LauraMcGovern

CAS138T
10April2015
IssueBrief:VeteransandtheirMentalHealth
Afterwar,veteransstillfaceabattle,abattleincomparabletoanyotherscenario
experiencedincombatbeforeaproblemtheNewYorkTimescalledinonearticlethe
U.S.Armysthirdfront.MentalhealthproblemssuchasPosttraumaticStressDisorder
(PTSD),SevereDepression,alcoholanddrugproblems/dependencydevelopmentand
suicidalideationoccurfrequentlyinveteransofwar.Afterbeingexposedtodangerous
deploymentlocationswheresoldiersexperienceandengageinfrequentenemyfirefight
orwitnessdeathsoffellowsoldiers,allies,enemies,orcivilians,thementalstabilityofa
personcannotbeexpectedtobeperfectlyintactoncetheyarrivebackhome. These
traumaticexperiencesgenerateanimpactthataffectsnotonlytheveteran,buttheirloved
onestooanimpactthatcausestheirlivestoneverbethesame.1
In an interview with the National Center for Posttraumatic Stress Disorder,
LaurentG.TailleferIIaspecialistandriflemanintheU.S.Militaryfrom20032006
whowasdeployedtoalDujail,IraqtellshisstoryandexperienceswithPTSD.When
askedabouthowPTSDaffectedhislovedones,SpecialistTaillefertoldastoryabouthis
mom,explaininghowshewasthefirstonetonoticethesigns.
One day, Im recently back from Iraq, asleep in the upstairs
bedroomofmyPhoenix,Arizona,homeinthesummer,anditisagood
120degreesinthisroom.Andforwhateverreason,Iamcomfortable.I
dontknowifitsbecauseIraqwassohot,orIdontknow. Whenshe

comesin,Idontstir. Butitssohotthatwhenshepullsthechain,the
chainbouncesbackandhitstheglobeontheceilingfaninsuchawaythat
it[pauses]oh,itwasaricochet,Iknewforafactitwasaricochet,andI
wasoutofbedinaheartbeat.Andmymother,forsomereason,dropsto
thefloorasifImgoingtojustsavagelybeather,andIwaslike,What,
whatsgoingoninhere?Somethingswrong?andshegoes,Iwasjust
turningonthefan.Thefan?Well,Ithoughtitwassomethingserious,
andIcouldntgobacktosleep.Andthatsnobigdealforme,youknow,
itrolledrightoffmyback.Butformymom?OhmyGod,shewasscared
shelostherkid,Oh,heschangedforevernow,hesadifferentperson
thanIknew.Andwithoutrealizingit,Iwasdevelopingthiscrazyguy
personawithouteventrying.2
Anothertale,toldbyVietnamveteranSargentCraigStuShipleyaweapons
specialist/machinegunnerfortheU.S.MarineCropsfrom19641968detailsthetime
hefirstrealizedhehadPTSD.
ProbablythemostprominentthingthatIrealizedatfirstwasI
didnt,Itrustednoone.Absolutelyzerotrusteveninmyownfamily,my
ownsons,myimmediatefamilybecauseIfeltlikeifItrustedsomebody
andsomewhatopenedup,Iwasgonnagethurt.Iwasgonnagetscrewed
intheprocessSoIisolatedmyselffromlifetotallyIfoundmyselfas
the years rolled on, I didnt wanna be around anybody at first, I
accepteditandIthought,itiswhatitis.Butafter10or20yearsofthis,
itreally,reallywearsonyouhard.Itgetsworse.3
SargentShipleyexplainedthatittookhimtothebrinkofsuicide,literallywitha
guntohisheadandalettertohislovedonesallwrittenout,forhimtorealizethathe
neededhelp.4
PTSDanditseffectsonServiceMembers
Posttraumatic Stress Disorder, the most common mental health condition
experienced by veterans, is an anxiety disorder that develops after exposure to a
traumatizingeventinwhichseverephysicalharmwasinflictedorthreatened. 5PTSDisa

