Posttraumatic stress disorder (PTSD) is one of the most important health problems faced by service members, veterans, their families and their communities. One of us (HSK) recently assumed the role of chief consultant for mental health for the Department of Veterans Affairs (VA) after more than 30 years in the VA system as a clinician, researcher, teacher, and administrator with a primary focus on PTSD. The other (DMB) has, for many years, taught medical officers about PTSD, treated countless patients and conducted clinical trials of new treatments as professor of psychiatry at the Uniformed Services University of the Health Sciences (USUHS).

We are both well aware of the challenges and controversies surrounding the care of those who have experienced trauma during military service. We are both familiar with the current range of resources as well as the limitations of current approaches.

The concept of PTSD has faced its own challenges. Respected voices have called for PTSD to be reframed as an injury rather than a disorder. Some argue that the diagnosis is too broad while others believe that the diagnostic criteria are not yet fully inclusive. While there are advocates on all sides and pros and cons associated with any proposed change, we believe that it is the dialogue surrounding these controversies that is critically important. This new volume succeeds in taking that dialogue forward.

Many in VA and at the USUHS are calling out for a community-based approach to the management of PTSD and other trauma-related mental health problems. We do not believe that the responsibility for these thorny problems can or should lie solely in the hands of the Military Health System or VA (if only because so much of the care for service members and veterans actually takes place in community practices and depends on family and community support structures that are well beyond the scope of our respective agencies).

For these reasons, the treatment of the psychological effects of deployment must be a community issue with collaboration from across the Department of Defense, VA, and state and community systems. This requires the coordination of public and private clinicians, health systems, community leaders, and policy makers who share an understanding of the challenges faced by service members and their families during military service.

Sadly, with regard to the challenges of reintegration, it appears that our criminal justice system must also be part of the dialogue. Law enforcement personnel often find themselves in the role of “first responders” to domestic violence or public disturbances involving service members, veterans and/or their loved ones. [Forward, p. v-vi]

Approximately a quarter of service members deployed to war have PTSD. The psychological injuries of war, PTSD, moral injury, and related conditions, lead to other issues with employment and intimate relationships. There are conventional, evidence-based therapies that are effective—if the service member or veteran is able to tolerate the treatments. However, the clinicians in the military and veteran’s health-care systems are innovative. They have experimented with alternative ways to engage veterans. These include mindfulness, art therapy, stellate ganglion block, training service dogs, virtual reality, and more. All these and others are highlighted in this book.