Veteran mental-health services are improving — but too slowly. While about 50 percent of returning service members who need treatment for mental-health conditions seek it, just over half who receive treatment are getting the type and amount of support they need. As a psychologist who supports veterans and military families, I have noticed cultural and structural obstacles that can interfere with effective behavioral health care.
From the start, the Warrior Ethos — a set of principles focused on selfless service that veterans have been trained to follow — calls for our service members to prioritize the needs of the military mission over their own. Selfless habits serving the mission can become a barrier to seeking support upon returning to civilian life. Many veterans believe that seeking support is a sign of weakness. Others think that they are taking the spot of a veteran in "greater need" of support if they pursue treatment.
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Once our veterans and their family members express a willingness to engage with care, access can be another hurdle. Many veterans, such as those in the National Guard and Reserves, do not receive the same affordable health-care options as their peers due to strict eligibility requirements. Moreover, the systems supporting veterans do not always offer mental-health services for family members, who have to transition into new, often demanding, caretaking roles as they support our veterans during and after service. For some families who are eligible, high costs, insufficient insurance coverage, limited provider options, and long wait times block them from services. In my experience, wait times between the initial assessment and follow-up appointments are especially concerning, as this is a period when those in need of support are more likely to drop out of care.
Fortunately, behavioral health organizations, such as the Cohen Veterans Network, recognize these barriers and are finding ways to manage them.
For starters, organizations, such as our clinic at Penn Medicine, are bringing care to more people by expanding the definition of veteran to include members of the National Guard and Reserves, welcoming veterans regardless of their role or discharge status, and offering services to family members. Our telehealth services are opening up our work geographically, using secure and confidential video conferencing to reach those who cannot attend sessions in person due to scheduling restrictions or limited transportation. Research has shown that telehealth sessions can be just as effective for many veterans and their family members when compared to holding sessions in-person. We are also improving care itself by bringing in evidence-based practice, encouraging treatments that have been carefully tested and can be tailored to fit individual needs.
Our field continues to advocate for members of our military families and adapt to changes in our health-care system. It's imperative to expand access to care by redefining eligibility, thoughtfully using technology, and providing personalized treatments to multiple members of the family. While barriers exist, we are making progress to support those needing our help — and other mental health-care providers can, too.
Jonathan Smith, PsyD, is a psychologist withat the University of Pennsylvania.