verycomplicateddisorderinwhichpeopleexperienceamultitudeofdifferentsymptoms.
SymptomsassociatedwiththosewhorelivethetraumaticeventwhichcausedtheirPTSD
includehavingbaddreamsabouttheeventorsimilarevents,behavingorfeelingasifthe
eventwerehappeningagainmorecommonlyknownasflashbacks,feelingalarge
amountofemotionswhenremindedoftheevent,thetriggeringofalargeamountof
physicalsensationswhenremindedoftheeventsuchasincreasedheartrateorskipping
abeat,sweating,difficultybreathing,feelingfaint,orfeelingoutofcontrol. Other
symptomsassociatedwithPTSDareavoidingthoughts,conversations,feelings,people,
orplacesassociatedwiththeevent,difficultyrememberingpartorpartsoftheevent,
emotionalnumbingorfeelingasthoughyoudontcareaboutanything,detachment,
lackofinterestinnormaoreverydayactivities,andlackofexpressionofemotions
alongwithfeelingofhopelessnessaboutthefuture.6
Roughly30%ofVietnamveteransdevelopedPTSD,alongwith10%ofGulfWar
(DesertStorm)veterans,611%ofAfghanistanWarveterans,and1220%ofIraqWar
Veterans.7 Since the start of the war in Afghanistan in 2001, over 100,000 combat
veteranssoughthelpformentalillness,onehalfofthemsufferingfromPTSD.In2003
an estimated 1.2 million male veterans and 209,000 female veterans identified as
sufferingfromaseriousmentalillness365,000ofthemalsoreportingacooccurring
abuseproblemalongwiththeirmentaldisorder.Inthatsameyear,around56.6percent
ofveteransusedalcoholinthepastmonthascomparedto50.8percentofnonveterans. 8
In 2010 an estimated 22 veterans committed suicide every day, 70% of these being
veterans 50 years or older.9 A devastating statistic reported in an article by Harvard

HealthPublicationsstatedthatin2012moremilitarydeathsweretheresultofsuicide
thanofcombat.10Amajorityofthesuicidesthatdooccurhappenduringtheperiodwhere
veterans are waiting to be approved by mental healthcare programs and get an
appointmentwithatrainedphysician.
11

Effectson

FamilyandLoved
ones

Itsnotjusttheveteransthemselveswhoareaffectedbythetraumaticeffectsof
militaryinvolvement,familymembersandlovedonesofveteranshavebeenshownto
have increased mental health issues as well. In fact, mental health conditionslike
depressionandPTS(posttraumaticstress)areascommoninfamilymembersasthey
areinservicemembers.Inastudyingwhichsurveyedover250,000spousesofmilitary
members,37%werediagnosedwithatleastonementaldisorder. Themostfrequently
diagnosed mental disorders were anxiety, depression, and sleep disordersnot to
mention the dramatic increase in the rate of depression that was observed in family
memberswhoselovedonesweredeployedfor11+months. Accordingtoastudyin

2011,34%ofMichiganNationalGuardspouses alonemetcriteriaformentalhealth
problemssuchasPTSanddepression.12
Morethanjustthespousesareaffected.AstudydoneonchildrenofMilitary
involvedpersonsdiscoveredthatadolescentsofparentswhoareintheMilitaryhave
greateremotionalandbehavioralissuescomparedtoadolescentswhodonothaveparents
intheMilitary.Onethirdofchildrenwhohaveorhavehadatleastonedeployedparent
developpsychologicalchallengesincludingacutestressreaction,depression,anxiety,or
behavioraldisorders.Moreover,upto58%ofservicemembersandveteranslivingwith
PTSDincombinationwithothermentalorsubstanceabuseconditionsareatextremely
highriskofdomesticviolenceaddingtothedifficultyoflifeonthehomefrontfor
familymembers.13
Whiletheseindividualsmaynothaveexperiencedwhattheirlovedoneshavein
combat,justlikesecondhandsmoke,Militaryinvolvementcandramaticallyeffectthe
onesinwhichservicemembersaresurroundedbytoo. Forthisreason,theydeserve
moreattentionfrommentalhealthcareprograms.
TransitioningfromWartoHome
Forveterans,returninghomefromcombatisthemostdifficulttransitiontheywill
evermake.InaresearchstudydonebyPewResearchCenter,itwasfoundthatveterans
whoservedinthepost9/11eraare15percentlesslikelythanpasteraveteranstohave
aneasytimereadjustingtolifeaftercombat.Thisstudywentevendeepertodiscoverthe

