Blaming what they say is a shortsighted, under-funded system that does not learn from past mistakes, some advocacy groups say they are concerned that the federal government is unprepared to help the wave of troops returning from Iraq seeking mental health care.
"We should have been ready for this," said Steve Robinson, director of the National Gulf War Resource Center, a veterans advocacy organization. "It's simple math: If there is an increase in demand, and there is not an equal increase in dollars to hire new people to buy more equipment or provide more services, the person who suffers is the returning veteran."
He and other critics point to recent Army statistics indicating that 35 percent of soldiers and Marines returning from Iraq sought mental health care and 19 percent were diagnosed with a mental disorder like post traumatic stress disorder, depression or anxiety within a year of coming home.
"The high rate of using mental health services among Operation Iraqi Freedom veterans after deployment highlights challenges in ensuring that there are adequate resources to meet the mental health needs of returning veterans," reads the study, published by the Walter Reed Army Institute of Research in the March 1 Journal of the American Medical Association.
The numbers were based on screening and follow-ups of more than 300,000 troops returning from Iraq, Afghanistan and Bosnia from May 2003 to April 2004, leading many to surmise that the number with mental health problems has increased since then, since the rate of battlefield casualties among U.S. service members has also risen.
"[The study] is only marginally relevant to what condition our troops currently find themselves in," said I.L. Meagher, editor of PTSD Combat: Winning the War Within. "A lot has changed since that time, including increased number of troop deployments ... and an escalation in [improvised explosive device] attacks."
The Army study found that engaging in combat or witnessing people being wounded or killed is by far the greatest factor behind the diagnosis of mental disorders among returning service members.
Rob Timmons, an Iraq veteran and Army Reservist in New York who sought private therapy after the war and now does outreach work for Iraq and Afghanistan Veterans of America, formally Operation Truth, said the results of the study don't surprise him.
"Because of the type of war it is, everybody is a target," he said.
When troops deploy out of the war zone, they either return to active duty stateside, where they can seek help for emotional problems on their bases or they leave the military and seek assistance from the Veterans Administration.
According to VA statistics, 505,366 troops from Iraq and Afghanistan have left the military as of February. Of that number, 144,424, 29 percent, have sought VA health care, and 20,638, more than 14 percent of those, have been diagnosed with PTSD.
Symptoms of PTSD include hyper-vigilance, irritability, outbursts of anger, sleeplessness and fatigue, and can be accompanied by alcoholism, depression, anxiety and drug abuse.
Meagher said an alarming rate of violent incidents, suicide, homelessness and unemployment among recent veterans has been documented, but the issue has not garnered much national attention.
"We simply have not been the beneficiaries of that type of substantial coverage by the media these past three years," she said. "So, how exactly would the public be expected to be prepared for what's to come — in fact, what is already here?"
The VA acknowledges the concerns, but insists it is prepared financially and with adequate human resources to handle the returning wave of patients with emotional injuries.
"The VA has been a leader in mental health of all sorts, particularly in PTSD. We are very attuned to our responsibility for the full breadth of service," said Dr. Michael Kussman, principal deputy undersecretary for health for the VA.
Kussman said President Bush's 2007 VA budget asks Congress for a record $80 billion — an increase of $8.8 billion over 2006. Included in that is $3.3 billion for mental health care, a $340 million increase over 2006.
"It's a precedent-setting budget that has increases more than any other (VA) budget in the past," Kussman said. "We believe we have the resources and are giving priority to these new veterans. We're encouraging them to come."
In addition to direct care at the country's VA hospitals and clinics, the VA has set up PTSD specialists in each of its facilities, he said. It is also employing recent veterans who "have an acute sense of the war" to reach out to other veterans in communities with high military populations.
"They make sure these veterans have all they need," said Kussman.
But critics doubt the VA has factored in the increased demand the Iraq war will bring. The number of total patients treated in VA facilities rose by 22 percent in three years — from 4.1 million in 2001 to more than 5 million in 2004.
"The administration and folks in Washington on both sides of the aisle totally low-balled everything that had to do with this war," said Paul Rieckhoff, an Iraq veteran and director of Iraq and Afghanistan Veterans of America.
Last year, Congress was forced to add $1.5 billion in emergency funding to the budget after it discovered a huge shortfall in health care resources.
"Right there was an indication that the overall number of veterans coming back with needs were underestimated," said Peter Gaytan, director of the VA and rehabilitation division of the American Legion.
He said the American Legion, which represents approximately 3 million U.S. veterans, generally takes the position that the budget is a "step in the right direction," but the VA will probably need more as the "needs are continuing to increase."
Republican Sen. Larry Craig of Idaho, chairman of the Senate Veterans Affairs Committee, said the government is already meeting the new demands.
"The president has always made it clear that military veterans are among his highest priorities, and this budget demonstrates his dedication to all who have worked in uniform," he said.
In any case, advocates like Meagher say they hope the government will stick to its promises.
"How loudly we cheered them onward as they laced up their boots has no relevance once they've done their job," said Meagher. "It's how well we took care of them when they return that really defines our true moral character."