The Challenge of Mental Health Care for Veterans and Their Families

Abstract

It may seem that our world of wars will never end. And with the wars come the challenges and aftermath of caring for veterans and their families. These individuals and families reside in all of our communities, and we have an obligation to address the special mental health needs that they experience. As professional nurses we are aware of the challenges of transitions from one status to another, in the many aspects of life. But to move from active military to veteran (and ordinary citizen) is sometimes beyond our understanding without a deep analysis. Think alone about the killing and maiming that military personnel experience in was, and it is not surprising that they are haunted by their memories. On the positive side, think about the extreme bonding that occurs among individuals assigned to the same military grouping, and it is no wonder that in the absence of that extreme comradery that they feel lost and alone in their experiences post-deployment. Equally challenging is the disconnection that they feel from their families, as often family members expect the veterans to pick up where they left off, with no change in the way they are treated. The problems that our veterans face as a result of wars are not new. We know that the consequences for Vietnam veterans were substantial, just as we know that the ongoing deployments in Iraq and Afghanistan have led to similar challenges. One of the major mental health challenges is that of suicide among veterans, particularly post-deployment. In an analysis of deaths among two veteran cohorts, those who served in Iraq or Afghanistan, Kang et al., 2015Kang H.K. Bullman T.A. Smolenski D.J. Skopp N.A. Gahm G.A. Reger M.A. Suicide risk among 1.3 million veterans who were on active duty during the Iraq and Afghanistan wars.Annals of Epidemiology. 2015; 25: 96-100Abstract Full Text Full Text PDF PubMed Scopus (169) Google Scholar found that there was a 41% to 61% higher risk of suicide compared to that of the United States (US) general population. Our first level of intervention is understand: both the nature of the challenges of reintegration of veterans into their communities and also the data about who is most at risk. Recently the US Department of Veterans Affairs published a comprehensive analysis of the incidence of suicide among both veterans and other Americans, and outlined the veteran groups at most risk (US Department of Veterans Affairs, 2016US Department of Veterans Affairs Suicide among veterans and other Americans 2001-2014. US Government Printing Office, Washington, D.C.2016Google Scholar). This report provides great breadth and depth regarding the extent of the problem, and is unprecedented in its comprehensiveness. Both of these references should be required reading for all nurses, but most especially for those providing primary care and mental health care in communities. We know that many individuals seek primary care for mental health concerns, suicide thoughts and ideation among these. In Archives we will be dedicating special issues of the journal to both of these topics: mental health and primary care and suicide among military personnel and veterans. We invite you to consider writing about special programs you have development to address these needs, and research that has been launched in these key areas of psychiatric mental health nursing.