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Health care providers, both inside and outside of the VA health care system, can play an essential role in helping America’s Veterans access the mental health support they have earned.
Explore these pages to learn about the mental health issues that Veterans may face and access VA clinical training and resources that can enhance your delivery of health care and ultimately improve Veterans’ health and well-being.
Understanding Military Culture
Veterans’ identification with military culture will vary. Many view their service as an important period in their lives, both positive and challenging, which has contributed to who they are today. Trying to understand key aspects of a Veteran’s military experience may help clinicians to establish a connection and build trust.
Awareness of a patient’s military service and its possible implications can inform treatment planning and consideration of resources and benefits. Below are a few example questions you can use to get the conversation started:
Considerations
Cultural and Contextual Awareness
Every Veteran has a unique story about their military service, and it is critical for providers to have an appreciation for and understanding of the cultures and contexts in which these stories and experiences take place.
Identity and Values
Although Veterans will differ in the extent to which they continue to identify with military culture after separation, rarely do they consider their military service to be a minor event in their lives. Often, the values and aspects of identity that Veterans acquire while serving will continue to be important as they move forward in their civilian lives.
Personal Storytelling
Some Veterans will be less inclined to speak about their military service history than others, but once you know your client served in the military, you can express an interest to hear more about their experience if and when they are open to discussing.
Barriers to Seeking Health Care
Within the military, putting others and the mission before the needs of oneself is a core value. As a result, some Veterans may not prioritize care for themselves and may be hesitant to seek health care. Moreover, Service members and Veterans who continue to serve in the Reserves may have concerns that seeking mental health care could harm their career. Other barriers to seeking care may include perceptions that a provider lacks familiarity with military culture, hesitancy to appear weak, or may be logistical in nature (for example, lack of available time or distance from healthcare).
Military Family Members
Military families often live the “military lifestyle” and face similar benefits and challenges. Many considerations for mental health professionals working with Veterans are relevant to working with military family members as well.
Eligibility for Benefits
If someone has served, they may be eligible for a range of benefits from the Veterans Administration (VA). There are VA programs to support those close to Veterans as well, such as the Coaching into Care and the Caregiver Programs. If your client is not already connected with VA benefits, you could direct them to their local VA Medical Center or the Veterans Health Administration’s (VHA) or Veterans Benefits Administration’s (VBA) websites.
There are six branches (Army, Navy, Air Force, Marine Corps, Space Force, Coast Guard) of the U.S. Military, all with their own roles, responsibilities, histories, cultures and relationships to each other. Understanding some of the basic characteristics of each branch, and distinctions between them, can help contextualize your client’s military experience and aid your comprehension of situations they describe.
On active duty, Service members usually live and work full-time in the military. Serving on active duty typically means more time away from friends and family outside the military and generally a greater degree of separation from civilian society during their tour of duty. At the same, it can lead to a greater sense of camaraderie and deeper bonds between Service members and their “military family.”
National Guard and Reserves
Serving in the National Guard or Reserves is typically a part-time commitment — usually one weekend a month and two weeks a year, plus any deployments or special training. Guardsmen and Reservists often have homes and jobs off base, which they must maintain and balance with periodic service requirements. They may be deployed at any time and see combat like other Service members, but their duties tend to be more focused on disaster response and infrastructure projects (and more often in the U.S. for the National Guard).
Job While Serving, Military Occupational Specialty (MOS) and Rank
One's job and rank during their military service can indicate what unique skills or experiences they may have acquired in the military. Definitions of and distinctions between job and rank may have implications for a client’s level of education, technical skills, leadership qualities, occupational responsibilities, identity and career outlook.
Deployment and Combat
Broadly, deployment is a movement of the armed forces and may last up to 15 months. These include humanitarian aid and increased security operations, which can take place within combat zones. Service members may be deployed just once, multiple times or not at all. War-related deployments have varied greatly depending on the era (e.g., WWII, the Korean War, the Vietnam War, Gulf War and Operations in Iraq and Afghanistan). Stressors experienced vary by deployment phase (e.g., preparation for deployment, transition to deployment (leaving), during deployment and redeployment (returning)). Experiences such as family separations and civilian-life disruptions; feelings of pride, regret, loss, grief, or guilt; and deployment-related conditions such as posttraumatic stress disorder and traumatic brain injury may be important to consider during the course of treatment. Service members can also experience health exposures while deployed, such as tropical diseases or physical injuries. It can be helpful to inquire about exposures that can impact both mental and physical health as this information may inform treatment planning or referrals to other healthcare professionals.
Since Service members’ individual experiences and the degree to which they continue to identify with military culture can vary tremendously, taking the time to understand how their military experiences may or may not be related to seeking care can inform treatment and planning.
Examining Biases
Misunderstandings, generalizations and inaccurate representations can lead to the rise of negative Veteran stereotypes in our culture. Prior to serving Veterans, it is important to ask yourself whether your own perception of Service members’ experiences, behaviors and circumstances are rooted in assumptions and personal biases or valid observations and evidence-based conclusions.
Positive Outcomes
One assumption can be that most Service members’ experiences in the military are full of hardship and struggle, and therefore most Veterans carry a heavy burden of negative outcomes and emotions into their “civilian lives.” In fact, numerous positive outcomes can result from military service, including technical and leadership skills, a mission-oriented attitude, self-determination and resilience, loyalty and dependability, organizational skills, among many others. Indeed, many Veterans consider their time in the military as one of the best and most important times in their lives.
Transition to Civilian Context
The transition out of military service, into a civilian setting, is understandably stressful for many Veterans and military families. Losses that occur when separating from the military can include benefits such as military housing and medical care, close relationships with other military Service members and their families, and a familiar lifestyle. Moreover, the Service member may need to adjust from a mission-focused and structured military-service environment to a civilian environment that can be more individualistic and unstructured.
Mental Health and Wellness
Some mental health conditions are more prevalent among certain Veteran groups. For example, reported rates of posttraumatic stress disorder tend to be higher among Veterans than the general population. Some conditions are connected to eligibility for specific VA benefits. For example, Veterans who have experienced military sexual trauma (i.e., assault and harassment) may be eligible to receive specific VHA benefits.
Veterans also have a higher rate of suicide than those in the general population. The VA has many resources to support clinicians and Veterans who are in crisis or at risk of suicide. Links to these resources can be found in the Learn More section below.
It is also possible a Veteran may not recognize a problem they are presenting with is actually related to their military service. For example, sleep problems often begin in the military for various reasons, but a client may come in seeking help simply “to fix my sleep.” Treatment can be supported through a deeper understanding of these conditions, evidence-based treatments and available resources.
Specific Veteran Populations
Unique considerations, benefits and resources exist for some Veteran and military family groups. Gaining additional knowledge of these groups and what is available to support their care can increase your clients’ sense of being understood and directly benefit their care.
For a closer look at your own perceptions, expectations and biases as a provider working with Veterans, consider asking yourself some questions as well. The following cultural competency exercise and checklist were created especially for health care professionals as part of VA and the Department of Defense’s Integrated Mental Health Strategy:
Explore this toolkit, which provides information for the management of co-occurring mental health and traumatic brain injury conditions. Using this toolkit, clinicians will learn about the most advanced care for treatment of patients with post-traumatic stress disorder and traumatic brain injury who are also experiencing an additional mental health condition, a substance use disorder or chronic pain.
This inventory has an overview of programs and publications that can help health and social service professionals support older Veterans and adults at risk for behavioral health conditions. It covers topics such as PTSD, suicide prevention, and long-term support. Professionals can use this inventory to learn more about connecting with programs and initiatives to support Veterans.
