Vets 2x As Likely To Suicide.

[SirNitram]

Link

(CBS) They are the casualties of wars you don’t often hear about - soldiers who die of self-inflicted wounds. Little is known about the true scope of suicides among those who have served in the military.

But a five-month CBS News investigation discovered data that shows a startling rate of suicide, what some call a hidden epidemic, Chief Investigative Reporter Armen Keteyian reports exclusively.

“I just felt like this silent scream inside of me,” said Jessica Harrell, the sister of a soldier who took his own life.

"I opened up the door and there he was," recalled Mike Bowman, the father of an Army reservist.

"I saw the hose double looped around his neck,” said Kevin Lucey, another military father.

"He was gone,” said Mia Sagahon, whose soldier boyfriend committed suicide.

Keteyian spoke with the families of five former soldiers who each served in Iraq - only to die battling an enemy they could not conquer. Their loved ones are now speaking out in their names.

They survived the hell that's Iraq and then they come home only to lose their life.

Twenty-three-year-old Marine Reservist Jeff Lucey hanged himself with a garden hose in the cellar of this parents’ home - where his father, Kevin, found him.

"There's a crisis going on and people are just turning the other way,” Kevin Lucey said.

Kim and Mike Bowman’s son Tim was an Army reservist who patrolled one of the most dangerous places in Baghdad, known as Airport Road.

"His eyes when he came back were just dead. The light wasn't there anymore," Kim Bowman said.

Eight months later, on Thanksgiving Day, Tim shot himself. He was 23.

Diana Henderson’s son, Derek, served three tours of duty in Iraq. He died jumping off a bridge at 27.

"Going to that morgue and seeing my baby ... my life will never be the same," she said.

Beyond the individual loss, it turns out little information exists about how widespread suicides are among these who have served in the military. There have been some studies, but no one has ever counted the numbers nationwide.

"Nobody wants to tally it up in the form of a government total," Bowman said.

Why do the families think that is?

"Because they don't want the true numbers of casualties to really be known," Lucey said.

Sen. Patty Murray, D-Wash., is a member of the Veterans Affairs Committee.

"If you're just looking at the overall number of veterans themselves who've committed suicide, we have not been able to get the numbers,” Murray said.

CBS News’ investigative unit wanted the numbers, so it submitted a Freedom of Information Act request to the Department of Defense asking for the numbers of suicides among all service members for the past 12 years.

Four months later, they sent CBS News a document, showing that between 1995 and 2007, there were almost 2,200 suicides. That’s 188 last year alone. But these numbers included only “active duty” soldiers.

CBS News went to the Department of Veterans Affairs, where Dr. Ira Katz is head of mental health.

"There is no epidemic in suicide in the VA, but suicide is a major problem," he said.

Why hasn't the VA done a national study seeking national data on how many veterans have committed suicide in this country?

"That research is ongoing,” he said.

So CBS News did an investigation - asking all 50 states for their suicide data, based on death records, for veterans and non-veterans, dating back to 1995. Forty-five states sent what turned out to be a mountain of information.

And what it revealed was stunning.

In 2005, for example, in just those 45 states, there were at least 6,256 suicides among those who served in the armed forces. That’s 120 each and every week, in just one year.

Dr. Steve Rathbun is the acting head of the Epidemiology and Biostatistics Department at the University of Georgia. CBS News asked him to run a detailed analysis of the raw numbers that we obtained from state authorities for 2004 and 2005.

It found that veterans were more than twice as likely to commit suicide in 2005 than non-vets. (Veterans committed suicide at the rate of between 18.7 to 20.8 per 100,000, compared to other Americans, who did so at the rate of 8.9 per 100,000.)

One age group stood out. Veterans aged 20 through 24, those who have served during the war on terror. They had the highest suicide rate among all veterans, estimated between two and four times higher than civilians the same age. (The suicide rate for non-veterans is 8.3 per 100,000, while the rate for veterans was found to be between 22.9 and 31.9 per 100,000.)

"Wow! Those are devastating," said Paul Sullivan, a former VA analyst who is now an advocate for veterans rights from the group Veterans For Common Sense.

"Those numbers clearly show an epidemic of mental health problems," he said.

“We are determined to decrease veteran suicides," Dr. Katz said.

“One hundred and twenty a week. Is that a problem?” Keteyian asked.

“You bet it’s a problem,” he said.

Is it an epidemic?

