From a distance, the more than 11,000 state residents who have returned from war in the past five years have disappeared seamlessly into the Connecticut landscape — back to colleges, spouses, civilian or military jobs.
But up close, the transition has not been so smooth.
A first-ever survey of returning state troops shows that at least one-quarter of them meet the diagnostic criteria for post-traumatic stress disorder, while many cite problems with a spouse or partner and difficulties "connecting emotionally with family" as major concerns.
A state mental health hot line has fielded more than 300 calls for assistance from Iraq and Afghanistan veterans and their family members in the past nine months. Recently, the state veterans' affairs commissioner has begun working with the courts to ensure that increasing numbers of recently returned troops who are arrested for domestic violence, drunken driving or other offenses are flagged and referred to counseling programs.
"There's a lot of real high risks here — not only for the military members themselves, but for their families," said Linda Schwartz, commissioner of the state Department of Veterans' Affairs. "We have people in almost every town in our state who have served deployments, and the VA is just not going to be able to get to them all. We have to do more to reach out to them … to catch them when they fall."
Preliminary findings of a survey sent to 1,000 Connecticut troops who served in Iraq and Afghanistan — more than half in the National Guard or reserves — found that about 19 percent met criteria indicating they are at risk of traumatic brain injury, while at least 24 percent met the diagnostic criteria for PTSD. Schwartz said the percentage of troops who are experiencing symptoms of PTSD is likely higher than the rate captured in the survey, which used strict criteria.
The study also suggests that troops are reluctant to seek counseling from mental health professionals, with a large proportion of respondents saying they have sought psychological help from primary care doctors or emergency rooms. About half reported that their general health was "much worse" or "somewhat worse" than before they were deployed to war.
The state-funded study — conducted by Central Connecticut State University's Center for Public Policy and Social Research, with assistance from the Yale School of Medicine — identified several key areas of concern among the returning troops, among them: a sense of being disconnected from their community; trouble communicating with everyone except fellow veterans; feelings of being "tightly wound" or "aggressive"; and a reluctance to seek psychological help, for fear of being stigmatized or perceived as weak.
"When we look at the data regarding both family and peer relationships, we see that a sizable proportion of veterans report difficulties in these areas," the study's authors wrote in a draft report. "These problems are undoubtedly exacerbated by the symptomology of PTSD, with nearly a quarter of respondents exceeding the diagnostic threshold."
The experiences of Connecticut veterans mirror their counterparts nationally, with data cited in a 2007 report by a Defense Department task force indicating that about 38 percent of soldiers reported mental health concerns in the months after their return. Among "citizen-soldiers" serving in the National Guard, the figure rises to 49 percent. The task force recommended sweeping improvements in psychological services to Guard and reserve members and their families.
Connecticut, which has dispatched more than 4,000 Guard and reserve members to the Iraq and Afghanistan wars, already has taken steps to fill gaps in the network of care provided to returning troops by the VA, vet centers and the military. Officials say they now plan to use the survey findings to bolster those initiatives and embark on new ones.
Schwartz said incidents of Iraq and Afghanistan veterans being arrested for domestic violence, drunken driving and other offenses have increased in recent months, prompting her to work with court officials and the VA on ways to flag veterans in legal trouble and refer them to appropriate treatment or alternative incarceration programs.
"We're trying to get [court officials] to ask people, 'Are you a veteran?'" Schwartz said. "It's not that we want to give them a free ride, but we do want to make sure they get the help they need."
Schwartz said the experience of the Iraq war — the hyper-vigilance that comes with being under constant threat of attack — can foster "thrill-seeking behavior" in some returning troops and aggressive or self-destructive behaviors in others.
Last spring, state agencies and the Connecticut National Guard launched a hot line and referral program that links returning troops and their family members with a network of trained community mental health providers. The program — funded with $1.3 million in state money — has received more than 315 calls and made 180 referrals.
State officials, concerned that troops with PTSD and other psychological problems are not seeking care, say they are hoping to draw more people to the program in the next year through outreach and advertising.
The survey findings indicate some adjustment problems for troops returning to jobs or enrolling in colleges. Almost 20 percent of respondents said that after being deployed, their civilian jobs were not as satisfying to them. Some who returned to colleges said they felt like outsiders on campus.
Schwartz said she has begun asking state colleges to establish "drop-in centers" where veterans can go to socialize with other veterans, to help ease the sense of isolation.
Lt. Col. John Whitford of the Connecticut National Guard said the state has been "ahead of the game" in meeting the mental health needs of returning troops. Guard members report more family and relationship problems than work-related concerns, he said, and Guard leaders have stepped up their family-support programs to address those issues.
The coming year could bring new strains on Guard members, as some Connecticut units are expected to be called to deploy for the second time. Only 15 state Guard members are currently deployed and are due to return from Afghanistan in April.
"For a brief period, we'll have no one deployed," Whitford said. "[But] we are fast approaching some units going back a second time." He said he expects 200 to 250 Guard members could be deployed by the end of 2008.
Some private sector efforts to help returning troops also are underway. The Hartford Financial Services Group, in collaboration with the Disability Management Employer Coalition, has produced a free guide for employers that contains recommendations on helping returning troops re-integrate into the workplace. The recommendations include providing sensitivity training to managers about issues faced by civilian soldiers during and after deployments and providing mentoring programs to link returning troops with other veterans.
"When they return, you've got to acknowledge their service and welcome them back," said Carol Harnett, vice president and the national disability and life practices leader for The Hartford's group benefits division. "Some of them may need a little bit of ramp-up time" to adjust.
On the positive side, employers should recognize that many veterans will come home from deployments with new strengths.
"Many of them have stepped up into leadership roles they didn't have in their companies," Harnett said. "They may come back with a whole new set of skills. That's something employers need to recognize."
The state's mental health hot line for military members who have served in Iraq and Afghanistan and their family members is 866-251-2913.
Contact Lisa Chedekel at email@example.com.