Policy makers are calling for an enhancement to the process of screening, assessment, referral, treatment and follow-up for OIF Veterans. By identifying and treating post-deployment behavioral health disorders as soon as possible, the negative impact on Veterans and families can be minimized. Traditionally the VA has not initiated outreach efforts to identify newly returning Veterans at-risk for mental health and substance use disorders and link them with appropriate behavioral health treatments. However, there is a growing interest in developing such interventions as demonstrated by recent calls for applications from the VA and NIH. In addition, this project addressed three of the six research areas emphasized in the Rapid Response Proposal announcement: 1) intervention and implementation research targeting recently separated military personnel from the OEF/OIF conflicts; 2) quantitative and qualitative surveys of performance gaps for emerging needs of new Veterans; and 3) enhancing access to evidence-based care as well as continuity and coordination of care for new Veterans entering the VA healthcare system.
The purpose of the study was to conduct an intervention planning assessment to identify needs for and barriers to VA behavioral health care from the perspectives of newly returning National Guard soldiers deployed for Operation Iraqi Freedom (OIF) and Veterans organizations representatives. This application was a partnership between the MH QUERI Coordinating Center and the MH QUERI Clinical Coordinators Office.
Specific aims included: 1) assessing perceived needs and barriers to behavioral health treatment among returning OIF soldiers and 2) assessing perceived needs, barriers and resources for behavioral health treatment among key stakeholders in Veteran organizations
Two studies were implemented. One focused on returning OIF soldiers and assessed barriers to behavioral healthcare in the VA using both quantitative and qualitative methods. Soldiers who meet screening criteria for depression, generalized anxiety or PTSD were asked to participate in an in-depth qualitative interview on barriers to care. The second study focused on how representatives of Veteran organizations perceive the need for behavioral health care for returning soldiers. Representatives included Veteran or consumer representatives on the MH QUERI Executive Committee, the Committee on Care of Veterans with Serious Mental Illness, the VISN 1 MIRECC Consumer Advisory Board, and the Translating Initiatives in Depression into Effective Solutions (TIDES) project.
Findings from the first study suggested that there were themes around beliefs about treatment seeking. Stigma was portrayed as a major disadvantage to treatment seeking generally (being labeled as crazy) and specifically (decisions about military promotions and operations). Meanwhile, reducing symptom expression (in relationships, feeling the same as before deployment) were major advantages of care. The majority of participants indicated that people (military, friends, family) would be supportive of treatment seeking. Barriers, however, especially those viewed as "self-induced" such as pride, not being able to ask for help, and not being able to admit to a problem, were considered major impediments to treatment seeking in this population. Individuals who served in the war in Iraq have considered the emotional consequences of war and are willing to engage in dialogue regarding these consequences. Mental health treatment was perceived in both positive and negative ways and individual beliefs impacted the decision to seek treatment.
Regarding key stakeholders, four key issues surrounding mental health care for OEF/OIF veterans were identified as problems by most of the VSOs. These included: 1) The stigmatization of mental health problems in the active duty military and veteran populations; 2) The lack of adequate funding and manpower at VA hospital facilities to handle the large influx of mental health problems; 3) The faulty transition process and transfer of information from the Department of Defense (DOD) to the VA health care system; and 4) The use of outdated outreach and education programs for a new generation of "information age" veterans who have different information sources and more modern networks of communication. At least twenty of the twenty-seven interviewees cited each problem.
The findings suggested that interventions developed to engage veterans into care must be directed toward contextual and cognitive factors that motivate treatment seeking, particularly in primary care settings where many veterans seek care.
- Stecker T, Fortney JC, Hamilton F, Ajzen I. An assessment of beliefs about mental health care among veterans who served in Iraq. Psychiatric services (Washington, D.C.). 2007 Oct 1; 58(10):1358-61.
- Stecker T. Post-Deployment Assessment of Mental Health Needs and Barriers in OIF National Guard Soldiers. Paper presented at: VA HSR&D National Meeting; 2007 Feb 22; Arlington, VA.