Wednesday, May 14, 2008




Several years into a pair of wars, the Department of Veterans Affairs is struggling to cope with a task for which it was tragically unready: the care of soldiers who left Afghanistan and Iraq with an extra burden of brain injury and psychic anguish. The last thing they need is the toxic blend of secrecy, arrogance and heedlessness that helped to send many of them into harm’s way.

“Shh!” said the e-mail in February from Dr. Ira Katz, head of mental health services for V.A., to a colleague. “Our suicide prevention coordinators are identifying about 1,000 suicide attempts per month among the veterans we see in our medical facilities. Is this something we should (carefully) address ourselves in some sort of release before someone stumbles on it?”

Dr. Katz’s hushed-up figure was nowhere near the number he gave to the House Veterans’ Affairs Committee last year; he said there had been 790 suicide attempts in all of 2007, and denied there was a suicide epidemic. The veterans affairs secretary, James Peake, apologized for Dr. Katz’s “unfortunate set of words” and promised more candor and transparency.

Give some credit, anyway, to Mr. Peake for realizing that there is no hope of denying or wishing away this problem. As the economists Joseph Stiglitz and Linda Bilmes made clear in “The Three Trillion Dollar War,” their analysis of Iraq, the medical toll of a war rises in a swelling curve for many decades after the shooting stops. The current suicide figures include a large proportion of aging and ailing veterans of Vietnam. Suffering for that long, on that scale, will not be covered up.

A study by the Rand Corporation last month found that nearly one in five service members returning from Iraq and Afghanistan, or about 300,000, have symptoms of post-traumatic stress disorder or major depression. About 19 percent reported having a possible traumatic brain injury from these bomb-afflicted wars.

Alarmingly, only half have sought treatment, the study found, and they have encountered severe delays and shortfalls in getting care. The V.A.’s inspector general has faulted the agency’s case management of brain-injured veterans, and a federal lawsuit by veterans’ groups in San Francisco seeks to force the V.A. to streamline and improve treatment.

Fortunately, the solutions are clear: more money for mental health services, closer tracking of suicides and more aggressive preventive efforts, more efficiency at managing veterans’ treatment and more help for their families. If this country gave back to wounded troops even a fraction of the commitment and service that it has received from them, they will be well cared for.