Veterans' mental health always seems to be a hot topic. For such a large population – a population with its own designated health care system – we should not see any gaps in the care of their behavioral health. There are many Veterans who struggle with their behavioral health. Some may have started to have issues while they were on active duty, while others do not start to have issues until after they have separated from service. What are some of the causes for this specific group of people to struggle so much? Is there any way we can fix the system?

The Veteran community is notorious for having high rates of anxiety, depression, addiction, and suicide. Unfortunately, even with better access to care, these issues seem to plague the community constantly. It seems like every day, we hear of another Veteran who committed suicide. In addition to the diagnosable mental health problems Veterans experience, many outside influences can exacerbate these issues. Unemployment, physical handicaps, and homelessness are common issues within the Veteran community that can worsen mental health. 

Unemployment is a fairly common problem in the Veteran community. There are many reasons for this. One of the biggest reasons is that military skills do not always transfer fairly to the civilian world. One example of this barrier is a hospital corpsman who, while active, performed many duties that would typically be done by a nurse or other licensed medical provider. Once this hospital corpsman leaves active duty, they are no longer qualified to perform these same tasks without receiving a college degree. For some, this means 5 to 10 years of experience is no longer valid and cannot be performed until the Veteran attends and graduates from college. This can be very disheartening and extremely depressing, especially when they love their job. This can set the Veteran back several years from obtaining a comparable salary to what they made in the service. The skills don't transfer over, and that is a huge problem. It may also be hard to obtain or hold down a job for many Veterans because of their former work environment behaviors. The service truly has a different lifestyle than the civilian world, and the two worlds do not always match up perfectly. 

Physical handicaps are also a huge problem for the Veteran community. Many former service members receive a disability rating from the VA. While this is not a big deal for some, depending on the physical health problems they have been diagnosed with during or after active duty, this can severely impact their life. Active duty can take a toll on a Veteran's body. Deployments and years of active-duty service can often leave members with chronic health problems. Bone and joint conditions, especially in the back, knees, and shoulders, are common, along with respiratory and neurological problems. Generally, those who enter active-duty service are in good physical condition. Those who leave usually have some permanent physical and mental reminders of their service. Being diagnosed with a physical handicap can cause or increase depression. Some Veterans are even deemed totally and permanently disabled and labeled as unable to work. This, again, can cause major depression and homelessness. Even if a Veteran only has a few disabilities following their service, there is a high chance this will cause issues for them in the future. 

Homelessness is another significant concern for Veterans. Unemployment and physical handicaps can increase the chance of a Veteran becoming homeless. Mental health also plays a prominent role in this. Poor mental health and untreated conditions can keep a Veteran from obtaining and maintaining a home or living space. Paired with unemployment, this is a bad combination. Once a Veteran is homeless, receiving proper health and behavioral health care becomes much more difficult. This will cause their issues to worsen, and the cycle of homelessness will continue. Mental health would likely significantly decline once a Veteran becomes homeless. These issues increase the likelihood of depression and suicide risks in the community. 

There is a statistic floating around social media that 22 Veterans a day commit suicide. This has prompted several rounds of the 22-a-day challenge. This "challenge" involves doing some sort of physical workout, usually pushups, and filming it to post on social media. The idea behind this is to bring attention to the dramatic rate of suicide in the population. According to the 2021 National Veteran Suicide Prevention Annual Report, the actual rate is closer to 17.2 Veterans a day committing suicide. While this number is lower than the 22-a-day from social media, this number is not something that should be brushed off. The annual rate has been increasing since 2001, even though access to crisis care has expanded. 

There are some higher-profile Veteran suicides, as well as ones that have gained national attention. In several instances, Veterans have committed suicide on VA campuses, some even in the parking lot of those campuses. While the VA explains that these individuals were very disturbed, many blamed the VA for the suicides. Many voice concerns that the VA does not do enough to support behavioral health care and suicide prevention. 

Veterans have many outlets for help in a crisis. For starters, there is the Veteran's Crisis Line, which as of July 16, 2022, is even part of the prompt for the new (988) national mental health crisis line. There is also a prompt for the Veteran's Crisis Line whenever you call any VA official phone number. This option is always given at the beginning of a voice option, usually option 1. The VA has a special call center for the Veteran's Crisis Line, and the people working the line are trained to handle the sensitive issues Veterans struggle with. There are also screenings that take place at every VA doctor's appointment. They will always be asked if they feel safe or have any thoughts of suicide, homicide, or attempts of suicide. There is also a depression screening typically done. These can help get Veterans the care they need. The problem from here is keeping up with the need for mental health care.

Once a Veteran is diagnosed with a behavioral health concern, there needs to be a firm or set care plan. This could include therapy, medications, rehabilitation programs, etc. A VA care coordinator is often provided to Veterans with several issues or a care plan with many parts. The care coordinator usually helps with scheduling appointments, testing, and general advice based on the next steps in the care plan. These care coordinators are very helpful if they are used properly or if they are available. 

The most significant problem in the VA care community is access to care. The VA system is bogged down. It can take months to get appointments. If one needs to be canceled or is missed, it can be just as long until the Veteran is rescheduled. If they are in a crisis or having a flare-up of mental health concerns, it is impossible to wait such a long time. Even once they are in a care system, say for therapy, the appointments can be spread very far apart. This is counterproductive in the treatment of behavioral health. When a Veteran is in crisis, they can feel helpless. If they go to a VA facility in a crisis, they often have to wait based on the volume of patients already being seen. There never seems to be enough providers. Veterans in crisis are a frequent occurrence at a VA facility. 

Another significant problem with the VA is understanding. Many Veterans feel that their providers do not care or believe what they are saying. This heavily comes into play when they are being evaluated for their disabilities. Each disability is assessed and must be justified. If the Veteran cannot prove that a health problem impacts their life to the evaluator's level, then they may not receive a disability rating for those issues. This can mean that it will not be treated or taken seriously. The VA has a set of standards that each disability must meet in order to have it rated. Many evaluators are callous and can try to underplay the disability so that the VA does not have to compensate the Veteran for it. This seriously impacts the mental health of a Veteran. Being told that a chronic health issue they have been dealing with does not meet their criteria for being a covered disability can drive anyone to have depression and feel that their needs are not being met. As for female Veterans, there is often a feeling of not having their needs met or being told that their concerns are not valid. Being told that a situation that happened while active shouldn't give you PTSD or should have just been ignored are some of the most common responses female Veterans hear when discussing their active-duty service. Many female Veterans face a divide when they are talking about the trauma and can end up feeling rejected by the system that is supposed to support them. All of these concerns combine to increase poor mental health in Veterans. 

Mental health will always be a concern for the Veteran community. While the VA is making strides to increase care for those in crisis, upkeep of care, lack of providers, and other barriers will always create dividing lines for those that need help the most. Changes to mental health care treatment should be at the forefront of the VA community. 

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You can learn more about the Annual Reports for the National Veteran Suicide Prevention here. 

To learn more about the new (988) Lifeline, click here.