Wednesday, January 28, 2009

Military Suicides Continue to Rise

By: Courtney Kube and Alex Johnson

Suicide rates among active-duty U.S. military personnel are continuing to rise even as the Defense Department dedicates more resources to identifying troubled service members and getting them the help they need, NBC News has learned.

At least 125 soldiers were confirmed to have killed themselves in 2008, compared with 115 in 2007, 102 in 2006 and 87 in 2005, a senior defense official told NBC News. Last year’s figure is likely to rise even higher, because the Army is investigating at least 17 other deaths as possible suicides.

The Marine Corps reported 41 possible suicides last year, up from 33 in 2007, a defense official said, while the Navy and the Air Force saw smaller increases. The officials, all of whom spoke on condition of anonymity, disclosed the figures ahead of a public roundtable scheduled for Thursday to discuss suicides in the military.

According to figures compiled by the U.S. Centers for Disease Control and Prevention, the civilian suicide rate was 11 per 100,000 Americans in 2005, the last year for which fully adjusted national figures are available.

Officials said the Marine Corps’ rate was 19 per 100,000 Marines in 2008, while for the Air Force, it was 11.5, and for the Navy, it was 11.3. All three rates represented statistically significant rises over the same figures in 2007.

The officials did not provide a comparable breakdown for suicides in the Army, but the ratio works out to roughly 18 per 100,000 soldiers in 2008, pending open investigations and accounting for differing methods of counting the overall active-duty Army force.

And exact comparisons could be misleading because the makeup of the military forces does not mirror that of American society as a whole. But among the segment of the civilian population that most closely reflects the demographic makeup of the military — males ages 18 to 24 — about 19.8 Americans committed suicide per 100,000 in 2005, according to CDC figures.

Problem difficult to get a grip on

While the active-duty military force is expanding, the rate of suicides is growing even faster among all four services, a phenomenon that has alarmed defense officials.

“They’ve lost buddies,” said Army Brig. Gen. Loree K. Sutton, director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury. “They’ve been exposed to the most corrosive environment known to warfare — physically, psychologically, spiritually and morally.”

Maj. Gen. Mark A. Graham, commanding officer of the Army base at Fort Carson, Colo., said the military still suffered from a shortage of behavioral health professionals, even thought strides have been made in the past year. The Army, for example, has allocated $50 million to study the causes of military suicides and to bolster its programs to identify and help troubled soldiers.

The American Psychological Association reported in 2007 that there was a 40 percent vacancy rate in active-duty psychologists in the Army.

“With the stress that our soldiers and families are under, it’s taken a toll,” Graham said.

Fighting the stigma

A major problem is the stigma attached to service members who seek counseling and other mental health assistance, said Graham, whose youngest son, Kevin, 21, committed suicide in June 2003 as an ROTC cadet.

Eight months later, Graham was considered retiring when his other son, Jeff, was killed by an improvised explosive device in Iraq.

Until that point, Graham said, he himself thought “it was a sign of weakness” for a soldier to acknowledge emotional trauma.

But “guess what?” he said. “I actually found out what I was putting my family through.”
The epidemic of suicides in the military is a wake-up call, said Graham, who with his wife is now active with the Suicide Prevention Action Network.

“We could either let this tragedy be the book of our life, or we could let it be a tragic chapter in the book of our life,” Graham said. “And we’ve chosen the second, to make these [just] sad chapters in our life, but to make the overall book hopeful.”

“The message is it’s OK to ask for help,” he said. “It’s a sign of strength and not weakness to come forward.”

RELATED: Effects of Concussion Can Last Decades

Thirty years after injury, memory, attention and reaction time issues persist

By: Reuters

A single concussion early in an athlete's career can take a toll on memory, attention and reaction time 30 years later, Canadian researchers said on Tuesday.

Compared with athletes with no history of concussion, those who had sustained a concussion had memory and attention problems and had slower reaction times, researchers reported in the journal Brain.

"This study shows that the effects of sports concussions in early adulthood persist beyond 30 years post-concussion and that it can cause cognitive and motor function alterations as the athletes age," Louis De Beaumont of the University of Montreal, who led the study, said in a statement.

