Introduction
The gap in Healthcare Delivery
Ensuring the improved outcomes within the sphere of mental health for veterans is among the critical healthcare priorities due to the high intensity of the work they have done as well as the range of adverse consequences that occur as a result of it. Rates of emotional trauma and mental illnesses are disproportionately high among American veterans, especially those who have participated in the most recent wars, such as Afghanistan and Iraq.
The specific gap to be explored pertains to the limited attention to the mental health needs of veterans alongside the limited capacity of the healthcare field to address such needs. Therefore, removing the barriers to accessing mental health care is imperative to eliminate disadvantages that adversely affect an already disadvantaged group of individuals. The current exploration aims to identify the limitations of inequitable access to appropriate and affordable mental health services as well as propose interventions for solving the problem.
History
The lack of attention to the mental health needs of the military has its roots in the limited understanding of counselors regarding what combat really is. Dating back to the return of World War II, veterans home increased the need for mental health services that could resolve the trauma witnessed during battle. However, veterans had other issues with which to deal, such as battling socio-economic challenges and rebuilding families. Posttraumatic stress disorder in veterans of Iraq and Afghanistan veterans has also had a significant impact on the target group. However, unemployment and poor educational support were the issues that were of a higher priority compared to counseling and mental health improvement.
The issue of inequities in mental health care among veterans has developed historically as a result of delaying the improvement of psychological well-being because of other challenges. Today, the lack of attention to the problem is supported by the fact that not many veterans seek help as they deal with other life issues, which shows that the problem has been developing for decades.
Socioeconomic Background
Regardless of the fact that military services are intended to foster resilience in individuals serving their countries, the prevalence of mental health issues is on a high level. Individuals have multiple reasons for enlisting in the military, often due to patriotic intentions, financial incentives, educational benefits, as well as the family tradition of enrolling in the military. Furthermore, many recruits are graduates from high school who have “limited prospects for occupation and, therefore, choose military services as a method for attaining a job and develop some skills for future careers” (Hester, 2017, p. 1).
However, what many fail to understand is the fact that war is a multi-dimensional affair involving both physical and emotional strain. Modern soldiers deal primarily with suicide bombers and improvised explosive devices (IEDs) that lead to multiple injuries.
After finishing their service, many veterans feel separated from society and have questionable employment prospects, which limits their quality of life and opportunities. A large number of veterans face the consequences of emotional strain, “which include depression, the loss of purpose in life, and, in some instances, a severe family crisis” (Hester, 2017, p. 1). These findings show that the mental health of veterans should not be taken lightly, as the lack of awareness and education about their needs would further exasperate the problem. These socioeconomic conditions put a strain on the mental well-being of veterans, with gaps in access showing the population that their needs have not been considered.
Healthcare Affected by Gap in Access
The gaps in mental health care access lead to the development of adverse psychological conditions adversely affecting the target group. According to the statistics presented by the U.S. Department of Veteran Affairs (VA) (2018), “around 11-20 out of every 100 former soldiers (11%-20%) who participated in Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF) were diagnosed with posttraumatic stress disorder.
For the Desert Storm operation (Gulf War), around 12% of veterans had the disorder as a result of their involvement in a military battle” (para. 2). In regards to the Vietnam War, the latest study that took place at the end of the 1980s found that 15% of veterans were diagnosed with the disorder. However, the U.S. Department of VA (2018) estimated that “around 30% of Vietnam veterans had PTDS” in their lifetime (para. 4). The statistics show that the situations that military members face in combat develop severe mental instabilities.
The healthcare delivered to the population is also limited in terms of human resources that could work toward veterans’ mental health improvement. The lack of specialists that would work toward providing high-quality mental health care services points to the imbalance in the demand and supply of comprehensive veteran health care. As mentioned in the RAND report prepared by Farmer, Hosek, and Adamson (2016), it was expected that “between 2014 and 2024, the overall health of the veteran population would deteriorate” (para. 4).
Mental health complications, such as posttraumatic stress disorder (PTSD) and depression, would contribute to the widespread adverse impact on physical conditions, which include diabetes and hypertension. The decline in the physical and mental well-being of veterans adds to the urgent need to implement effective measures for balancing between the demand and supply of services. Furthermore, it is imperative to monitor the changes in the demand, and in cases, if it expands exponentially, report to the relevant authorities as to the need for service expansion.