root(s)towhytransitioningissohardforsomevetsandnotothers. After18variable
tests, researchers found that having experienced emotional orphysical trauma during
combatistheleadingfactoraffectingveteranstransitionlevelofdifficulty. 14Psychiatrist
andAuthorJonathanShayexplains:
Incombat,youhavetoshutdownthoseemotionsthatdonot
directlyservesurvival.Sosweetness,thegentlerformsofhumor,griefall
shutdown.Andthisisprofoundlydisconcertingtofamilieswhenasoldier
comes back, and he seems to be made out of ice. Its not that he is
irrevocablyandpermanentlyincapableoffeelinganything. Itsthatthis
adaptation of shutting down those emotions that dont directly serve
survivalincombatispersisting.15
Withthisbeingsaid,mentalhealthcarecouldnotbeofanymoreimportanceto
servicememberspostcombat.Thehastinessofthetimeittakesforthemtoreceivecare
isthereforeextremelyimportantaswell.Withoutthepropercareandtreatment,aservice
memberslifecouldactuallybemoreatstakethanitwasduringcombat.Justlikeany
illness,withouttreatmentitonlygetsworse.Aftereverythingtheseindividualshavedone
forourcountry,theydeservetolivetherestoftheirlivesinhappinessandpeacenot
tauntedandbrokendownbyadauntingmentalcondition.
CurrentMentalHealthcarePrograms
Theseindividualsarebraveenoughtoputtheirlivesatstaketofightforour
countryandkeepourfreedom,whichwesoproudlybragabout.Withoutindividualslike
them,whoknowswhatstateofdisarrayournationwouldbein.Forthegreatsacrifice
that these heroes make, they deserve a better quality of life than many of them are
receiving.Thementalhealthissues,whichstemfromhavingexperiencedwar,prevent

themfromleadinganormallifeandtheonlywaytochangethisistoimprovethequality
ofmentalhealthcarethatveteransandtheirfamiliesreceive.
ThemostrecentmentalhealthcarebenefitsofferedtoveteransbytheDepartment
ofVeteranAffairsincludesthecontinuumofcareofinpatientandoutpatientservices
(includingpharmaceutical,prosthetic,andmentalcare),institutionalandnoninstitutional
longterm care, readjustment counseling16, and other health programs including the
Civilian Health and Medical Program of the Department of Veteran Affairs
(CHAMPDVA)which is a comprehensive health care program in which the
Department ofVA shares thecost ofcoveredhealth careservices andsupplies with
eligiblebeneficiariesforveterans.17 TheVHAsystemisonlyofferedtocombatveterans
and individuals with serviceconnected disability. Other programs offered, such a
TRICARE, offer active duty and retired members of the uniformed services, their
families,andsurvivorsmentalhealthservices.18
Inaddition,TheDepartmentofDefenseofferstwotypesofhealthcaresystems
InTheaterandStateside. TheDepartmentofDefense,InTheater(theaterbeingthe
geographicalareaforwhichacommanderofgeographiccombatantcommandhasbeen
assigned responsibility19) system provides supportcounseling chaplains for service
membersduringdeploymentandonlyduringdeployment.TheDepartmentofDefense,
Stateside system provides military installations with communitybased and hospital
mentalhealthcareinadditiontoonlinecounselingthroughMilitaryOneSourceandthe
insurance program TRICARE. The DoD Stateside system is offered to active duty

members, Guard/Reserve members, retired military, and dependents of active duty,

militaryretireesorGuard/Reservemembers.
ThefinaloptionforveteransandservicemembersistheCivilianHealthSystem,
which is employer sponsored health coverage and public community mental health
systems mostly for veterans with non serviceconnected mental health needs or
Guard/Reserveandtheirdependentsbasedoffoftheirdutystatus.20