“Suicide in America is an epidemic, and that includes veterans,” Katz said.

Sen. Murray said the numbers CBS News uncovered are significant: “These statistics tell me we've really failed people that served our country."

Do these numbers serve as a wake-up call for this country?

“If these numbers don't wake up this country, nothing will,” she said. “We each have a responsibility to the men and women who serve us aren't lost when they come home."

Up to 31.9 per 100,000 for vets who served in the War On terror. Absolutely heartbreaking.

An update from CBS.

An update: The chairman of the Senate Veterans' Affairs Committee, Sen. Daniel Akaka, D-Hawaii, responded to the CBS News story Tuesday.

“The report that the rate of suicide among veterans is double that of the general population is deeply troubling and simply unacceptable. I am especially concerned that so many young veterans appear to be taking their own lives. For too many veterans, returning home from battle does not bring an end to conflict. There is no question that action is needed."

[LadyTevar]

I signed about 10 death certificates last month for Veterans who had shot or hung themselves. Most were in their 20-40s, the age range for Desert Storm and Iraqi Freedom.

[Sea Skimmer]

I’m honestly surprised the rate isn’t even higher; and I’d very strongly suspect that the murder rate for returning veterans is also substantially higher. I know back in 2004 some Army bases had extremely serious problems with stemming domestic violence related murders.

[DavidEC]

For a second I genuinely thought you meant veterinarians.

Tragic nonetheless.

[Medic]

Certainly the implication is that 'zomg we're killing our soldiers by putting them through hell' but on top of that, the obvious: 1) returning servicemembers, ... required to operate firearms while deployed quite likely in their personal lives in fact own personally owned firearms and simply are more likely to succeed in suicide and on top of anything directly related to war, tertiary effects of deploying are factors in suicide -- tertiary factors being obviously strained relationships due to being apart for 6, 12 or 15 months at a time. (and that all piled upon every other stressor)

In other words, what's the suicide rate among the recently-divorced and among those recently experiencing anything amounting to what could be described as a 'traumatic event?' and do these compare to the twice-as-likely suicide rate of veterans? And keep in mind that in fact, a 'traumatic event' could be something as mundane as bullying? Just because it's military service doesn't mean it isn't something else much more entirely fundamental to the human will being only so strong.

[NeoGoomba]

I'm curious, when you recieve your discharge at the end of your term, what is the procedure? Do they just basically hand you a pink slip, slap you on the back, and BAM you're on your own? Is there any sort of post-military program you go through, and if so is it different/dependant on if you've seen combat?

[Alex Moon]

Did CBS account for the difference in the makeup of vets vs non-vets?

[MKSheppard]

PS

Link

Self inflicted deaths for the 80's: 2482
Self inflicted deaths for the 90's: 2099
Self inflicted deaths for 2000-06: 1125

If the numbers hold up, there will be less than 1700 suicides for the
period of 2000-2009.

[Aaron]

I'm curious, when you recieve your discharge at the end of your term, what is the procedure? Do they just basically hand you a pink slip, slap you on the back, and BAM you're on your own? Is there any sort of post-military program you go through, and if so is it different/dependant on if you've seen combat?

I can only speak for the CF (who are also experiancing this problem), for us if your being medically released you go to a case manager that helps you transition to civvie life. Stuff like work out a schedule with your new employer so you go half days to ease into it, help minimise the culture shock. There's also a bunch of seminars that you attend geared towards preparing you for civvie life.

That's the system I went through. If your being released regularly you basically attend a seminar on how to get into a second career, take out the rest of your leave and one day your a civvie.

How the US does it I don't know but in general the Army has a horrible track record on things like this whereas the Marines do a lot better. And they've been pilfering our ideas for the last three years.

[Stile]

I'm curious, when you recieve your discharge at the end of your term, what is the procedure? Do they just basically hand you a pink slip, slap you on the back, and BAM you're on your own? Is there any sort of post-military program you go through, and if so is it different/dependant on if you've seen combat?

I can only speak for the CF (who are also experiancing this problem), for us if your being medically released you go to a case manager that helps you transition to civvie life. Stuff like work out a schedule with your new employer so you go half days to ease into it, help minimise the culture shock. There's also a bunch of seminars that you attend geared towards preparing you for civvie life.

That's the system I went through. If your being released regularly you basically attend a seminar on how to get into a second career, take out the rest of your leave and one day your a civvie.

