When Clay Hunt returned home to Texas after two combat tours in Iraq and Afghanistan, the struggle didn’t end. Tormented by flashbacks and post-traumatic stress, he sought medical help from the Department of Veteran Affairs – but faced a pile of paperwork. While waiting for help, he turned his energy towards helping his fellow veterans, raising money for the wounded and appearing in public service announcements for veterans struggling, like him, with the psychological trauma of war.

Hunt took his own life on March 31, 2011. His disability checks arrived five weeks later.

Tragically, Clay’s story is not unique. Every day, 18 veterans of the nation’s armed forces become casualties by their own hands. One thousand more attempt to take their own lives every month. The numbers are as grim for active duty and reserve soldiers: The Army just reported 27 suspected suicides for the month of May, higher than any other month this year.

“Those numbers are just the tip of the iceberg,” Paul Rieckhoff, executive director of the Iraq and Afghanistan Veterans of America, tells Danger Room. “This is a problem that’s clearly out of control.”

As Obama promises a drawdown of troops in Afghanistan and Iraq is coming to a close, the number of soldiers returning home is only rising. But after fighting for their country, these veterans are forced to fight a health care system that is not sufficiently able to help them. Last month the U.S. 9th Circuit Court of Appeals berated the Department of Veteran Affairs for delays in treating veterans who have the combat-related mental injuries that put them at an increased risk of suicide.

“The VA’s unchecked incompetence has gone on long enough; no more veterans should be compelled to agonize or perish while the government fails to perform its obligations,” the judges wrote in the majority ruling.

But it may be years before the situation improves. As of 2010, the VA had a backlog of over 1 million benefits claims. Veterans can wait a year or more for disability checks, and weeks for mental health referrals. The problem is only getting worse, with the influx of troops from Afghanistan and Iraq. Meanwhile, the rate of suicide for veterans is three times higher than the general public, according to a 2006 study.

“We’re almost 10 years into the war, the backlog has gone up, and it doesn’t look like things are getting better,” Rieckhoff says.

While the number of stories like Clay Hunt’s are on the rise, the concern over veteran suicides is not new. Over seven years ago, the Bush administration commissioned the VA to overhaul its mental health system. The “Mental Health Strategic Plan” that followed promised all sorts of improvements: better screening for at-risk veterans, more urgent health care, less waiting time for treatments and benefits claims. But a 2007 report (.pdf) by the Office of the Inspector General concluded that much of that plan had not been implemented. It found that almost two-thirds of the Veterans Health Administration facilities lacked a suicide prevention strategy to target returning Iraq and Afghanistan veterans, and 70 percent didn’t have a system to track veterans who showed risk factors for suicide.

Since then, the VA has made continued efforts to strengthen its suicide prevention program. The Veterans Crisis Line (1-800-273-8255) was opened in 2007 to provide telephone access to trained counselors 24 hours a day, seven days a week.

“The hotline has grown tremendously over the last four years, to about 500 calls a day,” says Janet Kemp, the national director of the VA’s suicide prevention program. In April, the hotline fielded more than 14,000 calls, the most ever for a single month. Kemp credits the hotline with saving over thousands of lives, but admits that the VA could do better.

“People do wait too long to get the services they need,” says Kemp. “Hopefully we’re putting those into place.”

The hotline guarantees medical attention to anyone in a crisis situation, but not every case appears to be an immediate crisis. For thousands of veterans at risk of suicide, theirs is a much slower, but no less urgent, predicament. Risk factors for suicide are complex, but psychological illnesses like post-traumatic stress disorder (PTSD) are clear culprits. One study found that the risk of suicide doubles for men with psychological conditions. For women, the risk is five times as high.

Unfortunately, these are exactly the mental disorders that President Obama has called the “signature wounds of today’s wars.” An unprecedented number of veterans are being diagnosed with PTSD, and the increased use of explosives by hostile forces in Afghanistan and Iraq raises the risk for traumatic brain injury. Currently an estimated 20 percent of soldiers with combat-related injuries also have traumatic brain injury (compared to 12-14 percent of Vietnam War veterans), which can lead to further mental health problems, and even suicide.

The psychological toll of war, a flood of returning troops and an overburdened VA healthcare system has proven to be a deadly combination. There are some options for veterans – the IAVA has put into place an online community for veterans of Iraq and Afghanistan, to ease the transition back to civilian life. It’s not enough.

“I don’t think we’ve seen a sustained national effort around suicide, period,” said Rieckhoff. “This needs national attention, and there needs to be a demand for services. We need help.”

Photo: U.S. Air Force