21

ProblemsandSolutionsforCurrentMentalHealthcarePrograms
AccordingtotheNationalAllianceonMentalIllnessresearchdonein2007,of
103,788OperationEnduringFreedom/OperationIraqiFreedom(OEF/OIF)veteransseen
atVAhealthcarefacilities,25,658(25percent)receivedmentalhealthdiagnosesand
56%ofthose25,658veteranswerediagnosedwithtwoormoredistinctmentalhealth

issues.22AlthoughtherehavebeenreformstothehealthcareofferedbytheVA,DoDand
othersystemsinrecentyears,theyarestilllackingimportantqualitiesthatcouldmakeor
breakaveteranandtheirfamilymembersrecovery.Toprovidethefullcoveragethat
theseU.S.citizensneedandrightfullydeserve,thegovernmentneedstoprovideamore
extensivehealthcaresystemtotheiractivedutymembersandveteranswhichexpandsthe
amountofhealthcareprovidersanddoctorsavailabletotheminordertopreventveterans
frombeingwaitlistedforcare.
IntheVAs2015BudgetRequest,$7.2billionisrequestedtoexpandinpatient,
residential,andoutpatientmentalhealthcareanincreaseof$309millionfromtheyear
before. The budget also asks for an increase of $23 million from 2014 for home
telehealthas a way to improve access to careending in a total request of $567
million.TospeedupprocessesandshortenwaitliststheVAalsoincludesarequestof
$100 million for development and implementation of the Veterans Relationship
Management Initiative23a new initiative established to improve veterans access to
healthcareandbenefitsinformationthroughtheimplementationanduseofinnovative
21stcenturytechnologies.24Inadditiontosupportingandapprovingtheserequests,the
governmentstillneedstofurtherexpandtheavailabilityofprovidersanddoctors.The
firstwaytodothisisbyofferingsalaryincentivestodoctorsandtaxdeductionincentives
tomedicalfacilities.Oftenjobsassociatedwiththemilitarygetabadreputationleaving
peopleunawareofjusthowrewardingthecareerreallyis.Withsalaryincentivesbeing
offered,morephysicianswouldbeinclinedtojointhefield,experiencingfirsthandthe
rewardingopportunitiesitopenedthemupto;therefore,spreadingawarenessofhow

fulfillingthejobisandmakingitmoresoughtafter.Furthermore,iftaxincentivesare
offeredtomedicalfacilitiesforbeingapartofveteranmentalhealthprogramsmore
hospitalsandothermedicalpracticeswillbelikelytoparticipate.
Restrictionsoneligibilityforhealthcareneedtobecutdowntomakeiteasierfor
servicememberstoreceivethetreatmenttheyrightfullydeserve. Forexample,tobe
eligible for VA medical benefits a veteran must have been honorably discharged or
released;servedintheactivemilitary,naval,orairserviceorasareservistorNational
Guardmembercalledtoactiveduty;andVeteransmusthaveeitherservedatleast24
continuousmonthsorthefullperiodforwhichtheywerecalledtoactiveduty. With
requirementssuchasthese,manyservicemembersaffectedmentallyduringcombatare
preventedfromreceivingthehealthcaretheyneed.25 Itonlytakesonetraumaticeventto
change a persons life forever; one event that could total to only 5 minutes. Being
requiredtohaveservedforanextendedperiodoftime,astheVArequires,isabsolutely
absurd. Itisunderstoodthatofferingtreatmenttoeveryonecanbecomeverycostly;
however,soisaveteranslife. TheVAshouldATLEASTofferonementalhealth
assessmenttoallreturningservicemembersupontheirarrivalhome. Ifafterthatfirst
assessment, the service member is found to not be suffering from any warrelated
illnessesthentheywillnotreceiveanyfurthertreatment;however,thosewhoarefound
tohavesomeformofmentalhealthcondition,thepropertreatmentplanshouldbefully
coveredandprovidedtotheindividualbytheVA.

AccordingtoVeteranAffairs,morethan70%ofdisabilityclaimsareinbacklog
status.Veteransneedanddeservedisabilitybenefitstofillthegapstheinlossofearning
potentialandqualityoflifeasaresultofacombatsustainedinjury.Morefundingneeds
tobeadministeredtohealthcaresystemssotheycanprovidedisabilitybenefitsasaform
ofincomereplacementforservicememberstransitioningfromcombatbacktocivilian
life.26AlsointheVAs2015BudgetRequestisa$95.6billionrequestformandatory
benefits(thisincludesdisabilitycompensation)anda$138.7millioninvestmentrequest
toconvertpaperclaimstodigitalclaimstoimprovetheclaimsprocessingsystem. 27The
acceptance of these requests would greatly improve the state of the VAs claims
processingsystem,enablingbettercareforourveterans.
To actively prevent/reduce the effects of war and trauma on and individuals
psyche,activedutymembersshouldreceivemorementalhealthattentionduringtheir
deploymenttime.Providingmorecounselingservicestoactivemembersmaypossibly
be the first step in lowering the great number of veterans who come back from
deployment with severe mental health conditions. Even if the individual has not
experienced anything traumatic yet, routine checkins with a trained psychologist or
psychiatrist could ease the transition and experiences that occur in the wartime
environment.Mentalhealthshouldbetreatedsimilarlytophysicalhealth:beingchecked
routinely.Althoughtheofferedserviceofchaplainstodeployedmembersisagoodidea,
havingactualtrainedmentalhealthprofessionalsonsitecouldproduceevenbetterresults
andfurtherreducethismentalhealthprobleminwhichthemilitaryhasbeenfacing.To
doso,morefundsneedtobeprovidetoprogramssuchastheDepartmentofDefense,in