How the US does it I don't know but in general the Army has a horrible track record on things like this whereas the Marines do a lot better. And they've been pilfering our ideas for the last three years.

That's the way it's supposed to happen in the US. My experience was stay overseas and come back 2 weeks before your out date. Then all of the classes are overbooked, come back in a few weeks (or months), mmkay?

[Androsphinx]

Self inflicted deaths for the 80's: 2482
Self inflicted deaths for the 90's: 2099
Self inflicted deaths for 2000-06: 1125

Average size of military in 80s - c2.1 million
Average size of military in 90s - c1.6 million
Average size of military since 2000 - c1.4 million

The suicide rate in fact rose between the 80s and the 90s, and is just a touch above the 90s at the moment.

[Sidewinder]

This problem was noted at least 18 fucking months ago. I'm very upset that the Pentagon didn't deal with it then, although I should've expected something this heartless and/or brainless from Rumsfeld & Co.

Potent Mixture: Zoloft & A Rifle

The military told Congress that medications aren't used to keep soldiers with serious mental illness in combat. But a Courant investigation reveals that drugs are increasingly being handed out.

STORY By LISA CHEDEKEL And MATTHEW KAUFFMAN | The Hartford Courant

May 16, 2006

When Army Sgt. 1st Class Mark C. Warren was diagnosed with depression soon after his deployment to Iraq, a military doctor handed him a supply of the mood-altering drug Effexor.

Marine Pfc. Robert Allen Guy was given Zoloft to relieve the depression he developed in Iraq.

And Army Pfc. Melissa Hobart was dutifully taking the Celexa she was prescribed to ease the anxiety of being separated from her young daughter while in Baghdad.

All three were given antidepressants to help them make it through their tours of duty in Iraq - and all came home in coffins.

Warren, 44, and Guy, 26, committed suicide last year, according to the military; Hobart, 22, collapsed in June 2004, of a still-undetermined cause.

The three are among a growing number of mentally troubled service members who are being kept in combat and treated with potent psychotropic medications - a little-examined practice driven in part by a need to maintain troop strength.

Interviews with troops, families and medical experts, as well as autopsy and investigative reports obtained by The Courant, reveal that the emphasis on retention has had dangerous, and sometimes tragic, consequences.

Among The Courant's findings:

• Antidepressant medications with potentially serious side effects are being dispensed with little or no monitoring and sometimes minimal counseling, despite FDA warnings that the drugs can increase suicidal thoughts.

• Military doctors treating combat stress symptoms are sending some soldiers back to the front lines after rest and a three-day regimen of drugs - even though experts say the drugs typically take two to six weeks to begin working.

• The emphasis on maintaining troop numbers has led some military doctors to misjudge the severity of mental health symptoms.

Some of the practices are at odds with the military's own medical guidelines, which state that certain mental illnesses are incompatible with military service, and some medications are not suited for combat deployments. The practices also conflict with statements by top military health officials, who have indicated to Congress that psychiatric drugs are not being used to keep service members with serious disorders in combat.

In an interview Monday, Army Surgeon General Lt. Gen. Kevin C. Kiley insisted that the military uses psychiatric medications cautiously in the war zone, saying that medical professionals may prescribe them at low doses, "for very mild symptoms that might assist soldiers in transitioning through an event." He said the emphasis on keeping troubled troops close to the front lines is in the service members' best interests, because it helps them recover and avoid the stigma of abandoning their duty.

But many outside the chain of command see it differently.

"It's best - for the Army," said Paul Rieckhoff, a former platoon leader in Iraq who said he was overruled when he tried to have a mentally ill soldier evacuated. "But find me an independent mental health expert who thinks that that's a proper course of action."

Vera Sharav, president of the Alliance for Human Research Protection, a patient advocacy group, said retaining troops with mental disorders serious enough to require medication is "completely irresponsible."

"It's really just plain dehumanizing. They are denying these guys a humane treatment, which is to get out of the battle," she said. "The best therapy for someone in that kind of stress is to get them out of the stress. The worst thing is to add a drug to this."

Distributing Drugs

Some soldiers' advocates and medical experts criticize the military for taking an overly pharmacological approach to mental illness in an effort to retain troops, without proper oversight.

Autopsy and investigative reports show that at least three service members who killed themselves in 2005, including Warren and Guy, were taking antidepressants.