Potential Implications
The effective maintenance of mental health and well-being among the veteran population is expected to guarantee a good quality of life and multiple opportunities for growth and development. If remained unaddressed, the gap in mental healthcare has shown to “limit the capacity of veterans of being productive in work and education” (Artiga et al., 2017, p. 3). As a result of the limited attention to mental health needs, veterans may also develop posttraumatic stress disorder (PTSD).
According to Whealin, Jenchura, Wong, and Zulman (2016), the condition occurs in “13% to 21% of veterans, which is associated with such symptoms as the high occurrence of intrusive memories, flashbacks, negative mood, concentration difficulties, and avoidance of stimuli linked to trauma” (p. e280). PTSD may also significantly impair the abilities of veterans to address their needs in health care and seek medical evaluation. Moreover, as reported by Artiga, DiPietro, and Ubri (2017) for the Kaiser Family Foundation, veterans are more likely to become homeless as opposed to the general public, “making up 12% of the entire homeless population” (p. 3). Coupled with PTSD, limited work and education opportunities create a complex socioeconomic position for veterans.
Existing Initiatives
APHA Healthcare Initiative
The current initiatives, such as the APHA-initiated program, aims to provide medical benefits to individuals who have been honorably discharged and released from service. The initiative covers several policy statements that include suicide prevention, mental health as a comprehensive part of health care, “accountability in healthcare and welfare services, and non-discriminatory coverage of all mental treatment for veterans” (APHA, 2014, para. 3). Through basing the initiative on the four policy statements, APHA works on providing mental healthcare benefits to veterans in the military, navy, and air service.
Goals of the Initiative
The VA initiative has set a goal of shifting the gradation of eligibility for health care services to expand the coverage. However, limitations remain in terms of the eligibility of veterans for VA-related initiatives. For instance, key priority goes to veterans with “50% and more of disability as well as those who are unemployed due to their disability” (APHA, 2014, para. 2). Another goal of the initiative is improving VA health personnel retention through reducing their compassion fatigue and burnout, which limits their capacity to be effective in caring for vulnerable populations. This goal is important because it addresses the aspect of personnel support and its positive outlook on their work. The more effective the staff is, the higher is the likelihood of ensuring that the mental health outcomes of veterans.
Circumstances for Development
The initiative was developed in the context of disproportionately high rates of mental illness and trauma among US veterans, with Iraq and Afghanistan being the most recent wars that have caused an impact. Because of this, the US Congress and the Department of Veterans Affairs took steps to develop cohesive policies to overcome the problem. Furthermore, apart from the growing problem of poor mental health among veterans, “the initiative was also developed because the majority of policies and proposals were highly dated and could not work effectively” (APHA, 2014, para. 6).
It should also be mentioned that have been no policies that would address mental health care services for veterans. The combination of the mentioned circumstances prompted the development of the initiative in 2014. The fairly recent date for the initiative’s creation points to the limited attention of policymakers to the issue of veteran’s mental health, which has resulted in ongoing gaps in access to services among the target population.
Resources Required
Veterans have also experienced gaps in mental health care access due to the issues associated with high rates of personnel turnover. APHA and other initiatives developed to help veterans improve their mental health have established a goal to widen the coverage of services. However, there are limited resources necessary to reach the goals of initiatives. The first category of resources needed refers to personnel. It is imperative to reduce compassion fatigue and burnout among healthcare providers who care for such a “vulnerable population” (APHA, 2014, para. 4). Therefore, gaps in accessing mental healthcare are attributed to a systematic absence of non-human and human resources that could support the implementation of successful interventions.
The second category of resources required for the initiative is the finances. The economic strain on the population causes them to experience not only mental health issues but also “substance abuse, addiction to gambling, as well as higher rates of substance abuse and deaths” (Hester, 2017, p. 2). The gaps in accessing effective care are rooted in the Affordable Care Act (ACA) not addressing the problem through expanding mental health coverage for low-income veterans within the recent health plans.
The federal government has invested in attracting and retaining mental health providers through financial incentives and provider subsidies. Financial-based incentives are the key resource for the initiative because they are successful in placing physicians in underserved areas. The financial participation of the Department of Veteran Affairs is also important because it was funding the academic research on moral injury, stigma, military culture, and military sexual trauma.
