Donald Trump will take office in January with strong support among veterans, and he’s made reforms to the Department of Veterans Affairs a key part of his platform. When it comes to one of the biggest health issues facing vets — that of mental health and post-traumatic stress disorder — there’s a lot more to be done.
Trump hasn’t spoken about the subject much. Last month he told a gathering of veterans that his team would be “addressing … very strongly” the issue of suicides among veterans, and that “the whole mental health issue is going to be a very important issue when I take over.” As part of his plans to reform the VA, Trump’s platform would increase the number of mental health care professionals in the agency.
Nonprofits that serve vets hope that as he transitions into office those commitments maintain their urgency. Here are four things Trump’s administration could do to shore up veterans’ mental health:
1. Improve civilian awareness
“We teach people to do CPR or the Heimlich maneuver, but so many don’t know what to do when someone is having a panic attack or thoughts of suicide,” Rebecca Farley, vice president for policy and advocacy at the National Council for Behavioral Health.
Farley pointed to Mental Health First Aid, an eight-hour training course currently offered to teachers and people who work with youth. “It teaches people about the signs and symptoms of a mental health crisis,” she said. Funding for this training has been part of the federal budget for three years, and could be expanded to train people who work with veterans.
2. Look beyond post-traumatic stress
While post-traumatic stress is common among those who have served in the military, veterans face a number of different mental health challenges which can take a variety of forms.
For one thing, greater use of blast-generating explosive devices in combat has led to more traumatic brain injury among soldiers. These injuries can cause symptoms ranging from nausea to loss of balance to amnesia and slurred speech.
Veterans also experience depression, anxiety, and suicide, the National Alliance on Mental Illness (NAMI) points out, and these require tailored treatment.
“They also have a moral injury,” added Eva Usadi, a New York trauma therapist and executive director of Trauma and Resiliency Resources, a program for veterans. “Some of the things they’ve done in war have left them feeling so ugly inside, some even describe it as ‘soul loss.’”
3. Make more use of technology
Researchers and clinicians are already testing new ways to help veterans that go beyond the weekly visit to a therapist’s couch, said Christopher Miller, a VA clinical psychologist based in Boston. In September, he published a survey on veterans’ interest in using technology for health care services — such as getting therapy via Skype, or receiving medication reminders via text message.
“Our research suggests that they have an interest in a variety of tasks,” he said. “But the interest differs by the device. So in order to appeal to as many veterans as possible, we’d have to pay attention to a variety of platforms.”
Technology in the clinic itself is another area in need of change. “Full electronic records would keep people from being dropped when transitioning from active duty to civilian,” said Emily Blair, the lead on veterans’ issues for NAMI.
When military members leave active duty, their medical records remain under control of the Department of Defense, while the Veterans Health Administration starts a new set of records if he or she seeks care.
“The DOD and VHA are operating on different levels of technology,” Blair said. “It’s a process they’ve been trying to fix for 20 years.”
4. Bolster mental health care outside the VA system
President-elect Trump has pledged that his administration will “allow veterans to be able to seek mental health care outside of the VA.” The current Veterans Choice program already does this for veterans who live a certain distance from the VA or have been on a wait list for more than 30 days.
But it could serve veterans better, said Blair.
“A lot of individuals have problems with Choice because the clinicians don’t have the cultural competence,” she said — meaning that psychologists not within the VA system may have less familiarity with the military’s unique culture and challenges. That could in part be overcome, Blair said, by training more non-military clinicians in military culture.
Additionally, Blair suggested, measures could be taken to bolster mental health support from peers, not just professionals. Peer support groups across the country could use funding to expand.
“When veterans talk to other veterans, they stick with it and do better because they are relating to someone who has had some of the same experiences,” she said.