[Sidewinder]

Warren intentionally overdosed on his heart medication, the military ruled, and a medical examiner concluded he died of "mixed drug intoxication," finding that the combination of the heart drug and the Effexor, an antidepressant, had a "synergistic" effect that led to his death.

Guy was placed on Zoloft by a military doctor one month before he locked himself in a portable toilet and shot himself in the head, according to military reports. An investigator concluded that Guy's suicide was caused in part by the effects of Zoloft - a conclusion later rejected by a commanding general.

Zoloft, and other drugs in a class known as SSRIs, such as Prozac, Paxil and Celexa, are the most commonly prescribed antidepressants. But they can worsen depression and increase suicidal thinking, and the FDA says patients taking any antidepressant medication should be monitored carefully when the drugs are first prescribed - a task that can be difficult to accomplish in a war zone.

Families of some troops report that their loved ones were readily prescribed SSRIs by military doctors in Iraq, with no requirement for regular monitoring or counseling.

Marine Lance Cpl. Nickolas D. Schiavoni, 26, of Haverhill, Mass., earned a Purple Heart during his first deployment to Iraq in 2004, but came home shaky and anxious after seeing heavy combat, his parents said. Soon after he was deployed back to Iraq for his second tour, in September of 2005, he told his father in an e-mail that he had been prescribed Zoloft.

"He said, `I'm real angry. I can't take anything from anyone. They have me on Zoloft,'" David Schiavoni, of Ware, Mass., recalled. "I couldn't believe it - an antidepressant, while he's out there holding a gun? I told him, `Get off the Zoloft because I hear bad things about it.'"

Two months after that exchange, Schiavoni, who was married with two small children, was killed by a car bomb. David Schiavoni said he has been told that the incident occurred after the driver of the car ignored demands from his son's unit to stop.

"A lot of things go through my mind," the father said. "Maybe I'd rather him be angry than medicated. Maybe if he's angry, he grabs his gun and shoots."

Shelly Grice said her husband, Chris, a Fort Riley soldier, was put on Zoloft and the sleep aid Ambien after surviving an incident in February 2005 in which his close friend was killed by an improvised explosive device. She spent the rest of her husband's yearlong tour worried about his mental well-being.

"His [commanding officer] said, `If I could, I would ship you home right now,' but they lost two guys that day and five others were injured, so they needed him," Grice recounted. "It bothers me that these guys are just experiencing too much."

As part of an effort to avoid evacuations out of the war zone, the military's cadre of combat stress teams typically treat troubled troops with a 72-hour break from the front lines - three hots and a cot, in military parlance - sometimes with drugs prescribed. But medical experts and drug makers themselves say it often takes weeks for SSRIs to have any therapeutic value, while the side effects can kick in immediately.

"I have a fundamental problem with prescribing someone an SSRI and then, with a couple days' rest, allowing them to return to duty," said Dr. Stefan Kruszewski, a Harvard-trained psychiatrist in Harrisburg, Pa. "If you're newly introducing a drug, the most problematic side effects often occur right at the beginning. So at 72 hours or at 96 hours or at seven days, you may have more of a problem, not less, because of a drug-related side effect."

Dr. Jonathan Shay, an expert on combat stress who has served as a consultant to the military on ethics and personnel issues, said SSRIs generally do not impair a person's ability to think clearly or react to danger. But he said the use of such drugs should be accompanied by counseling, and patients should be monitored closely during the initial "window of danger," when they begin the medications.

Shay said there is no evidence that SSRIs such as Prozac or Paxil help with acute stress or would "protect someone in a traumatic situation" from developing post-traumatic stress disorder or major depression.

"There's nothing to suppose that it helps with an immediate trauma," said Shay, a Boston area psychiatrist who counsels Vietnam veterans. "I would expect to see it used for a previously deployed service member who has been diagnosed with PTSD" or other disorders.

Kruszewski agreed.

"It's not even a Band-Aid," he said. "It might make the doctor feel better, but the patient's not going to benefit."

Some Iraq war veterans say antidepressants and sleep aids were relatively easy to obtain, with no requirement for regular counseling or follow-up care.

Paul Scaglione, 23, an Army mechanic from the Detroit area, said he was put on Wellbutrin in 2003 after telling a medical worker at Tallil Air Base, "I'm not feeling so hot," and asking for "something to keep my mind off everything."

"It was no big deal," he said. "They just talk to you a little and give it to you. They say you can come back if you want, but they don't follow up or anything."