De Beaumont studied former university-level athletes aged 50 to 65, most of whom had played hockey. Nineteen had sustained a concussion more that 30 years prior; the remaining 21 had not. All were healthy and physically fit.

The former athletes answered questionnaires on their general health and took a battery of memory and attention tests. Those who remembered having had concussions did more poorly on the tests.

De Beaumont said the findings suggest "athletes should be better informed about the cumulative and persistent effects of sports concussion on mental and physical processes so that they know about the risks associated with returning to their sport."

Tuesday, January 27, 2009

$20 Million Settlement for VA Data Theft

By: Associated Press

The Veterans Affairs Department agreed Tuesday to pay $20 million to veterans for exposing them to possible identity theft in 2006 by losing their sensitive personal information.

In court filings Tuesday, lawyers for the VA and the veterans said they had reached agreement to settle a class-action lawsuit originally filed by five veterans groups alleging invasion of privacy. The money, which will come from the U.S. Treasury, will be used to pay veterans who can show they suffered actual harm, such as physical symptoms of emotional distress or expenses incurred for credit monitoring.

U.S. District Judge James Robertson in Washington must approve the terms of the settlement before it becomes final.

''This settlement means the VA is finally accepting full responsibility for a huge problem that continues to worry millions of veterans, retirees, service members and families,'' said Joe Davis, spokesman for Veterans of Foreign Wars, which was not involved in the lawsuit.

VA spokesman Phil Budahn said: ''We want to assure veterans there is no evidence that the information involved in this incident was used to harm a single veteran.''

The lawsuit came after a VA data analyst in 2006 admitted that he had lost a laptop and external drive containing the names, birth dates and Social Security numbers of up to 26.5 million veterans and active-duty troops.

The laptop was later recovered intact, but a blistering report by the VA inspector general faulted both the data analyst and his supervisors for putting veterans at unreasonable risk. The data analyst had lost the information when his suburban Maryland home was burglarized on May 3, 2006, after taking the data home without permission.

The VA employee promptly notified his superiors, but due to a series of delays, veterans were not told of the theft until nearly three weeks later, on May 22. Then-VA Secretary James Nicholson later said he was ''mad as hell'' that he wasn't immediately told about the burglary.

According to the proposed settlement, veterans who show harm from the data theft will be able to receive payments ranging from $75 to $1,500. If any of the $20 million is left over after making payments, the remainder would be donated to veterans' charities agreed to by the parties, such as the Fisher House Foundation Inc. and The Intrepid Fallen Heroes Fund.

Attorneys for the veterans groups said notices about the proposed settlement will be published in magazines and newspapers around the country, with a toll-free number and other contact information for veterans.

Five veterans groups filed a class-action lawsuit in June 2006 in U.S. District Court in Washington on behalf of all veterans, seeking $1,000 in damages for every veteran whose information was compromised in the computer theft.

''This is a very positive result,'' said Douglas J. Rosinski, an attorney representing the veterans groups. ''A lot of hard work went into finding a resolution that all the parties could be proud to say they were a part of bringing about.''

Smoking Worsens PTSD Symptoms

Half of those with disorder smoke, but nicotine may reinforce bad memories

By: Associated Press

Reaching for a cigarette to cope with a flashback is all too common among sufferers of post-traumatic stress disorder. The nicotine hit may feel good but scientists say its brain action probably makes their PTSD worse in the long run.

Here's the rub: At least half of PTSD sufferers smoke, and others wind up dependent on alcohol, anti-anxiety pills, sometimes even illegal drugs. Yet too few clinics treat both PTSD and addictions at the same time, despite evidence they should.

Now studies are recruiting PTSD patients — from New England drug-treatment centers to veterans clinics in North Carolina and Washington — to determine what combination care works.

"It's kind of a clinical myth that you can only do one at a time or should only do one at a time," says Duke University PTSD specialist Dr. Jean Beckham, a psychologist at the Durham, N.C., Veterans Affairs Medical Center. "Everybody's afraid to have their patients quit smoking because they're afraid they're going to get worse. There's not a lot of empirical data about that."

And her research on how to break the nicotine-and-PTSD cycle raises a provocative question for a tobacco-prone military: Are people at higher risk of developing PTSD if they smoke before they experience the violent event or episode?

