Stigmatization and mental health treatment barriers for Iraq and Afghanistan veterans

Policy Analysis for Veterans

The objective this paper is to discuss the stigmatization and mental disorders of Veterans after the service. After the Iraqi war, the numbers veterans suffering from mental illness continues to increase, and one of the factors that aggravate the problems is a stigmatization from the society. The paper identifies that the costs of providing treatment for veterans continue to increase in the last 10 years coupled with an increase in the waiting times to receive their benefits and healthcare delivery. The study also explores the political, economic, legal and social factors affecting Veterans administration. The study recommends that the government should provide both intensive and quality care for servicemen during and after the operations. Moreover, the government should pass a bill to reduce the waiting times to receive their benefits and care. The options will assist in reducing veterans mental problems and stigmatization they face in the society.

Introduction

The purpose of this assignment is to discuss the issue of mental health in the United States. It has been observed that after the military personnel serves in the wars such as Afghanistan and Iraq, the majority of them developmental problems. Since the government has started the foreign military operations, more than 2 million military personnel have been deployed. Regretfully, combat operations have been characterized by the use of high explosive devices. Moreover, the operations are also characterized by guerrilla insurgency, high-level deployment of the national guard, extended and multiple deployments of military personnel. Thus, there has been an increased injury rates at the battlefield that consequently lead to advanced medical care.

Problem Statement: What is the strategy of reducing the negative stigma within the U.S. military and method Veterans can employ to seek for appropriate mental health care?

Background

In the contemporary military environment, one out four of active duty members has developed a sign of mental condition based on the data presented by JAMA Psychiatry in 2014. For example, the rate of depression among service members is five times higher than the rate recorded among civilians. Moreover, 20% of veterans who serve in Iraq and Afghanistan suffered from major metal and depressive disorders. Since 2002, more than 1.9 Million of these service members are eligible for "Veterans Affairs health care, and an estimated 1.16 million veterans have registered for this care." (Pickett, et al., 2015 p 299). It is essential to realize that the military conflicts in the military operations such as OIF (Operation Iraqi Freedom), OND (Operation New Dawn), and OEF (Operation Enduring Freedom) are the longest "sustained military operations in the U.S. history". (Pickett, et al., 2015 p 299) that consequently provoke mental problems among military personnel.

In December 2014, 57.2% (662,772) of veterans received at least one categories of mental care diagnosis that include PTSD ("post-traumatic stress disorder"), anxiety disorders, and depressive disorders. (NIMH (2016 p 1). Other cases of prevalence among veterans are high rates of adjustment as well as substance use disorders. The issues have made a number of veterans who have suffered from a comorbid SUD and PTSD to increase by 76% since 2008. Moreover, many veterans have sustained the TBI ( traumatically brain injuries) because of the combat, and between 2007 and 2013, a total number of veterans who sustained a TBI has increased. Moreover, since 2000, there have been 327,299 cases of TIB and 5,912 cases recorded in the first quarter of 2015. Before the military personnel has been deployed for military services, only 2.4% of them have been diagnosed with a mental disorder, however, after deployment, more than 57% of them have been diagnosed with mental disorders.

Landscape

The government agencies and non-stakeholders will be responsible for influencing the policy related to the mental disorders suffered by the military men after the services. For example, Department of Veterans (DV) Affairs is responsible for managing the administration of veterans. The department supports the military personnel after their services by providing different supports and different benefits for the service men. The cogent initiative of the agency is to prevent the case of homeliness among the service members since the issue can aggravate mental disorder of the service men. (Pols, & Oak, 2007). Under the Department of Veterans, there is a mental health department that occupies military personnel suffering from mental disorder. The US Department of Health is also directly influencing the policy regarding the mental problems of the service men because the department disburses fund to take care of servicemen suffering from mental disorder. Additionally, the media and non-government organizations are indirectly influencing the issue. Through the media, the U.S. population have been aware of the concerning issue related to military mental disorders. Moreover, RAND Corporation, a non-governmental organization has also been in the forefront in publicizing the stigma that veteran experience after the services because of their mental problems. For example, RAND has been influencing the policy of the Veterans Health Administration and Department of Defense to ensure that the mental problems among military personnel are reduced. (Acosta, Becker, Cerully, et al. 2014).

Current Solutions or Policies

The federal government and state government have introduced different policies and solutions to address the current problems. For example, the Veterans Health Administration provides the intervention and treatment of veterans suffering from mental illness. The VHA has agencies across different states in the United States. For example, in North Carolina, and other states, the VHA implement and disseminate the evidence -based service to enhance psychotherapies therapy for service members. Moreover, "Mental Health Residential Rehabilitation Treatment Programs are offered for Veterans" (Pickett, et al. 2015, p 302), and the program is employed to facilitate treatment of veterans suffering from mental illness. The program is also designed to provide social skill training, peer support, and psychoeducation for veterans. Moreover, the government uses the program to deliver compensated work therapy as well as a homeless program through community participations to enhance reintegration of Veterans in the society. Pickett, et al. (2015) believe that

"the Veterans Access, Choice, and Accountability program allows veterans to access care in the community if distance or long wait times present a barrier to timely access to VA services." (, p 302). The program is also designed to offer readjustment counseling and outreach services for veterans.

