El Paso has focused on the economic opportunity presented by Fort Bliss, which is spending billions on construction, bringing in thousands of soldiers, and potentially attracting defense-contracting jobs.

There's a trade-off, and associated issues have been fairly well documented, with impacts to physical infrastructure such as water supply and transportation to civic infrastructure such as schools and fire and police services.

What has garnered less discussion is an issue that is gaining attention nationally and could hit home.

Experts say that a high percentage of soldiers returning from war suffer from Post Traumatic Stress Disorder, which, simply stated, means they cannot get the horrors of war out of their head. Sometimes, the results are tragic. In, a CBS news investigation the network uncovered e-mails from Veterans Affairs officials indicating a high level of suicide among veterans, perhaps as many as 18 a day.

Suicide is the extreme manifestation of PTSD, which can affect more than a quarter of combat veterans. Gary Larcenaire, CEO of El Paso Mental Health and Mental Retardation, a private mental health provider, said that "17 to 30 percent of soldiers will come home with PTSD. To clarify a little bit, we aren't talking about just simple combat stress. We're talking about severe diagnostic criteria that interferes with family, interferes with sleep, interferes with daily functioning, and ultimately can result in poor attempts to cope and deal with the stress."

"According to an Army survey of soldiers' mental health, one in four soldiers sent to Iraq will show signs of anxiety, depression and acute stress," Larcenaire said.

Larcenaire was one of the speakers at a joint Texas House-Senate hearing in May on the overall impacts of the Base Realignment and Closure process, known as BRAC. The federal process takes place periodically to assess which military bases ought to close, stay open, or change mission. Fort Bliss was a big winner in 2005 when the BRAC process led to plans for a transformation of the base from an Air Defense and Artillery post to a major mounted maneuver installation, which will expand the region's private sector economy.

While the hearing went over many of the impacts that previously have been discussed -- with some new information, such as the news that William Beaumont might expand and move from its Fred Wilson location to on post -- officials spent a good chunk of time on the issue of PTSD.

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The sheer magnitude of the suicide problem has led some to calling it an epidemic.

According to another CBS investigation, "Veterans aged 20 through 24 ... had the highest suicide rate among all veterans, estimated between two and four times higher than civilians the same age. (The suicide rate for non-veterans is 8.3 per 100,000, while the rate for veterans was found to be between 22.9 and 31.9 per 100,000.)"

According to the same report, former VA analyst Paul Sullivan said, "Those numbers clearly show an epidemic of mental health problems.”

However, Dr. Ira Katz, head of mental health at the VA, told CBS News, "There is no epidemic in suicide in the VA, but suicide is a major problem."

According to El Paso police spokesman Javier Sambrano, the police department hasn't seen a dramatic increase in calls involving PTSD. However, he did acknowledge it has been an issue.

“For many years it's something that law enforcement has been coming across,” said Sambrano. He said that's one of the reasons police are certified to recognize and understand those who may be suffering from PTSD or other mental illnesses.

In a case that received national attention in 2005, a PTSD-afflicted soldier living in El Paso barricaded himself in his home during a standoff lasting three hours. Army Spc. Joseph Dwyer, 29, believed he was being attacked by Iraqis when he began firing 9mm rounds inside his apartment. Furthermore, a month prior, he was involved in an automobile accident after he swerved to avoid what he perceived was a road-side ambush.

"These people didn't create the PTSD for themselves. This is a result of what's happened to them based on where we have sent them, and what we sent them there to do," said state Rep. Terri Hodge, D-Dallas, who spoke at the panel discussion in May.

Stephanie Dodson, executive director of El Paso Center Against Family Violence, said she couldn't agree with Hodge more.

"We train our soldiers to be aggressors because that's their job, and then we're surprised when it happens, and then we deal with the aftermath," Dodson said. She said there are risk signs that can make outbursts due to PTSD predictable, and she said more attention should be given to diagnosing and treating soldiers up-front, before the problems worsen.

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That discussion, the issue of diagnosing and treating up front, is hard to get to because the VA is avoiding diagnosis as a cost-cutting measure, some critics argue.

Citizens for Responsibility and Ethics in Washington, an American watch-dog group, obtained an email written by a PTSD program coordinator at a Texas veteran's center which told staff, "given that we are having more and more compensation seeking veterans, I'd like to suggest that you refrain from giving a diagnosis of PTSD straight out." [link]

VA secretary James Peake suggested the discouraged diagnosis scandal was an isolated incident. In a statement, he said, "A single staff member, out of VA's 230,000 employees, in a single medical facility sent a single e-mail with suggestions that are inappropriate and have been repudiated at the highest level of our health care organization." He added, "the employee has been counseled and is extremely apologetic."

