As the number of veterans returning from service in Iraq and Afghanistan and re-entering society grows, the instance of post-traumatic stress disorder among these veterans has skyrocketed. In the four year period between 2003 and 2007 diagnosis of this disorder among veterans grew more than tenfold, and the overall number of diagnosed cases is expected to continue rising as more return home.

But behind those numbers is another problem–many more are slipping through the cracks. A study from the Archives of General Psychiatry found that the mental health assessments given to soldiers after deployment are not doing enough to pinpoint cases of post-traumatic stress disorder. The study looked at more than 1,700 soldiers in Iraq between 2007 and 2008 and serving a third deployment in six years, and found that many avoided identifying signs of the mental illness on the test, which is not anonymous. When the study used a second test, this one anonymous, the results were very different. Those answering anonymously were two to four times more likely to report mental illnesses and soldiers screening positive for post-traumatic stress disorder jumped from 4 percent on the first test to 12 percent on the second.

For veterans, the signs of injury when returning from service were often more visible. Those with disabilities were treated accordingly and even veterans who found injury or illness outside the field of battle, like the thousands who developed mesothelioma after exposure to asbestos, could seek straightforward treatment for their injuries. Patients who have developed asbestos cancer do have one thing in common with those affected by post-traumatic stress disorder, though–reported difficulties seeking services through the Department of Veterans Affairs. The Institute of Medicine in 2007 criticized the government’s method for determining compensation for veterans with post-traumatic stress disorder, which unlike other disabilities required the person be unable to find work in order to receive benefits.

Though the Department of Veterans Affairs took the suggestions to heart in its approach to treatment of post-traumatic stress disorder and made it easier to apply for benefits, another study found that problems still remain today. A survey of social workers and doctors working for the department found low confidence in its ability to treat veterans seeking treatment for mental health disorders. More than 70 percent of respondents said the department lacks staff and space to meet this need.