Bagram airbase has 40-strong team of psychologists and others on hand, though stigma of such care in the military remains
The US military in Afghanistan has slowly been building up ways to help troops who are scattered across a harsh, hostile country which is almost as big as Texas, with little privacy and poor communications.
The network ranges from a basic "classified Skype" videophone system that gives all but the most isolated soldiers access to a psychologist at any time, to the last-ditch option for extreme cases, a Medevac plane to take any soldier assessed as suicidal or homicidal straight out of the country.
In between is a network of professionals and support centres that aim to stop troops needing to take that flight, or – even worse – never making it.
"I was at the point of blowing my head off," said 23-year-old Sidney in a "war fighter restoration centre" on the sprawling Bagram airbase, 30 miles north of Kabul, where he spent several days after a near breakdown that was sparked by his wife asking for a divorce.
"I lost 30lb in three weeks, I wasn't sleeping, I was ringing my wife five times a day," he said.
A team of about 40 psychologists, social workers and supporting behavioural health technicians are based in a concrete and metal hut with sofas, board and video games and a huge DVD library. It is probably as cosy as anywhere on a huge military base can be.
They offer everything from drop-in games evenings – where soldiers can quietly unburden themselves to one of the team – to a residential course for soldiers such as Sidney, who are most in need of their help.
"We're here as a last resort, before people would have to be sent home," said Staff Sgt Kimberly Aut, a behavioural health technician at the centre.
Smaller teams, one with a travelling "therapy dog" that looks like it is constantly begging for a hug, spend months on smaller bases.
"Its not necessarily about suicide prevention, its about making stronger, fitter, more resilient people," said Aut. "We remind people they are still soldiers, we don't call them patients, they are not sick, not broken."
There is still huge stigma surrounding mental health care in the military, perhaps born out of institutional suspicions about encouraging too much introspection in young people being trained to fight and, ultimately, kill.
"It seems to be a forever perpetuated myth that if you come to the behavioural health [services], that will be the end of your career," said Lt Col Marla Hemphill, a psychiatrist who oversees mental health support for troops across Afghanistan. "That couldn't be further from the truth … for most of them we can save their careers if they come to us before they run into trouble."
Sidney had to be harangued and cajoled into signing up for a residential course by his sergeant. "I was scared to come here," he told the Guardian in one of the rooms where psychologists teach classes in anger management, better sleep and other basic stress control techniques. "[The guys] will look at me differently."
The 23 year-old is not unusual in being pushed over the edge by a relationship problem, rather than the experience of war. Despite the loss of friends, injuries suffered, even perhaps the weight of civilian deaths accidentally inflicted, often it is not the daily reality of war – gruesome, exhausting and painful as it can be – that breaks troops while they are on or near the nebulous frontlines of modern war.
"Its always a mixture of everything, but it's usually home front issues that are the pushing point," said Aut, listing illness of a parent or child and financial problems as other recurring problems for the 3 or 4 people that do their residential course each week. "Units that go through different combat related stressors -- IEDs, suicide attacks -- they go through it together, so they deal with it together."
There are senior commanders among those who suffer, Aut says, though they tend to be wary of the impression their predicament might give. "The stigma is still there, and its interesting to see how senior people handle it."
Ultimately, the services themselves are their own best advertisement, through the lives saved, and those turned around.
"If I could come to this programme over and over, I would," said the once-reluctant Sidney, adding that he had already tried (and failed) to persuade a troubled friend to attend, and often drops by the centre in the day. "They taught me a lot of skills to take back home. How to push things that cause emotions away, so I don't do things that turn thoughts into consequences I regret."
Photo: Kentucky Adjutant General Maj. Gen. Tonini and wife Carol during a visit with families and Troops from the 138th Fires Brigade in Lexington. Soldiers stationed in the Horn of Africa joined the festivities via a Skype. (Air Force photo by Lt. Col. Kirk Hilbrecht, Kentucky Guard Public Affairs Officer).