Veterans’ behavioral health is a topic that, unfortunately, emerges in the media again and again in the wake of tragedy. These occurrences have often brought the unique challenges of supporting veterans’ behavioral health to the forefront of the public eye, highlighting a strange dichotomy between the national reverence Americans have for veterans’ service to our country, and the seemingly inadequate support extended to these veterans left to grapple with the behavioral trauma that often results from their service. We applaud veterans for their service, offer them discounts to movies or shopping, and give them priority boarding on airlines. But when it comes to providing the support they need to treat their behavioral health issues, our system fails to meet the demand needed to serve those who have so bravely served our country.
The nation places veterans on the front lines of war zones, drops them into geographic areas in the middle of global tension and real danger, and relies on them to execute military missions with high stakes and inconceivable peril. The U.S. Department of Veterans Affairs (VA) defines post-traumatic stress disorder (PTSD) as a behavioral health issue that “occur[s] after you have been through a trauma,” with trauma being defined as “a shocking and dangerous event that you see or that happens to you. During this type of event, you think that your life or others’ lives are in danger.” Given many of the experiences associated with military service, PTSD is a very real and potential byproduct of their duties. Additionally, PTSD can also be caused by military sexual trauma (MST), which is any sexual harassment or sexual assault that military members - men and women - experience while employed by the military.
The estimated number of veterans with PTSD in a given year varies, depending on when they served:
- ~20% of Iraq and Afghanistan veterans
- ~12% of Gulf War veterans
- ~30% of Vietnam veterans
Military members who have reported sexual assault and sexual harassment are even higher: 23% of women have reported a sexual assault, and 55% of women and 38% of men have reported sexual harassment. It’s important to note that these numbers only reflect men and women who come forward to report their experiences, and subsequent diagnoses - so it’s likely that the numbers could be even higher for those who are experiencing trauma of some sort.
- reliving their traumatic experiences in the form of nightmares or flashbacks
- being triggered by present events that can bring them back to past moments
- a negative change in their behavior or mood
- hyperarousal that makes it difficult to sleep or concentrate
- a heightened sense of alertness
- being easily startled
Given the number of veterans living with PTSD and these symptoms, they can be prone to anxiety and/or depression, both of which can lead to a myriad of other behavioral health symptoms and issues.
Of the 121 people who die by suicide per day (on average, according to the American Foundation for Suicide Prevention), 18-22 of those people are veterans. The rate of suicide for veterans is 21% higher than that for other U.S. adults - a fact that highlights the increased need for behavioral health support for veterans. Furthermore, when you adjust those numbers for any given population of veterans, depending on certain risk factors and demographics, that number can be even higher. The statistics don’t even begin to touch upon the number of veterans who live with behavioral health issues, or the number of veterans who attempt suicide. In fact, “one in two veterans of Iraq or Afghanistan wars say they know a fellow service member who attempted or [died by] suicide, according to a Washington Post-Kaiser Health poll.” On top of that, there is a growing rate of veterans battling drug or alcohol problems, who are more than twice as likely to die by suicide as other ex-service members. The growing opioid epidemic has also impacted veterans, where there is a reported strong link between suicide and opioid abuse.
These overwhelming statistics demonstrate an immense and comprehensive need for supporting the behavioral health of our veterans. With approximately 18 million veterans in the country, hundreds of thousands of veterans are likely living with PTSD -- and need an extensive infrastructure of behavioral health support.
The government does offer many resources to veterans, and the proposed 2018 budget includes $186.5 billion in budget authority for VA, with $8.6 billion allocated for mental health services. But when that money is distributed across various programs, and across the 18 million veterans who might need them, those resources are spread incredibly thin. For those doing the math, that leaves around $10,361 per veteran from the general budget, and a mere $478 per veteran from the mental health services budget (without taking into consideration the variation in needs and benefits for each veteran).
