Final - A Gap in Equity Related to Mental Health Access for Veterans PDF

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Running head: GAP IN EQUITY

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A Gap in Equity Related to Mental Health Access for Veterans Shanna M. Rodriguez Southern New Hampshire University HCM 340

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A Gap in Equity Related to Mental Health Access for Veterans War is part of our history and for many others around the world. Veterans of all eras in time have dealt with Post-Traumatic Stress Disorder (PTSD) in some form or another. According to the American community survey, “In 2016, approximately 4 million veterans had a "service-connected disability," defined as disease or injury (mental or physical) incurred or aggravated during active military service” (Green, 2017). PTSD impacts many of our military personnel; however, it is not always related to deployments. It is a fact, for some veterans, the memories of deployments haunt them in their dreams or with interactions in their everyday life. Another obstacle for veterans upon returning from deployments is reintegration into civilian life. On the other hand, in some cases, PTSD is related to veterans or their family members due to healthcare obstacles, disabilities, or adverse health diagnoses to include depression and substance abuse relating to other life circumstances. Gaps in equity for mental health access for all veterans is an overwhelming issue. It is common knowledge that the most protracted war for the U.S. military is the Iraq and Afghanistan wars. American magazine article stated, “As tensions rise with Iran, Afghanistan becomes the longest war in U.S. history” (Clarke, 2020). With these longstanding wars, the statistics state, “sending more than 2.2 million troops into battle, and resulting in more than 6,600 deaths and 48,000 injuries (Institute of Medicine, 2013). Numerous veterans are reporting PTSD or some type of coping problem. “More than 1.5 million of the 5.5 million veterans seen in VA hospitals had a mental health diagnosis in 2016. This represents about a 31% increase since 2004 (Hester, 2017). These numbers impact the gap in equity for veterans seeking to be diagnosed or even to be cared for. The impact of these numbers on Veterans Affair’s hospital (VA) providers and other civilian mental healthcare providers is the overwhelming amount of work. This shortage could stem from a veteran living in a particular region, which, unfortunately, there

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are not enough mental healthcare providers to match the patient load. Not having the number of providers to care for soldiers with mental illness properly allows for veterans to be lost in the system. Another gap in equity for veterans is stigmas and barriers. Barriers include but not limited to embarrassment about mental disabilities, shame over needing treatment, and the fear of being seen as weak. Stigmas associated with mental health issues, long wait times to receive treatment, logistical problems such as travel distances, or demographic barriers and false perceptions based on age and gender (National Veterans Foundation 2016). Although many skills are learned during military service, some veterans have little to no post-high school education, and the skills gained from their military occupation do not translate to civilian life. Therefore, many find it hard to transfer to civilian life or find employment with adequate medical insurance. Lack of mental health providers, stigmas, and barriers are a distinctive gap. When not corrected sooner rather than later, veterans who genuinely have a mental illness will not receive the care they need. Some may turn to private vices to deal with their mental health issues. When our veterans suffer, so do our communities in the long run. In the broader overview, it could impact people’s desire to join the military, knowing that access to longterm care is prevalent, and there is a possibility of not having adequate care. In 2017 the VA attempted to close this gap with the implementation of the Recovery Engagement and Coordination for Health – Veterans Enhanced Treatment (REACH VET) initiative. REACH VET analyzes existing data from veterans’ health records to identify those at a statistically elevated risk for suicide, hospitalization, illness, or other adverse outcomes. This allows the VA to provide preemptive care and support for veterans; in some cases, before a veteran even has suicidal thoughts (Office of Public and Intergovernmental Affairs, 2016). However, this initiative was not meeting the purpose and needed improvement because only 6 of 20 veterans (30%) who take their lives by suicide every day receive healthcare from the VA.

GAP IN EQUITY Regulatory control of the VA comes from congress, and they need to pass legislation that will direct the VA to improve upon programs to better coordinate with and provide funding for nonprofit and community suicide prevention resources. Casting a wider net could help reach the remaining 70% who never step foot onto a VA campus (Legislative Priorities, 2020). American Veterans (AMVETS) is one organization that has started to close the gap and improve upon the REACH VET initiative in equity for veteran’s mental health. AMVETS mission statement reads, “To enhance and safeguard the entitlements for all American Veterans who have served honorable and to improve the quality of life for them, their families, and the communities where they live through leadership, advocacy and services” (American Veterans, 2020). AMVETS is working with the VA to help many mentally afflicted veterans. The initiative is called Healthcare Evaluation, Advocacy, and Legislation (HEAL). HEAL encompasses all the elements of the AMVETS mission statement. The Executive in Charge of the VA, Carolyn Clancy, MD, stated, "the importance of assistance on the front lines "can't be overemphasized ... Veterans who get into our system for mental services have dramatically better outcomes” (Frieden, 2020). The AMVETS organization understands the mental health crisis and the stigmas associated with seeking help. In 2018 AMVETS partnered with the VA to ease the transition from military life to civilian life. The VA’s goal of partnering with AMVETS was to combat suicide (Shane, 2018). To confront the rampant barriers to quality healthcare that veterans face, AMVETS commissioned a team of clinical experts with experience in eliminating these barriers nationwide through direct intervention and policy changes (AMVETS, 2020). The HEAL team was initiated to intervene directly on behalf of veterans, service members, families, and caregivers to reduce veterans from being lost in the system and reduce the stress during their transition into civilian life. AMVETS target patient population are those affiliated with AMVETS and utilize Polytrauma/Traumatic Brain Injury (TBI)

