The wars in Iraq and Afghanistan no longer dominate the evening news or the public’s consciousness. According to a recent poll, only 16 percent of Americans name the Iraq war as the story that first comes to mind when asked what has been in the news lately. But for the thousands of U.S. servicemen and servicewomen still serving in these war zones, the war remains a central part of their lives — and the lives of their families and loved ones. And for the thousands of veterans who return home with physical, their wounds can present particular challenges for years to come. However, many servicemen and servicewomen returning to the U.S. without noticeable or debilitating physical reminders of their service suffer from deep mental and emotional health issues.

Mental health is the second largest area of illness (after orthopedic problems) for which veterans of the wars in Iraq and Afghanistan seek treatment at Department of Veterans Affairs facilities. Veterans and their families face a wide range of mental health and addiction issues, including major depression, alcohol abuse (sometimes beginning in an effort to sleep), narcotic addiction (often beginning with pain medication for combat injuries), generalized anxiety disorder, job loss, family-dissolution, homelessness, violence toward self and others, and incarceration.

Nearly 1 in 5 soldiers who have served in Iraq or Afghanistan have posttraumatic stress disorder or depression — approximately 30,000 men and women. Only about half of that number actually have sought treatment.

Unusual circumstances of the wars in Iraq and Afghanistan add to the normal stresses of war, increasing the potential for traumatic stress–related disorders. For example, absence of a clear distinction between frontline and rear echelon reduces the ability to escape high-stress situations. Other unique issues presented by these “modern wars” include extended and multiple tours of duty and intense involvement of National Guard members and reservists, many of whom are drawn away from established careers and young families.

Approximately 19 percent of returning service members report that they experienced a possible traumatic brain injury while deployed, and 7 percent of service members report both a probable brain injury and current post traumatic stress disorder or major depression. Many service members said they do not seek treatment for psychological illnesses because they fear it will harm their careers. But even among those who do seek help for post traumatic stress disorder or major depression, only about half receive treatment that researchers consider “minimally adequate” for their illnesses.

While representing only 11 percent of the civilian population 18 years and older, veterans represent roughly 26 percent of homeless people in the U.S. — even though veterans are better educated, are more likely to be employed, and have a lower poverty rate than the general population. Forty-five percent of homeless veterans suffer from mental illness, including many who report high rates of post traumatic stress disorder. Approximately 70 percent of homeless veterans suffer from substance abuse problems.

Although these rates of mental illness and substance abuse are similar to those of other homeless men, some research suggests that alcohol dependence and abuse are more common among homeless veterans than among homeless nonveterans. People with substance abuse problems may have trouble maintaining employment and meeting their monthly housing costs.

A suicide prevention hotline started by the VA and the Substance Abuse and Mental Health Services Administration in July 2007 has served 22,000 veterans and prevented 1,221 veterans from taking their lives in the first year of operation.

In 2006, the Army reported the highest suicide rate — 17.3 per 100,000 soldiers — since it began recording such deaths in 1980. A VA study found that 53 percent of veterans returning from Iraq and Afghanistan who committed suicide between 2001 and 2005 were reservists or National Guardsmen, citizen soldiers who may be less able to navigate the bureaucracy to get help.

As mental health communities in the U.S. gear up to effectively meet the needs of returning veterans and their families, they are faced with a multitude of important questions. What do we need to know to effectively serve veterans returning from Operation Iraqi Freedom and Operation Enduring Freedom and their families? What does cultural competency mean with respect to those who have served in the military and their families? What are the unique characteristics of the conflicts in Iraq and Afghanistan that should inform treatment? What lessons can be learned from behavioral healthcare providers who already specialize in treating these veterans and family members? These questions must be addressed in order to give our servicemen and servicewomen the mental health care and service they deserve.

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