Care for Your Mind acknowledges and appreciates the collaboration of the National Network of Depression Centers in developing this series.
Returning Veterans Face Many Mental Health Risks—We Need More Resources to Help Them
Sanjai Rao, M.D., VA Medical Center, San Diego
Of the 1.7 million Veterans returning from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), an estimated 30% are suffering from mental health issues. That’s hundreds of thousands of individuals in need of psychological care and, for those of us who work in Veterans Affairs (VA), it’s our responsibility to provide it.
I’m a psychiatrist at the VA Medical Center in San Diego, one of the busiest VA facilities in the country. San Diego has the largest population of returning Veterans of any city and we provide mental health care for thousands of them each year.
Unfortunately, despite our best efforts, we don’t have the capacity to reach everyone we’re tasked with treating in a timely manner. As a physician, I see the system from the inside, and every day I’m faced with the frustration of watching Veterans wait longer for care than they should have to.
Veterans have a 41% to 61% higher suicide rate than those who have never served in the military, a deeply troubling statistic. As our service members return home, they face a challenging reintegration into society. We must do a better job of supporting their mental health needs and providing care.
The VA has the expertise to offer that care, but we’re in desperate need of more resources to do so.
Higher risk, higher stakes
In addition to the other challenges facing new Veterans, they’re at a much higher risk for mental health issues than the general population. There are a number of reasons why this is the case, including
- Veterans are disproportionately male, and men die by suicide 3.5 times more than women
- Veterans often have severe medical problems in addition to mental health issues
- Support networks for soldiers are often nonexistent or damaged: deployment is hard on families and often leads to divorce; PTSD and mental health issues can erode connections with family members and friends
- Some have endured military sexual trauma. Though it’s rarely talked about, this is a serious problem in the armed forces
- Many Veterans have access to weapons/personal firearms. Research suggests that someone with access to guns is three times more likely to complete suicide
- Many have survived traumatic brain injury which often impairs judgment, increases impulsivity, and decreases the ability to tolerate stress
- According to the Bureau of Labor Statistics, recent Veterans are more likely to be unemployed than civilians
- Many Veterans with depression also have histories of early childhood neglect or abuse, as well as co-occurring PTSD, both of which are additional risk factors for suicide.
Barriers to care
Sadly, many Veterans never seek care for their mental health issues and those who do often face significant obstacles. Some don’t know where to turn, while others are held back by stigma or unable to access the care that’s available due to transportation or logistical issues.
In addition, many former or current soldiers believe that seeking care will jeopardize future job prospects, risk security clearance, or hurt their chance to rise in the ranks.
For those who do seek help, by far the biggest barrier is the one we deal with every day at the VA: a lack of resources. There simply aren’t enough trained mental health professionals to give timely care to all the Veterans who need it. Because of this capacity issue, wait times for patients can be excessive and frustrating.
Due to their unique experiences, Veterans also require specialized care, which can make it even more difficult for them to find the help they need. If they attempt to seek treatment in the community — away from the VA — they’re often met with clinicians who lack the training necessary to deal with more complex issues that arise from active military service. For example, many community mental health professionals don’t have experience with PTSD, traumatic brain injury, or other problems common among soldiers returning from combat. In addition, the best community physicians also have long wait lists, often longer than the VA’s, and don’t take insurance.
What many people don’t realize, and what the popular media will seldom tell you, is that Veterans who are able to receive mental health care at the VA are typically more satisfied with it than people getting care through private insurance. They are probably also getting better care: a recent study looking at the quality of medication treatment for mental disorders found that, in every measure, VA care was superior to private sector care by more than 30%.
Though the VA isn’t perfect, we are the most qualified to offer care to Veterans. However, we cannot do so without the proper resources.
In our next post, we’ll discuss how we can best address this military mental health care crisis.
- What has been your experience—or the experience of someone you know—in accessing mental health services through the VA?
- What mental health care and support resources would you recommend to a returning Veteran?
Dr. Rao received his medical degree from the University of California, San Diego, and is board certified in general psychiatry and psychosomatic medicine. His primary clinical role is inpatient attending psychiatrist at the VA Medical Center in San Diego. Dr. Rao currently serves as both an Associate Training Director and the Site Director at the VA Medical Center for the UCSD Psychiatry Residency and Co-Chair of the NNDC’s Military, Veterans and Families task group. Dr. Rao coordinates large parts of the residency curriculum, and has received a number of teaching awards based on his clinical and academic work. His current research activities include serving as the San Diego Site Investigator for VAST-D, a multi-site VA Cooperative study on treatment of depression in patients who have failed at least one antidepressant. He has also conducted research on improving the assessment and treatment of depression and delirium in the palliative care setting. Dr. Rao has published in several areas, including depression and delirium in palliative care, anxious depression, side effects of antipsychotic medications, and residency training.
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