The National Academies of Sciences, Engineering, and Medicine released a sobering report earlier this year on military veterans’ access to and use of mental health services. A survey of veterans of the recent wars in Afghanistan and Iraq found that about half of those who may have a need for mental health care do not use either Department of Veterans Affairs or non-VA services, suggesting that a large proportion of veterans do not receive any treatment for post-traumatic stress disorder, substance use disorder, depression or other mental health issues. The report also says that more than half of veterans who screened positive in the survey for having a mental health care issue do not think they need mental health services.
The report, which was mandated by Congress, listed a number of reasons why military vets fail to get mental health care. For one, many vets said they did not know how to apply for VA mental health benefits, are unsure whether they are eligible or are unaware that the VA offers these benefits. The VA has certainly been criticized for its overall performance in recent years — primarily due to long wait times and paperwork processing delays — but the report says that it “provides mental health care of comparable or superior quality to care provided in private and non-VA public sectors.” However, “accessibility and quality of services vary across the VA health system,” it adds.
[See: 11 Simple, Proven Ways to Optimize Your Mental Health.]
The problem extends far beyond the VA, though. “We haven’t got it right yet when it comes to treating vets,” says Jack Hammond, retired Brigadier General, who is the executive director of Home Base, a program that partners with the Red Sox Foundation to offer specialized treatment to veterans and their families at Massachusetts General Hospital in Boston. The challenges, Hammond says, are many, and they begin the moment someone enlists. “Any strategy has to begin on day one, when they enter the military,” he says. “Like Humpty Dumpty, the smarter play is not to let them fall off the wall rather than try to put them together after they do.”
Numerous Obstacles
One obstacle to getting mental health care is in fact ingrained into military personnel. “Throughout their career, and for good reason, we train people to suck it up and keep moving,” Hammond says. “We talk about ‘hell week’ and ‘hell day,’ and the guys that make it through are the ones that persevere and suck it up. We tell them, if you are injured on the battlefield you have to keep moving. You don’t want to be the weak link in the chain. Seeking care is contrary to military culture.”
The military also fails to help vets transition from active duty to civilian life. Other nations, such as Britain, France and Canada, send their transitioning vets on a short retreat before they leave the service. “They stop someplace warm for a week and decompress with beer and talk,” Hammond says. “We send them to some rainy, drizzly country, give them one beer ticket, then send them home. Then we ask them if they have any medical issues, and if not, they can leave. That is counterintuitive. They say no because they just want to go home.”
[Read: How Important Are Dogs for the Mental Health of Recovering Veterans?]
A mental injury is also harder to see. “If your ankle snaps, everybody gets it,” Hammond says. With mental health, soldiers wonder why their peers seem fine, and either blame themselves for being weak or avoid admitting it, he adds.
There is still a stigma in society when it comes to mental health. “If they tell their boss they got blown up in Afghanistan and have concussion symptoms and need to go to treatment for two weeks, of course they say yes, that is understandable,” Hammond says. “If the same person says he needs to see a psychiatrist once week for the next 10 to 12 weeks, they will say yes but look at you differently. And vets know that. Both are brain injuries, but one is behavioral and the other is physical, and even reasonable people raise an eyebrow on the behavioral issue.”
Those who do seek treatment still face obstacles. There are hundreds of VA hospitals, he says, some good, some not, but the common denominator with all of them is bureaucratic red tape. “The intake is often adversarial, which is why less than 50 percent will seek care at the VA.” In addition, “Most VAs look like geriatric hospitals,” he says. “If you are 20 and everyone looks like your grandfather in a nursing home, you are not getting a great vibe.”
Cost and Accessibility Problems
Outside the VA, there is a well-documented shortage of mental health professionals, says Robert Bossarte, director of the Injury Control Research Center at West Virginia University, who has studied suicide prevention for veterans in collaboration with the VA. The challenge is greatest in rural areas, he says, which typically have few if any mental health providers. And the shortage of therapists trained to treat trauma in general and war-related trauma specifically is particularly acute.
Even those lucky enough to find a qualified and competent caregiver face economic challenges. “Many young vets are at the low end of the employment pool, and the average protocol is prolonged therapy, once a week for 10 to 12 weeks. That means a day off from work, and that is a 20 percent pay cut,” Hammond says. “How many people, especially young people, can afford that?”
[See: How to Find the Best Mental Health Professional for You.]
“Vets are part of our community and benefit from the safety nets in those communities,” Bossarte says. But collaborations between primary care providers, mental health providers and others is “very complicated,” he says. There are few reliable ways to screen for at-risk individuals, who may exhibit suicidal behaviors. “With vets that often includes firearms, so there may be no opportunity for intervention,” he says, before it’s too late.
Many in the field are searching for better ways to help vets in need of mental health support. Bossarte and others are trying to develop new ways of identifying those who are at risk, using artificial intelligence and learning algorithms to analyze large sets of data. One of those efforts was launched in 2017 by the VA itself and is known as REACH VET, an acronym for Recovery Engagement and Coordination for Health — Veterans Enhanced Treatment. REACH VET uses veterans’ health records to try to predict who may be at an increased risk for suicide, hospitalization, illness or other health problems. And programs like Home Base are offering care in shorter, more directed ways.
“Our program compresses a year of therapy into 14 days,” Hammond says. The program covers all the costs. While only 30 percent of veterans complete the traditional 10 to 12 week course of therapy, he reports a 98 percent completion rate. “We have achieved off-the-chart, data-driven results in reduction in symptoms at four different sites,” he says.
These programs, and others, are determined to find ways to better serve those who have served us. “We owe them medical care. We owe them that,” Hammond says.
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What Are the Obstacles to Getting Good Mental Health Care for Vets? originally appeared on usnews.com
