R
Roger
Guest
July 4, 2007
After Iraq, Contractors Face Mental Health Issues
By JAMES RISEN
WASHINGTON, July 4 - Contractors who have worked in Iraq are returning home
with the same kinds of combat-related mental health problems that afflict
American military personnel, according to contractors, industry officials
and mental health experts.
But, they say, the private workers, who may number in the thousands, are
largely left on their own to find care, and their problems often go ignored
or are inadequately treated.
A vast army of contractors - up to 126,000 Americans, Iraqis and other
foreigners - is working for the United States government in Iraq. Many work
side-by-side with soldiers and are exposed to the same dangers, but mostly
they must fend for themselves in navigating the civilian health system when
they come back to the United States.
With no widespread screening, many workers are not identified as suffering
from post-traumatic stress disorder or other problems, mental health experts
and contractors say. And, they add, the quality of treatment for other
problems can vary widely because of limited civilian expertise in
combat-related disorders.
Only a few mental health professionals have focused on the issue, but they
warn that the number of contractors leaving Iraq with mental health problems
is large and growing.
"I think the numbers are in the thousands, maybe tens of thousands," said
Paul Brand, a psychologist and chief executive of Mission Critical
Psychological Services, a Chicago firm hired by Dyncorp International, a
major contractor in Iraq, to assess and treat its workers. "Many are going
undiagnosed. These guys are fighting demons, and they don't know how to
cope."
Jana Crowder, who runs a Web site for contractors seeking help, says she
gets new evidence of that every day in phone calls from desperate workers.
"In the first few years of the war, we were seeing a few trickle in," said
Ms. Crowder, of Knoxville, Tenn. " Now, as contractors start coming home,
you are starting to see a lot more."
Workers tell haunting tales of their psychological torment. Tate Mallory, a
police officer from South Dakota who worked as a Dyncorp police trainer, was
grievously wounded by a rocket-powered grenade last fall. After returning
home, he was so mentally scarred that he begged his brother to kill him.
Kenneth Allen, a 70-year-old truck driver from Georgia whose convoy was
ambushed in Iraq, says he endures mood swings, jittery nerves and is often
awake all night. And Nathaniel Anderson, a Texan whose truck was hit by
rockets while hauling jet fuel, lost a contractor friend to suicide. Though
suffering from stress-related symptoms himself, he has yet to see a doctor.
The toll of the war on contractors has largely been hidden from public view.
About 1,000 have died since the conflict began, and nearly 13,000 have been
injured. While some are well compensated, many more collect modest wages for
providing support services that are vital to the military.
The federal government, which has paid billions of dollars to corporations
for services in Iraq since the war began, has not examined the issue of
mental health problems among private workers, according to Pentagon and
Veterans Affairs officials. "To my knowledge, it has not been looked at
systematically," said Dr. Matthew Friedman, a Veterans Affairs official who
heads the national center for post-traumatic stress syndrome.
Contract workers who are wounded or disabled in the war zone are treated in
military hospitals in Iraq and Germany, but once home, they are not eligible
for care in the military or Veteran's Affairs system. And unlike troops,
they are not routinely evaluated for mental or stress disorders after their
tours. When soldiers and veterans complained in recent months of lapses in
their care, top officials in Washington promised improvements, but the
plight of troubled civilian workers has not captured such attention.
Many companies conduct pre-deployment psychological screening and offer
limited counseling but provide few resources when their workers return home
and often go off the payroll.
Employers are required by federal law to provide medical insurance for
workers in a war zone. Workers have filed about 205 claims for treatment of
post-traumatic stress disorder, or PTSD, according to the Department of
Labor, which monitors the data. Industry officials say that number
significantly underrepresents the problem because many troubled people do
not file claims.
Of those who do, many have been denied coverage and filed lawsuits. Gary
Pitts, a Houston-based lawyer, says insurers have challenged almost every
claim filed by about 50 clients, even though the insurance companies paid
for medical care involving their physical injuries.