High Rate of PTSD Among Returning Vets

Post-traumatic stress disorder — which can include flashbacks, debilitating anxiety, irritability and insomnia — is thought to affect nearly 8 million Americans at any given time. Anyone can develop it after a terrifying experience, from a mugging to a hurricane, a car crash to child abuse. But PTSD is getting renewed attention because so many veterans returning from combat in Iraq and Afghanistan seem vulnerable. A study last year by the RAND Corp. research organization estimated nearly 20 percent of them, or 300,000 people, have symptoms of PTSD or major depression.

What's less discussed is that patients often don't realize they might have PTSD and try to relieve symptoms by self-medicating with alcohol, tobacco and other substance use — worsening habits that existed before the trauma or starting anew.

Addiction itself is a mental health disorder that causes changes in some of the same brain areas disrupted by mood and anxiety disorders like PTSD, says a new report on the co-illnesses from the National Institute on Drug Abuse. That argues for simultaneous treatment. Indeed, up to 60 percent of people in addiction treatment are estimated to have PTSD — although they seldom acknowledge symptoms — and they're three times more likely than other patients to drop out.

A handful of studies suggest combo care helps. One example: VA researchers in Connecticut gave the alcoholism drugs naltrexone and disulfiram to PTSD patients, and watched not only their drinking ease but their PTSD symptoms improve, too.

Then there's nicotine. It temporarily enhances attention when it hits the brain — one reason that members of military tell the VA's Beckham they smoke. Although PTSD patients say a cigarette helps their mood when they're having symptoms, the extra attention may be reinforcing bad memories.

"If you think about your traumatic event and you smoke your cigarette, you can think about it even better," explains the VA's Beckham.

Yet the NIDA report found combination care rare, partly because of our specialty-driven health system.

Another big reason: "The majority of people with PTSD don't seek treatment," Dr. Mark McGovern of Dartmouth Medical School told a NIDA meeting this month that brought together military and civilian experts to jump-start research.

"People try to swallow it or take care of it on their own and it just kind of gets out of control," agrees Bryan Adams, 24, who is working with the Iraq and Afghanistan Veterans of America to raise PTSD awareness.

Adams, now a business major at Rutgers University, was awarded a Purple Heart after being shot when his Army patrol was ambushed in Iraq in 2004. Back home he handled restlessness and irritability with increasing alcohol use. Only when he got into college did a checkup lead to a PTSD diagnosis and therapy. He quit excessive drinking as the PTSD improved, despite no formal alcohol treatment.

The new studies may prompt more merging of care:
  • In Durham, Beckham is giving PTSD-suffering smokers either a nicotine patch or a dummy patch to wear for three weeks before they quit smoking. The theory: Steady nicotine release will blunt a cigarette's usually reinforcing hit to the brain, possibly helping both withdrawal symptoms and the intensity of PTSD symptoms.
  • In some New Hampshire and Vermont substance-abuse clinics, McGovern is randomly assigning patients to standard addiction-only care or cognitive behavioral therapy traditionally used for PTSD. A pilot study found the cognitive behavioral therapy improved both PTSD symptoms and substance use.
  • In Seattle, researchers at the VA Puget Sound Health Care System have PTSD therapists conducting smoking cessation therapy in the same visit. In a pilot study, those patients were five times more likely to quit cigarettes than PTSD patients sent to separate smoking programs.

Wednesday, January 21, 2009

Shinseki Sworn in as Secretary of the Deparment of Veterans Affairs

Retired Army Gen. Eric K. Shinseki took the oath of office today as the Nation's seventh Secretary of Veterans Affairs, assuming the leadership of the Department of Veterans Affairs following Tuesday's confirmation by the Senate.

"The overriding challenge I am addressing from my first day in office is to make the Department of Veterans Affairs a 21st century organization focused on the Nation's Veterans as its clients," Shinseki said.

Shinseki plans to develop a 2010 budget within his first 90 days that realizes the vision of President Obama to transform VA into an organization that is people-centric, results-driven and forward-looking.

Key issues on his agenda include smooth activation of an enhanced GI Bill education benefit that eligible Veterans can begin using next fall, streamlining the disability claims system, leveraging information technology to accelerate and modernize services, and opening VA's health care system to Veterans previously unable to enroll in it, while facilitating access for returning Iraq and Afghanistan Veterans.

