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Responding to Veterans’ Mental Health Needs

Military members are at great risk of developing a wide range of mental health issues due to their exposure to chronic traumatic events. Mental health problems can include, but are not limited to, depression, substance use, alcohol use, and post-traumatic stress disorder (PTSD). Due to the potential repercussions of seeing combat, the military provides a variety of interventions to respond to the needs of veterans during and after deployment. First, the military typically screens service members for psychological health problems at different times including pre-deployment, post-deployment, and reintegration (Denning, Meisnere, & Warner, 2014). During pre-deployment, military members are assessed using a PTSD screening tool, the PHQ-2 for depression, and the AUDIT-C for alcohol use (Denning et al., 2014). Following deployment, service members must complete a post deployment health questionnaire to identify any potential mental or physical issues (Denning et al., 2014). The assessment, again, screens for PTSD, depression, and alcohol use (Denning et al., 2014).

If the military member is deemed at risk during any of these screenings, psychological help can be provided to the military member. Mental health services are provided under the DOD’s military health system and covered by their insurance plans, such as Tricare (Denning et al., 2014). According the Veteran Affairs website, veterans can access mental health services in a variety of ways include online self-help, smart phone apps, and telemental health programs (Department of Veteran Affairs, 2020). There are also programs that connect veterans with other veterans, such as the BeThere peer assistance program (Department of Veteran Affairs, 2020). Furthermore, there are Vet Centers that offer free individual, group and family counseling services (Department of Veteran Affairs, 2020).

Crisis Intervention Strategies

During World War I, mental health treatment was provided to members using the PIE model (Proximity, Immediacy, and Expectancy) (Peterson et al., 2020). Psychiatric issues were provided in proximity to the battle front, immediately after combat stress symptoms appear, and with the expectancy that the service member will recover and return to the battlefield (Peterson et al., 2020). With that said, the treatment model used for those on deployment has changed slightly. The BICEPS model is now used for treating military members on deployment, which stands for: (Peterson et al., 2020)

(a) the brevity of the treatment (i.e., limited number of sessions)

(b) the immediacy of the initiation of treatment

(c) maintaining contact with the service member’s chain of command

(d) the expectancy that the service member will recover and return to the battlefield

(e) treatment occurring in the proximity of service member’s deployed unit

(f) the simplicity of straightforward and uncomplicated methods to restore functioning

Ultimately the goal of treatment within combat environments is to provide short term treatment to help return the military member back to a level of functioning that allows him/her to return to their job duties. Prolonged exposure (PE) and Cognitive Processing Therapy (CPT) are also beginning to be researched as effective first line treatment interventions (Peterson et al., 2020).

Treatment Modalities

With that said, crisis interventions strategies, such as the PIE and BICEPS model, are only meant to keep military members safe while deployed. Intervention needs to be continued after deployment is over. A variety of treatment modalities have been shown to be effective with military members, including cognitive behavioral therapy, Eye movement desensitization and reprocessing (EMDR), and cognitive therapy (Cigrang et al., 2015; Sochenko, 2017).

Moore and Jongsma (2014) also created a military psychotherapy treatment planner, which breaks down different diagnoses, such as PTSD, nightmares, traumatic brain injuries, depression, and a variety of other issues that affect military members. Each section provides behavioral definitions (i.e. symptoms), along with long-term and short-term objective (Moore & Jongsma, 2014). Finally, each of these goals are assigned with potential interventions (Moore & Jongsma, 2014). For example, a short-term objective for PTSD is to learn calming strategies, through breathing exercises and progressive muscle relaxation exercises (Moore & Jongsma, 2014).

Barriers

There are many barriers that military members face when dealing with a mental illness. One main barrier is the stigma around mental illness and receiving mental health treatment. Many military members believe that admitting to a psychological illness can have a detrimental impact to their careers, despite laws that are supposed to protect them. Furthermore, some members report that they feel that coworkers would distance themselves due to the mental illness (Langston, Gould, & Greenberg, 2007). Furthermore, they report feeling like they let their partners or team members down, that they are weak, or that they are unable to perform their job duties by admitting to struggling with a mental illness (Langston et al., 2007). Many also may feel that formal debriefings or treatment is not necessary and utilize their buddy support system (Langston et al., 2007). All of these fears and thoughts hinder military members from seeking mental health treatment during and after deployment.

References

Cigrang, J., Rauch, S., Mintz, J., Brundige, A., Avila, L., Bryan, C., Goodie, J., Peterson, and the e STRONG STAR Consortium. (2015) Treatment of active duty military with PTSD in primary care: A follow-up report. Journal of Anxiety Disorders, 36 (2015), pp. 110-114, 10.1016/j.janxdis.2015.10.003

Denning, L. A., Meisnere, M., & Warner, K. E. (2014). Preventing Psychological Disorders in Service Members and Their Families: An Assessment of Programs. National Academies Press. Washington, D.C.

Department of Veteran Affairs. (2020, February 27). VA mental health services. Retrieved from https://www.va.gov/health-care/health-needs-condit…

Langston, V., Gould, M., & Greenberg, N. (2007). Culture: What Is Its Effect on Stress in the Military? Military Medicine, 172(9), 931–935. https://doi-org.ezp.waldenulibrary.org/10.7205/MILMED.172.9.931

Moore, B. A. and Jongsma, A. (2015). The veterans and active duty military psychotherapy treatment planner with DSM-5 updates (Second edition.). Wiley.

Sochenko, T. (2017). Effectiveness of PTSD treatments for military service members and veterans. Psihosomatična Medicina Ta Zagalʹna Praktika, 2(4). https://doi-org.ezp.waldenulibrary.org/10.26766/pm…