Theaterprogramto1)providesalaryincentivestoattractmentalhealthprofessionalsto
thisrewardingjobopportunityand2)providethementalhealthprofessionalswithany
suppliesamongotherthings,inwhichtheymayneedwhileworking.
Lastly, as you probably noticed before, there are not many programs,
whichprovidecareforrelativesofservicemembers.WhileIunderstandthatthiscanget
costly,directrelatives ofservicemembers shouldatleasthavetheoptiontoreceive
mentalhealthscreeningsonceayear.Healthcareprograms,toensuretheyareremaining
stableundertheconditionsthatdeploymentofalovedone,amongothercombatrelated
issues,mayproduce,shouldcoversuchscreenings.Ifawarrelatedissueisdetectedina
dependentorcloserelative,mentalhealthcareprogramsshouldprovidethecoverage
necessaryforfamilymemberstoreceivethetreatmenttheyneedanddeserve.Again,the
budget must be adjusted here to allow for expanded mental health care access to
dependentsofmilitarymembersinadditiontotheinclusionofdependentsinhealthcare
programsingeneral.TheVAshouldstronglyconsideringaddinginthiselementtotheir
nextyearlybudgetrequest.
Conclusion/Overview
Withthestatusoftheworldtoday,thereisaconstantriskofwarinareaswhere
conflictarises.Becauseofthis,bravemenandwomenwillalwaysbecalleduponbythe
United States military to defend our country. The sights one sees in combat are
incomparabletoanyotherexperienceinlifeleadingtopotentiallyseriouseffectsona
personsmentalhealthandwellbeing;however,effectssuchasthisshouldnotleadan

individualtorethinkorregretmakingtheselfless,bravedecisiontheymadebyjoining
theU.S.Military.
BeallyoucanbeandBeArmyStrongaretwoverypopularrecruitment
slogansusedbytheUnitedStatesMilitary.28Asthepromotersofsloganssuchasthese;it
isthegovernmentsresponsibilitytomakesurethesestrongmenandwomenremain
ArmyStrongevenaftercombatisfarinthepast.Mentalhealthcareprogramsneedto
beenhanced,andfastforthatmatter,orourcountryisatriskoflosingthequalitythat
makes us so greatour strength. With the proper materials and programs readily
availabletoourbraveprotectors,treatmentofmentalhealthconditionsispossibleand
affective.Ifourheroscandefeatthetrialsandtribulationsexperiencedincombat,than
theycandefeatanythingandIdontthinktheUnitedStatesgovernmentwantstobe
thatroadblockthatstandsintheirway.Supportourtroops;afterall,theyrefightingfor
you.

1.
2.
3.
4.
5.
6.
7.
8.

Endnotes
Resul Cesur, Joseph J. Sabia, and Erdal Tekin. The Psychological Costs of War:
Military Combat and Mental Health. 5615. 1st ed. Vol. 1. Bonn: IZA, 2011. The
Institute for the Study of Labor. Web. Mar. 2015.
""Who I Am"" AboutFace: Hear from Laurent G. Taillefer. AboutFace, n.d. Web.
19
Mar.
2015.
Full
clip
available
at
http://www.ptsd.va.gov/apps/AboutFace/veterans/laurent-taillefer.html.
""Who I Am"" AboutFace: Hear from Craig "Stu" Shipley. AboutFace, n.d. Web.
19
Mar.
2015.
Full
clip
available
at
http://www.ptsd.va.gov/apps/AboutFace/veterans/craig-stu-shipley.html
Ibid
"Post-Traumatic Stress Disorder." Psychology Today: Conditions: Anxiety: PTSD.
Psychology Today, 24 Nov. 2014. Web. 19 Mar. 2015.
Ibid
Ibid
"Mental Illnesses." NAMI: National Alliance on Mental Illness. National Alliance
on Mental Illness, n.d. Web. 19 Mar. 2015.