Shinseki, a former Army Chief of Staff, takes the reins of a284,000-employee organization delivering health care and financial benefits to millions of Veterans and survivors under a $98 billion budget authorized this year through networks of regional benefits offices and health care facilities from coast to coast.

Born in 1942 on the island of Kauai, Hawaii, Shinseki graduated from the U.S. Military Academy at West Point, N.Y., in 1965. He served two combat tours and was wounded in action in Vietnam. He served with distinction in Europe, the Pacific and stateside, eventually becoming the Army's senior leader from June 1999 to June 2003.

Retired from military service in August 2003, Shinseki's military decorations include three Bronze Stars and two Purple Hearts.

Shinseki succeeds Dr. James B. Peake as Secretary of Veterans Affairs.

Tuesday, January 20, 2009

Shinseki Confirmed as New VA Secretary

By: Rick Maze
Staff Writer, Army Times


Retired Army Gen. Eric Shinseki was confirmed Tuesday to be secretary of veterans’ affairs in President Obama’s Cabinet.

The Senate confirmed Shinseki by voice vote and without debate just hours after Obama was sworn in as the 44th president. The Senate also approved the Cabinet appointments for the energy, education, interior, agriculture and education departments and Obama’s choice to head the White House Office of Management and Budget.

The nomination of Sen. Hillary Clinton, D-N.Y., to be Obama’s secretary of state will come to a vote in the Senate on Wednesday afternoon. The delay comes because some Republicans, especially Sen. John Cornyn of Texas, wanted a recorded vote on Clinton’s nomination instead of the voice votes allowed on the other cabinet posts.

No vote is required on Obama’s decision to keep Defense Secretary Robert Gates at the Pentagon.

Shinseki, who retired 2003 as Army chief of staff, takes over the Department of Veterans Affairs in the middle of an overhaul of the disability ratings system for ill and injured veterans and at a time when VA is being closely monitored on how it will handle the Aug. 1 effective date for the Post-9/11 GI Bill that promises to cover full tuition plus living and book allowances.

Tuesday, January 13, 2009

Ex-Army Officer, Suffering from PTSD, Not Guilty by Reason of Insanity

By: Tracey Kaplan, Mercury News

In a landmark case for veterans suffering from post-traumatic stress syndrome, a Santa Clara County jury Tuesday found a former Army captain diagnosed with PTSD not guilty by reason of insanity for robbing a Mountain View pharmacy of drugs at gunpoint.

Sargent Binkley, 34, faced a maximum of 22 years and eight months and a minimum of 12 years in state prison after the same jury convicted him last week of the 2006 robbery. He initially spent about two years in county jail awaiting trial and has been in a residential drug treatment program ever since.

The jury's verdict in the sanity phase of the trial Tuesday means Binkley could be treated for the syndrome in a state hospital or as an outpatient. He was taken into custody Tuesday to be evaluated.

"What this case means is that the jury stood behind a soldier,'' said Charles J. Smith, one of his attorneys. "We strongly believe that soldiers should get preferential treatment if they come back with problems after their service to our country.''

Binkley and his father, Edward, burst into tears when the verdict was announced.

"There was no reason this case should have ever gone to trial,'' Edward Binkley said, adding that his son turned himself in after committing a second robbery in San Mateo.

The prosecutor who tried the case, Deborah Medved, and a spokeswoman for the DA's office could not immediately be reached for comment.

Binkley graduated from West Point and served in Bosnia and Honduras before he received a general discharge in 2003. His defense attorneys argued that he became traumatized by two events — guarding a mass grave in Bosnia and shooting a teenager in a Honduran drug raid.

His father said he became addicted to morphine-based painkillers after dislocating his hip while running away from an alcohol-fueled fight in Honduras over a woman.

Tuesday, January 6, 2009

War Vets With Headaches Could Have Brain Problems

by: Tater Gunnerson, HealthDay

Headache frequency and severity caused by traumatic brain injury might signal cognitive deficits, suggests a new study of Iraq war veterans.

Traumatic brain injuries, also called concussions, are common among veterans who served in Iraq. And as deployment times have become longer, military personnel have more chances to be exposed to explosions that can cause injury.

