The unpredictability of urban warfare has taken a mental toll on US soldiers long after they’ve left the battlefield. A new study has shown that 25 percent of returning veterans have mental health problems, with more than half of those having two or more distinct conditions. Veteran soldiers between 18-24 years of age are most at risk.

“There is no front line to this war,” said Dr. Chirag Raval, a psychiatrist in the Army Reserves. Making reference to hand-propelled rockets, mortars, and IED attacks, Raval continued, “there is no true safe place in Iraq. You can be anywhere, even on your base, and still not be safe.”

Post-traumatic stress disorder is the most common mental health problem among veterans. Most vets with post-traumatic stress disorder relive traumatic episodes through nightmares, flashbacks, or an intense feeling of anxiety triggered by a sound or event.

With soldiers enduring multiple tours of duty and surviving more severe wounds than ever before, the percentage of post-traumatic stress disorders among Iraq and Afghanistan vets may begin to exceed those among Vietnam vets, which was at 15 percent. The exact number of vets affected is also likely to be higher than reported since the shame of mental illness prevents soldiers from reporting their symptoms. For those soldiers seeking psychological care after returning home, significant barriers still remain.

On military bases there are shortages of psychologists and psychiatrists and long waits for appointments. Relatively few military mental health professionals have been trained in recommended post-traumatic stress disorder treatments. And when evidence points to the disorder, only 22 percent of soldiers get referrals, a report by the Government Accountability Office found last year.

Although most observers say the Department of Veterans Affairs’ system has improved, specialized services for vets with post-traumatic stress disorder tend to be concentrated at major medical centers and are hard to access in smaller cities or rural areas. Clinics’ limited hours may coincide with the work week, when many vets can’t get away from their jobs.

The 25 percent rate of mental health problems among soldiers who served in Iraq and Afghanistan is higher than last year’s figures. Researchers say their observations indicate diagnoses are climbing. “It does look like there is indeed an upward trend, and it’s scary,” said Dr. Karen Seal, a physician at the San Francisco VA Medical Center and lead author of the study which drew on a database of 103,788 veterans for 4 years. “You have a young population possibly not getting treatment for these conditions, and going on to have chronic mental illness,” Seal said. “It’s potentially a big public health problem.”

There is a valid fear that Iraq veterans will develop the same long-term problems as Vietnam vets. According to the National Survey of Homeless Assistance Providers and Clients, veterans account for 23% of all homeless people in America. Without affordable housing or access to healthcare, Iraq veterans will also fall victim to substance abuse and homelessness (thanks Reagan).

According to a report last month by the American Psychological Association, less than 20 percent of military behavioral health personnel have been trained to provide therapies that professional review groups have identified as the best treatments for post-traumatic stress disorder. In November, the Government Accountability Office found that the Department of Veterans Affairs failed to spend over $100 million that had been newly allocated for post-traumatic stress disorder and other conditions in the previous two fiscal years.

24-year-old Chris Packley served with a sniper team in Fallujah and returned home with post-traumatic stress disorder. “It started before I came home,” Packley said. “I told the psychiatrist about it, but he didn’t care or do nothing.” Observing the care of Vietnam vets, Packley worries about the underfunding of mental health services. “You talk to them and you think, this system didn’t do nothing for them after all these years; what’s going to happen to me?”

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