Despite the significant limitations of the existing and proposed budgets, the government has taken many steps to address the behavioral health needs of veterans. Most recently and notably, in 2015, President Barack Obama signed the Clay Hunt Suicide Prevention for American Veterans Act, directly focusing on veterans exhibiting suicidal behavior, and other behavioral health symptoms. The eponymously named Act honors Clay Hunt - a Marine who served in Iraq and Afghanistan, and later died by suicide after his struggle with depression and PTSD. In an effort to prevent more tragic stories like Hunt’s, the law requires:
- third-party evaluations of the VA’s efforts to prevent suicide and address behavioral health issues
- a website listing all available mental health care services for veterans
- a collaboration with non-profit mental health organizations in prevention efforts
The Department of Veterans’ Affairs uses predictive analytics to assess the risk of veterans, and determine who is at the highest risk, so they can intervene early before they begin to exhibit clinical signs of suicide and offer them an enhanced level of care.
In an attempt to meet the demand, the VA has increased hiring of Designated Women’s Health Providers to serve female veterans requiring mental health services, and has expanded the use of telemedicine to provide mental health care as well. The VA also has an extensive directory of resources and programs available to veterans, taking into account the various ways veterans might want to interact with services or reach out for help. The VA has implemented a suite of behavioral health apps focusing on PTSD, insomnia, depression, meditation, and problem-solving skills. It also offers telemental health care, a 24/7 crisis line offering immediate mental health crisis intervention and support, and a suicide prevention hotline. There are veterans centers across the country that offer counseling and social and psychological services that help both veterans and active duty members.
But with all the government offers, we still come back to the funding, which, given the demands, clearly just isn’t enough to support the programs and services, let alone staffing those programs and services and providing quality care. Implementing this successfully requires fully-trained and experienced staff members to ensure that veterans can be adequately and capably treated and supported. Even if the budget had the money to compensate these staff members generously, there is a national shortage of trained mental health professionals - especially those who have worked with veterans and their unique behavioral health needs and are equipped to provide quality care. Additionally, more and more veterans - especially those from earlier wars and generations - continue to come forward seeking diagnosis, treatment, and care, meaning that the demand will only increase. So while the VA might currently have expansive services and programs, they are understaffed, under-financed, and under-equipped to provide the extensive care needed to prevent veteran suicide and treat behavioral health issues.
There’s another important aspect of addressing the needs of veterans: ensuring they feel comfortable coming forward and seeking treatment. But there is both a stigma attached to asking for help, and for addressing behavioral healthcare needs. Oftentimes, asking for help is considered a sign of weakness, rather than strength. For veterans - and military members in general - the emphasis on “machismo,” and the expectation of exhibiting courage and being tough has the unfortunate perception of being at odds with seeking treatment for behavioral health issues. Because veterans have had to endure all sorts of unique challenges and dangerous situations, they might assume that they must bear the brunt of their behavioral health issues on their own. Taking steps as a society to erase this stigma, and reminding veterans and civilians alike that asking for help is a sign of strength - not weakness - can help promote the importance of addressing behavioral health needs and encourage more people to seek treatment and care.
Moving forward, we must support our veterans through political and social change. We face an uphill battle in increasing the federal budget allocated for mental health services for veterans. Making our case to current elected officials while supporting new candidates who will prioritize veterans’ behavioral health needs ensures that this issue remains on their agenda. The House recently passed a bill that would expand mental health care services to veterans who received “other-than-honorable” discharges, services that aren’t currently available to these veterans. This will be a small step in the right direction so that all veterans have the behavioral health care they need. But this bill is one piece of the entire puzzle. Not only are services and a more comprehensive budget critical, but we also have to build a social movement to advocate for behavioral health services that are generously financed, appreciated, and prioritized across the country.
Social change is the second component to supporting veterans, which requires us, as individuals, to become advocates for veterans and their behavioral health needs. We can pick up some of the slack by working alongside organizations that aim to fill in the financial gaps that get in the way of providing quality care, programs, and services. Each one of us can help by volunteering or donating to organizations like the VA Voluntary Service, as well as non-profit organizations such as The Military Veteran Project or the National Veterans Foundation, which focus on behavioral health care. Just as important as volunteering or donating is helping to erase the crippling stigma associated with seeking help. Veterans need a safe space where they can ask for that help. We must not be afraid to talk about suicide and behavioral health challenges. We must constantly re-evaluate what we’re doing to support this conversation and the veterans.
The solutions are certainly complex and varied when it comes to supporting veterans with behavioral health issues, but through understanding, advocacy, and reform we might begin to make bigger strides in preventing suicide and saving lives.