Mental health stigma is a silent killer. For some of our military service men and women, to suffer in silence is more palatable than to seek mental health services. As for those of us who have never served, it’s difficult to imagine the physical, emotional and mental trauma of combat. To put mental health stigma into perspective, our service men and women courageously risk life and limb overseas. Afterwards, some return home unable to cope with the ravages of war – yet fear the repercussions of asking for help.

Joanna Gallup Eldridge knows this story well. Her husband, Justin, shot himself. “He just couldn’t take the pain anymore,” she told NPR in an interview. “He just wanted to have peace. He didn’t want to see it or feel it anymore.”

According to the National Center for Post-Traumatic Stress Disorder (PTSD), almost all soldiers will have stress reactions after returning from a war zone. These reactions are normal during the first few weeks. Research following conflicts in Afghanistan and Iraq indicate that 11 to 20 percent of veterans developed PTSD.

“PTSD depends on many factors, such as the severity of the trauma, injury, death of comrades, inability to control circumstances and the level of support following the event,” said Theresa Presley, LCSW, LSCW, RPT-S, CTS, who practices at Heartland Play Therapy Institute. “No one comes home from war unchanged. But with early screenings and access to mental health care, the effects of combat are treatable.”

As for Eldridge, the widow said her husband didn’t talk about his deployment. Instead, he said he’d take the awful memories to his grave. The signs before his death were telling. Eldridge said her husband was on edge, depressed and angry. He also suffered with bouts of insomnia, and when he could sleep, nightmares “plagued” him.

Presley said while stress reactions are normal during the first few weeks of returning home, if reactions are causing significant distress or relationship troubles, impacting functioning at work, at school or in the community, or if the individual is contemplating hurting himself or others, it’s time to seek help.

“It was always unstable at home with his moods and behavior,” Eldridge said, adding that her husband also used drugs and alcohol to cope. He later went to rehab and got the help he needed. Missing the military, he re-enlisted in the Marine Reserves in 2008. He continued to struggle emotionally, and after his first suicide attempt, he was admitted to a hospital, but it wasn’t equipped to handle PTSD.

“The majority of our troops that have been in war zones are serving through the National Guard and Reserve units,” Presley said. “This is important because active duty troops return to a base where others share similar experiences. Guard and Reserve units return back to their hometowns where others cannot relate to their military experience. This creates isolation and friction with families and employers. They return home to no support networks and a fragmented health care system that they try to navigate via the Internet.”

Presley said the consequences sometimes include unemployment, substance abuse, depression and suicide.

“Access to ongoing mental health services is going to require policies to encourage more service members and veterans to seek needed care,” she said. “Many who need care are reluctant to seek it. Service members and veterans need ways to obtain confidential services without fear of adverse consequences. Delivering evidence-based care has to happen in [all] settings. Providers in every setting need to be trained in evidence-based care. Civilian providers need to be trained in these practices to best serve military members and veterans.”

Kim Ruocco directs suicide prevention programs for an initiative called Tragedy Assistance Programs for Survivors, or TAPS. Her husband, a Marine helicopter pilot, killed himself in 2005. “A lot of their self-worth, a lot of their identity is tied around being a member of the military,” she told NPR. “So taking that issue – the illness, the injury – and then the fact that they have this culture that sees help-seeking as a weakness instead of something that’s a strength…it’s a dangerous combination.”

The Veterans Administration recently hired 800 additional mental health workers. For many veteran families, this is great news. For others, it’s too little, too late.

“Part of me is angry with Justin,” Eldridge said. “And as irrational as it may be, I am angry that he left me and my children. I’m also happy that he is at peace, and that he’s not suffering.”

Homeless Veterans

According to the National Coalition of Homeless Veterans, about 13 percent of the adult homeless population are veterans. That is an estimated 57,849 homeless veterans on any given night.

Presley said mental health issues complicate and contribute to homelessness, which is compounded by a lack of family and social support networks.

She said the steps needed to reduce the number of homeless military members include: help for veterans transitioning back into the civilian workforce, more workforce programs, improved services for homeless veterans, increased access to health care, assurance that veterans receive the benefits they earned, and improved social and community connectedness. “As a community, we need to wrap our arms around our military heroes to ensure they don’t suffer alone and in silence,” Presley said.