Best Practices for Veterans’ Mental Health Care
The first step to caring for veterans’ mental health is recognizing that it must be done. The second is to do it well. The Department of Defense and Veterans Affairs is failing at the second.
In recent months, mental health, chronic pain, post-traumatic stress disorder (PTSD), and traumatic brain injury (TBI) have dominated the conversation on veterans’ care, which demonstrates great progress in the VA’s recognition of mental health as a critical part of a veteran’s overall health. As a country, we are finally moving into a phase where we officially acknowledge that caring for one’s mental health is important — but there’s overwhelming evidence that when it comes to veterans, we still do not understand what quality mental health care looks like.
The Departments of Defense and Veterans Affairs (VA), therefore, must make steps to improve mental health services for servicemembers. This means reforming how we treat veterans with bad paper, hiring better doctors specialized in mental health, reforming the rotation cycles of active duty mental health professionals, and adopting more holistic approaches to care.
First, the VA has a duty to care for all veterans with service-related mental health issues, including those with “bad paper.” Currently, VA policy requires servicemembers to have a Honorable Discharge in order to access sustained mental health treatment. In March 2017, in testimony before the House Committee on Veterans Affairs, Secretary Shulkin promised to start caring for bad paper vets. While the intent was good, in practice, this policy was watered down to provide only emergency care for veterans and to last no more than 90 days. In other words, this “care” is a stopgap measure to prevent suicide, but not to provide holistic care for the actual mental health concern. It’s a step, but only a step. A 2017 study indicates this failure affects potentially 55,000 veterans who were discharged (administratively or judicially) with other than honorable characterizations and suffer from PTSD or TBI. Considering these veterans passed a mental health screening prior to entering military service, it’s safe to assume that the overwhelming majority of these mental health conditions are directly related to service, with at least a percentage directly related to their separation. Kris Goldsmith is one such example, who was administratively separated with a general discharge after a suicide attempt following months of suffering from PTSD.
For those qualified for mental health care, experiences may vary. Like any field of professionals, care providers range in capabilities, but the variance in the VA system is too wide-ranging and wholly unsatisfactory. As Marine Corps combat veteran Thomas Burke highlighted in his recent CNN interview, some doctors just didn’t seem to care about mental health, talking down to the patient and treating them like a victim incapable of treatment. Luckily, Thomas had other experiences that kept him committed to seeking mental health — but he seems to be the exception, not the rule.
Whole health care for veterans should start on active duty. The relationship between a patient and a doctor requires understanding, a certain level of familiarity, and, most importantly, trust. One of my fellow veterans spent 13 years suppressing the anxiety, fear, and PTSD he developed following a combat tour. After the symptoms continued affecting his personal happiness and relationships, he sought mental health counseling. For a little over a year, it worked: He trusted his provider, began to open up to her and his loved ones, and started to understand and work through his mental health issues and improve his personal relationships. Then the doctor was assigned orders and abrupted moved away. My friend declined transferring care to another doctor, saying, “It took me 13 years to open up, I don’t want to go through it again.” Active duty servicemembers should have the option of more stable care, either through permanent active duty providers or civilian providers.
Finally, mental health is a relatively new field for the veterans care community. As with any new problem, it’s useful to look for how other communities are tackling the issues. It’s also helpful to try and understand the problem holistically and be open to creative solutions. Mental health care for veterans currently consists of a combination of therapies and pharmaceuticals. As noted above, these therapies may be useful, but may also be useless or even detrimental to improving mental health. But what if we expanded our approach to include outdoor therapies or medical cannabis? Organizations like Warrior Expeditions specialize in what’s being called ecotherapy, which is proving to work. However, these non-profit organizations need official funding or partnerships with the VA if we want to make them accessible to all veterans. Medical cannabis is another approach that shows promise in battling mental and physical health issues. Yet, not only will the VA not study it themselves, but they also won’t let veterans participate in federally approved civilian studies either.
The veterans’ care community has made great strides in understanding the importance of mental health for both active duty and veterans, but it still has to understand and implement best practices. The VA must not simply offer mental health treatment in a nominal sense, but rather offer the best possible mental health treatment. They can start by offering mental health care to all veterans suffering from service-related mental health issues, stable mental health providers to active duty members, and creative solutions and a holistic approach to mental health for those who can best benefit.
Maggie Seymour is a member of Truman National Security Project’s Defense Council and a 2018 Fellow with High Ground Veteran’s Advocacy. After 10 years of active duty, she currently serves as a Major in the United States Marine Corps Reserve. Views expressed are her own.
