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In August 2007, a psychiatry consultant to the Army Surgeon General, Col. Elspeth Cameron Ritchie reported that the suicides had been caused by financial woes, troubled relationships, and other issues - and had not been caused by the war. But some experts disagree with that assessment, saying that the military has determined there is no direct relationship between the rate of suicides and deployments in order to avoid additional, wartime costs that might be required to treat or prevent suicides. "There are various possible explanations for the Pentagon's refusal to accept that connection," said Penny Coleman, author of Flashback: Posttraumatic Stress Disorder, Suicide, and the Lessons of War, before the House Committee on Veterans Affairs in December 2007. "But one of the most compelling is budgetary." In other words, treating soldiers and veterans with mental-health problems is expensive -- and refusing to draw a connection between war and suicide may simply be a way of saving money.
Col. Ritchie says that is not an accurate assessment of their position. In fact, she says in an email on February 21, "We do believe that the frequent deployments were straining marriages and other relationships." In addition, she says, "Failed intimate relationships are a definite risk factor for suicide. Other risk factors for our soldiers include legal and occupational difficulties, and the availability of firearms in theater. As time has gone on, we continue to see the effects of deployment on relationships. We also need to acknowledge the connection between PTSD, substance abuse, and suicide. To date, few of our suicides have had diagnosed PTSD."
The debate over the subject of suicide, and the treatment of soldiers and veterans, continues in Washington. Meanwhile, Pogany is traveling around the country to investigate mental-health care at Army posts so he can help soldiers who may need legal assistance or aid in obtaining proper health care. Several weeks ago, he arrived in Syracuse, New York, in the midst of a blizzard. The mental-health facilities at nearby Fort Drum have been taxed with visits up 200 percent above prewar levels, and an additional clinic, Mountain Community Tricare Behavioral Health, was added to Fort Drum in June to meet the demand. (Tricare is a managed-care company.) Assistant Secretary of Defense S. Ward Casscells told the House Armed Services Subcommittee on Military Personnel in July 2007 that the clinic is "a model for other installations."
Yet a soldier at Fort Drum still must wait six to eight weeks before he can see a mental-health worker, says Pogany. "The [mental-health-care] providers say, 'Hey, we're doing this, we're doing that,'" he says. "And on paper, they're seeing people. On paper, they have a PTSD group. On paper, they have someone coming in for an appointment. But when you pull that apart, it's all coffeehouse crap."
It is after 5 p.m. at Racine's restaurant, and Pogany is checking his watch. He has recently come back from another trip -- this time to Anchorage, Alaska, where 3,700 troops recently returned to Fort Richardson from Iraq. They have arrived home, he says, during the dark winter months in a place known for clinical depression, suicide, and crystal meth. "How many psychiatrists they have there? Zero," Pogany says. (Maj. Vanessa Venezia, the chief of the community mental-health division at Bassett Army Community Hospital, Fort Wainwright, who oversees Fort Richardson's mental-health services, says they are currently hiring a psychiatrist. In the meantime, she explains, soldiers are being treated in a full-service clinic at nearby Elmendorf Air Force Base.)
Pogany says the need for expanded mental-health services for soldiers at Fort Richardson is urgent. "If they don't address this problem now, the roof will cave in," he says. "All we have to do is sit back and wait ninety to one hundred days and see how many suicides and DUIs there are, and then separate out how many are combat-related
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