Some 150 mental health advocates, members of the military and their spouses gathered yesterday to talk about the impacts of war on Hawai'i's soldiers and how services can be improved to address their needs.

The talk, which touched on post-traumatic stress disorder, suicide, child behavior issues, domestic violence and sex assault, was designed to kick off the formation of a statewide task force to look at the incidence of mental health problems in Hawai'i-based soldiers deployed to Iraq and Afghanistan.

The task force, whose analysis will include active-duty military and reservists, will also examine the effects of deployments on spouses and children.

Marya Grambs, executive director of Mental Health America of Hawai'i, which organized the forum in Makiki yesterday, said soldiers and their families are facing incredible stressors as they prepare for war and when they return.

But the stigma of mental health issues deter many from seeking help. The military and mental health community also need to do more, she said, to make sure soldiers have access to services — and are directed to the help they need.

"Hawai'i is a state with a high proportion of military," Grambs told attendees at the two-hour gathering. "It is of critical importance that we as a community learn about what happens when our soldiers come home. We do not want to see a repeat of what happened to the Vietnam vets."

The discussion comes as big and small communities nationwide are grappling with how to help returning soldiers and their families, amid new distressing numbers that show increased rates of divorce, domestic and child abuse and suicide among Iraq and Afghanistan veterans.

The forum included a panel of experts, including Col. Laura Wheeler, Hawai'i National Guard's state family program director, and Dr. Michael Faran, of the child psychiatry department at Tripler Army Medical Center.

Wheeler, who has deployed to Iraq, said the military is making strides in making sure soldiers are prepared before they deploy to a combat zone and go through the necessary screening when they return. But she said soldiers still fall through the cracks, have difficulty overcoming the stigma of mental health issues or don't experience problems until long after they've come back.

"Most of them will minimize their problems," she added. And when that happens, problems can spiral out of control, spurring domestic violence and other marital problems.

Children can also experience mental health and behavioral issues when a parent is at war and when that parent returns. Faran, of Tripler, pointed out that since combat started in Iraq and Afghanistan, about two million children nationwide have seen parents sent into combat. About 700,000 children nationally have a parent deployed right now. And making sure they get services is difficult.

Faran said many children are not directly involved in the military community, since their parents are reservists. In the Islands, Faran is trying to overcome that barrier by reaching out to schools statewide so the children of soldiers can get the help they need in a setting they feel comfortable in.

Attendees said they hoped the gathering was the start of a broader conversation in the community about what soldiers and their families go through during a deployment — and what they go through when one is over.

"I think the issues they brought up are very important," said education specialist and social worker Anna Daddario, whose boyfriend is deploying to Iraq in two weeks. She said it's vital families are made aware of mental health issues that soldiers in combat can experience — and the signs to look for.

Lou Ann Roquemore, a Tripler nurse who works with soldiers suffering from post-traumatic stress disorder, said the military should do more to prepare families for the return of their loved ones from a combat zone. For instance, spouses sometimes just need to learn how to give a soldier some space.

She said more front-end training could prevent divorces and other problems.

Meanwhile, women soldiers can face a host of other issues in combat. In many cases, in addition to their combat experiences, they have had to endure sexual harassment or sex assaults at the hands of their fellow soldiers.

Ann Fisher, sexual trauma and readjustment counselor at the Honolulu Veterans Center, said that as of March 2008, about 180,000 had been deployed to Iraq or Afghanistan. That's up from 41,000 women who served in Desert Storm, and 7,500 women who fought in Vietnam, Fisher said.

For decades, the military has been criticized for how it handles sexual harassment and sex assaults. And though Fisher said the situation is getting better — with more accountability up and down the ranks — many women still feel too intimidated to come forward or experience repercussions if they do. "If you're sexually assaulted in the military, you can't get up and leave," she said.

Fisher did not have numbers for the incidence of sex assaults in Hawai'i among military members. But she pointed to a 2005 national report that showed 60 percent of women in the armed forces had experienced sex harassment.

About 11 percent had been raped, the report said.