9. Blakeley, Katherine. "Remembering America's Veterans in 2014." Name. Center

for American Progress, n.d. Web. 19 Mar. 2015.
10. Skerrett, Patrick J. "On Veterans Day, Don't Let the "invisible Wounds" of PTSD
Remain Hidden - Harvard Health Blog." Harvard Health Blog RSS. Harvard
Medical School, 11 Nov. 2013. Web. 19 Mar. 2015.
11. The PTSD/Suicide Epidemic. Digital image. Worthy Warriors. Worthy Warriors,
n.d. Web. 23 Mar. 205.
12. "PATRIOTS' DAY." The Journal of Education 67.14 (1674) (1908): 376-77.
NAMI: National Alliance on Mental Illness. NAMI, June 2012. Web. 24 Mar.
2015.
13. Ibid
14. Morin, Rich. "The Difficult Transition from Military to Civilian Life." Pew
Research Centers Social Demographic Trends Project RSS. Pew Research Center,
08 Dec. 2011. Web. 10 Apr. 2015.
15. Shay, Jonathan. "The Soldiers Heart." PBS. PBS, 2014. Web. 22 Mar. 2015.
16. Department of Veterans Affairs. 1st ed. Vol. 2. Olympia (506 E. 16th, PO Box
40910, Olympia 98504-0910): Committee, 1993. Medical Programs and
Information Technology Programs. Department of Veteran Affairs: Medical
Programs and Information Technology Programs Congressional Submission.
Department of Veteran Affairs, 2015. Web. 26 Mar. 2015. Mor information
available
at
http://www.va.gov/budget/docs/summary/Fy2015VolumeIIMedicalProgramsAndInformationTechnology.pdf .
17. "Chief Business Office Purchased Care." CHAMPVA -Chief Business Office
Purchased Care. US Department of Veteran Affairs, n.d. Web. 10 Apr. 2015.
18. Ibid
19. Department of Defense Dictionary Of Military and Associated Terms. Ft. Belvoir:
Defense Technical Information Center, 2010. Dictionary of Military and
Associated Terms. Department of Defense, 15 Jan. 2015. Web. 25 Mar. 2015.
20. "PATRIOTS' DAY." The Journal of Education 67.14 (1674) (1908): 376-77.
NAMI: National Alliance on Mental Illness. NAMI, June 2012. Web. 25 Mar.
2015.
21. Prepared By The National Center For Veterans Analysis And Statistics, and
December 2010. "National Center for Veterans Analysis and Statistics: Selected
Research Highlights." National Center for Veterans Analysis and Statistics:
Selected Research Highlights 1 (2010): n. pag. United States Department of
Veteran Affairs. National Center For Veterans Analysis and Statistics, Dec. 2010.
Web. 2 Apr. 2015.
22. "Mental Illnesses." NAMI: National Alliance on Mental Illness. NAMI, n.d. Web.
2 Apr. 2015.
23. "VA 2015 Budget Request Fast Facts." VA 2015 Budget Request Fast Facts (n.d.):
n. pag. VA 2015 Budget Request Fact Sheet. Veteran Affairs, 2015. Web. 3 Apr.
2015.
24. "Office of Public and Intergovernmental Affairs." News Releases -. US
Department of Veteran Affairs, 21 Sept. 2010. Web. 10 Apr. 2015.

25. "Removing Barriers to Mental Health Services for Veterans." Removing Barriers
to Mental Health Services for Veterans. American Public Health Association, 8
Nov. 2014. Web. 3 Apr. 2015.
26. Ibid
27. "VA 2015 Budget Request Fast Facts." VA 2015 Budget Request Fast Facts (n.d.):
n. pag. VA 2015 Budget Request Fact Sheet. Veteran Affairs, 2015. Web. 3 Apr.
2015.
28. Levine, Adam. "Popular US Army Slogans, Sayings, and Mottos." CustomInk
RSS. CustomInk, n.d. Web. 5 Apr. 2015.