Addressing Barriers To Veterans’ Mental Health Care

On the 11th of November, the US celebrates Veterans Day: a day to honor veterans, recognizing their service and contributions to the nation. November is also known as Military Family Month, during which campaigns are launched to improve family mental health and provide essential mental health services for military families. These initiatives emphasize overall health and well-being, promote mental health, and aim to enhance long-term health outcomes for veterans and their families through ongoing support and resources.

According to the United States Census Bureau, approximately 16.5 million veterans make up the adult population in the nation. While veterans have left the battlefield, some may continue to experience the effects of their time served, potentially remembering physical and emotional trauma or military sexual trauma. Because veterans often experience traumatic events, the rate of mental health conditions like depression, anxiety, and post-traumatic stress disorder (PTSD) can be high in these communities. 

To understand veterans' treatment barriers and how their experiences may impact their mental health and physical health, it can be helpful to look at current public stigmas and ways they can overcome these challenging beliefs.  

Effects of stigma on veterans’ mental health care

Although some people may be sensitive to the mental health concerns and invisible disabilities some veterans have, there are still stigmas surrounding this topic in the US. General mental healthcare has become less stigmatized in the past decade, making more people willing to go to therapy and seek out mental health resources. However, veterans may face the following stigmas that make it difficult to reach out for help. This could mean they require more resources. 

Public stigma

Some veterans experience perceived public stigma, which may dissuade them from seeking mental health services or availing mental health resources. Dr. Alicia Lucksted of the University of Maryland School of Medicine notes that many veterans feel like outcasts because of their mental health. She also reports that many veterans believe they are violent or will become violent unprovoked.

Public stigma can point to a culture that may not seem as accepting toward those seeking support for mental concerns. In addition, it can indicate that mental health is not discussed enough by direct leadership and peers in veterans' circles, making it an uncomfortable topic for some. 

Internalized stigma

In a study by Dr. Dwane Vogt, researchers reported that 70% of veterans don't seek mental health services out of fear of being diagnosed with a mental illness. In the study by Dr. Alicia Lucksted above, veterans who did receive care said they were angry that they were diagnosed and didn't want to believe it. They felt they should "suck it up" and ignore their mental health symptoms because they "knew what they were getting into." 

Some veterans may believe that, because of their veteran status, they are "supposed to be strong enough" to overcome their mental health challenges without help from a mental health provider or other mental health resources. However, due to the nature of conditions like PTSD, depression, and anxiety, it can be challenging to cope healthily and reduce symptom severity alone. Most people require more resources and support and not just from their families.  

Veterans may form these beliefs due to social pressure to be "tough" and silently cope with all challenging events. Instead of talking about emotions with their peers or families, veterans may have memories of silence and internalized fears. In addition, being in a rugged and intense environment one year and in an office with a counselor the next might feel confusing and insulting. However, despite these stigmas, it can take bravery and grit to connect with a professional despite outdated cultural norms. 

What other treatment barriers do veterans face? 

Another barrier to mental healthcare resources is that a veteran can only receive insurance-covered mental health services from the VA if they were honorably discharged, whether it be categorized as a medical or general discharge. Veterans with an "other than honorable discharge" may be eligible for some benefits, but not all. Those who were discharged dishonorably lose all health insurance benefits of their service. However, people facing these barriers can still receive treatment and resources outside of the Department of Veterans Affairs if they pay for a personal insurance plan or out-of-pocket for services and support. 

The cost of VA treatment is often not a barrier for veterans. However, the time it takes to be seen at a VA facility can be an obstacle. Some people report months to years of waiting for an appointment with these services. Veterans who require immediate mental healthcare may seek care outside of the VA or pay for these services. In some cases, the Veterans Crisis Line may be able to fill the gap for veterans and their families with online resources and support. This service is available 24/7 every day of the year. 

Seeking treatment for trauma-related mental health conditions

According to the American Psychology Association, one-third of military soldiers returning from Operation Enduring Freedom have a mental illness or cognitive challenge. Another paper by Miriam Reisman reports that 13.5% to 30% of veterans from all branches have PSTD. In addition, according to the Department of Veterans Affairs, 11% of veterans have depression. These rates can be in higher concentration in veteran groups than in non-veteran communities; as the National Alliance on Mental Illnesses (NAMI) reports veterans are five times more likely to have depression than non-veterans.

Benefits of online mental health care for veterans

If you are a veteran experiencing symptoms of a mental illness, you're not alone. If these symptoms interfere with your quality of life, make it difficult to accomplish daily tasks, or cause fear, consider contacting VA mental health services for VA resources or a licensed therapist for support. If you face the above barriers, live in a remote location, have a busy schedule, or want to stay in the comfort of your home to receive support, you can also try methods other than vet centers like online therapy through platforms like BetterHelp. If you’re in crisis, go to the nearest emergency room for inpatient care or contact the Veterans Crisis Line. 

Effectiveness of online treatment for PTSD and other mental health conditions

Online therapy is an available, affordable, and convenient option proven as effective as in-person therapy and equally beneficial. A research trial published in the Journal of Clinical Psychology compared the efficacy of online therapy for veterans with combat-related PTSD concerning in-person therapy. The study results revealed that home-based telehealth therapy was equally as effective as the standard in-person treatment, with both showing a significant reduction in symptoms of PTSD. Researchers added that online therapy offered the benefits of addressing stigma and geographic-related barriers to treatment, including travel time and cost.