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It is notable that the Army only began keeping records on suicides in 1980, a policy likely fueled by the cascade of attempted and successful suicides by Vietnam veterans. In 1983, with the introduction of the diagnosis of Post Traumatic Stress Disorder (PTSD) in the American Psychiatric Association’s Diagnostic & Statistical Manual, the military and VA began, finally, to acknowledge the debilitating effects of this combat-related trauma reaction. Increased risk of suicide is among the many symptoms of the half-million Vietnam veterans diagnosed with chronic PTSD. Using the most conservative estimates, there may be as many as 75,000 active duty military or recently discharged veterans with PTSD or significant symptoms of PTSD, according to psychologist Alan Peterson of the University of Texas. Peterson is a researcher with a multidisciplinary consortium recently awarded a $25 million Department of Defense grant to study behavioral treatments for PTSD.To date, there has been no comprehensive epidemiological study on military suicides resulting from PTSD. In 1988, however, the Centers for Disease Control presented congressional testimony, confirming 9,000 suicides among Vietnam combat veterans.

According to figures obtained by the Associated Press, there has been a steady increase in suicides since 2003, totaling 450 active duty soldiers, with the highest numbers occurring in the past year. Military suicides vary considerably between branches of the service, with the Army and Marine Corps frequently reaching the highest annual rates. Longer and more frequent deployments and the primacy of ground combat operations are factors often blamed for the Army’s higher rates of physical injury, mental illness and suicide. In October 2008, the Army announced a five-year, $50 million collaborative study with the National Institute of Mental Health to address suicide. In a rare public admission of the urgency of the problem, Dr. S. Ward Cassells, assistant secretary of defense for health affairs, stated in the New York Times, “We’ve reached a point where we do need some outside help.” Such efforts are encouraging but will yield little immediate assistance to active duty soldiers, returning veterans and their families.

The Saturday program speakers include Ilona Meagher, author of "Moving a Nation to Care: Post Traumatic Stress Disorder & America's returning Troops," Sue Lynch from There and Back Again Yoga, Judy Barrett Litoff, PhD, from Bryant University and Cheryl Baxa Ph.D. of the Natick Soldier Center.

The few veterans courts in the nation are modeled on drug courts that allow defendants to avoid prison in exchange for strict monitoring. Most are only a couple of months old and it is difficult to track their effectiveness, but the results from the first court, which opened in Buffalo, N.Y., in January 2008, are striking. Of the more than 100 veterans who have passed through that court, only two had to be returned to the traditional criminal court system because they could not shake narcotics or criminal behavior, said Judge Robert Russell - a far lower rate of recidivism than in drug courts. "It's the right thing to do for those who have made a number of sacrifices for us," Russell said. "If they've been damaged and injured in the course of their service . . . and we can help them become stable, we must." There are no comprehensive statistics on how often veterans get in trouble with the law, and the majority never become entangled with the legal system. But psychiatrists and law enforcement officials agree that the traumas of combat can lead to addiction and criminality. Studies have shown that as many as half of the troops returning from Iraq and Afghanistan suffer post-traumatic stress and other disorders, and mental health is the second-most-treated ailment for returning veterans in the Department of Veterans Affairs system.

Since Russell's court started, veterans courts have opened in Orange and Santa Clara counties in California; Tulsa; and Anchorage, Alaska. Pittsburgh, southern Wisconsin, Phoenix and Colorado Springs, Colo., are opening or considering new courts this year. Some in Congress have proposed a federal program to help spread veterans courts across the country. Most veterans courts admit only nonviolent felony offenders, though some include violent crimes. Defendants are required to plead guilty to their crimes. In exchange for a suspended sentence that can include prison time, they must consent to regular court visits, counseling and random drug testing. Should they waver from the straight and narrow, their sentences go into effect. Orange County, Calif., Superior Court Judge Wendy Lindley started her veterans court in November after a young Iraq war veteran on her docket died of a drug overdose. "It was horrible," she said. As in most of the nation's nascent veterans courts, many of the defendants in Lindley's court fought in the Vietnam or Persian Gulf wars. But she has seen a few Iraq war veterans, all of whom had clean histories before joining the military but started getting into trouble after they returned.

I was in Iraq in 2004. From the day we had arrived home to the day we were scheduled to return to Iraq was exactly nine months. The pressure to prepare ourselves quickly was intense. When the first Marine came to my office and asked to see the psychiatrist about some troubling issues from our time in Iraq, I was sympathetic. I said, "No problem." When another half dozen or so Marines approached me with the same request, I was only somewhat concerned.But when all of them and several more returned from their appointments with recommendations for discharge, I'll admit I was alarmed. Suddenly I was not as concerned about their mental health as I was about my company's troop strength.

As all those Marines in my company began filtering out, some from essential positions, I started to worry about the welfare of those remaining. I worried, quite naturally, that if the exodus continued, we might not have enough to accomplish our mission or to survive on the battlefield. My sympathies for those individuals claiming post-traumatic stress began to wane. A commander cannot serve in earnest both the mission and the psychologically wounded. When the two come in conflict, as they routinely do as a result of repeated deployments, the commander will feel an internal and institutional pressure to maintain the integrity of his unit. I did. And there begins a grassroots, albeit subconscious, resistance to Mullen's plan to destigmatize the people who seek help. Because as much as I cared about my Marines, it was difficult to look upon those who sought to leave without suspicion or even mild contempt.

Where psychological and traumatic brain injuries can still, to some extent, be doubted and debated, and when their treatment stands in opposition to troop strength and to mission accomplishment, the needs of those wounded service members will be subordinated.The result by necessity, which we are already witnessing today, will be dubious treatment protocols within the military aimed at retention, diagnosed soldiers returning to the battlefield, and a slowly diminished emphasis on screening. It will happen. It has begun already. There will be no policy shift. There will be no change in the language we hear from our leaders. But we will know all too well that our soldiers are still not being properly treated by the ever-increasing number of suicides that occur.