[Sidewinder]

Kiley insisted that troops receiving medications are afforded a balance of care, including counseling.

He characterized the use of medications in Iraq as limited, saying some troops were allowed to deploy "on a low-dose SSRI," while others who developed problems in the war zone were placed on "a little bit of medication for a relatively short period of time, to get them through something."

He acknowledged that giving mood-altering drugs to troops in combat could be controversial.

"There are those out in the community who would be very concerned about that, as though you've altered the mental capacities of a soldier by putting them on those medications," he said. "My understanding . . . is that, in fact, is not what happens. When properly managed and properly dosed, with evidence that the soldiers are . . . doing well, there's no reason why they can't do their soldierly duties."

Fully Resolved?

Exactly how many troops are taking psychiatric drugs remains unclear. In response to a Freedom of Information Act request by The Courant for data on all prescriptions dispensed in Iraq, Defense Department officials were able to produce only limited records on medications.

Those records, as well as the Army's own reports, indicate that the availability and use of psychiatric drugs in Iraq has increased steadily. A 2004 report by a team of Army mental health professionals cited widespread complaints from combat doctors about a lack of psychotropic drugs, which prompted the military to approve making antidepressants including Prozac, Zoloft and Trazodone, and the sleep aid Ambien, more widely available. A follow-up report 13 months later cited far fewer complaints about access to drugs.

But in a little-noticed change a year ago, the Army revised its deployment guidelines to include a caution about deploying troops who are taking antidepressants for "moderate to severe" depression. The guidelines say such medications "are not usually suitable for extended deployments" and "could likely result in adverse health consequences."

Also, Dr. William Winkenwerder Jr., the assistant secretary of defense for health affairs, characterized the use of psychotropic drugs as limited when he testified before a congressional committee last summer that service members were being allowed to deploy on "maintenance medication" if their conditions had "fully resolved."

"For example, it is prudent to continue antidepressants six to 18 months after an episode of major depression has fully resolved, in order to prevent relapse," he said.

How the military interprets "fully resolved" is in question.

"We have seen people diagnosed within three to four weeks [before] deployment, put on medications like Paxil, and their deployment schedule rolls along," said Kathleen Gilberd, a San Diego legal counselor for service members who heads the Military Law Task Force of the National Lawyers Guild. "People are being deployed when there is no way to tell whether this potentially serious depression will have remitted or whether it will become a problem."

Melissa Hobart, the East Haven native who collapsed and died in June 2004, had enlisted in the Army in early 2003 after attending nursing school, and initially was told she would be stationed in Alaska, her mother, Connie Hobart, said.

When her orders were changed to Iraq, Melissa, the mother of a 3-year-old daughter, fell into a depression and sought help at Fort Hood, Texas, according to her mother.

"Just before she got deployed, she said she was getting really depressed, so I told her to go talk to somebody," Connie Hobart recalled. "She said they put her on an antidepressant."

Melissa, a medic, accepted her obligation to serve, even as her mother urged her to "go AWOL" and come home to Ladson, S.C., where the family had moved. But three months into her tour in Baghdad - and a week before she died - she told Connie she was feeling lost.

"She wanted out of there. She said everybody's morale was low," Connie recalled. "She said the people over there would throw rocks at them, that they didn't want them there. It was making her sad."

Around the same time, Melissa fainted and fell in her room, she told Connie in an e-mail. She said she had been checked out by a military doctor.

The next week, while serving on guard duty in Baghdad, Melissa collapsed and died of what the Army has labeled "natural" causes. The autopsy report lists the cause of death as "undetermined."

The report notes that the only medication found in Melissa's system was the antidepressant citalopram, the generic name for Celexa, at what appears to be a normal dosage level. It also suggests that because all other causes were ruled out, a heartbeat irregularity is a possibility.

[Sidewinder]

But the report does not explore whether the medication might have played a role in her death - something Connie finds troubling.

"Maybe they don't want to know how a healthy young woman died - but I do," Connie said.

Tomas Young, 26, an infantry soldier from Kansas City, Mo., also was sent to Iraq in early 2004, from Fort Hood, with a mental condition that was not "fully resolved." He was diagnosed with depression about three months before he deployed, he said.

Young said a military doctor put him on Prozac and told him to continue the medication while in combat.

"It was, `Here's the Prozac.' I didn't get counseling or anything," said Young.

