Veterans’ Mental Health Challenges and Training Solutions for Providers

The mental health landscape for veterans is a complex terrain laden with challenges that arise from experiences unique to military service and the often turbulent transition from active duty to civilian life. The prevalence of post-traumatic stress disorder (PTSD), depression, anxiety, and other debilitating mental health conditions within the veteran community is a solemn testimony to the harsh realities veterans often face.

As society advances towards a more compassionate understanding of mental health, the necessity for educated and well-trained healthcare professionals to specifically address the mental health issues of veterans and their families is increasingly evident. These professionals stand as a critical bridge to the improvement of veterans’ mental health, yet the specialized training and education to effectively serve this community are often lacking.

Tailored training for healthcare professionals is paramount in not only understanding the unique mental health needs of veterans but also in providing the caliber of care that can significantly improve their quality of life.

Studies reveal that an estimated 14% to 16% of US service members who were deployed to Afghanistan and Iraq have experienced PTSD or depression.¹ This data only scratches the surface of a much broader mental health crisis among veterans.The stark reality of veterans’ mental health challenges is further underscored by a heightened prevalence of suicide. The traumatic experiences of combat, the strain of military service, and the often difficult transition to civilian life can culminate in a profound mental and emotional toll, leading to an increased risk of suicidal ideation, intent, and/or attempts.

The U.S. Department of Veterans Affairs 2 has reported that the suicide rate among veterans is significantly higher (57.3%) compared to the general population, illuminating the dire need for targeted mental health interventions.

Unique Challenges

According to the National Alliance on Mental Illness, 19.7% of U.S. Veterans experienced a mental illness in 2020 (3.9 million people).3 PTSD, depression, and substance use disorder are the mental health conditions most commonly highlighted in the veteran population.4

Post Traumatic Stress Disorder (PTSD)

PTSD, formally recognized in 1980,5 has been hinted at throughout history with terms like “soldier’s heart” during the Civil War and “shell shock” in World War I. Its diagnosis has evolved but remained largely unchanged until 2013, although debates continue regarding its classification.

PTSD is a complex disorder, arising from a mix of biological, psychological, and social factors, often seen in individuals exposed to severe trauma like war or natural disasters. However, PTSD can also indirectly affect those who learn about loved ones facing violent threats.5 While many people may experience temporary distress post-trauma, around 10% to 20% may see their symptoms worsen and lead to persistent PTSD characterized by intrusive thoughts, flashbacks, and avoidance of trauma-related reminders, which significantly disrupts daily functioning. Due to the nature of their work, military personnel are often exposed to traumatic events, which, alongside other non-combat related traumas, can exacerbate PTSD symptoms.

Depression

When treating veterans, it is essential for healthcare providers to consider both physical injuries and emotional and psychological distress such as depression. Although less discussed than PTSD, depression is common in the active duty military and veteran population and accounts for a notable percentage of healthcare appointments.

Due to periods of family separation and combat stress, the military setting can worsen depression. Medical facilities typically see a rise in depression diagnoses post-deployment.6 Hence, it is crucial for healthcare providers to accurately identify and treat depression among active-duty personnel and veterans.

Major depression can cause various issues that impair overall daily functioning including persistent sadness, loss of interest, sleep problems, weight changes, fatigue, concentration difficulties, decreased sense of self-worth, and suicidal ideations. Unfortunately, many depression cases go undiagnosed, making accurate screening and treatment vital in the military and veteran community.

Substance Use Disorders

Substance Use Disorders (SUDs), including alcohol use, remain issues for active duty military personnel and veterans who often use substances for stress relief or socializing. SUD can lead to serious physical and mental health, social, and work-related problems. Studies have shown that about 30% of suicides and 20% of deaths from risky behaviors in the military were linked to alcohol or drug use. 7

Alcohol is a major cause of preventable deaths in the U.S., contributing to 31% of driving-related fatalities.8 SUD, as defined in the DSM-5, involves behaviors like compulsive drug-seeking and impaired control over drug use that affects social functioning and causes physiological changes.9 Addiction, the severe stage of SUD, leads to uncontrollable drug-seeking despite the desire to quit. Substances range from legal ones (e.g., caffeine, nicotine, and alcohol) to prescription medications (e.g., opioids) and illicit drugs (e.g., marijuana and cocaine).