"The most important finding was that the soldiers who continued to have problems with headaches and PTSD [post-traumatic stress disorder] were much more likely to have signs of residual cognition impairment or abnormalities," said study author Dr. Robert L. Ruff, professor of neurology at Case Western Reserve University and neurology service chief at the Louis Stokes Cleveland Veterans Affairs Medical Center. "By themselves, the deficits were not severe, but they compromised the veterans' ability to return to where they were."

The researchers studied 126 veterans who had lost consciousness from blasts and explosions an average of three times while in Iraq, none for more than 30 minutes. Neurological and neuropsychological testing revealed impairments in 80 of the veterans that the researchers attributed to concussions. Those veterans had been exposed to more explosions than the others, the study found.

Among veterans who had brain impairments, 93 percent reported having headaches, compared with 13 percent of those who showed no dysfunction on the neurological tests.

Their headaches also were more severe and persistent. Veterans with no brain impairments all described having tension-like headaches about four times a month, whereas 60 percent of those with brain impairments resulting from their concussions described migraine-like headaches that occurred an average of 12 times a month.

In addition to more frequent and severe headaches, many of the veterans also experienced other PTSD symptoms, including sleep disorders and problems with their sense of smell, the study found.

"The olfactory nerves are very small, so when there's movement, they get sheared off," said Keith Young, associate professor and vice chairman for research at Texas A&M Health Science Center College of Medicine in College Station, Texas, who also works with the VA Center of Excellence for Research on Returning War Veterans.

"People who have multiple exposures to blasts that cause loss of consciousness need to be carefully monitored for potential problems in the future," Young said.

And he believes the study, published in the latest issue of the Journal of Rehabilitation Research & Development, could lead to better methods to identify veterans who need more intensive treatment.

"The study points to the possibility of using olfactory testing to look for people who might benefit from additional medical testing," Young said. "The good news about these olfactory tests is that they don't require computers, so in a field hospital, you could use scratch and sniff tests to identify people who need additional testing."

The findings may lead not only to new diagnostic techniques but to different approaches for treating people with concussions, Ruff said.

"It suggests that the treatment for these people needs to be integrated," he said. "We need to treat not just head trauma or the PTSD but to treat them together."

Saturday, January 3, 2009

A Focus on Violence by Returning G.I.’s

By: Lizette Alvarez and Dan Frosch

For the past several years, as this Army installation in the foothills of the Rocky Mountains became a busy way station for soldiers cycling in and out of Iraq, the number of servicemen implicated in violent crimes has raised alarm.

Nine current or former members of Fort Carson’s Fourth Brigade Combat Team have killed someone or were charged with killings in the last three years after returning from Iraq. Five of the slayings took place last year alone. In addition, charges of domestic violence, rape and sexual assault have risen sharply.

Prodded by Senator Ken Salazar, Democrat of Colorado, the base commander began an investigation of the soldiers accused of homicide. An Army task force is reviewing their recruitment, medical and service records, as well as their personal histories, to determine if the military could have done something to prevent the violence. The inquiry was recently expanded to include other serious violent crimes.

Now the secretary of the Army, Pete Geren, says he is considering conducting an Army-wide review of all soldiers “involved in violent crimes since returning” from Iraq and Afghanistan, according to a letter sent to Mr. Salazar in December. Mr. Geren wrote that the Fort Carson task force had yet to find a specific factor underlying the killings, but that the inquiry was continuing.

Focusing attention on soldiers charged with killings is a shift for the military, which since the start of the war in Iraq has largely deflected any suggestion that combat could be a factor in violent behavior among some returning service members.

Maj. Gen. Mark Graham, the Fort Carson commander, said, “If they had a good manner of performance before they deployed, then they get back and they get into trouble, instead of saying we will discipline you for trouble, the leadership has to say, Why did that occur, what happened, what is causing this difference in behavior?”

General Graham, whose oldest son, Jeff, was killed by a roadside bomb in Iraq a year after another son, Kevin, committed suicide, has made mental health a focus since taking command of Fort Carson in 2007. “I feel like I have to speak out for the Kevins of the world,” he said.
The inquiry, the general added, is “looking for a trend, something that happened through their life cycle that might have contributed to this, something we could have seen coming.”

