WV: Mental Health Care of American Veterans and Their FamiliesPage 8 of 9

6. Making Appropriate Referrals

The Veterans Administration and Department of Defense have developed numerous government programs, services, and benefits for Veterans and family members. The Substance Abuse and Mental Health Services Administration offers publications to educate and support healthcare providers who are treating Veterans and their families. Providers are encouraged to learn about the unique needs and challenges of Veterans.

Primary care and behavioral health providers can make a positive difference in the lives of Veterans and their families.

Ask and assess: Providers can screen for military service and Veteran status. Then they can screen for PTSD; substance abuse; depression; risk for suicide, grief, and domestic violence; and other behavioral health issues. Several examples of screening tools are available here.

Intervene: Healthcare professionals can provide brief interventions such as giving feedback on screening results, describing risks associated with behavioral health disorders the Veteran may be experiencing, and advising the Veteran and family about ways to address substance use or mental health issues such as depression and PTSD.

SAMHSA provides the following useful publications:

  • TIP 34: Brief Interventions and Brief Therapies for Substance Abuse
  • TIP 50: Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment

Refer: If health screenings indicate that a Veteran is in need of specialized care for behavioral or mental health problems, providers should refer the Veteran for a thorough assessment, diagnosis, and appropriate treatment. Evidence-based treatments are available for substance use and mental disorders, including psychotherapies, behavioral and pharmacologic therapies, and combination therapies. Evidence-based treatment for PTSD includes exposure therapy, cognitive processing therapy, eye movement desensitization and reprocessing, and cognitive behavioral therapy (SAMHSA, 2012).

Community healthcare providers are encouraged to refer Veterans and their families to local VA medical centers, behavioral health counselors, and local Veterans’ organizations and support groups. Alcoholics Anonymous and Narcotics Anonymous groups specifically for Veterans exist in some communities. 

Mini-clinics on the topics of mental and behavioral health for Veterans offer clinicians easy access to useful Veteran-focused treatment tools. The mini-clinics provide information on assessment, training, and educational handouts. Click here for mini-clinics for providers.

Providing Services to Family Members of Veterans

Providing care to a Veteran’s family member is often the first step in providing care to the Veteran.

Veterans spouses and other family members are often more willing than Veterans to seek care, making families important links to Veterans’ recovery and well-being. Family members are an important part of the services team. Family members’ referrals to resources and educational materials can be the first step to a Veteran’s healthful adjustment to civilian life and recovery. (SAMHSA, 2012)

Rehabilitation and Reintegration

The Iraq and Afghanistan wars have been the longest sustained U.S. military operations since Vietnam. More than 2.2 million all-volunteer U.S. troops went into battle, resulting in more than 6,000 deaths and 48,000 injuries (IOM, 2013). For many, returning home and reintegrating into life away from war happens with few difficulties. For others, however, complicated multidimensional health problems make readjusting to home, family relationships, and employment or school a struggle. According to a congressionally mandated report by the Institute of Medicine, 44% of troops report difficulties after returning home.

Problems with traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), depression, and substance misuse and abuse are common. Furthermore, many of these military personnel and Veterans have more than one condition. “The most common overlapping health disorders are PTSD, substance use disorders, depression, and symptoms attributed to mild TBI” (IOM, 2013).

In addition to health problems, Iraq and Afghanistan Veterans face other reintegration difficulties. Unemployment for all post 9/11 Veterans ages 18 to 24 was 30.2%, compared with 16.1% for non-Veterans of the same age. Military sexual trauma also impacts returning soldiers (IOM, 2013).

The IOM report recommends that the DoD and the VA continue to improve the quality, timeliness, and followup of evidence-based treatment of Veterans and military personnel, especially therapies to treat PTSD, depression, and substance use disorders (IOM, 2013).

Furthermore, the IOM report recommends strengthening military families because strong, supporting families undergird service members’ resilience to stressors and assist in reintegration. The DoD definition of family, however, must be extended to include the full constellation of military families, including nontraditional households such as unmarried partners, same-sex couples, single parents, and stepfamilies. The IOM recommends that the DoD make reducing domestic violence, such as intimate partner violence and child abuse, a priority (IOM, 2013).

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