An estimated one-point-nine million U.S. veterans are now receiving mental health services. But studies commissioned by Congress and the Department of Defense (NIH, 2017), (National Acadamies of Science, Engineering & Medicine, 2018), and (VA, 20180), say that may be half the number who should be.
Feeling like a number
Joanna Bashear is the wife of a marine wounded in Iraq--twice. “My husband was blown up in 2003 by three roadside bombs. And his Humvee flipped over fifteen times with nine men inside, and they were tossed around like a washing machine.”
She says he was hurt in another explosion during a second deployment. She says he still needs treatment for the bodily injuries from the two incidents, and even more so for the emotional damage--and that’s been a problem. “My husband is a complicated patient. They don’t want to deal with it. I know what my husband would say is that he’s only a number that they can throw away in a trash can.”
But, she says he’s recently begun trying again to get behavioral counseling with the VA and this time may be making progress.
A lack of trust
Many veterans do not have confidence in the VA mental health system and that is one of the reasons noted in those government studies for why vets shy away from the program.
John Buck is a former Army Ranger, also wounded twice and carrying scars both physical and mental. He says he’s been let down by the VA too. And, though he believes there have been positive changes, a persistent issue that affected him remains in the way. “It’s evolving, even just since I came out, as far as different techniques and therapies. But some places, and it’s really hit or miss depending on where you go, they don’t have a lot of therapists. That’s the only downfall: the VA is very overworked.”
Psychiatrists and Pyschologists needed
Shortages of mental health practitioners have been reported in the VA since the 1940s. Tiffany Hawley, a program director at Freedom House for veterans in Kent, and a multi-deployment veteran herself, calls that a critical VA weakness. “A lot of physicians over the different VAs I’ve gone to really cared and have really wanted to help better the lives of the veterans they’re serving. But then they transfer or get another job, and you’re just back and forth with all these people. And you don’t want to keep rehashing these stories over and over again. You know, like it’s hard enough to go through it the first time.”
Options for care outside of the VA
Going to civilian practitioners might help prevent that discontinuity of therapy. But Stark County Veterans Center Director Tom Chronister says there are things to consider in doing so. Like what’s the practitioner’s ability to deal with the multiple traumatic events a combat veteran may be facing? “Which one is he reliving, and which one is he talking about? Are there five more that are somewhere in his mind that he’s also reliving? So there’s definitely a different approach to combat related stress versus a one-time trauma. And I think that’s where oftentimes civilian mental health providers struggle with an understanding.”
Local connection strategy
In fact only 13 percent of private providers currently meet VA criteria for delivering veterans’ mental health care. Chronister says that‘s why the VA is using the facilities of its local services division--its Veterans Centers, like the Stark County Veterans Center—as bases for what’s called the Readjustment Counseling Service. The RCS arranges for local or nearby qualified mental health care for veterans from both private and VA sources. And it provides an expanded range of help including with practical and domestic issues. “It specializes in combat veterans. We can serve families, we can do marital counseling. We can do a variety of things that VA necessarily is not able to do.”
Wounded Special Forces veteran John Buck says he hopes those VA moves will help, but he still clings to something he finds more reliable. “The best mental health treatment that I’ve had is with the guys in the unit. We served together. We were there, we shared the exact same experiences. We know how each other feel. We can pick each other up. A brotherhood and a bond, nothing can ever take that.”
Studies to understand the scope of the problem show nearly a third of Vietnam-era veterans now diagnosed with Post Traumatic Stress Disorder or other serious mental health problems, and one in five returning veterans from Afghanistan and Iraq likely to suffer from similar disorders. Meanwhile, the VA launched campaigns to hire a thousand more psychiatrists for its hospitals in both 2017 and 2018.