Peake promised that the VA is, "committed to absolute accuracy in a diagnosis and unwavering in providing any and all earned benefits. PTSD and the mental health arena is no exception."

According to CBS, U.S. Senator Patty Murray, D-Wash, member of the Senate VA Committee, said, "VA staff across the country are working their hearts out to get our veterans the care they need and deserve. But e-mails like these make their jobs far more difficult."

Locally, the VA recently hired 40 new staffers in response to El Paso's growing needs.

Peake said he wants to eventually hire 100 more staff, because the veterans deserve the best.

Recently, the VA said it had finished a phone campaign to notify potentially sick or injured veterans of the benefits they are eligible to receive, and said it will soon begin calling those who have not yet contacted the VA to acquire benefits.

El Paso veterans advocate Ron Holmes said, “I don't think that DOD or VA can handle the influx because they won't admit the actual problems, but want them to fit into a pigeon hole and underplay the issue so they don't have to deal with it.”

Service in El Paso was ranked last in the nation, according to an internal VA survey on patient satisfaction. Delays of service, not quality, seemed to be the issue.

El Paso state Sen. Eliot Shapleigh, who helped put the May 13 panel together, said that "first, the VA system needs to be improved. Serious deficiencies in this war are due to repeat deployment and time in combat. PTSD is much higher than in other wars, so expanding services for returning veterans who suffer distress and depression is a real issue."

Veterans and active-duty soldiers aren't the only ones afflicted by mental health problems. Family members of military personnel are in need of assistance as well.

"Among military spouses, 40 percent believe their mental health was hurt by their spouse's service over-seas," Larcenaire said.

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More than 70,000 soldiers and family members are expected to arrive in El Paso within the next four years, according to Richard Dayoub, president of the Greater El Paso chamber of Commerce.

"El Paso is excited about the growth it will soon experience. The chamber is working with community partners to make sure that the region is prepared to received the influx of soldiers and families and those tied to industry moving to El Paso as a result of BRAC and the Grow The Army initiative. Our community has come together to prepare for this growth, but we cannot do it alone," Dayoub said.

"It is becoming a growing vital concern for all of us in El Paso and of course throughout our nation as our soldiers begin returning with combat experiences and symptoms of PTSD. We must be prepared to offer support. Also the community needs to have enough health care professionals to meet those growing needs created by the influx of troops and their families. El Paso is already among the neediest communities in terms of physician to patient ratio," Dayoub said.

Mathew McElroy, Military Growth and Expansion coordinator for the City of El Paso, also acknowledged the problem.

"We are a health care shortage area. That's no surprise. By 2017 we know that we're going to need... across all practice areas... 615 new doctors and 2,289 nurses," McElroy said.

There is clearly a great need for growth in the mental health care sector of El Paso. However, there are conflicting ideas about whether everyone will be covered.

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The BRAC meeting revealed that a new hospital and two primary care clinics may be built to accommodate the arriving troops. Services will also be expanded to include a womens' center at the hospital. However, there aren't plans to expand all services.

"William Beaumont, at this time, is not planning for growth in the retiring and retiring family member beneficiary categories," said LTC Timothy Edman, Chief of Staff at William Beaumont Army Medical Center. Edman said he expects that TRICARE will absorb those growing categories within the civilian health care system.

But Larcenaire doesn't think the civilian system will be able cover everyone. He said he expects a number of people,"...are going to be falling into a system that is significantly over capacity and will be unable to serve them and to absorb that additional workload."

"From my understanding, the members of active duty personnel will be cared for through the Department of Defense, and their TRICARE or TriWest coverage will extensively cover their mental health benefits. Those that are determined to be disabled and that are released, will receive VA benefits," Larcenaire said.

However, there will be a number of people who, "don't have any service-related disability benefits, no VA connected benefits, and will be released with what we are understanding is 18 months of coverage from TRICARE," Larcenaire said.

"Most of those that come to us will not have any kind of coverage. They won't have TriWest, TRICARE, or VA benefits. So they are going to fall to the safety net and the safety net is already 35 percent above its funded capacity for adults. So more than likely, those experiencing PTSD under the current system, unless something changes in 2009, will just simply be put on a waiting list," Larcenaire said.

He said lack of planning isn't the only problem within the system. Difficulties in obtaining licensing may be slowing the development needed to meet these growing needs.

"I found a doctor, he just graduated from medical school in Saint Louis. El Paso is his home, he wants to come here to be with his family and friends and work here. So we recruited him and immediately applied to get him licensed to practice in the state of Texas, and it took us 12 months go get his license," Larcenaire said. "He was here for 12 months sitting on his hands, not seeing any patients. We've got to speed that up. If we're going to deliver care, I have to be able to recruit doctors. 12 months is a lifetime."