Mental health and the cost of our wars

The Biden administration has pledged to have U.S. forces out of Afghanistan later this year. With that action, we will close the book on what has been America’s longest sustained period of military conflict. Hopefully, the occasion will represent an opportunity for all Americans to reflect on the costs and consequences of those wars.

Almost 3 million Americans have been deployed to Iraq and Afghanistan since 2001. More than 7,000 service members have died in the fight. In financial terms, estimates suggest that to date, the cost of our post-9/11 wars has exceeded $6.4 trillion. 

However, these numbers do not tell the whole story. What too few Americans fully understand is that without bold action, the “costs and consequences” of these wars will continue to accumulate, long after places like Iraq and Afghanistan stop making the news.   

Since 2001, 30,177 service members and veterans have died by suicide. That number is more than four times those who died at the hands of the enemy. The psychological trauma of 20 years at war has contributed to an unprecedented mental health challenge, impacting countless post-9/11 veterans and military-connected families. 

It is past time that all Americans commit to ending the scourge of military-connected suicide. We must hold our politicians and policymakers accountable to define a whole-of-the-nation plan that ensures our veterans and service members have access to robust mental health resources. That commitment should begin today — on National Post-Traumatic Stress Disorder (PTSD) Awareness Day.

National PTSD Awareness Day was established to encourage Americans to better understand and reflect on the relationship between traumatic life events, and mental health. Contrary to the stereotype, PTSD is not confined only to those who experience wartime trauma. Countless Americans struggle with the effects of PTSD, stemming from traumatic events such as sexual assault or other incidents of violence. That said, the trauma of war makes PTSD the most pressing mental health challenge facing the military community.

There are several reasons that researchers have identified to explain why PTSD is so persistent and pervasive among veterans in general, and specifically among those who have fought our wars since 2001. Yet, I would contend one reason stands above the rest. 

Over the last 20 years, the American public became increasingly disconnected from war and its associated costs. Consider that a 2018 poll found that 42 percent of Americans are either unaware of ongoing conflict, or believed that the global war on terror had ended. In other words, as the wars in Iraq and Afghanistan dragged on, those fighting those wars became more isolated from civil society. At the same time, those veterans and service members watched their friends and teammates succumb to the trauma of war. A recent poll conducted by Iraq and Afghanistan Veterans of America (IAVA) found that 67 percent of post-9/11 veterans know another post-9/11 veteran who attempted or died by suicide.

It’s true that the complexity and scale of the mental health challenges to be addressed in this community is daunting. However, our collective objective is simple and clear. As one expert described to me, we need innovations and policy that empowers veterans challenged by PTSD to both survive and thrive. 

What does that look like in practice? It starts at the transition from military to civilian life. Here, we must do better.

Feelings of isolation and hopelessness that some veterans experience are often most pronounced during the transition from military to civilian life. One recent study found that the highest rates of suicide and suicidal ideation occur among veterans during the period immediately following the transition from military service. Enabling a successful transition means not only supporting wellbeing and mental health, but also providing a pathway to civilian employment, stable and adequate housing, to education and access to earned benefits.  

On transition, the President’s Budget Request acknowledges the imperative enhanced support for those leaving service. New funding for programs in the Office of Transition and Economic Development and at the Department of Labor will provide much needed focus on transition programs and services. In addition, several new pilot programs have been proposed to explore innovative ways to train veterans and prepare them for the workforce of the future. 

Looking beyond transition, the VA plans new investment in hospital infrastructure and expanded access to clinical and mental health care resources. Maybe even more important is that for arguably the first time, the VA’s budget request acknowledges the need to consider the social and economic determinants of health as part of a holistic strategy to combat veteran suicide and PTSD.  

Importantly, the government can not and should not “go it alone.” We must engage and empower nonprofit organizations and community-based providers to connect and serve veterans in the communities where they live, work and raise their families. 

Last year Congress introduced a new and innovative Suicide Prevention Grant Program, designed to direct grant funding to community-based organizations who are able and willing to provide clinical and mental health care to veterans. Importantly, this program will also fund organizations to coordinate access to additional social and economic supports — such as housing, employment, benefits or legal needs — necessary for veterans to survive and also thrive. 

All these efforts represent positive and hopeful signs that there is progress on the horizon toward combating the current epidemic of military-connected suicide and PTSD. At the same time, there is much more work ahead. Until all Americans commit to the cause of ensuring that veterans and service members have broad access to robust and community-connected mental health resources, the costs and consequences of our wars in Iraq and Afghanistan will continue to accumulate. The cost of inaction, across generations, will be exceedingly high.

So, on this National PTSD Awareness Day, please commit to action that advances the cause of mental health across the military-connected community. This is a challenge that we have the capacity to address, but only if we act together.  

Dr. Mike Haynie is vice chancellor at Syracuse University, a veteran of the U.S. Air Force, and the founder and executive director of Syracuse University’s Institute for Veterans and Military Families. The views expressed here are his alone.