Many have been involved in heavy combat, witnessing death and injury firsthand.
Soon they will come home, where life is relatively normal by the standards of American masses. They will be thrust back into the lives they left behind as fast as they were thrust into combat.
Kym Owens, a Fort Campbell spouse of more than eight years who now lives at Fort Hood, is well attuned to the reintegration process. Especially after the first time.
"I didn't honestly know what reintegration looked like," she said, and equated the distance she felt from her husband to the quality of their relationship.
"He wasn't ready to snuggle yet. ... I also took (his attitude and behavior) personal," she said.
Knowing that many soldiers and their families face similar struggles, Blanchfield Army Community Hospital has ramped up its services to prepare, and has given its new reintegration program a dry run with some 600 soldiers already back from Afghanistan. But it will be truly tested in the next few weeks as thousands more come home.
More services have been added, along with more people and a more comprehensive way to identify and track the soldiers who might be experiencing problems.
Welcome to DRAT
During their six-day reintegration process mandated by the Army, soldiers will answer questions and go through briefings about what to do now that they're home and where to go if they need help.
Getting that reintegration process down to a science has been a focus of the Army for the last several years after cases of post-traumatic stress, traumatic brain injury and suicide became more common.
"This is definitely not a Fort Campbell issue — this is an Army issue," said Maj. Tangeneare Singh, a psychiatrist and chief of the behavioral health department at BACH.
She said one new process — called the Down Range Assessment Tool, or DRAT — allows commanders to submit information on their soldiers and specifically identify those who might have additional problems or might be considered "high-risk" cases.DRAT, combined with standard Post-Deployment Health Assessments and Soldier Readiness Processing, makes Singh believe Fort Campbell is well-poised to handle the rush of soldiers in the next several months.
"(Those tests) will give us a good picture of what needs to happen," she said.
Anonymous tool
Owens, a Family Readiness Group leader, is advocating an online anonymous assessment being instituted by the Department of Defense called Military Pathways. It doesn't link to chain of command, it doesn't ask for names or units. It asks soldiers and family members questions and provides a list of referral information or what might need professional attention.
"You can be completely honest because no one is going to see it but you," Owens said. "It's not meant to diagnose. It's just meant to give an idea of things you might want to see someone about."
It's been well-received. Since 2006, more than 200,000 people have been screened, but Owens said it's difficult to track the program's effectiveness because of the anonymity.
One measure, however, is the attitude among soldiers toward seeking behavioral health treatment. Owens said she has seen a change, but not necessarily top to bottom.
"(Senior soldiers) encourage young guys to do it, but have a hard time doing it themselves," she said. Owens expects a generation or two to pass before the stigma around mental health treatment is gone.
But in Singh's world, rank carries no weight. All soldiers go through SRP, DRAT and other processes. All are screened. All are potential cases of depression, PTSD and other unseen war wounds. The early response from those who have gone through the reintegration process is positive.
"Soldiers love it," Singh said. "They love the fact that someone is calling to see if they're OK."
More staff to help
Added to the existing services is a 12-person staff to handle high-risk cases, Singh said. Twice as large as in the last major redeployment of the 101st, the staff is dedicated to handling and helping those soldiers who have shown symptoms of severe depression, suicidal ideations or other high-risk conditions.
Singh said the outside community also has volunteered services. Hospitals in Nashville and Hopkinsville, Ky., are stepping up, and whenever soldiers can't reach staff here, they can talk with behavioral health specialists in San Antonio through video teleconference.
"Everyone is pitching in to help," she said. "All of these hospitals have their own soldier or warrior care wing."
Owens pointed out that the reintegration process is not overnight, or even a one-week stint.
"They're not used to typical life at home," she said of the returning soldiers. "The best piece of advice I got was to let go of expectations, and let the soldier guide events.
"They've got to have time to adjust."
For more information on the Military Pathways program, visit www.militarymentalhealth.org.
