Ailise Delaney
Ailise Delaney is a Resident Forum Blogger shedding light on emerging issues in Mental Health Law and Disability Rights.
Each year on November 11th, millions of Americans come together to honor our Nation’s veterans and their sacrifices. On that same night more than 300,000 veterans will sleep on the street or in a shelter. Twenty-Two will end their life.
Veterans experience disproportionate rates of mental illness, which often manifests in elevated reports of homelessness, unemployment and suicide. Among the host of challenges veterans encounter when attempting to access mental health care, there are three recurring issues: (1) eligibility requirements to receive VA benefits; (2) long wait times for services; and (3) social stigma.
In order to receive VA benefits, veterans are required to have either an honorable or general discharge. This hurdle to mental health care gained national attention when NPR released a story detailing the more than 22,000 soldiers returning from Iraq and Afghanistan diagnosed with mental health issues and traumatic brain injuries (TBI) who the US Army discharged for “misconduct,” depriving them of vital treatment and benefits they would have been eligible for with an honorable discharge. The “misconduct” in question included offenses linked to substance abuse. Despite evidence consistently linking mental health problems and TBI with substance abuse problems in the military, soldiers were discharged instead of provided with the assistance they needed.
Veterans who are eligible for VA benefits and are seeking mental health care may wait nine months before even receiving an evaluation. Follow up appointments prove equally daunting, with some waiting as long as two months—this is particularly troublesome considering the tens of thousands of veterans prescribed antipsychotics and antidepressants. Those veterans who experience poor reactions to medications may wait months before seeing a psychiatrist again, leading some to abruptly discontinue medications, such as antipsychotics and antidepressants. This is a move cautioned against by physicians because of associated withdrawal symptoms and increased likelihood of suicidal thoughts.
Congress passed the Veterans Access, Choice and Accountability Act in 2014 to help mitigate some of these problems by allowing veteran’s to receive non-VA care if they are unable to obtain an appointment at a VA facility within 30 days, or if they reside more than 40 miles away from the nearest VA medical facility. Unfortunately, some veterans still wait as long as 57 days before receiving treatment.
Because veterans faced access issues despite passage of the Veterans Choice Act, lawmakers introduced telemedicine legislation into Congress in October of this year. In order to expand care among veterans, the Veteran’s E-Health & Telemedicine Support Act (VETS Act) would allow veterans to communicate with their health care providers and have their health monitored remotely.
But accessibility is only half the battle. Only 38-45% of veterans meeting the criteria for PTSD express interest in receiving help, and of those who sought treatment, less than half followed up with clinical referrals. Stigma associated with mental health remains one of the most cited explanations for why people do not seek treatment. A military ethos that emphasizes stoicism only exacerbates this, with nearly one in four veterans who screened positive for mental illness reporting they did not seek help because “their leaders discouraged the use of mental health services.”
Though some progress has been made, there is still a long way to go. As President Obama remarked while signing the Suicide Prevention for Veterans Act last February,
“This is not just a job for government. Every community, every American can reach out and do more with and for our veterans. This has to be a national mission. As a nation, we should not be satisfied until every man and woman in uniform, every veteran, gets the help that they need to stay strong and healthy.”
Published on November 17, 2015