Improvement
The initiatives that have been put in place do not meet the required improvement because veterans would have to increase their out-of-pocket spending on services. The APHA initiative requires improvement because it cannot cover all veterans for free. As a result of the issue, many American veterans experiencing mental health complications have not to access to insurance coverage, nor can they pay for services themselves as the initiative is also limited by the lack of personnel and high turnover rates due to compassion fatigue.
This problem requires significant financial support to ensure that the veterans receive the desired level of mental health care and there is enough staff available. In addition, the initiative is not advertised properly, which limits the ability of veterans to get to know about it and use the services available to them.
Regulation
Current Regulation
The reported lack of effectiveness on the part of existing methods of dealing with gaps in mental health care access calls for the regulation of the problem. According to Whealin et al. (2016), “eHealth technologies have been increasingly used for helping veterans overcome their mental health problems and PTSD in particular” (e280). The importance of this solution is attributed to the fact that it bridges the gap between veterans and service providers with the help of simple technologies that will help to refine interactions, develop new resources, and promote greater awareness. EHealth tools range from online chat groups for therapy support to one-on-one calls for patients and care providers.
The technologies can offer guidance on symptom management, which is imperative for the ongoing treatment of mental health issues. Therefore, programs that involve technologies are highly important for fostering a broader coverage of mental health support for veterans due to their broad applicability in different contexts.
APHA regulations have also been implemented to help veterans overcome barriers to mental health access. According to the policy statement made by the organization, significant “efforts on the part of the US government are needed to eliminate discrepancies in veterans’ eligibility for relevant services” (APHA, 2014, para. 8). Furthermore, VA is recommended to adopt less complicated mechanisms for approaching PTSD and other mental health conditions diagnoses. In the absence of circumstances preventing veterans from gaining mental health care benefits, the VA should facilitate the process of appeals that are simple and affordable for veterans. Furthermore, the regulation must address the problem of moral injury needs through additional research.
Reducing gaps in health care access equity also call for an audit in scheduling and recruitment practices for healthcare professionals. Questionable scheduling practices coupled with high rates of turnover prevent VA and other relevant organizations and facilities from developing a cohesive strategy for overcoming the problem. The move toward the design and implementation of a new system of medical appointment scheduling is an improvement within the model of mental health care management for veterans. Data streamlining will not also help schedule appointments but also provide data that is crucial for the long-term maintenance of ongoing innovations and improvements.
Regulatory Level
The proposed set of regulations requires addressing at a national level. Resources for helping veterans deal with mental health challenges should be available in every state and region, especially in terms of severe complications such as suicide attempts due to PTSD, homelessness, or depression. Besides, the identified gaps in personnel training, turnover, and scheduling require a comprehensive approach to solving the issues (APHA, 2014, para. 6). A unified nationwide strategy that covers every state and healthcare facility is necessary because veterans face gaps in access throughout the entire country.
Conclusion
At this time, veterans do not receive the desired quality of mental health care. The ACA and VA have shown limited capacity in addressing the fundamental psychological challenges that develop among veterans due to exposure to extreme and dangerous events. From high rates of employee turnover due to compassion fatigue to limitations ineligibility for services within the ACA, veterans face a wide range of constraints when addressing their emotional health needs.
As the funding of programs targeting veterans is insufficient due to changes in insurance coverage as well as its availability for veterans, special attention should be paid to the issue. While the proposed initiatives offer some solutions to support the elimination of the gaps in access and care provision, there is a need for a comprehensive review of the current efforts. The focus should be placed on interviewing veterans and inquiring about their suggestions to solve the problem.
References
APHA. (2014). Removing barriers to mental health services for veterans. Web.
Artiga, S., DiPietro, B., & Ubri, P. (2017). The role of Medicaid and impact of the Medicaid expansion for veterans experiencing homelessness. Web.
Farmer, C., Hosek, S., & Adamson, D. (2016). Balancing demand and supply for veterans’ health care. Web.
Hester, R. (2017). Lack of access to mental health services contributing to the high suicide rates among veterans. International Journal of Mental Health Systems, 11(47), 1-4.
U.S. Department of Veteran Affairs. (2018). How common is PTSD in veterans? Web.
Whealin, J. M., Jenchura, E. C., Wong, A. C., & Zulman, D. M. (2016). How veterans with post-traumatic stress disorder and comorbid health conditions utilize eHealth to manage their health care needs: A mixed-methods analysis. Journal of Medical Internet Research, 18(10), e280.