Young ended up forgoing the pills during his brief deployment. He was shot within a week of arriving in Iraq and was evacuated. He is now paralyzed from the chest down.

Emphasis On Retention

The use of medications is just one aspect of the military's emphasis on treating psychologically wounded troops close to the front and returning them to duty quickly.

Military combat-stress teams pride themselves on high "return to duty" rates, which are also touted in reports by a team of military mental health experts who were sent to Iraq after a spate of suicides in 2003.

But in 2004, top military health officials acknowledged shortcomings with a key principle of modern combat psychiatry, known as "PIES," which emphasizes treating troops who exhibit problems as close to the front lines as possible, with the expectation that they will return to duty.

"Unfortunately, the validity of these concepts has never been demonstrated in clinical trials," the group of officials acknowledged in a written report. They also said proponents of the principle frequently leave out its most important element - "respite." They said relief from stress "is the primary principle of acute combat-related behavioral and mental health [care] in theater."

Still, military leaders maintain faith in their decision to treat psychiatric wounds in the field, arguing that the approach is better for service members than "pathologizing" their stress by evacuating them to a hospital.

Col. Elspeth Ritchie, the psychiatric consultant to the Army surgeon general, acknowledged that the practice also serves the military.

"Historically, we've found patients evacuated out of theater don't return," said Ritchie. "In time of great difficulty - and there's no question the war over there is very difficult - sometimes anxiety and depression may overwhelm a soldier, and they feel like they've just got to get out of this place.

"But if they are evacuated out, they tend to have the stigma of leaving as a psychiatric case - and then it's a loss of manpower for the service."

Throughout the war, the military has evaluated the success of its mental health programs primarily on the basis of how many troops are retained in combat.

While Winkenwerder had assured Congress last summer that troops with severe mental illnesses were being sent out of the war zone, the Army's own reports indicate that the number of soldiers evacuated from Iraq for psychiatric problems has dropped steeply since the first year of the war, as combat-stress teams and medications have become more accessible.

Mental health evacuations have fallen from an average of 75 a month in 2003 to 46 a month in 2005, according to Army statistics. Overall, barely more than one-tenth of 1 percent of the 1.3 million troops who have been deployed to Iraq and Afghanistan have been evacuated because of psychiatric problems. Meanwhile, the mental health teams close to the front lines pride themselves on return-to-duty rates that typically exceed 90 percent.

But in some cases, the troubled troops who remain in the war zone never make it home.

Army Spec. Joshua T. Brazee, 25, of Sand Creek, Mich., had been in Iraq for less than three months when the military says he shot himself with his rifle in May 2005. According to his autopsy report, he had "talked with other soldiers about death and killing, and also about the idea of suicide."

[Sidewinder]

His mother, Teresa Brazee, said she still has questions about how he died, and believes there were conflicts within his unit. She said one of Joshua's superiors told her that his death taught him to pay closer attention to his soldiers.

"It's a little too late for that," she said.

In another case, Pfc. David L. Potter was kept in the war zone despite a diagnosis of anxiety and depression, a suicide attempt and a psychiatrist's recommendation that he be separated from the Army.

Potter, 22, told friends that he believed the recommendation had been overruled, leading to a deepening of his depression, a fellow soldier said. On Aug 7, 2004 - 10 days after the psychiatrist recommended he be sent home - Potter took a gun from under another soldier's bed and killed himself.

The fellow soldier, who did not want his name used because he is still in the military, said Potter was clearly having trouble dealing with the stress of deployment, but wasn't getting the help he needed.

"We saw what was going on," he said, "but we couldn't do anything about it."

Ann Scheuerman knew her son Jason was having a rough time in Iraq, but she didn't know the depth of his despair until she awoke to a short e-mail from him last July that left her shaking with fear.

"I'm sorry, mom, but I just can't deal with this anymore," he wrote from his base in Muqdadiyah. "I love you, but goodbye."

After an agonizing morning of frantic phone calls, Scheuerman learned that officers and a chaplain had reached Jason in time, taking away his rifle, posting a guard and ordering a mental evaluation for the 20-year-old private first-class.

For the first time that day, Ann Scheuerman could breathe.

But her son's problems were just beginning.

Jason got a psychological evaluation, but afterward, he sent his mother another disturbing e-mail.