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centers and mental health services within the Veterans Health Administration (VHA) to include civilian community healthcare facilities.” (American Veterans, 2020). In order to achieve the goal for the HEAL initiative, a team of providers closely monitor the quality of care veterans receive. The AMVETS system of measuring quality consists of gathering the necessary resources to improve the efficiency of healthcare services to veterans, including the services provided at VA Polytrauma/TBI centers and mental health clinics, and will share this information with the Secretary of Veterans Affairs. Another aspect for the HEAL initiative is in collaboration with the VA providers is to establish a helpline to assist veterans and their family members, including reporting issues. AMVETS’ overall goal is to advocate for policies and laws that will benefit veterans’ healthcare delivery. According to the article “Initiative Aims to Help Veterans with Mental Illness” by Joyce Frieden, it is estimated to cost around $700,000 to support this initiative. AMVETS will try to partner with interested corporations to fund the HEAL initiative. In an effort to raise funds, the Chief Strategy Officer of AMVETS, Sherman Gillum, proposed an idea of stock offerings. The HEAL initiative has only been established since 2018 and will need time to see if the measures are working. The biggest hurdle this initiative will face is funding. For AMVETS to meet its purpose, it requires support from the government. In January of 2018, President Trump signed an executive order called “Supporting Our Veterans During Their Transition From Uniformed Service to Civilian Life.” It requires the Department of Defense, Veterans Affairs, and Homeland Security to ensure Veterans receive quality mental healthcare for at least one year following their leave from uniformed service. This order gives agencies 60 days to develop a Joint Action Plan to provide access to mental health and suicide prevention. Within 180 days, the Department of Defense, VA, and Military Health Systems have to inform the President of the Joint Action Plan about their progress. This order will hold individuals responsible for providing access to care.

GAP IN EQUITY AMVETS support hinges on the executive order President Trump signed, which will help address these gaps by holding people accountable for making sure within specified time frames, veterans have the access they need to appropriate healthcare.

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References American Veterans. (2020). About Us. Retrieved April 2, 2020, from https://amvets.org/about-us/ American Public Health Association (2014, November 18). Removing barriers to mental health services for veterans. Retrieved from https://www.apha.org/policies-andadvocacy/public-health-policy-statements/policydatabase/2015/01/28/14/51/removing-barriers-to-mental-health-services-for-veterans

AMVETS Heal Program. (2020). Retrieved April 16, 2020, from https://amvets.org/vet-heal/ Clarke, K. (2020, February 6). As tensions rise with Iran, Afghanistan becomes the longest war in U.S. history. Retrieved March 20, 2020, from https://www.americamagazine.org/politics-society/2020/02/05/tensions-rise-iranafghanistan-becomes-longest-war-us-history Frieden, J. (2020, April 4). Initiative Aims to Help Veterans with Mental Illness. Retrieved April 3, 2020, from https://www.medpagetoday.com/publichealthpolicy/militarymedicine/71577 Green, M. (2017, November 9). America's Veterans, By the Numbers. Retrieved March 19, 2020, from https://www.kqed.org/lowdown/20095/u-s-veterans-by-the-numbers Hester, R. D. (2017). Lack of access to mental health services contributing to the high suicide rates among veterans. International Journal of Mental Health Systems, 11, 47. http://doi.org/10.1186/s13033-017-0154-2 Institute of Medicine. (2013). Returning home from Iraq and Afghanistan [PDF file]. Retrieved from https://www.nap.edu/resource/13499/Returning-Home-Iraq-Afghanistan-RB.pdf

Legislative Priorities. (2020). Retrieved April 18, 2020, from https://amvets.org/legislativepriorities/

GAP IN EQUITY National Veterans Foundation. (2016, April). Veteran Mental Health - Facts and Stats that need to be addressed. Retrieved from https://nvf.org/veteran-mental-health-factsstatistics/ Office of Public and Intergovernmental Affairs. (2016, September 01). Veterans Affairs. Retrieved April 16, 2020, from https://www.va.gov/opa/pressrel/pressrelease.cfm? id=2878 Shane, L., III. (2018, March 13). AMVETS unveils new effort with VA to combat veterans suicide. Retrieved April 15, 2020, from https://www.militarytimes.com/veterans/2018/03/06/amvets-unveils-new-effort-withva-to-combat-veterans-suicide/

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