COLUMBIA — Specialist Michael Cookson, 22, describes his deployment to Afghanistan as terrible. Most days, he said, he feared for his life.
Cookson was with the 101st Airborne Division in the Army, stationed in the rugged Kunar Province on the Pakistan border where heavy fighting was common. He lost fellow soldiers at a base in the Pech River Valley.
"We were the people you didn’t want to be, but we were the people that you wanted there," he said.
When it was time to come home, he recalled an initial period of elation at the prospect of seeing friends and family and returning to civilian life. But ultimately, serving in a brutal war zone for 12 months took its toll.
After a few months in the States, Cookson found himself struggling with depression, anxiety and occasional thoughts of suicide. He found help at the veterans hospital in Columbia.
He remembers it as a positive experience: "They gave me a time period where I could just cool down and get my thoughts straight."
Many soldiers in a war zone face the constant threat of danger and see firsthand how combat can mangle and kill. For some, the battle isn't over when they get home, even though mental wounds aren't as noticeable as physical wounds.
For the past seven years, there has been a steady climb in the suicide rate for active-duty Army soldiers.
In 2010, the rate went from 21.8 deaths per 100,000 in 2010 to a projected 24.1 per 100,000 in 2011, according to the Army report "Generating Health & Discipline in the Force," released Jan. 19.
The report also showed that last year, active-duty soldiers in the National Guard and Army Reserve had about six times the suicide rates of civilians. The report suggests stressors are related to combat, the poor job economy at home, deteriorating relationships and behavioral health issues.
Coming home after battle
Cookson was assigned to patrols in the mountains where he encountered "firefights" — sustained gunfire — every day. He said he often couldn't tell exactly where the gunfire was coming from, but he knew when to find cover.
"(Firefights) can last for several seconds or several minutes," he said. "They never last very long, but it's a long time when you have bullets whizzing by you."
After surviving that kind of anxiety for a year, coming home presented a wave of conflicting emotions for Cookson.
"It's kind of surreal. ... Your whole perception of the world is different," he said, "(One moment) I was living in the barracks, and then I was living with a roommate at Fort Campbell."
His first stop after he returned was Fort Campbell, Ky., a military base where he went through the official process of re-entry. The process includes updating personal files and completing medical check-ups, some targeting mental health matters.
Because he was still in a state of elation about being home, he didn't yet sense the depression.
In January, when Cookson moved to Columbia to start his first semester at MU, it had set in. He decided to seek help at Harry S. Truman Memorial Veterans Hospital.
No cellphones were allowed, and hospital personnel helped him find a place for his cat, Chip, while he was away. They also called a professor about an exam Cookson was going to miss.
It's been a month and a half since Cookson checked out of the hospital. Since then, he said he has gotten better but isn't "quite over the hill yet."
Addressing the issues
To address the mental health needs of returning soldiers like Cookson, the military has adopted a number of strategies.
These include local support groups, crisis hotlines, VA medical centers and transition assistance programs that help soldiers find employment. There are also specific therapy programs, including individual therapy and group therapy, to help cope with post-traumatic stress disorder.
Cheryl Hemme has worked as a doctor in behavioral health services at the Truman Veterans Hospital for nine and a half years and sees combat veterans daily. She hears many similar concerns from her patients.
"It's almost as if, you're in your life, and you went away," Hemme said. She said that the patients are physically present but mentally they are not there.
"'It's as if I'm watching my life and it's not me,'" many patients have told her.
When soldiers come back, they expect everything to pick right up again, she said. But very little remains the same.
"Everything seems to have shifted," she said; their world is not as they left it, and they feel disconnected and at odds with everyone.
Hemme said they might ask: "How do I fit into my life again? My children's lives again? My family life again?"
The veterans hospital provides plenty of preventative measures to help soldiers adjust, she said.
Hospital resources include a list of warning signs for friends and family as well as information about the Veterans Crisis Line for emergencies.
"Just getting past the hurdle of seeing a mental health provider is huge," Hemme said. "Once you do that, there's a lot we can do."
Stephen Gaither, public affairs officer for the hospital, said soldiers must be military veterans to be admitted. Active-duty soldiers at a designated military base will have access to psychologists and other mental health programs, he said.
Still, the veterans hospital comes in contact with veterans and active-duty soldiers because emotional trauma from a deployment affects them both.
The veterans hospital will see active-duty soldiers if they use TriCare military insurance, but visits are limited. Hospital staff will find resources elsewhere for soldiers who aren't eligible.
Gaither said he believes the hospital does as much as possible for veterans who might be suffering, but some might refuse help or don't want access to it.
These soldiers might be reluctant to seek treatment if they think it will have a negative impact on their careers. Cookson said a friend from his platoon hasn't sought help because he wants to attain a leadership position.
"People don’t always want to go for help," Cookson said. "Sometimes you can be penalized for it. You wouldn't want someone in a leadership position if they weren't stable of mind."
The National Guard encourages all service members who are having problems to seek help when they can, said Maj. Douglas Frank, who directs the National Guard's Yellow Ribbon Reintegration Program, which works with military families before and after deployment.
"It's a common and unfortunate misconception that seeking help would hold back a soldier's career," Frank said.
The Guard encourages soldiers to seek help, he said, although avoiding help "is more common than we would like."
"If they need assistance, all they need to do is ask for it," he said.
Sensitive topics are not to be reported to the chain of command in order to protect a soldier's career, said 2nd Lt. Terrence Selvy, a Yellow Ribbon specialist with the Guard.
Frank said the National Guard will continue doing everything it can to reach out to service members and provide them care.
"Having served their state and their country," he said, "they deserve nothing less."
Changing the stigma
Heather Paxton, 30, served as an E4 Specialist in the northern region of Iraq in 2003.
After flashbacks, nightmares, panic attacks and feeling constant vigilance in certain situations, she started a therapy program a year ago to help cope with her post-traumatic stress disorder.
"It's not that I would have (committed suicide), but I did think about it," Paxton said.
Therapy includes talking about "stuck points," or particularly traumatic moments she often recalls. It is aimed at changing patterns of behavior and thought related to those stuck points, she said.
"I had to write down everything. What I felt that day (of the stuck point), what I smelled. Then I had to read that every morning and night," Paxton said. "It desensitizes you."
Now she works as supervisor of patient benefits at the veterans hospital. She believes services have "improved tenfold" since she came home.
"I think (the veterans hospital) has really done a great job of providing every resource now," she said. "We're giving them suicide prevention phone lines; they can go online. There's PTSD apps for their smartphones now."
Paxton said, "There's 24/7 help. They just have to reach out and ask for it. Hey, if your buddy's acting a certain way, call this number. Let us go check on them and make sure they're OK."
Still, some soldiers and veterans must fight the stigma of mental health. Paxton said it's important to put that aside and get help.
"There's still that perception of behavioral health as a bad thing," he said. "If you take care of it now, it's not going to harm your family or relationships in the future."
Cookson said he is grateful for his stay at the veterans hospital. Now, if necessary, he knows where to go for help.
"Living here, I have a giant 'VA' sign that I see on campus, so I know I can always find help."