"He was very discouraged," said Scheuerman, of Lynchburg, Va. "He said, `Mom, they think that I'm making this up and that there was nothing wrong with me, that I needed to just be a man, be a soldier and quit wasting the Army's time.' He said they were going to court-martial him for treason, that sergeants said they were tired of people making up excuses to try to get out of combat and it wasn't fair to all the other real soldiers."

Jason was pulled off missions with his fellow soldiers, assigned menial jobs around the barracks and given his gun back.

He used the weapon three weeks later to become the 1,797th U.S. military fatality of Operation Iraqi Freedom.

Ann Scheuerman, who, like Jason's father, is an Army veteran, strongly supports the military. But she wants to know how things could have gone so wrong in Jason's case.

"The enemy should not be dressed in a United States Army military uniform. That's not what the enemy looks like, and should never be what our soldiers see as the enemy," she said.

"If someone would have taken two or three days, if he would have just been in the hospital for a few days, where someone could have actually talked to him, I think that's all it would have taken," she said.

Kiley, the Army surgeon general, said he believes that mental-health professionals in Iraq are quick to evacuate troops who are at risk of hurting themselves or others, or who have "risen to the level of being moderately or severely depressed."

[Sidewinder]

Who's Helping The Troops

After the spike in suicides in 2003, military officials said they had faith that teams of mental health specialists deployed to Iraq and Kuwait would be able to provide needed care to troops, and help to break the stigma associated with mental health issues.

But with the 2005 suicide rate in Iraq climbing to the highest level since the war began, some soldiers' advocates are now questioning whether the specialists have become too reliant on short-term treatments and medications, and not enough on one-to-one counseling.

Sandy Moreno, a Sacramento, Calif.-based psychiatric technician in the Army Reserve, was among the first combat-stress team members in Iraq. While her team prided itself on a return-to-duty rate of about 95 percent, she said counseling and respite - not medications - were the focus in the early months of the war.

"You can't start someone on antidepressants and then not see them again because their unit is moving around," Moreno said. "When you put them on those kinds of meds, a lot of times it takes six weeks before they take effect, or they can cause side effects. We could never keep that good track of a soldier."

The military has about 230 counselors dispatched in Iraq and Kuwait for about 100,000 troops, about the same number as in 2004, an Army spokesman said. But there are signs that the providers themselves are burning out.

A team of mental health experts reported in January 2005 that caregivers were experiencing "compassion fatigue," with one-third of behavioral health workers reporting high burnout, and one in six acknowledging that stress was hurting their ability to do their jobs.

"If our providers are impaired," the team wrote, "our ability to intervene early and assist Soldiers with their problems may be degraded."

Beyond burnout, military documents and interviews reveal a culture in which mental health professionals are constantly on the alert for troops faking mental illness to get out of duty.

"Clinicians must always maintain a keen eye for potential malingerers," instructs the Iraq War Clinician Guide, a 200-page bible compiled by the Department of Veterans Affairs and the Walter Reed Army Medical Center. "Suspicions require close consultation with commanders to ensure proper diagnosis and disposition."

Some Iraq veterans say the military is too quick to dismiss mental health complaints, and still has a problem treating injuries to the mind the way it treats injuries to the body.

"If you break your leg over there, you're going to get treatment," said Georg-Andreas Pogany. "When they go for mental health services, they are belittled, they are shoved aside, they are called malingerers. Their experiences are completely invalidated."

In 2003, Pogany, a former Army interrogator, was charged with cowardice - a crime punishable by death - after suffering a panic attack and seeking counseling because he had seen the body of an Iraqi man who had been cut in half by American gunfire. The charge was later dropped.

Bob Johnson, former chief of combat stress control for an Army brigade of about 2,800 soldiers, said he would routinely review soldiers' work and disciplinary histories when they complained of serious mental problems. If a soldier with a history of antisocial behavior came in insisting he was going to shoot himself if he wasn't sent home, "then that's a pretty clear-cut case of malingering," he said.

Johnson said he took a punitive approach to dealing with those soldiers, taking away their guns - which he compared to "losing your manhood" - and forcing them to sleep at the command point, in the line of sight of commanders.

He said he had treated one soldier who threatened to starve himself to death, and later swallowed a handful of pills - both acts that Johnson deemed bogus attempts to get out of serving.

"There's no doubt about it, the guy had mental health issues," Johnson said. "But he wasn't going to get the treatment he wanted, which was to go home."

"The question is, do we want to reward this behavior? Because if we reward this behavior, more soldiers are going to do it."