Veterans’ mental health care guide

According to Veteran Affairs (VA), around one in five adults in the U.S. have a mental health condition. In 2018 alone, over 1.7 million veterans sought mental health treatment. The stigma surrounding mental health has waned over the years, and society is more open about discussing treatments for depression and anxiety. Veterans, however, face unique challenges that may be best addressed by certain programs and services designed specifically for their needs. 

Whether you are a veteran, looking to transition to civilian life, or simply care about someone who has served, you may have concerns about mental health. Mental health is an essential part of veterans’ health care, and there are more options than ever to help veterans who may be recovering from their experiences. From PTSD to everyday stress, this veterans’ mental health care guide will answer all of your questions. 

Mental health issues and veterans

Are veterans more likely than others to deal with mental health issues? Researchers have conducted studies to answer this question with mixed results. Studies show that veterans are at a higher risk of mental health-related illness than other people. How veterans develop mental health problems may be unique, however, since veterans live a life that is unfamiliar to many. Their struggles are their own, and it can be hard to know how to help them unless you understand the distinct daily challenges of a veteran.

A 2016 study conducted over a one-year period revealed that over 1 million veterans were treated for at least one of several mental illnesses. The diagnoses included depression, anxiety, PTSD, substance use disorder, schizophrenia, and bipolar disorder.

Mental illnesses and their treatments

Here are the conditions most commonly seen by the Department of Veterans Affairs and the treatments most commonly administered by mental healthcare providers under their guidance. 

Depression and anxiety

According to the U.S. Department of Veterans Affairs, depression is one of the most common and costliest mental disorders in veterans. It is also one of the most common mental health conditions in the general population. Depression can be treated with drug and non-drug treatments, including the following:

• Talk therapy, such as cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), and interpersonal therapy, which helps a person develop new thinking patterns, deal with emotional stress, and resolve conflicts
• Antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)

People in the military have experienced unique challenges that can contribute to depression and anxiety. However, the treatment strategies for these mental health conditions are universal and proven to be effective for people from all walks of life. 

PTSD

A life-threatening trauma, which is common in combat situations, can cause post-traumatic stress disorder, or PTSD. Symptoms of PTSD can vary but can often appear as flashbacks, nightmares, trouble sleeping, angry outbursts, and severe anxiety. PTSD may lead to different issues, such as substance abuse and other destructive behaviors.

PTSD is often the first term people think of when talking about veterans and mental health, leading people to assume that all veterans who served in combat have it. But PTSD statistics show a different picture. The prevalence of PTSD in veterans varies depending on the conflict. For example, up to 20% of veterans who served in Iraq or Afghanistan have been diagnosed with PTSD. However, the VA’s National Center for PTSD estimates that the prevalence of PTSD is about 8% across the entire population.

Here are some treatments for this trauma-related condition.

Talk therapy, such as CBT, cognitive processing therapy (CPT), and prolonged exposure (PE) therapy

• Eye movement desensitization and reprocessing (EMDR)
• Theta-burst transcranial magnetic stimulation (TMS)
• Mantram therapy
• Antidepressant medications, including SSRIs and SNRIs

If more attention is needed, veterans with PTSD may live in community-based residential treatment centers where they can receive daily care and monitoring. 

Substance use disorder

Whether it’s the misuse of drugs, alcohol, or other substances, a substance use disorder can keep veterans from thriving in their new civilian lives. Treatment for substance use disorder may include:

• Medications designed to stop cravings, help with detoxing, and reduce dependency on the substance.
• Talk therapy and counseling
• Opioid treatment programs (OTP), which combine therapy and prescription meds to help ease a person gradually and safely off opioid drugs.

Residential treatment facilities are another option that provides services and medical support while a veteran is returning to optimal health. Residential programs often involve individual and group therapy, as well as medication-based treatment options. 

Traumatic brain injury

Another condition that’s associated with mental health conditions in veterans is traumatic brain injury (TBI). One study found that TBI is linked to an increased risk of anxiety, schizophrenia, PTSD, and other mood or cognitive disorders. TBIs can also increase the risk of other issues, such as suicidal thoughts or behaviors. Suicide is the leading cause of TBI-related death with higher rates than TBI-related motor-vehicle crash deaths. 

