The US military has been slow to provide mental health services that might stem the rise in suicides. Civilian clinicians are needed to step up to counsel and treat veterans
Wars have always taken a toll on those who fight them. Today, we know that the psychological wounds of war are just as painful as physical injuries—and often more difficult to heal. Reports about post-traumatic stress disorder, brain injuries, and suicide have captured media attention, but despite the publicity, efforts to improve the mental health of veterans have fallen woefully short. The military lacks the culture and resources to provide veterans with effective mental health services, so civilian clinicians are increasingly needed to fill the gap.
The culture of the military remains an obstacle to mental health care. “Soldiers are trained to suffer in silence,” says Rick Veno, a US Army officer in South Korea during the Vietnam War era who is now a psychologist. This self-denial is critical when you’re part of a unit under fire, he says. But such a mindset is devastating to veterans once they return home; the habit of suppressing emotions and fears becomes so deeply engrained it’s difficult to turn off.
While the majority of veterans are able to readjust to civilian life without much difficulty, others become so disabled by emotional trauma that they are unable to leave the house, hold a job, or handle family responsibilities. Without intervention, troubled soldiers are more likely to abuse drugs and alcohol or take their own lives. The Department of Veterans Affairs (VA) estimates that 8,000 veterans die by suicide each year, a rate of 22 veterans per day. And the problem is likely to get worse. As this population ages, the numbers of veterans at high risk for suicide—over 50, male, socially isolated, struggling with physical or mental difficulties, and with access to firearms—will continue to grow.
Soldiers who could benefit from mental health treatment often don’t seek it, for a variety of reasons. They may be in denial about their situation. Or they are afraid of being labeled as mentally ill. They may feel their problems are of less magnitude compared with those who are physically wounded. And they may be too discouraged by the bureaucracy at the VA to apply for benefits.
Civilian mental health professionals will need to step up to engage, counsel, and treat veterans, says Veno, who designed and teaches a graduate-level course on counseling veterans as part of the division of Counseling and Psychology trauma specialization at Lesley University. He urges clinicians to gain at least a basic-level understanding of the military—including its organizational structure, traditions, and values—as well as an overview of recent and historic conflicts. Such knowledge will place them on firmer footing to help veterans.
For example, Veno explains that practitioners should be aware of the unique situation faced by American troops in Afghanistan and Iraq. Soldiers are asked to play a difficult dual role: hunt down Taliban and serve as goodwill ambassadors. “In the morning, they might be searching house to house for rebels, in the afternoon they might be building a school,” he says. Added to this confusion over roles is an uncertainty about who is the enemy: A family in a car, an elderly woman, a young child—any civilian could be carrying explosives. Soldiers also don’t know which Afghan troops they are training might turn on them.
Helping veterans involves a multifaceted approach, Veno says. Not only do clinicians need to be aware of the military context and the special circumstances of the particular conflict, they should also understand the effects of family dynamics, race, culture, gender, socioeconomic background, and sexual orientation on a veteran’s experience. All these factors inform the choice of appropriate intervention strategies.
Innovative tools for treating veterans are being developed in the private sector, but they can be prohibitively expensive. Some treatments involve the use of virtual reality systems, like video games, in conjunction with traditional talk therapy to help veterans re-experience and process problematic emotions. Other approaches that have benefitted veterans include holistic psychology—which addresses the whole person, including the physical, mental, spiritual, and emotional dimensions. Expressive therapies, using the power of art, music, drama, and movement, can help veterans who find it difficult to put their emotions into words.
Even with newer interventions, what works for one veteran does not always work for another. Mental health practitioners need to develop effective methods of assessment and referral to make sure veterans are guided toward the type of treatment that is most beneficial.
The Pentagon and the VA are taking steps to make mental health more of a priority. But leaders concede it will likely take years to change the military mindset, says Tom Tarantino, chief policy officer of the Iraq and Afghanistan Veterans of America. As long as asking for help is seen as a sign of weakness, veterans are going to have a harder time reentering civilian life and dealing with stress. As more troops return home, the problem of how to treat their emotional and psychological problems will only grow more acute.
“No one gets out of the military unchanged,” Veno says. “We can do a better job equipping our veterans with the coping skills and support they need to live more productive lives.”
Banner Image - U.S. Army photo by Patricia Deal, CRDAMC Public Affairs
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