Mental Health Needs of Recent Veterans Largely Go Unmet

Kerry Dooley Young

February 01, 2018

Many veterans of the wars in Iraq and Afghanistan have unfulfilled needs for mental health services, and a large proportion of them are not receiving treatment for conditions such as posttraumatic stress disorder, substance use, and depression, according to a new report from an influential federal panel.

About 41% of the roughly 4.2 million American service members who took part in the recent conflicts have a potential need for mental health services, including the simple step of undergoing further evaluation, said a National Academies of Science, Engineering, and Medicine (NAS) panel. This estimate is based in part on results of screening regarding the mental health of veterans, not actual diagnoses.

Thus, some veterans who are considered in need of further evaluation might be found to have no mental health conditions as a result of such testing, the report states. Still, the finding should spur greater efforts to persuade these veterans to seek mental health services, said Alicia Carriquiry, PhD, chair of the NAS committee, who is also a professor of statistics at Iowa State University in Ames, Iowa.

"It was pretty shocking to find what the proportion of veterans with a potential need actually was," Dr Carriquiry told Medscape Medical News.

The report depicts challenges in aiding Iraq and Afghanistan war veterans who have already been identified as having mental illness. The suicide rate for such veterans is higher than for the general population. These veterans served in some of the longest wars in US history and faced stresses little known in previous generations, Dr Carriquiry said.

"They were deployed for longer periods than usual, more times than usual. Sometimes you had two parents deployed at the same time. This was pretty stressful," Dr Carriquiry said. "It's no wonder that there's such a prevalence of potential mental health needs."

A Positive Review

Congress commissioned this NAS study through a 2013 law intended to address the needs of veterans at a time when the media were reporting about flaws in way the US Department of Veterans Affairs (VA) addressed the medical needs of veterans.

In general, the NAS report gives the VA a good review. It reports that the VA's mental health services are comparable or superior to those of other medical providers.

"The VA has its challenges, of course, but the story that hasn't been told is that there have been millions of veterans who have been very well served by the VA," Dr Carriquiry said.

The NAS report urges the VA to better coordinate with the US Department of Defense to make departing service members fully aware of the help available to them. The VA faces challenges in persuading veterans to seek help for mental health problems, because many veterans fear being stigmatized and worry that receiving psychiatric help could affect their future employment.

"We need to say it's okay not to be okay," Melissa Bryant, director of political and intergovernmental affairs for the Iraq and Afghanistan Veterans of America (IAVA), told Medscape Medical News.

Bryant's group has been pressing for wider use of telehealth services to address a shortfall of personnel in the mental health workforce for treating veterans.

The NAS report notes that Iraq and Afghanistan veterans appear more open to this approach and lists telehealth services among the priorities for improving its mental health outreach. This is among the areas the NAS panel targets in suggesting that the VA set as a goal the overhauling of its mental health care system within 3 to 5 years.

The report also urges the VA to address problems regarding the workforce in its health programs. Members of the study committee have said they have repeatedly heard during visits to the department's centers about a "cumbersome and onerous" human resources management program.

In addition, the NAS report highlights the need for more medical and office space and staffing to reduce wait times, and it calls for efforts to lessen clinician burnout, which may contribute to staff turnover.

Care Disrupted

The report also notes that the VA's key role in developing the nation's supply of physicians and other healthcare professionals can disrupt veterans'care.

"Veterans sometimes experience a lack of continuity in their mental health care because of the turnover of providers, and especially providers in training," the report notes. "The training of mental health care providers at VA facilities is highly desirable, but VA should make an effort to better bridge the transition from one trainee therapist to another."

The NAS report notes that veterans who seek mental health services may experience problems relating with physicians and medical professionals who have not seen war.

The report quotes a veteran who dropped out of treatment for that reason: "[I]t just wasn't working at all. I felt like they were patronizing me." Another veteran told the committee that he struggled with a healthcare professional who had not been in the service, "yet she's trying to sit there [saying,] 'I understand.' What...do you understand? I went to combat. I've been blown up. Our bodies got blown up to pieces."

Groups such as the Veterans of Foreign Wars (VFW) and IAVA have urged greater use of programs in which former service members help others cope with the lasting mental effects of war.

"There is a nationwide shortage of trained mental health professionals, yet one resource continually engaged are America's military veterans themselves, whether individually or collectively," Joe Davis, the VFW national spokesman, told Medscape Medical News. "No one knows how two people experiencing the same time and place can walk away totally different, yet being amongst others who have walked the talk is a resource that needs to be embraced and encouraged."

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