed military and civilian facilitates.

“The total health care burdens associated with the wars in Afghanistan and Iraq are undoubtedly greater than those enumerated in this report because this analysis did not address care delivered in deployment locations or at sea, care rendered by civilian providers to reserve component members in their home communities, care of veterans by the Departments of Defense and Veterans Affairs, preventive care for the sake of force health protection, and future health care associated with wartime injuries or illnesses,” the report noted.

Broken Warriors is an ongoing series on mental health issues in the military.

The report drives home the mental burden on the active-duty force after 11 years of war: “Mental disorders accounted for nearly two-thirds of all estimated excess hospitalizations during the war period . . . The predominance of these causes of excess hospitalizations and hospital bed days is not surprising, because they directly reflect  the natures, durations, and intensities of the combat in Afghanistan and Iraq, as well as the psychological stresses associated with prolonged and often repeated combat deployments.”

Nextgov reported in  March 2011 that slightly more than half of all Afghanistan and Iraq war veterans treated by Veterans Affairs received care for mental health problems, roughly four times the rate of the general population. The Congressional Budget Office reported in February that VA has treated 103,500 Afghanistan or Iraq veterans for post-traumatic stress disorder, or 21 percent of all veterans of those war receiving care from the department.

Dr. Remington Nevin, a former Army epidemiologist who left the service this fall to get a degree in public health at the Johns Hopkins Bloomberg School of Public Health in Baltimore, said the mental health report was long overdue. It “finally makes clear the tragic costs of our military's decade of unremitting conflict. Yet with few exceptions these striking totals reflect straight line trends that began 10 years ago and that should have been apparent as early as 2006,” he said.

“The somber conclusions of this report stand in sharp contrast to the optimistic testimony offered by military officials throughout the first five years of war. A critical question civilian policy makers must now ask is why analysis similar to this was not published five or even six years earlier, when it could have aided healthcare planning efforts and informed a meaningful debate on the direction of the war," Nevin added.

President Obama in August issued an executive order to beef up health care for veterans, mandating that VA hire an additional 1,600 mental health counselors by June 2013 and 800 peer counselors by Dec. 31, 2013.