Last January, The New York Times published articles examining the cases of veterans of the wars in Iraq or Afghanistan charged with homicide after their return. At the time, it counted at least 121 such cases. In many of them, combat trauma and the stress of deployment appeared to have set the stage for the crimes.

At Fort Carson, at least four of the accused killers from the Fourth Brigade Combat Team, Fourth Infantry Division were grappling with post-traumatic stress disorder and several had been injured in battle.

One was John Needham, a 25-year-old private from a military family in California, whose downward spiral began when he sustained shrapnel wounds in Iraq and tried to commit suicide. This September, after being treated for stress disorder and receiving a medical discharge from the Army, Mr. Needham was charged with beating his girlfriend to death.

“Where is this aggression coming from?” asked Vivian H. Gembara, a former captain and Army prosecutor at Fort Carson until 2004, who wrote a book about the war crimes she prosecuted in Iraq. “Was it something in Iraq? Were they in a lot of heavy combat? If so, the command needs to pay more attention to that. You can’t just point all of them out as bad apples.”

The Fourth Combat Brigade, previously called the Second Combat Brigade, fought in Iraq’s fiercest cities at some of the toughest moments. Falluja and Ramadi, after insurgents dug into the rubble. Baghdad and its Sadr City district, as body counts soared. By 2007, after two tours, the brigade, which numbers 3,500, had lost 113 soldiers, with hundreds more wounded. It is now preparing for a tour in Afghanistan this spring.

Most Fort Carson soldiers have been to Iraq at least once; others have deployed two, three or four times.

Kaye Baron, a therapist in Colorado Springs who treats Fort Carson soldiers and families, said, “It got to the point I stopped asking if they have deployed, and started asking how many times they have deployed.”

Ms. Baron added, “There are some guys who say, ‘Why do I have to get treatment for P.T.S.D.? I just have to go back.’ ”

While most soldiers returning from war adjust with minor difficulties, military leaders acknowledges that multiple deployments strain soldiers and families, and can increase the likelihood of problems like excessive drinking, marital strife and post-traumatic stress disorder.
Domestic violence among Fort Carson soldiers has become more prevalent since the Iraq war began in 2003. In 2006, Fort Carson soldiers were charged in 57 cases of domestic violence, according to figures released by the base. As of mid-December, the number had grown to 145.
Rape and sexual assault cases against soldiers have also increased, from 10 in 2006 to 38 as of mid-December, the highest tally since the war began. Both domestic violence and rape are crimes that are traditionally underreported.

Fort Carson officials say the increased numbers do not necessarily indicate more violence. Karen Connelly, a Fort Carson spokeswoman, said the base, whose population fluctuates from 11,000 to 14,500 soldiers, is doing a better job of holding soldiers accountable for crimes, encouraging victims to come forward and keeping statistics.

Even so, Col. B. Shannon Davis, the base’s deputy commander, said the task force was examining these trends. “We are looking at crime as a whole,” he said.

The killings allegedly involving the nine current or former Fourth Brigade soldiers have caused the most consternation. The first occurred in 2005, when Stephen Sherwood, a musician who joined the Army for health benefits, returned from Iraq and fatally shot his wife and then himself.

Last year, three battlefield friends were charged with murder after two soldiers were found shot dead within four months of each other. Two of the accused suffered from post-traumatic stress disorder, and all three had been in disciplinary or criminal trouble in the military. One had a juvenile record and been injured in Iraq.

The latest killing was in October, when the police say Robert H. Marko, an infantryman, raped and killed Judilianna Lawrence, a developmentally disabled teenager he had met online. Specialist Marko believed that on his 21st birthday he would become the “Black Raptor” — half-man, half-dinosaur, a confidential Army document shows. The Army evaluated him three times for mental health problems but cleared him for combat each time.

Senator Salazar, President-elect Barack Obama's choice to be secretary of the interior, called for the Fort Carson inquiry, saying the killings raised questions about what role, if any, combat stress played.

“It’s a hard issue, but it’s a realistic issue,” he said.