"The contrast between the way the military and the civilian contractors are
handled on PTSD is like night and day," said Mr. Pitts. "The contractors
have to figure it out on their own, and they often have to litigate it with
the insurance company."
The insurance problems may be partly related to the dearth of civilian
mental health professionals equipped to deal with combat related-stress,
according to Mr. Brand, the Dyncorp psychologist, and Dr. Spencer Eth, who
helped write the treatment guidelines for post-traumatic stress syndrome for
the American Psychiatric Association.
"The availability of mental health care providers with specific expertise in
this is scant around the country," said Dr. Eth, a New York psychiatrist.
"You have problems of access to care, financial obstacles to care, and so
most of these people are not going to get the help they need."
AIG, the giant insurance company that provides coverage for several of the
largest contractors in Iraq, has paid about half of claims involving PTSD ,
according to Chris Winans, an AIG spokesman. But many of the others are
delayed or challenged because the insurers' medical experts disagree with
the diagnoses, he said.
Mr. Pitts, the lawyer, said many contractors live in small towns or rural
areas without access to high-quality mental health workers. But even when he
has sent clients to respected psychiatrists or psychologists to confirm the
diagnoses, AIG still often contests the claim, he said. Dyncorp, a
Texas-based firm which has a State Department contract to train the Iraqi
police, is sponsoring its first conference this week on post-traumatic
stress for ex-employees. The company is also treating workers in Iraq after
bringing in Mr. Brand's firm to determine the extent of problems.
Twenty-four percent of the Dyncorp police trainers showed symptoms of
post-traumatic stress disorder after their deployment, Mr. Brand said. He
and others say they know of no other studies that formally assess the
problem among private workers in Iraq.
Those findings parallel an Army study earlier this year that about 17
percent of personnel in Army combat units in Iraq showed symptoms of PTSD
one year after their deployment, according to Dr. Charles Hoge, chief of
psychiatry at the Army's Walter Reed Institute for Research.
If marital problems, alcohol abuse and other adjustment problems are
counted, the number rises to 30 to 35 percent, according to Col. Elspeth C.
Ritchie, a psychiatric consultant to the Army surgeon general.
Last October, Tate Mallory, the police officer from South Dakota, was riding
in a Humvee in Iraq's Anbar Province when a rocket-propelled grenade snaked
into the vehicle, hit him in the lower back and went through his abdomen
before exiting his inner thigh. Miraculously, the rocket did not explode,
and quick-acting Marines rushed him to a combat hospital.
After intensive medical care in Iraq, Germany and finally back in Sioux
Falls, Mr. Mallory left the hospital in December and went to live with his
brother in the Black Hills in Belle Fourche, S.D.
Though his physical injuries were healing, Mr. Mallory's psychological
wounds were left untreated. He isolated himself and turned against family
members, including his sister. "I called her up and just screamed, you are
dead to me," he recalls, now deeply embarrassed.
He hit bottom one day in January, when he asked his brother to kill him.
Brad Mallory, 45, recalls how frightening that was. "What I saw was how
hollow his eyes were," he said of his brother. "I'm a hunter, and to me, it
was like when you come up on your deer, when you didn't get a clean kill,
and they just want it to be over. "
He drove his brother to a local hospital emergency room, but the doctors
were suspicious that his brother was faking symptoms to obtain painkillers.
Eventually, Tate Mallory said, he was put on anti-depressants and began to
see a psychiatrist in Sioux Falls.
Mr. Anderson, the Texan truck driver who worked for KBR in Iraq, has yet to
find relief. He said combat-related stress is a constant among truck drivers
in Iraq.
"Just about all the drivers got it and don't realize it when they fly off
the handle," he said. Now that he is home near Houston, the 52-year-old man
has difficulty eating and sleeping. He has not sought treatment for what he
believes are stress-related problems and instead sounds resigned.
