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Veterans Turning to Private Mental Health Services: What Providers Need to Know

It is estimated that American veterans die by suicide at a rate that is 57% higher than their civilian counterparts.

The specific lived experiences of veterans and their families present particular stressors. And while the data on veterans’ behavioral health is mixed, the increased prevalence of suicide among veterans is undeniable. Several behavioral health organizations have created or plan to create specific services for veterans to address a clear need.

“Understanding the unique needs of veterans is a great example of this,” said Meridith Johnson, associate vice president of military affairs at Acadia Healthcare Co. Inc. (Nasdaq: ACHC), to BHB.

Acadia Healthcare, based in Franklin, Tennessee, is the largest provider of behavioral healthcare in the US. Johnson’s duties include overseeing the Acadia Military Family Support Team, which provides and coordinates care exclusively for veterans, active duty service members and their families.

Data from the Substance Abuse and Mental Health Services Administration shows that veterans self-report having similar or lower rates of behavioral health problems than their non-veteran counterparts. These data show no major differences in rates of binge drinking, substance use disorders (SUDs), or suicidal ideation or planning. They also self-report lower rates of mental illness (AMI) compared to their civilian peers.

Rates of post-traumatic stress disorder (PTSD) are high among the veteran population, especially among those who served in the most recent theaters of war in Iraq and Afghanistan. Overall, about 7% of veterans will experience PTSD, compared to about 6% of civilians. Together, veterans of the Iraqi and Afghan conflicts have a collective estimated PTSD rate of 10.4% and specific rates of 12.9% and 7.1%, respectively.

The specific experiences of America’s approximately 18 million veterans can vary widely depending on their tenure. Still, several common experiences can lead to behavioral problems, not all of which are directly related to fighting. For example, veterans report a higher rate of adverse childhood experiences. Moral injury, deployment stress, traumatic brain injury, abuse (including sexual assault), and the transition to civilian life also complicate the picture.

However, none of these issues can be addressed specifically or with appropriate subtlety if providers do not ask basic questions, including about prior military service.

“The vast majority of healthcare providers in America do not ask their patients if they have served in the military or if anyone close to them has served in the military,” Dr. Harold Kudler, member of the American Psychiatric Association’s Veterans Affairs Caucus, told BHB. “We discovered that doctors don’t like questions to which they don’t know the answer. They are not educated about this in medical school in general. Because community physicians are not asking this question, because they are not trained in what the resources are or what is available, they are not well positioned to serve veterans. ”

What drives access to private providers

Expanding access to care is an ongoing and evolving issue for the U.S. Department of Veterans Affairs. Much of what sends veterans into the private sector is driven by reforms established in the Veterans Access, Choice, and Accountability Act of 2014 (Choice Act), the VA MISSION Act of 2018, and the Veterans Comprehensive Prevention, Access to Care, and Treatment (Veterans Comprehensive Prevention, Access to Care, and Treatment). COMPACT) Act of 2020. Both are intended to expand veterans’ access to private health care providers through the Veterans Community Care Program (VCCP).

This effectively opens the door for providers to serve this population. Historically, the VCCP has been the exception rather than the norm. The cost of the VCCP in federal fiscal year 2023 was $28.5 billion, nearly twice as high as in fiscal year 2018, according to a working group report organized by the Veterans Health Administration. About 5%, or $1.43 billion, was spent on mental health care.

“Many veterans don’t know where to start when it comes to getting help,” Johnson said.

Veterans may also be driven to private sources of care by stigma. While on active duty, some fear that their progress through promotion or overall treatment by superiors will be different if it is known they are receiving care for a behavioral problem, said Felicia Pressley, a counselor and founder of Pressley Counseling and Wellness. She works with veterans and active duty service members.

“If a client builds a good rapport with you and feels comfortable with you, they will stay with you,” Pressley said.

That stigma can continue after discharge from service.

What private providers should do

Behavioral health insiders say organizations need to strengthen their military cultural competency and build connections with local VA facilities and related veterans organizations. On the training side, several sources — including Meredith and Kudler — pointed to PsychArmor, a nonprofit organization that provides training and other awareness activities on behalf of the military community.

“Providers can understand some of the issues that veterans present and how veterans feel when they talk to non-military or non-VA physicians – they feel misunderstood,” Kudler said. “The best advice I can give to a doctor, and that I have followed myself, is the creative use of ignorance. That’s not necessary (knowing everything about military history). You can simply ask a veteran, “Can you tell me about your experience?” You just have to keep an open mind and not get defensive if you don’t know something.”

Providers must also be prepared to handle serious issues, including crisis care and suicide support, or have the right partnerships in place to refer patients. The COMPACT Act allows veterans to seek crisis care at no cost in both VA and non-VA settings.

It is possible for non-veterans to provide quality care to veterans, Johnson said. Specialization in care and continuing education can help meet the unique needs of veterans. Yet, where possible, it is often preferable for veterans to treat veterans. At Acadia Healthcare, some facilities have dedicated units staffed by veterans.

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