Veterans returning to civilian life from Iraq and Afghanistan are suffering from tragically high rates of mental and substance use disorders. Post-traumatic stress disorder (PTSD) has become a hallmark injury among returning veterans, with a prevalence rate of approximately 20 percent—a rate two to three times the general population. Overwhelmed by flashbacks, nightmares, increased arousal, startling easily, and difficulty sleeping, returning service members with these symptoms experience significant challenges reintegrating back into civilian life. This issue is coupled with a staggering suicide rate; the Veterans Affairs Department estimates that a veteran dies by suicide every 80 minutes. And the magnitude of this issue is all the more urgent with more troops coming home.
Higher rates of PTSD are associated with these more recent wars due to longer deployments, multiple deployments, and a greater time away from base camp. Among returning soldiers, PTSD isoften associated with co-occurring disorders, such as depression, substance abuse problems, and traumatic brain injury (TBI), complicating diagnosis and treatment. For instance, PTSD and TBI, which are both signature problems among returning veterans, have similar, overlapping symptoms, which professionals are often challenged in differentiating. Veterans with PTSD are also more likely to experience psychosocial challenges such as relationship problems, violence, unemployment, homelessness, and incarceration.
Family members are also suffering. The return home requires great adaptation, particularly in supporting a veteran with a behavioral health need. Children of veterans with PTSD are at risk of experiencing secondary traumatization (PTSD symptoms related to witnessing their parent’s symptoms) as well as at greater risk for academic, behavioral, and interpersonal problems.
Many veterans and family members need help in dealing with these challenges. Unfortunately, only half of returning veterans with PTSD receive treatment. Significant barriers exist in seeking and accessing appropriate care. Many veterans do not seek mental health services for reasons of stigma, fear of the impact it will have on their careers, lack of information about available resources, distance to a VA facility, lack of eligibility for VA services and finding the system too difficult and time consuming to navigate.
The VA, known for state-of-the-art services, has made significant strides in recent years to address this problem by launching the Veterans Crisis Line (800-273-TALK, Press 1), and increasing its mental health service capacity, both of which have been expanded under President Obama’s recent Executive Order.
However, the fact remains that only 55% of OIEF/OEF veterans have obtained VA health care. Perhaps more would use the VA if the eligibility and access problems were addressed. But many veterans simply do not want to use the VA. According to the RAND needs assessment of New York State veterans, nearly half of veterans want to receive mental health care outside the VA system. Many prefer to return to civilian life and get care from primary care physicians or community clinics in their local communities.
Therefore, while the federal VA must continue to bolster its resources, it cannot bear the sole responsibility for caring for veterans with behavioral health needs. It is going to take concerted, focused, and coordinated efforts by all—the VA; other government agencies at the federal, state, and local levels; not-for-profits providers; and the private sector—to overcome this challenge.
This is why the Mental Health Association of New York City (MHA-NYC) and the Iraq and Afghanistan Veterans of America (IAVA) have joined forces to co-lead a Leadership Council for Veterans, Service Members, and Their Families (The Council). The Council is a high level advisory to the National Traumatic Brain Injury and Emotional Wellness Alliance, which was recently founded by MHA-NYC and is made up of a diverse cross section of prestigious, respected leaders from around the country who are dedicated to diligently confronting and collaborating to overcome the significant gaps in behavioral health care that veterans now face.
We are calling for:
- Expanded suicide prevention efforts
- Expanded access to mental health supports through more responsive and integrated services via the VA, other public, and private systems
- A larger and more competent behavioral health workforce both in the VA and in the civilian based system
- Enhanced public education and outreach efforts to combat stigma and to provide information about behavioral health issues and about where to get help
- Increased mental health supports for military families
By working together, we can expand our reach in advancing these recommendations. Implementation will require significant political will and resources, which will be difficult in a tight economy. But after risking their lives for our great nation, we owe our brave military heroes nothing less than the best possible care so they can successfully reintegrate into society and thrive as fellow civilians. We must ensure that every veteran gets the care they deserve.
Kimberly Williams, LMSW, Director, National TBI and Emotional Wellness Alliance, the Mental Health Association of New York City and Jason Hansman, Senior Program Manager, IAVA.