"It just goes through your mind over and over and over," he said, "all the
stuff you've been through. I dream about it half the night and during the
day."
http://www.nytimes.com/2007/07/04/health/psychology/04cnd-contractors.html?_r=1&hp&oref=slogin
After Iraq, Contractors Face Mental Health Issues
By JAMES RISEN
WASHINGTON, July 4 - Contractors who have worked in Iraq are returning home
with the same kinds of combat-related mental health problems that afflict
American military personnel, according to contractors, industry officials
and mental health experts.
But, they say, the private workers, who may number in the thousands, are
largely left on their own to find care, and their problems often go ignored
or are inadequately treated.
A vast army of contractors - up to 126,000 Americans, Iraqis and other
foreigners - is working for the United States government in Iraq. Many work
side-by-side with soldiers and are exposed to the same dangers, but mostly
they must fend for themselves in navigating the civilian health system when
they come back to the United States.
With no widespread screening, many workers are not identified as suffering
from post-traumatic stress disorder or other problems, mental health experts
and contractors say. And, they add, the quality of treatment for other
problems can vary widely because of limited civilian expertise in
combat-related disorders.
Only a few mental health professionals have focused on the issue, but they
warn that the number of contractors leaving Iraq with mental health problems
is large and growing.
"I think the numbers are in the thousands, maybe tens of thousands," said
Paul Brand, a psychologist and chief executive of Mission Critical
Psychological Services, a Chicago firm hired by Dyncorp International, a
major contractor in Iraq, to assess and treat its workers. "Many are going
undiagnosed. These guys are fighting demons, and they don't know how to
cope."
Jana Crowder, who runs a Web site for contractors seeking help, says she
gets new evidence of that every day in phone calls from desperate workers.
"In the first few years of the war, we were seeing a few trickle in," said
Ms. Crowder, of Knoxville, Tenn. " Now, as contractors start coming home,
you are starting to see a lot more."
Workers tell haunting tales of their psychological torment. Tate Mallory, a
police officer from South Dakota who worked as a Dyncorp police trainer, was
grievously wounded by a rocket-powered grenade last fall. After returning
home, he was so mentally scarred that he begged his brother to kill him.
Kenneth Allen, a 70-year-old truck driver from Georgia whose convoy was
ambushed in Iraq, says he endures mood swings, jittery nerves and is often
awake all night. And Nathaniel Anderson, a Texan whose truck was hit by
rockets while hauling jet fuel, lost a contractor friend to suicide. Though
suffering from stress-related symptoms himself, he has yet to see a doctor.
The toll of the war on contractors has largely been hidden from public view.
About 1,000 have died since the conflict began, and nearly 13,000 have been
injured. While some are well compensated, many more collect modest wages for
providing support services that are vital to the military.
The federal government, which has paid billions of dollars to corporations
for services in Iraq since the war began, has not examined the issue of
mental health problems among private workers, according to Pentagon and
Veterans Affairs officials. "To my knowledge, it has not been looked at
systematically," said Dr. Matthew Friedman, a Veterans Affairs official who
heads the national center for post-traumatic stress syndrome.
Contract workers who are wounded or disabled in the war zone are treated in
military hospitals in Iraq and Germany, but once home, they are not eligible
for care in the military or Veteran's Affairs system. And unlike troops,
they are not routinely evaluated for mental or stress disorders after their
tours. When soldiers and veterans complained in recent months of lapses in
their care, top officials in Washington promised improvements, but the
plight of troubled civilian workers has not captured such attention.
Many companies conduct pre-deployment psychological screening and offer
limited counseling but provide few resources when their workers return home
and often go off the payroll.
Employers are required by federal law to provide medical insurance for
workers in a war zone. Workers have filed about 205 claims for treatment of
post-traumatic stress disorder, or PTSD, according to the Department of
Labor, which monitors the data. Industry officials say that number
significantly underrepresents the problem because many troubled people do
not file claims.
Of those who do, many have been denied coverage and filed lawsuits. Gary
Pitts, a Houston-based lawyer, says insurers have challenged almost every
claim filed by about 50 clients, even though the insurance companies paid
for medical care involving their physical injuries.
