Veterans and mental health care

As awareness grows relating to the mental health problems of those who served in Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF), much of the focus has been on providing adequate and effective care to the newest population of combat veterans. Although efforts have significantly increased with the employment of Evidence Based Practices (EBP) and while the Department of Defense (DOD) and the Veterans Healthcare Administration (VHA), have updated their clinical practice guidelines, barriers remain and reaching the majority of this particular population remains a challenge.

According to Connor, Jones, Watts, Shiner, and Stecker (2013), “[o]nly about one quarter of active duty troops with psychiatric disorders actually receive treatment services” (p. 280).These researchers conducted a study using a qualitative analysis method by means of an intensive cognitive-behavioral telephone interview lasting approximately forty-five to fifty minutes. The participants consisted of approximately 300 service members who were recruited within a three year time frame, beginning in November 2009 and ending in January 2012.  The makeup of the participants included: 84% percent male, 67% Caucasian, 13% African Americans, and 9% Latinos. The sample identified participants from forty-eight to fifty states including veterans from all branches of military service. Research findings revealed four primary reasons veterans do not seek treatment for PTSD symptoms: concerns about treatment (40%), emotional readiness for treatment (35%), stigma (16%), and logical issues (8%) (p. 282-283). Overall, the research concludes that if there is an increase in veterans seeking treatment for PTSD after serving military time then the primary care physician should emphasize to the veterans upfront certain expectations. These expectations include

Rates of trauma and mental illness are reported to be disproportionately higher among American veterans, especially those of the recent wars in Iraq and Afghanistan. The barriers to care after civilian reentry further disadvantage this already vulnerable population. The wars in Iraq and Afghanistan have been the longest sustained US military operations since the Vietnam era, sending more than 2.2 million troops into battle and resulting in more than 6,600 deaths and 48,000 injuries. Veterans are at risk mental health challenges, as well as family instability, elevated rates of homelessness, and joblessness. Veterans have disproportionate rates of mental illness, particularly posttraumatic stress disorder (PTSD), substance abuse disorders, depression, anxiety, and military sexual trauma.

There are several barriers to rural veterans receiving quality of care. These include the rural and military stigma against mental health services, the insufficient timeliness of receiving care, the lack of skilled professionals in positions to serve veterans, and the tangible challenge of access to care. These barriers cause many veterans to not receive services at all. At best, it causes major hindrances for rural veterans resulting in sporadic treatment, low quality of care (Buzza, et al., 2011) and financial concerns (Gayle & Heady, 2011).

Therefore, Spelman, Hunt, Seal, & Burgo-Black (2012) recommend that the best practices for care should consist of an interdisciplinary approach involving integrated teams of primary care, mental health, and social work providers which can normalize and de-stigmatize mental health treatment. Recognizing that co-located, interdisciplinary care may not be feasible for many providers, they suggest utilizing local resources and facilitating interagency collaboration with local Veteran Centers or with the VA (Spelman et al., 2012).

two types of health need returning veterans, and their families might need Returning veterans and their families may have numerous health needs. One of those needs is mental health needs of the veteran. People have many several reasons for why they join the military, very few joins because they want to go to another country and fight a war. Regardless of their intentions, and how much training they receive, once a person goes through a military conflict it changes that person. Once they return from the conflict, they should obtain personalized counseling, not just a debriefing.

The VA runs the largest substance use disorder treatment program in the world. Treatment of veterans with SUDs and co-occurring psychiatric disorders is one of the following three paradigms; parallel, sequential, and integrated. Most VA programs are parallel, where the patient receives treatment for SUD in one program and treatment for PTSD in another. Many SUD-PTSD veterans may be unable to navigate the separate systems or make sense of the disparate messages about PTSD treatment and recovery. One challenge to dissemination and implementation of EBTs is that of dual disorders, particularly SUD and PTSD. These patients use costly inpatient services, tend to have frequent relapses, and are less likely to adhere to or complete treatment.