Since arriving at Fort Carson, General Graham has spoken openly about mental health, particularly post-traumatic stress disorder, calling it an act of courage, not frailty, to ask for help.
His 21-year-old son, a top R.O.T.C. cadet, hanged himself in 2003 after battling depression. He had stopped taking his antidepressants because he did not want to disclose his illness, fearing such an admission would harm his chances for a career as an Army doctor, General Graham said.
“He was embarrassed,” the general said. He added: “I feel it every day. We didn’t give him all the care we should have. He got some care, but not enough. I’ll never be convinced I did enough for my son.”

At Fort Carson, in cases of dishonorable discharge, General Graham asks whether the soldier might be struggling with combat stress disorder. He has sometimes opted instead to grant medical discharges, which entitle veterans to benefits. All Fort Carson soldiers who seek medical attention are now asked about their mental health and, if necessary, referred for treatment.
Still, some sergeants view stress disorder skeptically and actively discourage treatment, some therapists and soldiers say.

Billie Gray, 71, who until recently worked at a base clinic helping soldiers with emotional problems, said “that was the biggest problem at Fort Carson today: harassment” and “the very fact they are harassed made their mental status worse.”

Ms. Gray said she believed she was fired in October for being an outspoken advocate for mental health treatment. Base officials declined to comment, citing privacy reasons.

Colonel Davis, the deputy commander, acknowledged that sergeants had been reprimanded for discouraging treatment. “We have had to take corrective action,” he said, “but fewer and fewer times.”

John Wylie Needham, one of the accused killers whose case is now being examined by the task force, was “cracking up” in Iraq, he told his father in an e-mail message. Yet, he felt he had to fight to get help, his father said in an interview.

In October 2006, during his first week in Iraq, Private Needham, a California surfer, watched a good friend die from a sniper bullet. Months later, he was blasted in the back by shrapnel from a grenade. To cope with his growing anxiety, he stole Valium and drank liquor. Caught twice, he was punished with a reduction in rank, a fine and extra work, a confidential Army document shows. Eventually, he was prescribed medication, but he wrote to his father, Mike Needham, that it did not help.

Private Needham became angry at the way other soldiers reacted to the fighting, and he did not hide it. “They seemed to revel in how many people they had killed,” said a friend in his unit who spoke on condition of anonymity.

In September 2007, Private Needham tried to kill himself with a gun, the Army document states, but another soldier intervened. Mike Needham, a veteran, said that rather than treating his son, the Army disciplined him for discharging a weapon and confined him to barracks. The Army declined to comment.

“I’m stressed to the point of completely losing it,” Private Needham wrote to his father in October 2007. “The squad leader brushed me off and said suck it up.”
He added, “They keep me locked up in this room and if I need food or water I have to have 2 guards with me.”

The Army evacuated Private Needham to Walter Reed Army Medical Center to treat his back and his post-traumatic stress disorder. But a month later, he was back at Fort Carson.

“The first words out of the Mental Health Authority was, ‘we are severely understaffed,’ ” Mr. Needham said in an e-mail message to an officer at Walter Reed. “If you’re suicidal we can see you twice a week, otherwise once a week.”

Fort Carson assured Mike Needham that his son was receiving proper care. But during his son’s visit home during the Thanksgiving break, Mr. Needham found him smearing camouflage-colored makeup on his face and frantically sharpening a stick with a kitchen knife.
“He was a total mess,” Mr. Needham said.

He was treated at a California naval hospital until last July when he received a medical discharge from the Army. While Private Needham was in the early stages of getting help from a Veterans Administration clinic, he spent his days depressed and often drinking at his father’s condominium.

Then last summer, Private Needham met Jacqwelyn Villagomez, a bubbly 19-year-old aspiring model who saw him as a kindred spirit, said Jennifer Johnson, who had helped raise her. Her mother had died of AIDS when she was 6 and her father had left the family. Ms. Villagomez, “who saw the good in everyone,” had recently kicked a heroin habit, Ms. Johnson said.

“She thought she could save him,” Ms. Johnson said. But a month later, the police say, Private Needham beat Ms. Villagomez to death in his father’s condominium.

Mr. Needham said the Army handled his son’s case poorly, but Ms. Johnson finds it hard to muster sympathy for him. “I’m sure what happened to him was awful,” she said. “I’m sure he saw some horrible things that altered him. But this is a 200-pound guy who beat up this 95-pound little girl. It’s disgusting.”