Each veteran has internalized a set of values that have enabled them to endure hardship, overcome obstacles, and find resilience in their service. But these same values can also make it difficult for them to seek help when they are experiencing mental health issues.
The teamwork they forge creates close bonds that can discourage seeking outside help; altruism allows them to prioritize their mission and their comrades, but may prevent them from prioritizing their own health; a commitment to excellence drives their motivation but also creates a constant push towards perfection.
As a partner of an active duty member and a licensed therapist who works with veterans, I have seen firsthand the challenges that current and former service members face in finding appropriate care.
We frequently thank veterans for their service, but I challenge all of us to show it by listening to the mental health needs of the military and veteran community, educating ourselves about the impact of military life, and supporting organizations that are on the ground to make it work.
About 11% to 20% of veterans who served in the wars in Iraq and Afghanistan reported suffering from post-traumatic stress disorder, according to the US Department of Veterans Affairs. And about half of veterans who have served since 9/11 said in a Pew Research Center survey that it was somewhat or very difficult for them to readapt to civilian life after their military service.
I also learned how few people seem to understand the effect of military life on military families. I was battling postpartum depression while my partner was stationed overseas, but was told “I signed up for this”. Feeling disconnected from civilians is a common struggle.
Veterans continue to experience trauma and depression, but it has become more difficult to access care for themselves and their families. During the pandemic, referrals to my clinic more than doubled. Yet many clinicians do not have a full understanding of military culture and often have misconceptions about this community, which creates a barrier to providing adequate treatment to service members.
Licensing to work in the mental health care field often requires some form of cultural competency training, which typically focuses on race, ethnicity, geography, sexual orientation, and spirituality. But training has rarely fully included the military as a culture or discussed the military community’s intersectional identities. When providers are not properly trained to understand the military community, their ability to provide effective and culturally appropriate care can be challenged.
Lack of cultural competence in the community can leave veterans feeling isolated from their caregivers. Myths, such as the misperception that all military and veterans have or develop PTSD and that PTSD means someone will be violent, can contribute to the stigma that keeps many people from seeking help.
Many veterans are hesitant to seek mental health treatment because of the pervasive military culture that espouses the warrior ethos, a set of commitments to mental toughness in service. These beliefs make it difficult for veterans and service members to admit they suffer from depression and anxiety.
It is often assumed that the health care needs of the US military community are met within government systems such as the VA. However, many veterans who choose to access services in the community outside of the VA find that they are ineligible for care due to dishonorable discharge. In decades past, veterans had been separated from the service due to mental health and sexual orientation issues, and their dismissal had been called dishonorable.
Care-seeking options can be even more restrictive for family members, who are often not at the center of veterans’ resources. Few health care providers accept TRICARE, the US Department of Defense health insurance program, or have a good understanding of military culture, and wait times can be excessive.
Asking for help can be difficult under optimal circumstances. Imagine being told that you have to wait months for treatment.
While options like telehealth have helped break down barriers to seeking mental health care, there is still work to be done. Together, we can build a better system for active military members, veterans, and their families that includes access to timely behavioral health care and empowered providers who know the unique challenges as well as the strengths of this community.
Dr. Nichole Ayres is Clinic Director of the Steven A. Cohen Military Family Clinic at Valley Cities in Lakewood, which is part of the Cohen Veterans Network. The Cohen Clinic of Valley Cities provides confidential, high-quality therapy and local support services to post-9/11 veterans, service members, including National Guard and Reserves, and their family members. Healing is available regardless of discharge status, uniformed role, or combat experience. As a military spouse for over 13 years, Ayres is also an active member of the JBLM community supporting military families through the challenges of deployment and redeployment.
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