01 Jun How to Better Serve the Underserved: Caring for the Mental Health of Veterans and Active Military

Part Two in a Series

When they sign up for active duty, military members know that they’re putting everything on the line to protect their country. But what they can not prepare for is the impact their service will have on their own mental health. For many, the extent of their trauma doesn’t make itself known until their return home.

Despite a Department of Defense infrastructure budget of at least $700 billion in 2021 alone, many active military members and veterans remain vulnerable to the devastating mental health effects of their service, and are unable to access care when they need it most. 

As of 2018, Department of Veterans Affairs records show that 22 veterans and active service members commit suicide every day. That rate is 1.5 times the rate of non-veteran adults, and experts warn that those numbers have risen during the COVID-19 pandemic.

To serve the veteran and military population effectively, behavioral healthcare clinicians must understand their unique needs. They must also educate themselves on the methodologies that are most constructive in treating PTSD, substance use disorder (SUD), depression, and anxiety–many of the behavioral health issues that are so common among active military members and veterans alike.

The Historical Impact of War on Mental Health

The mental health implications of war and conflict go back centuries but have only recently begun to be studied in depth. The first Department of Defense policies on the use and abuse of alcohol were put into place in the 1970s during the Vietnam War era. Since then, these policies have slowly been refined as clinicians and researchers have developed the evidence base.

However, substance use disorders are just the tip of the iceberg. Combat-induced PTSD as well as mental illnesses like anxiety and depression triggered by sexual assault are all common outcomes for military members and veterans who have transitioned out of active service. Whether it’s called shell shock, war neurosis, or PTSD, war-related terminology for mental health has evolved, but effective treatment continues to lag behind.

The Challenges Associated with Seeking Mental Health Care Services

To improve the clinical outcomes of military members and veterans, clinicians need to understand the nuances of the challenges they face when seeking mental health treatment.  

• Mental Health Stigma: A stigma of mental health treatment continues to be a major barrier to effective care for many active-duty military and veterans. Many fear consequences to their career if news of their diagnosis or treatment plan reaches their superiors. Under 2014 rules, no military member’s career should be at risk because of a mental health disclosure, but even 7 years later the habit of discretion can be hard to overcome. 
• Lack of Institutional Understanding: Negative PTSD coping behaviors such as substance use, aggression, and impulsivity have earned many military members an OTH (other than honorable) discharge, putting their VA benefits as well as their social and military standing in jeopardy. When institutions are not able to make a connection between trauma and negative coping behavior, it can stigmatize this population, denying them the care they so desperately need.
• Isolation: Another common barrier to mental health care for military and veterans is isolation. It can be difficult to transition back into civilian life. Even years later, many veterans feel isolated from friends, family, and mental health professionals because these civilians are unable to understand what they went through, and how to help them talk about their struggles on their terms. 

Improving Mental and Behavioral Health Care

To better serve this underserved community, clinicians must educate themselves and think both critically and creatively to ensure they’re able to offer veterans, military members, and their families the care they deserve.

Here are a few ideas that your practice can use to treat these populations more effectively.

• Be Aware of Stigma: Stigma of mental health care is deeply rooted in military culture. Clinicians must be aware of this stigma, and actively work to address it empathetically with their military and veteran clients. This is a key step to ensuring that the client continues with their treatment plan, rather than stopping treatment prematurely. 
• Test New Models of Care: After living for years or even decades in a community-oriented environment, many military members and veterans struggle with the individual model of mental health care. If your practice can incorporate new and innovative patient-centric models of care like stress reduction training and peer support programs, this may help individuals with a military background feel more comfortable.
• Monitor Performance Measurements: An effective behavioral health EHR can help your practice monitor ongoing performance measurements, allowing you to tailor care to each client and ensure that the treatment options you’re offering are working for their needs. A treatment planning tool within your EHR can aggregate various metrics, encouraging a more accurate outcomes-based care plan.  
• Explore Alternative Modalities of Treatment: Many experts like Jen Satterly, the Co-CEO and Co-Founder of the All Secure Foundation, are advocates for alternative modalities of treatment. “When you are in the fog of PTS it can be difficult to navigate non-traditional options that are available,” she says. “From Transcranial Magnetic Stimulation for depression and anxiety to Stella Ganglion Block to calm the hyper-vigilance response, to proper diet and supplementation to reset the body and mind. There are many ways to treat PTS and there is hope for healing. Keep an open mind, do your research and never give out a dose of hopelessness, it’s the greatest killer.”

Additional Resources

Serving the behavioral health needs of the military and veteran populations can be challenging, but by educating yourself, you can ensure more effective and personalized outcomes for the clients within your practice. 

You can find additional resources here:

U.S. Department of Veterans Affairs

Warrior Canine Connection

All Secure Foundation

Grace After Fire

Military Crisis Line 

Military One Source on Substance Use Disorder 

How to Better Serve the Underserved is a multi-part series. To read the previous post, “How to Better Serve the Underserved: Racial and Ethnic Groups”, please click here.