How is TBI connected to veterans? TBI occurs when the brain is jarred, hit, or penetrated by force, such as a fall, crash, or gunshot. The nature of military service results in more instances of these types of injuries happening than in parts of the general population. 

TBI can lead to both short- and long-term health problems, and the long-term problems may not be discovered right away, which can lead to veterans not getting the care they need to reduce mental health issues down the road. Older veterans may not be treated for TBI-related illness, as the symptoms may overlap with other conditions that are more common among seniors. Instead of getting treated for an illness caused by TBI, a veteran with a TBI may be seen for conditions such as dementia instead. 

Recovery and rehabilitation are the primary treatments for a TBI. 

Other mental health disorders

Approximately 120,000 veterans have been diagnosed and treated for schizophrenia, a severe and often misunderstood condition that causes hallucinations, issues with concentration, decreased ability to feel pleasure, and delusions. Schizophrenia has been linked to hearing problems caused by a defective gene, leading those affected to hear sounds that resemble voices. 

Other mental health disorders, such as bipolar disorder, can disrupt life and hinder the transition from life in the military to life as a civilian. These mental health disorders can often occur sporadically throughout life; some veterans may have periods of almost complete relief before the symptoms return later while other veterans may find that they deal with mental health issues constantly. 

Without a formal diagnosis, treatment can’t be started, but once it is determined that a veteran does have a mental health condition, treatment options are available:

• Talk therapy
• Antidepressant, anti-anxiety, or antipsychotic medications. For schizophrenia or schizoaffective disorders, the VA recommends the use of clozapine after two unsuccessful tries with other antipsychotic drugs
• Residential care 

It may take some time to find a treatment that works, but the sooner treatment is tried, the sooner a solution can be found. 

How to notice signs of mental health illnesses

Mental health problems can show up in different ways, and there is not always a clear-cut way to identify how a veteran may be struggling with mental health. There are some common behaviors and symptoms that may be connected to mental health problems, however.

• Feelings of sadness or nervousness that persist or worsen over time
• Changes in sleep, such as issues falling asleep and night terrors
• Changes in appetite, which can lead to weight changes
• Changes in sex life
• Decreased motivation and energy
• Lack of interest in activities and hobbies that were once enjoyed
• Engagement in risky behaviors, such as drug use, overeating, gambling, or uncontrollable shopping
• Difficulty functioning at home, school, or work

Mental illness may show up as new physical symptoms, such as pain, weakness, muscle tightening, or headaches. 

Any symptoms of a mental health problem should be discussed with a health professional or veteran mental health support worker as soon as possible. A professional can help create a plan for determining the cause of the problem and getting the veteran back to themselves again. 

Transitioning to civilian life as a veteran

There have been many studies on PTSD and its effect on veterans adjusting to civilian life. There has been less research on the overall population of veterans as they look for ways to adjust to life outside of their military identity. The veteran statistics on mental health show that as many as 72% of veterans experience stress during this transitional time. Veterans may especially be vulnerable to stress when looking for work, maintaining relationships with friends and family members, and trying to live and work within a different schedule than what they are used to. 

Interestingly, post-9/11 veterans seem to have more trouble adjusting than veterans who served in previous conflicts, and transition stress may be a factor that affects how a veteran may seek treatment and deal with the mental health problems down the line. Veterans who have recently begun transitioning to civilian life may even have a higher risk of suicide than other people.

Because transition stress is common and can lead to other issues, taking time to adjust and seek help with the process is recommended. 

Adapting to everyday life

Where should veterans start? The process of adapting can begin before a veteran returns home from deployment, and what works for one person may not be effective for another. The VA offers the Transition Assistance Program (TAP), which helps service members with tools and resources to help with the logistics and administrative side of transitioning. The program covers things from finding a job or buying a home to addressing concerns about family support and health benefits. 

Adjusting to civilian life can be difficult and not many people outside of the military can relate to the transition process. What a veteran experiences from civilian life may not line up with their expectations. This is why it may be useful for a veteran to keep in touch with other past service members. Veterans may consider joining veterans groups in the community to touch base and have someone to talk to that understands the transition process.

