Program helps N.H. Guard ease back into civilian life

WASHINGTON -- A program designed to help New Hampshire National Guard troops who served in Iraq and Afghanistan readjust to civilian life includes mandatory screenings designed to identify soldiers who are struggling with mental health problems and the horrors of combat and to blunt the stigma of asking for professional help.

The ``Reunion and Reentry" program has become a model for other National Guard units, including those in New Jersey and Massachusetts, according to military officials.

Required for all troops returning from both war zones, the program offers a series of briefings on topics ranging from how to get reacquainted with families to taking advantage of medical and veterans' benefits.

But the cornerstone of the program -- compulsory, one-on-one counseling sessions with a mental health professional -- gives soldiers a chance to talk about any problems they had on tour or at home while avoiding the stereotypes some may associate with counseling and therapy.

``We were looking for a comfortable environment where soldiers could have a place to talk about dark times during transition," said Colonel Deborah Carter, a human resources officer with the New Hampshire Guard. ``We wanted to make sure soldiers knew what the normal transition things are."

Major Winfield Danielson, Massachusetts Guard spokesman, said the ultimate goal ``is to make sure that people understand that [mental health counseling] isn't something to be embarrassed about." All Guard commanders, he said, ``need to make sure soldiers are aware of the services that are available to them."

The program, developed in 2004, is part of the New Hampshire National Guard's strategy of helping its citizen-soldiers adjust to civilian life after intense tours of duty in Iraq or Afghanistan.

Since the advent of modern warfare, battle-weary troops have been plagued by post-traumatic stress disorder and other mental health issues. Even after returning home, it's not unusual for some combat veterans to have nightmares, panic attacks, or violent outbursts, while others can become susceptible to substance abuse problems or have trouble focusing on day-to-day life.

Carter said many soldiers feel ashamed to talk about their problems, fearing it makes them seem weak in a military culture that values strength and independence. But for those who are struggling, serious problems inevitably begin to appear, Carter said, and New Hampshire Guard officials noticed a pattern when some troops returned home for mid-deployment visits.

``When some of the soldiers started coming back for their two-week R and R, we started to hear about some challenges that families were having with heavy drinking" and other signs of mental distress, Carter said. Some families reported that their loved ones spent their time off locked in their bedrooms , she said.

An Army study published in the July 1, 2004, edition of the New England Journal of Medicine suggested that only 40 percent of the Iraq and Afghanistan veterans who reported mental health problems sought treatment.

Some soldiers fear being ostracized for seeking help, according to Colonel Charles W. Hoge, the study's author and chief of psychiatry and neuroscience at Walter Reed Army Institute of Research in Silver Spring, Md.

``One of the reasons why a lot of service members don't seek care is because they have concerns that they might be seen differently or treated differently if they got care," Hoge said. ``That's just a perception, but perceptions may influence behavior."

About 17 percent of the veterans surveyed reported having symptoms of major depression, general anxiety, or post-traumatic stress after returning from their tours of duty in Iraq. About 11 percent of the Afghanistan veterans surveyed reported similar problems.

New Hampshire's mandatory screenings take place a few days after the soldier returns home, Carter said. The veterans go through a three-day series of briefings, including the mandatory visit with a mental health counselor.

The idea has spread to Guard units in other states, including New Jersey and Massachusetts, which began requiring counseling for all returning veterans last year. In March, Bay State officials added a second mandatory screening after 120 days of returning home.

Counselors give soldiers the option to continue counseling or to have someone check up on them in a few months, said Timothy Beebe , a regional manager for the US Department of Veterans Affairs.

``Some soldiers have come back [from Iraq] deeply affected," said Beebe, who is also a counselor. ``In others, problems might take longer to manifest."

So far, the center's therapists have seen about 1,600 soldiers from New Hampshire, Massachusetts, Rhode Island, and Connecticut, Beebe said. After the initial meeting, 65 percent requested help, he added.

New Jersey established a similar program three years ago that includes mandatory counseling, said Gary Englert , director of the state veterans services division.

Officials at the National Guard Bureau in Arlington, Va., were not able to confirm whether they are considering a national counseling policy. They said the Guard is participating in a Defense Department-wide program designed to offer help to all deployed soldiers, sailors, airmen, and Marines.

The program, Post-Deployment Health Reassessment, requires troops to fill out a four-page questionnaire, though only parts of it are mandatory. They don't need to answer any of the questions pertaining to their health, said Chief Warrant Officer Bonny Bell , who manages the program for the National Guard Bureau.

``The goal of the National Guard is to screen all soldiers and to offer this service to our veterans," Bell said. ``It really is done to give the soldier an opportunity to talk to a medical professional about what he or she is feeling."