"Getting through it at the time was pretty easy because there were soldiers there who needed you," she said. Horrigan has spent her time home relaxing and at the moment says she is not worried about post-traumatic stress disorder, the debilitating mental illness that studies show is affecting increasing numbers of soldiers returning from combat in Iraq. "But I heard it can take 30 or 40 years" to show up, Horrigan said this week before leaving for a family vacation in Key West.
Soon, the Pentagon will begin a program that requires mandatory screening of Iraq war veterans for PTSD and other ailments 3 to 6 months after they return from combat. It is a departure from the current practice, which provides a vast array of mental health services for veterans and soldiers in the field and after war duty as long as the soldier seeks them out. The new approach, which lifts some of the burden from the soldier, is long overdue, some say.
Maj. Stephen Misarski, an Army chaplain and pastor of New Hope Chapel in Westborough, has been on the front line of providing mental health care during a yearlong assignment in Iraq. Follow-up assessments months after returning home would be extremely valuable, he said. "Having gone through the screening when you come home, it's not significant in terms of post-traumatic stress," Misarski said. "As long as you don't have any evidence at that moment, they just let you go. Once they come back to normalcy (after a few months home), there could be some opportunity to take care of (mental health problems)."
According to Harry Sarles, spokesman for the deployment health directorate at the Pentagon, the screening will consist of an online survey and a follow-up session in person with a health professional. That interview would go over the survey and determine if the soldier should be referred for further evaluation. Sarles said the new Pentagon post-deployment assessment program grew out of a study on reassessment of soldiers at the military's medical base in Landstuhl, Germany, last year. "You think you're OK," said Sarles, who served in Afghanistan. "And the soldier thinks nothing has changed, (but) the people around him may think something has changed."
According to Perry Bishop, a Pentagon spokesman, Assistant Secretary of Defense for Health Affairs Dr. William Winkenwerder has assembled a team of health professionals to draft the online questionnaire, which is slated to be ready in April.
U.S. Rep. Marty Meehan, D-5th, this week sent a letter to Secretary of Defense Donald Rumsfeld, urging him to expedite the new policy on PTSD screening. "It is essential for the Pentagon to implement a system to monitor our returning warriors for signs of combat-related stress that may not emerge until months after they leave the military service," said Meehan. Seeing those changes and acting on them can be a matter of life and death.
In a speech last month in Worcester, U.S. Sen. John Kerry spoke about a Marine reservist from Belchertown who began drinking heavily, complained of recurring nightmares and eventually killed himself. Kerry cited Jeffrey Lucey as an example of why the military needs to do more to reach soldiers in trouble rather than wait for soldiers to speak up.
Kerry called for the expansion of PTSD programs that would require Veterans Affairs workers to find veterans that need care.
Meehan plans to refile his Matthew Boisvert H.E.R.O.E.S Act this congressional session. The legislation, named for a Tyngsboro Marine injured by a roadside bomb in Iraq, calls for mandatory testing of veterans for warning signs of PTSD, among other measures.
"The war in Iraq is the most intense combat experience American fighters have faced since Vietnam," Meehan said. "In the months and years to come, the toll of that traumatic combat will become increasingly clear."
Tapper said new grants would help his department assess that toll by hiring outreach workers to contact veterans after they have demobilized. "There are a significant number of people coming back with issues," said Tapper. "We let people know that there are indicators that they should be looking for." Current outreach in Tapper's department includes giving soldiers a one-on-one debriefing just before they are demobilized. He and his staff were doing just that on Friday in Milford for a group of 35 Air National Guard air traffic controllers returning from a 15-month deployment to Iraq.
Tapper said he routinely gives a verbal PTSD screening to any soldier who comes into his office at the VA in Jamaica Plain. But outreach could still run into problems with some who believe a culture that embraces toughness does not admit to needing help. "This is not a weakness, but it is something that happens to people when they are in an extreme life situation such as being in a combat area," Tapper said.
A New England Journal of Medicine study published in July showed more soldiers returning from combat in Iraq met the general criteria for PTSD than before they shipped out. Of the U.S. Army soldiers who participated, the rate of PTSD rose to 19.9 percent compared to 9.4 percent before the war. Marines showed PTSD rates of 18 percent.
A vast majority of soldiers in the study reported seeing dead bodies, being attacked and knowing someone killed or ambushed. About half of the soldiers who participated said they had killed an enemy combatant. Despite all of those sources of stress, many soldiers still choose not to seek help. They cited a fear of being perceived as weak or that their fellow soldiers would treat them differently.
Horrigan said the debriefings when returning home from deployment were nearly endless. "They come at you from every angle," she said. "There were five or six briefings on psychological effects. They really make you understand that these problems can happen." But Horrigan was reluctant to embrace mandatory screening 3-6 months after returning from deployment. "Even a mandatory meeting doesn't mean that person will discuss their problems," she said.
Misarski admitted soldiers could choose to lie or hide their problems but providing them with an opportunity rather than relying on them coming forward and making an appointment could be the difference between help and tragedy.
Parents of soldiers agreed. "Anything that's offered to the veterans is for their benefit," said Ann Amatucci of Franklin whose son, Noah Amatucci, 21, is serving with a National Guard military police unit in Iraq and previously served six months in Afghanistan.
Ann Amatucci compared the excitement of coming home from deployment to Christmas, and just like that holiday, the joy wears off. For that reason alone, the military should do follow-up assessments with returning soldiers months afterward. "It's not going to make anyone less of a man or a woman or a soldier," she said.
Framingham's Bill Petro, who this weekend welcomed home from Iraq his son Billy, a Marine lance corporal and 2002 Framingham High School graduate, said the idea of increased screening after deployment makes sense. "He said it might take a while to get used to sleeping without worrying about being bombed," Petro said of his son, who drives an Abrams tank. Billy's unit, the 24th Expeditionary, lost three soldiers just weeks before coming home. The elder Petro, a former Marine himself, wholeheartedly agreed with making the screening mandatory.
"I would think that the Marines have a more macho type of feeling, and I don't think they would voluntarily do it," Petro said. "It gives them the option to open up or not, but it forces them to sit down."
Rob Haneisen
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