Addressing Veterans’ Mental Health: An Overview

Military personnel put their lives on the line for their country. In the line of duty, they can experience events that have a lasting impact on their behavioral and mental health. Unfortunately, once they’ve left the service, they do not always receive the care they need or deserve. That’s where your organization comes in. To help you and your staff provide better behavioral and mental health services to veterans, we’ll review some of the most prevalent mental health challenges veterans face and the first steps your organization can take to helping this population.

Behavioral and mental health challenges for veterans

Veterans are at high risk for mental health issues. Healthcare professionals need to have a clear understanding of the ways that military experiences and culture can affect the health and well-being of veterans. They should also be aware of the best approaches to address the behavioral health needs of veterans.

Before we discuss how your organization can help this population, let’s review the most common mental health conditions that veterans face after they leave the military: PTSD, depression, and suicidality.

Post-Traumatic Stress Disorder (PTSD)

An estimated 7% of veterans are diagnosed with PTSD in their lifetimes. However, statistics vary depending on other demographics, meaning certain segments of the veteran population will have a higher risk for PTSD. For instance:

• Women are about three times more likely to develop PTSD than men.
• Younger veterans are at a higher risk than older veterans.
• Veterans who were deployed are more likely to have PTSD than those who were not deployed.

PTSD can be caused by any number of traumatic events. But not everyone who undergoes a traumatic event will develop PTSD. The inequitable nature of PTSD, coupled with other intense feelings (such as survivors’ guilt), can lead to increased levels of post-traumatic stress and lower levels of self-esteem among those experiencing PTSD.

To properly help veterans who develop PTSD following a traumatic event, you and your staff need to be aware of the symptoms of PTSD. Some common symptoms of PTSD experienced by veterans include:

• Re-experiencing: The person relives the traumatic event in some way, including flashbacks, persistent disturbing memories, or nightmares.
• Avoidance: They attempt to stay away from anything that reminds them of trauma (e.g., people, places, thoughts, feelings).
• Arousal and reactivity: They have a heightened nervous system as evidenced by body tension, strong startle reactions, extreme watchfulness, insomnia, or angry outbursts.
• Cognition and mood: They have negative beliefs or problems remembering important parts of traumatic events. They might feel extremely guilty or have trouble enjoying life.

In addition to these symptoms, veterans with PTSD are more likely to have:

• Comorbid depression, anxiety, substance use, or personality disorders
• More difficulties functioning in their daily lives
• Poor physical health and worse pain
• Increased risk of early death

Depression

Approximately 10-15% of veterans have a depressive disorder. Veterans share many risk factors for depression with the general population, such as:

• Family history of depression
• Major life changes, trauma, or stress
• Certain physical illnesses (e.g., cancer, diabetes, heart disease)
• Economic insecurity, especially unreliable access to food

Through their military service, veterans are more likely than non-veterans to experience unique risk factors for depression, such as death, exposure to harm, and separation from loved ones (e.g., deployments).

Depression can take several forms. For instance, a veteran may have major depressive episodes that last two or more weeks and then go into remission. Or they may have persistent depressive symptoms for years without much relief.

Suicidality

Suicide is among the leading causes of death in the United States. Among veterans, it’s especially concerning. Studies have found that 18% of all deaths by suicide in the United States involve a veteran, and that veteran suicide rates were 1.5 times higher than among non-veterans.

This prevalence of suicide among the veteran population has many root causes. The extreme conditions that soldiers can experience during their service can lead to several mental health conditions that increase the likelihood of dying by suicide. In addition to depression and PTSD, these conditions include substance use disorders (SUDs) and serious mental illness (SMI).

One study found that 30% of suicides among military personnel could be attributed to substance use. Additionally, of the veterans with mental health conditions, an estimated 34% were diagnosed with SMI.

How to address veterans’ behavioral and mental health concerns

There are many ways that clinicians, counselors, and care givers can address the behavioral and mental health needs of veterans. To help acquaint you with this subject, we’ll explore a few of the more popular and effective methods. While these are not the only ways in which you and your staff can help veterans improve their overall health, they’re a great place to start.

Provide person-centered, integrated care

Person-centered care, also called patient-centered or client-centered care, is respectful to the veteran’s specific preferences, needs, and values. Mismatches between a veteran’s preferences and the treatment they receive can affect whether they participate in care, adhere to recommendations, or benefit from interventions.

In tandem with a person-centered approach, veterans can benefit from integrated care.

In an integrated care system, behavioral and physical health providers work together to treat the whole person. Providers share information among all people involved in the client’s care to:

• Organize care activities into a cohesive plan.
• Minimize confusion and repetition.
• Ensure the client’s safety.

By using a person-centered, integrated care approach, your organization can provide more personalized, holistic care. This type of care approach can prove helpful when working with individuals with PTSD, depression, and other conditions common among veterans.

Help veterans navigate the VHA

Even when using an integrated care model, veterans can still face challenges when navigating Veterans Health Administration (VHA) services. While the services that the VHA provide are essential, unfortunately, the current system can be confusing.

What’s more, the number of veterans in need of the VHA’s services has put strain on the system, leading to fragmented care. Care providers can have a huge impact on the well-being of veterans by helping them navigate this tricky system.

To do so, your organization can help veterans with the following:

• Get appropriate releases of information to collaborate with VHA providers.
• Help patients develop strategies to communicate with providers.
• Assist in making appointments and overcoming barriers to keeping them.
• Help veterans familiarize themselves with local veteran-specific resources.
• Know what their local VHA offers and helping patients navigate that system.

In addition to the difficulties securing care, veterans do not have all the same benefits or eligibility for services. Your organization should help each individual veteran understand what healthcare services they qualify for and to gain access to those services.

Provide culturally competent care

To provide proper mental health care, providers must take culture into account. Known as cultural competency, this means understanding how a client’s culture will impact how they perceive and respond to trauma.

When working with veterans, it’s important to understand military culture and how it could affect their response to trauma and treatment.

Each military branch has its own set of values, beliefs, rituals, and symbols. The branches share an underlying “warrior ethos” that can be highly adaptive for active-duty service. These values can help service members:

• Develop group cohesion.
• Feel a sense of comradery.
• Accomplish missions.
• Endure hardships.

There are several principles of the warrior ethos, each of which can increase a veteran’s vulnerability to mental health issues and suicide risk. These principles include:

• Selflessness: Putting the needs and well-being of others before their own.
• Loyalty: Commitment to serve one’s country, protect fellow service members, and accomplish missions.
• Stoicism: In military culture, stoicism is a form of emotional control that emphasizes self-reliance, self-sufficiency, and mental toughness.
• Moral code: Military service members must follow a code of conduct with clear definitions for right and wrong behavior. Each branch has its own moral code that all members must follow.
• Excellence: Military culture emphasizes excellence by expecting service members to do and be their best.

While this is just an introduction to aspects of military cultural competence, it can help your organization better serve the veterans under its care.