Political factors

In the United States, there are political factors that are influencing the Veterans affairs. While some legislative members are in support of improving the health conditions of veterans through a disbursement of more funds, however, some member of the House are opposing the motion. Typically, different federal government policies are affecting the Veteran affairs. For example, the Trump administration has signed a memorandum to freeze future hiring by the federal government agencies. Typically, federal hiring freezes that has been imposed by President Trump is currently affecting thousands of opening jobs available at the Department of Veterans Affairs, and the recent freeze will affect the health improvement for veterans suffering from mental illness. It is mandatory that after veterans serve the country, they are entitled to financial benefits. However, it is reported that red tapism of the federal government is affecting the wait claims decision, sometimes it can be up to 9 months before they are able to receive their claims. The average waiting times across the nation is between 316 and 327 days a year. Thus, an increase in the wait times before veterans receive their benefits can often aggravate their mental disorders. In 2009, the number of veterans waiting to receive claim rose from 11,000 to 245,000 before the end of 2012. The method to alleviate the veterans' mental problems is to remove the red tapism affecting the veterans affairs. Moreover, the federal government should create specialist mental hospitals that will be equipped with modern and sophisticated equipment to alleviate the problems of veterans population.

Social factors

In the United States, stigmatization has been the social factors affecting the veterans. Yamawaki, et al. (2016) believes that stigmatism been the major social factors affecting the veteran population. After the Iraqi war, the number of veterans rose to more than 1 million. As the United States is sending military men for services outside the country, the number of veterans who will be suffering from mental illness will continue to increase. Culturally, people do not like integrating with people suffering from mental illness, and the issue is relegating the integration of veterans in the society. Yamawaki, et al. (2016) reveals that the negative stereotype that veterans receive affect their cognitive, emotional and behavioral components. "These negative stereotypes often involve the idea that people with mental illness are violent, incompetent, or at fault for their condition." (Yamawaki, et al. 2016 p 1547).

Economic factors

The economic factors affecting the veterans is a rise in the population of veterans leading to the high costs of the administration. As being revealed in Fig 1, the number of veterans with mental illness has increased, and the budget approved for VA mental health in 2013 was $6.2 billion. With an increase in the number of veterans in the United States, the costs will continue to increase. (Department of Veterans, 2015). Based on the increase in the number of veterans, the government will need to disburse addition fund to manage their affairs. The solution to the problem is to provide additional staff to cater for their affairs. There is a need for the provision of mental health trainees.

"Mental health trainees and advanced fellows can expand VA's capacity to provide mental health services by providing clinical care under the direct supervision of regular mental health staff. In addition, these trainees form a recruitment pool from which future mental health professionals can be hired with confidence in their training and commitment to the VA mission." (Department of Veterans, 2015 p 13).

Fig 1: Number of Veterans with Mental Illness

Legal factors

The Veterans affairs have been influenced by the legal factors for several decades. For example, "the bill -- The Prioritizing Veterans Access to Mental Health Care Act of 2015" (Petruzzelli, 2015 p 1). have been introduced in the House to remove the barriers that veterans face when receiving care. Although, this bill has not yet been passed into a law, if it is enacted, the veterans' problems will be alleviated. The Veteran Administration has also introduced a plan to reduce the average waiting times for veterans.

Quality of Care factors

It has been observed that an increase in the waiting times is the major factor affecting the quality of care for service men. The best strategy to improve the quality of care is to reduce the waiting times that veteran requires to access care. Moreover, the study suggests that the government should provide intensive care for veterans immediately they arrive from the service to alleviate their mental problems.

Viable Options

The government should disburse more fund for the health benefits of the service men.

The government should develop a program that will assist integrating the service men in the society to alleviate the stigmatization they face in the society.

The government should speed up the bill to remove the waiting times that delay service men from receiving the quality of care. The government should develop more specialized mental hospital which all service men should be referred for immediate treatment after the service.

The government should speed up the number of days that veterans receive their benefits.

Recommendation

The best solution to alleviate the problem of stigmatization is to develop a comprehensive plan to make the service men having access to the quality of health care during and after services. The benefits of this option are that the government will be able to detect the servicemen suffering from the disorder as early as possible. With this strategy, they will have access to quality health care before their problems are aggravated. Although, the costs of implementing this option may be high, nevertheless, the option is the best strategy to reduce the number of veterans suffering from the mental health disorders.

Reference

Acosta, J., Becker, A., Cerully, J. et al. (2014). U.S. Military Making Progress on Reducing Stigma Associated with Seeking Help For Mental Illness. Retrieved April 24, 2017, from http://www.rand.org/pubs/research_reports/RR426.html

Congress (2016). H.R.203 - Clay Hunt SAV Act 114th Congress (2015-2016). Veterans' Affairs.

Department of Veterans (2015). VA Mental Health Services Public Report. Department of Veterans Affairs. Retrieved April 24, 2017, from https://www.mentalhealth.va.gov/docs/Mental_Health_Transparency_Report_11-24-14.pdf

IAVA (2016). IAVA Program Iraq and Afghanistan Veterans of America. Retrieved April 24, 2017, from https://iava.org/programs/

NIMH (2016). Post-Traumatic Stress Disorder. National Institute of Mental Health.

NAMI (2016). About NAMI. National Institute of Mental Health.

Pickett, T., Rothman, D., Crawford, E. F., Brancu, M., Fairbank, J. A., & Kudler, H. S. (2015). Mental Health Among Military Personnel and Veterans. North Carolina Medical Journal, 76(5), 299-306. doi:10.18043/ncm.76.5.299.

Petruzzelli, M. (2015). Veterans Mental Health Bill Introduced in the Senate. Veterans and Military Families.

Pols, H. & Oak, S. (2007). WAR & Military Mental Health. Am J. Public Health. 2007 December; 97(12): 2132 -- 2142.

Slack, D. (2017). rump hiring freeze includes the short-staffed VA. USA Today.

Yamawaki, N., Kelly, C., Dresden, B. E., Busath, G. L., & Riley, C. E. (2016). The Predictive Effects of Work Environment on Stigma Toward and Practical Concerns for Seeking Mental Health Services. Military Medicine, 181(11). doi:10.7205/milmed-d-15-00489