1 in 8 returning soldiers suffers from Post-Traumatic Stress Disorder. Soon after returning home, family members start noticing a change in the soldiers. Most are in denial about having PTSD. What they need to know is that the earlier that they can get help, the better off they’ll be. With so many suffering, where are all the treatments? Even though some soldiers would abuse the treatment provided for Post-Traumatic Stress Disorder, American Veterans need to be provided with the proper treatment for it.

I found a number of services that are currently available to Veterans that suffer from PTSD and their families such as counseling for individuals, groups, and families at all Va hospitals.

The Department of Veteran’s Affairs (VA) has been tasked with providing support and benefits to Veterans after they have completed their service. However, many Veterans are reporting difficulty accessing care due to systematic barriers within the VA’s Veterans Health Administration (Oliver, 2007). Complex eligibility requirements, long wait lists and lack of providers are a few of the issues Veterans are faced with when trying to access health and mental health care. Additionally, studies indicate that veterans, predominantly those from the recent wars in Iran and Iraq, have disproportionately high amounts of mental illness (Shim & Rust, 2013). These same veterans are experiencing difficulty accessing mental health care due to issues around a backlog of healthcare eligibility applications and a shortage of mental health providers through the Veterans Health Administration (VHA), which operates the Nation’s largest, integrated health care delivery system (APA, 2014). In 2014, at the request of the Chairman of the U.S. House Committee on Veterans’ Affairs, the VA Office of Inspector General (OIG) evaluated the merit of the allegations of mismanagement at the Veterans Health Administration’s (VHA) and the Health Eligibility Center (HEC).

“The Veterans Health Administration (VHA) is home to the United States’ largest integrated health care system” (Mason e.t. al 2016). Because of technological and medical advancement, surviving injuries from war has lead to a greater need for post deployment and discharge care. I often hear the phrase “Freedom is not free”; the mental health of our active duty soldiers and veterans is one area that ends up costing America. Some lose time with their families, some are injured physically and mentally, and some lose their lives.

For many years, the VA has offered health care to the men and women who have surrendered a large part of their lives to protect our nation. The VA has made great stride in providing specialized services to veterans such as Traumatic Brain Injury (TBI), Military Sexual Trauma (MST), and Mental Health treatment. In fact, the VA is leading the field on Post-Traumatic Stress Disorder (PTSD) research, but now that many of our men and women are returning home from war, the commitment that the VA made to provide accessible health services and a smooth transition from military life back to civilian life to these heroes and their dependents are not being granted in a timely manner. Studies show that suicide among veterans is the number one leading cause of death in the United States and

Both articles identify the issue of providing mental health services for veterans with an extra emphasis on those that served in Afghanistan and Iraq (OEF/OIF veterans). It is no surprise that returning veterans suffer from both visible/invisible (physical and mental) wounds. Most veterans have this “high” expectation that they are going to receive quality care from both the DoD and VA. Unfortunately reality steps in where veterans are slapped in the face because they are receiving a lack of poor quality care all while jumping through Beuracractic hoops. The challenges faced to access these services include resistance, stigma, lack of professionalism, and geographic and/or regional disparities in the distribution of services resources and/or benefits, and the system simply refusing to change.

“Treatment for PTSD is usually based on a combination of therapy and medication to manage symptoms”(SocialChoice). Some veterans may be embarrassed to get help. Group therapy is a good option for these people. During “group therapy members of the service talk about the trauma they have been through. They also learn skills to cope or manage their symptoms of PTSD”(military.com). Family and couples therapy is also an

T. Stecker, J. Fortney, F. Hamilton, and I. Ajzen, 2007, address that mental health symptoms have the likelihood to increase within post deployment for military veterans, especially for the ones who have seen combat. An estimated quarter of recent war veterans who are currently receiving care in the Department of Veteran Affairs (VA) Health Care System have reported mental health problems. Soldiers who have served in Iraq come home suffering from depression, anxiety, and posttraumatic stress disorder (PTSD). The Statistics of Iraq soldiers meeting the criteria for depression, anxiety, and posttraumatic stress disorder (PTSD) is greater than the soldiers who served in Afghanistan. The mental health symptom rates for soldiers who served in Iraq were as high as 20% for PTSD, 18% for anxiety, and 15% for depression.