As large numbers of American military veterans return from Iraq and Afghanistan, facilitating their reintegration into families, communities, and jobs will be a growing challenge. Some veterans will find this to be an easy task. Many will experience some difficulties. Yet others, particularly those who have become disabled as a result of serious mental health and substance use problems, will find reintegration to be extremely difficult.
Three factors—long length of combat tours, ubiquitous danger, and lack of linkage to the civilian culture for career military personnel—will compound the adjustment difficulties experienced by many returning veterans. At least one-third of them have self-reported symptoms of serious mental health conditions, and still others have serious substance use symptoms. Other veterans suffer from severe head wounds that lead to long-term disability and mental health symptoms, particularly major depression, and female veterans may be particularly at risk.
Returning vets do receive excellent screening for mental health and substance use conditions, physical health problems, and family health and readjustment issues. The VA operates 209 community Vet Centers to facilitate returning veterans' readjustment, and the VA is opening 23 more over the next two years. This program is laudable, but in many communities mental health and substance use services are not readily available through current VA programs to meet the needs of veterans with more severe behavioral health disabilities.
The VA will need to mobilize state and local mental health and substance use agencies to fill these service gaps successfully. An essential factor will be to offer mainstream services by mental health and substance use specialists in the local community to supplement current VA programs to facilitate community reentry and reintegration. Major components of this initiative must include:
Mapping the epidemiology of the aggregate flow of veterans with serious mental health and substance use issues into America's communities.This mapping can be used to identify locales where the VA currently has a mental health and substance use response capacity and locales where an insufficient or no capacity exists. The mapping also can be used to identify other potential state and local providers who could be enlisted to extend current VA capacity. Together, these maps will identify the locales where the VA's response needs to be enhanced.
Creating partnerships with public and private providers to access local supplemental mental health and substance use services, as well as related ancillary services, with appropriate reimbursement.Where no local services are available, telemedicine solutions will need to be implemented.
Refining services.Once the partnerships are in place, the supplemental mental health and substance use services will need to be refined as necessary. The VA electronic health record and the VA personal health record (My HealtheVet) will be particularly useful because they permit outcome measures to be collected in real time for each veteran who participates. These outcome measures can be used to make necessary program adjustments if community-based providers are given access to and support for these IT tools.
Promoting community supports and a virtual (online) community for returning veterans.The former can be developed via veteran groups that already exist in many American communities; the latter, through the creation of an online virtual community (e.g., I would propose a new system, My eBuddy) for veteran-to-veteran communication with friends.
Our Iraq and Afghanistan veterans are heroic Americans who have risked their lives daily. We owe them our full and unconditional support when they return to our shores. I've listed a few steps we can take especially to help those grappling with mental health and substance use problems. I hope this commentary will inspire some discussion of how you can partner with VA services near your community.
Ronald W. Manderscheid, PhD, currently Director of Mental Health and Substance Use Programs at the consulting firm Constella Group, LLC, worked for more than 30 years in the federal government on behavioral health research and policy. He is a member of Behavioral Healthcare's Editorial Board.