The mental health landscape for veterans is a complex terrain laden with challenges that arise from experiences unique to military service and the often turbulent transition from active duty to civilian life. The prevalence of post-traumatic stress disorder (PTSD), depression, anxiety, and other debilitating mental health conditions within the veteran community is a solemn testimony to the harsh realities veterans often face.

As society advances towards a more compassionate understanding of mental health, the necessity for educated and well-trained healthcare professionals to specifically address the mental health issues of veterans and their families is increasingly evident. These professionals stand as a critical bridge to the improvement of veterans’ mental health, yet the specialized training and education to effectively serve this community are often lacking.

Additionally, simulation-based training provides a safe environment for healthcare professionals to make mistakes, receive feedback, and continuously refine their approach. This iterative learning process is invaluable and enhances competence and confidence in handling real world situations. The immediate feedback and the opportunity to practice various strategies, assessments, and approaches equip professionals with a robust skill set that is pivotal for delivering effective, empathetic, and informed care to veterans and their families.
of suicide.

1. Inoue C, Shawler E, Jordan CH, Moore MJ, Jackson CA. Veteran and military mental health issues. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 17, 2023.

2. U.S. Department of Veterans Affairs. 2022 National veteran suicide prevention annual report. Published September 2022. Accessed November 8, 2023. https://www.mentalhealth.va.gov/docs/data-sheets/2022/2022-National-Veteran-Suicide-Prevention-Annual-Report-FINAL-508.pdf

3. National Alliance on Mental Illness. Mental health by the numbers. Updated April 2023. Accessed November 8, 2023. https://nami.org/mhstats#:~:text=Among%20people%20in%20the%20U.S.%20 aged%2018-44%2C%20 psychosis,mental%20health%20 or%20 substance%20use%20 condition%20in%202021

4. RAND Corporation. Veterans’ mental health issues. Accessed November 8, 2023. https://www.rand.org/health-care/projects/navigating-mental-health-care-for-veterans/mental-health-issues.html

5. Friedman MJ. PTSD history and overview. Updated October 6, 2022. Accessed November 8, 2023. https://www.ptsd.va.gov/professional/treat/essentials/history_ptsd.asp

6. Shen YC, Cunha JM, Williams TV. Time-varying associations of suicide with deployments, mental health conditions, and stressful life events among current and former US military personnel: a retrospective multivariate analysis. Lancet Psychiatry. 2016;3(11):1039-1048. doi:10.1016/S2215-0366(16)30304-2

7. Teeters JB, Lancaster CL, Brown DG, Back SE. Substance use disorders in military veterans: prevalence and treatment challenges. Subst Abuse Rehabil. 2017 Aug 30;8:69-77. doi: 10.2147/SAR.S116720. PMID: 28919834; PMCID: PMC5587184.

8. National Institute on Alcohol Abuse and Alcoholism. Alcohol-related emergencies and deaths in the United States. Updated 2023. Accessed November 8. 2023. https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics/alcohol-related-emergencies-and-deaths-united-states#:~:text=It%20is%20 estimated%20that%20 more,physical%20in activity%2C%20and%20 illegal%20 drugs.

9. McNeely J, Adam A. Substance use screening and risk assessment in adults [Internet]. Baltimore (MD): Johns Hopkins University; 2020 Oct. Table 3, DSM-5 Diagnostic Criteria for Diagnosing and Classifying Substance Use Disorders [abc] Available from: https://www.ncbi.nlm.nih.gov/books/NBK565474/table/nycgsubuse.tab9/