mainstream facts



Between 2001 and 2008, “approximately 1.64 million U.S. troops were deployed in support of operations in Afghanistan and Iraq.  Many have been exposed for prolonged periods to combat-related stress or traumatic events.  Safeguarding the mental health of these service-members and veterans is an important part of ensuring the future readiness of our military force and compensating and honoring those who have served our nation.  In the wake of recent reports and media attention, public concern about the care of the war wounded is high.  In response, several task forces, independent review groups, and a Presidential Commission have examined the care of the war wounded and recommended improvements.  Policy change and funding shifts are already underway.” (


However, the impetus for policy change has outpaced the knowledge needed to inform solutions.  Fundamental gaps remain in our understanding of the mental health and cognitive needs of U.S. service members returning from Afghanistan and Iraq, the costs of mental health and cognitive conditions, and the care system available to deliver treatment.” (


The Rand study “focused on three major conditions: post-traumatic stress disorder (PTSD), major depression, and traumatic brain injury (TBI).  Unlike physical wounds, these conditions affect mood, thoughts, and behavior often remain invisible to other service members, family, and society.  In addition, symptoms of these conditions, especially PTSD and depression, can have a delayed onset – appearing months after exposure to stress.” (


“The RAND study addressed questions in three areas: (

  • Prevalence: What are the rates of mental health and cognitive conditions that troops face when returning from deployment to Afghanistan and Iraq?
  • The Care System: What programs and services exist to meet the health care needs of returning troops with PTSD, major depression, or TBI? What are the gaps in programs and services? What steps can be taken to close the gaps?
  • Costs: What are the societal costs of these conditions?  How much would it cost to deliver high-quality care to all who need it?

“About 1/3 of returning service members report symptoms of a metal health or cognitive conditions.


The survey… drew from the population of all those who have been deployed for Operations Enduring Freedom and Iraqi Freedom, regardless of Service branch, component, or unit type.”


“Many services are available, but the care systems have gaps:

  • In recent years, the capacity of DOD and the VA to provided health services has increased substantially, particularly in the areas of mental health and TBI.  However, gaps in access and quality remain.  There is a large gap between the need for mental health services and the use of those services.”
  • “This pattern stems from structural factors, such as the availability of providers, as well as from personal, organizational, and cultural factors.  For example, military service members report barriers to seeking caret hat are associated with fears about the negative consequences of using mental health services… Survey results suggest that most of these concerns center on confidentiality and career issues, and so are particularly relevant for those on active duty.  Many felt that seeking mental health care might cause career prospects to suffer or coworkers’ trust to decline.”
  • However, the VA also faces changes in providing access to returning service members, who may face long wait times for appointments, particularly in facilities resourced primarily to meet the demands of older veterans.  Better projections of the amount and type of demand among the newer veterans are needed to ensure that the VA has appropriate resources to meet potential demand.
  • These access gaps translate into a substantial unmet need for care.  Our survey found that only 53% of returning troops who met criteria for PTSD or major depression sought help from a provider for these conditions in the past year.

Of those who had PTSD and also sought treatment, only slightly over half received a minimally adequate treatment (defined according to the duration and type of treatment received).

  • The number who received high-quality care (treatment supported by scientific evidence) would be even smaller.

Unless treated, PTSD, depression, and TBI can have far-reaching and damaging consequences.  Individuals afflicted with these conditions face higher risks for other psychological problems and for attempting suicide.

  • They have higher rates of unhealthy behaviors – such as smoking, overeating, and unsafe sex – and higher rates of physical health problems and mortality.
  • Individuals with these conditions also tend to miss more work or report being less productive.
    • These conditions can impair relationships, disrupt marriages, aggravate the difficulties of parenting, and cause problems in children that may extend the consequences of combat trauma across generations.
    • There is also a possible link between these conditions and homelessness:
      • The damaging consequences from lack of treatment or under-treatment suggest that those afflicted, as well as society at large, stand to gain substantially if more have access to effective care.
  • These consequences can have a high economic toll; however, most attempts to measure the costs of these conditions focus only on medical costs to the government.
    • Yet, direct costs of treatment are only a fraction of the total costs related to mental health and cognitive conditions.
      1. Far higher are the long-term individual and societal costs stemming from lost productivity, reduced quality of life, homelessness, domestic violence, the strain on families, and suicide.
        • Delivering effective care and restoring veterans to full mental health have the potential to reduce these longer-term costs significantly.
  • Therefore, it is important to consider the direct costs of care in the context of the long-term societal costs of providing inadequate care or no care.
    • The RAND study sought to measure the total costs to society by factoring in treatment costs, losses or gains in productivity, and the costs associated with suicide.

Estimates of the cost of PTSD and major depression for two years after deployment range from $5,900 to $25,760 per case:

  • Applying these per-case estimates to the proportion of the entire population of 1.64 million deployed service members who are currently suffering from PTSD or depression, RAND estimates that the total societal costs of these conditions range from $4.0 to $6.2 billion, depending on whether the costs of lives lost to suicide are included.