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The National Alliance on Mental Illness, a mental health advocacy group, is calling on the Defense Department to award Purple Hearts for post-traumatic stress disorder.
In a report published Thursday, the group urged DoD to recognize those who suffer PTSD or other mental health injuries resulting from combat exposure by awarding the Purple Heart "with the same level of appreciation and recognition as those awarded to warriors with visible wounds."
Arguing that PTSD and other mental health issues such as depression can be war-related injuries, the group said the department has an obligation to honor personnel.
"NAMI is drawing a line in the sand with the Department of Defense," said Executive Director Michael Fitzpatrick. "Troops with invisible wounds are heroes. It's time to honor them. It will also strike a tremendous blow against the stigma that often discourages individuals from seeking help when they need it."
The Pentagon in 2009 decided not to award the Purple Heart to troops with PTSD because the disorder can be difficult to diagnose, and symptoms can arise later in life not linked necessarily to any one action or an enemy.
The Purple Heart is given specifically to those who receive injuries resulting from enemy engagement requiring treatment by a medical officer.
In cases of concussion and mild traumatic brain injury where a service member may not have immediately recognized his or her injury and was not treated by medical personnel, a Purple Heart may be awarded if a medical officer later certifies the injury would have required treatment if a physician were available.
An ongoing debate in the medical and psychology communities focuses on whether combat-related PTSD could be the result of an undetected physical injury, like microscopic brain changes resulting from exposure to a blast wave; other outside influences or the physiological or hormonal overload of stress; or a psychological reaction to trauma exposure.
The Pentagon concluded that more research was needed in the field of brain science before deciding to award the Purple Heart for PTSD.
In the report "Parity for Patriots," the alliance also said DoD should "forcibly end discrimination associated with invisible wounds of war" by requiring military leaders to focus on reducing stigma associated with mental health treatment and hold them accountable for suicides in their commands.
"Suicides are preventable just as are the heat and cold injuries of service members for which leaders are routinely relieved of command," the report states.
The Veterans Affairs Department and the general public also must do their part in supporting veterans with behavioral health concerns, the organization argues.
The group called on the Veterans Health Administration to expand its treatment options by using already existing community health networks and private practitioners, and it urged the public to "reach out, listen and care."
"Give veterans rides, watch their children or grant them extra time off work in order to make it possible for them to get treatment," Fitzpatrick suggested.