Another thing to be aware of is that some people might not know how to interact with a veteran who recently returned home from service. A veteran might be asked questions by their family or friends that seem ignorant or insensitive. The veteran may grow weary of having to tell people what they did or why they left. A veteran should never be made to feel that they have to answer any questions that make them uncomfortable. How much they reveal about their experiences and feelings is up to them. 

The transition process is also a great time to take care of physical health. Veterans may have more choices in their diet and exercise plans than when they were serving, which can lead them to wonder about the best way forward. Joining a gym and finding an engaging fitness plan can help. Talking to a healthcare provider or nutritionist can also be a good start to maintaining optimal physical health. 

Reestablishing relationships

Remember, veterans lived in a world that’s not understood by many. Despite their best efforts, civilians won’t always understand the phrasing and lingo of the military. A veteran may not even remember how much of their language is military-specific anymore. A veteran can start slowly and develop a plan for reestablishing relationships. They can start volunteering in veterans groups, reach out to old friends or family members, and start a conversation with their neighbor or other members of their community. 

Reducing suicide risk

A sense of duty and purpose while serving (along with readily available healthcare access) often keeps the thought of suicide far out of the minds of military service members. However, that can change during the transition to civilian life. Suicide is among the top 20 leading causes of death in the U.S., and almost 15% of those who commit suicide are veterans. Data shows that suicide risk is time-dependent with veterans at the highest risk of suicide in the six to 12 month period after they return to civilian life. 

In response to the unique challenges faced by people who serve their country, the National Suicide Prevention Lifeline has opened up a dedicated support team for this group. By calling 1-800-273-TALK (8255) and pressing 1 for the Veteran line, or going to http://www.suicidepreventionlifeline.org and clicking on the “Veterans Chat Live with a Counselor” link, help can be accessed seven days a week, 24 hours a day. 

If you or someone you know is having a mental health emergency or threatens to harm themselves or others, call 911 or visit the nearest hospital emergency room. You may be able to move from a non-VA hospital emergency room to a VA facility, in some cases. The VA provides mental health services that can specifically help veterans and help provide ongoing care plans. 

Managing mental health in a new career

In the military, both body and mind need to be sharp to do the job at hand. This means that it’s in a veteran’s best interest—and the employer’s—to deal with mental issues as they arise and before they become unmanageable. The same is true in civilian life, whatever that job may be.

The military has been more forthcoming in recent years about the existence of mental strain on members and the ways it should be addressed. In fact, health coverage is provided as part of military health insurance plans. There’s no need to worry about the financial burden of seeking help. But what about future career prospects? 

Untreated mental illness can be a liability for an employer. Taking a passive approach to mental health can be easy to do, but not treating mental health problems could have a negative impact on productivity. Today’s employers often take a holistic approach to wellness, and some offer benefits designed to address mental health beyond insurance. Veterans should feel free to ask their employer what’s available, to see if they could be getting more benefits for their mental health. 

Finding veteran mental health help near you

Because the source of mental health problems can vary, it may be beneficial to seek out resources specific to each type of issue. Survivors of military sexual trauma (MST), for example, can find veteran-specific help and resources at their local VA facility. Every VA location has someone designated to handle every type of issue and can help advocate for care. Veterans can also find local resources online at the VA website.

In addition to local community-run veteran mental health organizations, those who need help can reach out to official VA sources. The VA site provides a search page where veterans can search for specific VA facilities. The PTSD program locator is a good resource to find specialized PTSD programs by state. A community mental health point of contact (MHPOC) is also available in every state within the VA healthcare network. 

Another resource for veterans’ mental health care is the National Resource Directory (NRD), which contains listings for programs and sites that offer help organized by state and category of the problem. State and local groups, as well as community listings, can be found here. 

Veterans may also consider dialing 211, which connects to a local or regional center that connects people to a number of organizations and resources for anything from health issues to financial concerns. The experts there have a database full of ways to get help. 

Remember, although it can feel that no one understands the challenges of a veteran, there are many organizations and resources available to help. Veterans should never hesitate to keep asking for the help they need. Life can and will get better.