Michael B. Brennan PsyD

The War Within

Identifying Challenges Effecting Veteran Mental Healthcare

Why are they struggling?

Posted Jul 29, 2017

  AccessTo Care For Veterans
Source: Dave Rucker: AccessTo Care For Veterans

First, let me start by saying that it is an absolute honor to be invited to write about veterans issues, as I am a veteran myself. I am also a clinical psychologist, so the issues that I will be addressing in this blog truly hit home for me.

I believe that it takes a nation to build a military and go to war and that it takes a nation to welcome them home. This is an obligation that we as a nation need to take more initiative on as a whole to continue to fill gaps that impact our veteran community. Given this need to support our veterans in multiple contexts, I will be examining a variety of presenting concerns and how we, as individuals and a community, can gain awareness and offer support. Today’s political forum and environment is interspersed with many veteran’s topics and issues, so focusing on one topic can be difficult. However, one of the most pressing issues is the challenge that our veterans face in seeking mental healthcare today. This includes access to care, frequency of care, quality of care, incentivized symptomology, stigma, and the continuing divide between civilian understanding of military issues and service.

For the sake of brevity, today’s post will focus on two of the aforementioned challenges—access to care and frequency of care. I will address the remainder of the challenges in posts to follow.

Lawlis Peavey PNP Center
Source: Lawlis Peavey PNP Center

Access is an essential component surrounding many of the diagnoses and conditions that veterans face on a daily basis. The (U.S. Department of Veteran’s Affairs) VA provides incredible care, but they cannot be in all places all over the country. It is logistically impossible. They have attempted to expand their reach by establishing multiple CBOCs (Community Based Mental Health Clinics); however, there are only so many locations that are feasible. In many areas, there are “dead zones” of care that do not have mental health resources of any kind to include VA resources.  Roughly 41% of all registered Veterans live in rural areas where resources are scarce. This poses several problems. First, distance is a significant factor. For some veterans, they would have to travel over 50 miles for an appointment which would take a considerable amount of time and resources. Second, 54% of rural veterans make less than $36,000 per year, potentially negatively impacting their ability to take off work (if they are employed), own a vehicle that could transport them a long distance as well as pay for the fuel to get them to their appointment. Additionally, Tricare (one of the largest military medical insurance companies) does not have strong roots in many areas outside of military installations. This poses a concern for retired veterans who have Tricare as well as Reserve and National Guard service members who live and work in areas that are outside of a military treatment facility or military post. The availability of both medical and behavioral health providers who take that insurance is limited which further impacts access to care concerns. There is no easy solution to this problem; however, several solutions are in the process of being implemented to include tele-health and continued public and private partnerships to “widen the net” of services that would be able to increase access to care.

Regarding the second issue, namely, frequency of care, this continues to be an ongoing concern. The demand of veterans needing mental health services continues to grow as “official” combat operations have shifted to an train, advise and assist model. As many Vietnam veterans are continuing to initiate services for the first time even to this day, we have only "scratched the surface" of the need for them to come. If a veteran has a severe condition of Posttraumatic Stress Disorder or Major Depression, they usually need more frequent appointments with evidenced based types of treatments to reach sustained symptom reduction and therapeutic benefit. Due to the increased demand of services, many veterans that I see often state they are in “treatment” but, upon gathering additional information, they only see a mental health counselor once per month or sometimes even less frequently than that. This is not the case for everyone; but it is an occurrence that I continue to notice happening in the field. This places more emphasis on the importance of continued community collaboration and partnerships with private entities that have made it their mission to serve veterans alongside the VA. As awareness continues to grow and more people and veterans are taking initiative to bridge the gaps and challenges that veterans encounter in seeking mental health care, the future is hopeful.

In the next post, I will address some of the remaining challenges that veterans face in seeking mental healthcare.

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