"The contrast between the way the military and the civilian contractors are
handled on PTSD is like night and day," said Mr. Pitts. "The contractors
have to figure it out on their own, and they often have to litigate it with
the insurance company."
The insurance problems may be partly related to the dearth of civilian
mental health professionals equipped to deal with combat related-stress,
according to Mr. Brand, the Dyncorp psychologist, and Dr. Spencer Eth, who
helped write the treatment guidelines for post-traumatic stress syndrome for
the American Psychiatric Association.
"The availability of mental health care providers with specific expertise in
this is scant around the country," said Dr. Eth, a New York psychiatrist.
"You have problems of access to care, financial obstacles to care, and so
most of these people are not going to get the help they need."
AIG, the giant insurance company that provides coverage for several of the
largest contractors in Iraq, has paid about half of claims involving PTSD ,
according to Chris Winans, an AIG spokesman. But many of the others are
delayed or challenged because the insurers' medical experts disagree with
the diagnoses, he said.
Mr. Pitts, the lawyer, said many contractors live in small towns or rural
areas without access to high-quality mental health workers. But even when he
has sent clients to respected psychiatrists or psychologists to confirm the
diagnoses, AIG still often contests the claim, he said. Dyncorp, a
Texas-based firm which has a State Department contract to train the Iraqi
police, is sponsoring its first conference this week on post-traumatic
stress for ex-employees. The company is also treating workers in Iraq after
bringing in Mr. Brand's firm to determine the extent of problems.
Twenty-four percent of the Dyncorp police trainers showed symptoms of
post-traumatic stress disorder after their deployment, Mr. Brand said. He
and others say they know of no other studies that formally assess the
problem among private workers in Iraq.
Those findings parallel an Army study earlier this year that about 17
percent of personnel in Army combat units in Iraq showed symptoms of PTSD
one year after their deployment, according to Dr. Charles Hoge, chief of
psychiatry at the Army's Walter Reed Institute for Research.
If marital problems, alcohol abuse and other adjustment problems are
counted, the number rises to 30 to 35 percent, according to Col. Elspeth C.
Ritchie, a psychiatric consultant to the Army surgeon general.
Last October, Tate Mallory, the police officer from South Dakota, was riding
in a Humvee in Iraq's Anbar Province when a rocket-propelled grenade snaked
into the vehicle, hit him in the lower back and went through his abdomen
before exiting his inner thigh. Miraculously, the rocket did not explode,
and quick-acting Marines rushed him to a combat hospital.
After intensive medical care in Iraq, Germany and finally back in Sioux
Falls, Mr. Mallory left the hospital in December and went to live with his
brother in the Black Hills in Belle Fourche, S.D.
Though his physical injuries were healing, Mr. Mallory's psychological
wounds were left untreated. He isolated himself and turned against family
members, including his sister. "I called her up and just screamed, you are
dead to me," he recalls, now deeply embarrassed.
He hit bottom one day in January, when he asked his brother to kill him.
Brad Mallory, 45, recalls how frightening that was. "What I saw was how
hollow his eyes were," he said of his brother. "I'm a hunter, and to me, it
was like when you come up on your deer, when you didn't get a clean kill,
and they just want it to be over. "
He drove his brother to a local hospital emergency room, but the doctors
were suspicious that his brother was faking symptoms to obtain painkillers.
Eventually, Tate Mallory said, he was put on anti-depressants and began to
see a psychiatrist in Sioux Falls.
Mr. Anderson, the Texan truck driver who worked for KBR in Iraq, has yet to
find relief. He said combat-related stress is a constant among truck drivers
in Iraq.
"Just about all the drivers got it and don't realize it when they fly off
the handle," he said. Now that he is home near Houston, the 52-year-old man
has difficulty eating and sleeping. He has not sought treatment for what he
believes are stress-related problems and instead sounds resigned.
"It just goes through your mind over and over and over," he said, "all the
stuff you've been through. I dream about it half the night and during the
day."
http://www.nytimes.com/2007/07/04/health/psychology/04cnd-contractors.html?_r=1&hp&oref=slogin
