Mental Health Care for Iraq and Afghanistan War Veterans
May 1, 2009
Veterans' Barriers to Care
A series of roadblocks often prevent veterans from receiving the mental health care they need.
Photo by franz12/Adobe Stock
Only about half of all veterans who need mental health care ever receive it, according to RAND research.
Why? It’s because of a perfect storm of provider shortcomings, access problems, and personal and social attitudes.
For instance, shortages in the mental health workforce can make it difficult for veterans to schedule a timely appointment. And some providers aren’t as extensively trained as they could be in evidence-based practices, which means fewer veterans are likely to receive the highest-quality care in the private sector.
But there are also attitudes ingrained within the military that can prevent veterans from seeking care at all. For instance, the false notion that seeking help is a sign of weakness is prevalent in military circles. And career questions come into play; veterans may wonder whether receiving a prescription medication will affect their job eligibility.
Thankfully, the DoD and VA have taken dramatic steps over the past decade to address barriers to care. For instance, the VA has hired more mental health providers and has established outreach programs to help veterans overcome logistical issues. The DoD has added many programs addressing psychological health and focusing on both clinical and nonclinical concerns.
But, ultimately, ensuring more veterans receive the care they need will require complex and multifaceted solutions.
Recommended policy action
Reduce barriers to care.
VA, DoD, and other providers should explore new delivery approaches that can help expand access, including training additional providers in delivering evidence-based treatment and telemental health care options, which can provide remote access to veterans in rural settings.
Types of barriers to care:
Organizational Barriers
Issues rooted in the provider system can often prevent veterans from receiving the highest-quality care.
Dwindling provider capacity can affect providers’ ability to accept new patients or see veterans in a timely manner. And inadequate provider training, coupled with insufficient quality monitoring and reporting, can mean the quality of care available to veterans can suffer. Insurance and provider financial models bring more issues into play, such as coverage eligibility and care financing.
Logistical Barriers
Some veterans struggle with the logistical aspects of making it to care appointments. Scheduling an appointment that works with their schedule can hold them back, as can coordinating transportation to and from the provider. If they do have a ride, long drive times can deter veterans from following through with appointments. And a lack of information about things like provider eligibility and first-line treatments can stop them from receiving the best possible care.
Social Barriers
Personal anxieties and cultural concerns can discourage veterans from seeking the treatment they need.
Many are often skeptical about the effectiveness of treatment and whether they’ll experience side effects from any medication. Military attitudes can also trickle into veterans’ decisionmaking; they’re sometimes concerned that seeking help could be viewed as a sign of weakness, or could cause career repercussions.