Veterans, Mental Health, and Veterans Day in 2020
By Connie Walker, CAPT, USN (Ret.)
Every year on November 11th we officially honor the men and women who have served in our nation’s Armed Forces. Veterans Day matters. Ceremonies, speeches, and meals abound as we thank Veterans for their dedication and sacrifice in service to our nation. Then we return to the dailiness of our lives – and every year, as a Veteran, it strikes me again that most Americans who haven’t known the privilege of serving have not seen or heard the military oath of enlistment. That matters too. The commitment levied by that oath is serious. So serious that keeping it may one day lead to physical injury, psychiatric injury, cognitive impairment, disfigurement, or death – and not only in war.
Taking stock on Veterans Day 2020 – we’ve had forces in Afghanistan since 2001; in Iraq since 2003. Talk of troop reductions dusts up and settles down, and some reductions have been made. Some of us have heard about readjustment and reintegration challenges that Post-9/11 Veterans may face in returning from war and re-entering civilian life. Some of us know, have seen, or are living hard lessons learned on the backs of Vietnam Veterans with chronic or delayed onset psychiatric injury – what the DSM-V calls Post-Traumatic Stress Disorder (PTSD). The Journal of the American Medical Association (JAMA) reported in 2015 that “approximately 271,000 Vietnam Veterans have current full PTSD plus subthreshold war-zone PTSD, one-third of whom have current major depressive disorder, 40 or more years after the war.” JAMA Psychiatry. 2015;72(9):875-881.
Forty years after Vietnam. Consider what that means with respect to Veterans of our wars in Afghanistan and Iraq.
Equally striking: A 2015 study in the American Journal of Public Health says that “over one million Veterans treated in VA Patient Aligned Care Teams (PACT) between 2010–2011 were diagnosed with at least one of these conditions or injuries, often with a co-occurring Substance Use Disorder (SUD): depression, PTSD, schizophrenia, bipolar disorder, or Traumatic Brain Injury (TBI).” Am J Public Health.2015 Dec; 105(12):2564-9.
Over 20 years we’ve normalized forever wars. We’ve rightfully wearied of them and are in danger of not seeing what that means.
This is why the need for community awareness and education has never been greater to enable an understanding of the tension between military culture and Veterans who are often unwilling to seek help for PTSD, Military Sexual Trauma (MST), moral injury, or the effects of Traumatic Brain Injury (TBI). The need has never been greater for communities to have a baseline understanding of VA healthcare and benefits and how they work or don’t work. The need has never been greater for sustained collaboration between non-VA providers, two and four year colleges and universities, community leaders, and people like us, to enhance suicide intervention and prevention and close gaps in services for Veterans and their families, caregivers, and survivors.
To offer an example: Americans who are unfamiliar with the VA often think that Veterans are automatically eligible for VA health care by virtue of their military service. In fact, Veterans seeking access to VA healthcare must complete the VA enrollment process. When Veterans are separated from the military with a less than honorable discharge – what we call “bad paper” – it can be difficult to impossible for those Veterans to qualify for VA healthcare and other benefits without a discharge upgrade – historically hard and time-consuming to get. At the same time, studies over the past decade report that approximately 350,000 Post-9/11 Veterans have been separated from the military with bad paper discharges stemming from misconduct due to PTSD, MST, mental illness, TBI, or co-occurring SUD. It’s important for communities to know that our All Volunteer Force and National Guard and Reserve forces sent to Afghanistan and Iraq have often seen their tours extended and have returned home only to redeploy again and again. Repeated exposure to trauma and improvised explosive devices has consequences. The mental and physical tolls of untreated psychiatric injury, serious mental illness, and TBI are lifelong. While efforts are being made to find these Veterans and speed up processes so VA healthcare and other appropriate treatment is made available to them – a notable success is the establishment of Veteran Treatment Courts across the country – much work remains to be done.
What keeps me up at night, in addition to what I’ve already said …
Realizing that in the absence of a mandate, there are non-VA providers who don’t screen for military service in their new patient intake process
Knowing that the isolation and loneliness that Covid-19 brings is exponentially worse for Veterans and non-Veterans with psychiatric injury, mental health conditions, and TBI
Thinking that communities have reached the point where people are no longer paying attention to the human cost of forever wars, and Veterans will suffer over the next 40 years because of it
What gives me hope? My belief that most people – not just the VA – care enough about what happens to Veterans with psychiatric injury, serious mental health conditions, or TBI to want to learn more, find ways to reach out to Veterans who often won’t or can’t reach out on their own, and work as community leaders, members, and strategic partners with the VA to build effective, sustainable solutions for short and long term challenges facing this special population of Veterans for years to come.
And for those who’ve never seen or heard the military oath of enlistment – here it is: I do solemnly swear that I will support and defend the Constitution of the United States against all enemies, foreign and domestic; that I will bear true faith and allegiance to the same; and that I will obey the orders of the President of the United States and the orders of the officers appointed over me, according to regulations and the Uniform Code of Military Justice, so help me God.
Have a peaceful, reflective – and decision-making! – Veterans Day.
Connie Walker, CAPT, USN (Ret.), is the president of the Veterans Community Action Network of South-Central Wisconsin. Her son is a disabled Veteran of our war in Iraq.