In 2020, 5.2 million veterans experienced a behavioral health condition. However, more than half of veterans with a mental illness did not receive treatment during that period. Additionally, more than 90% of those experiencing a substance use disorder did not receive treatment. The data highlights that many veterans and active-duty military personnel may be suffering in silence and that barriers to care exist, including stigma. Demand for behavioral health care services from the Veterans Administration has also grown significantly over time. The number of veterans receiving behavioral health care services from the VA increased nearly 100% between 2006 to 2019. Many veterans have multiple mental health conditions such as depression, anxiety, and post-traumatic stress disorder (PTSD).
Recent Congressional Actions to Address Veteran Mental Health
To address the needs of veterans with mental health conditions, Congress has taken several actions to increase access to needed services.
NBCC has advocated for increased recognition and hiring of professional counselors by the VA for several years, efforts that resulted in the passage of a 2006 law adding licensed professional mental health counselors (LPMHCs) to the list of professions eligible for VA employment.
In October 2020, the Commander John Scott Hannon Veterans Mental Health Care Improvement Act was signed into law, which was the most significant legislation passed for the counseling profession in over a decade, when the counseling profession was added to the Minority Fellowship Program in 2011.
The Veterans Mental Health Care Improvement Act is far-reaching legislation to address mental health care delivery issues in the VA, including provisions related to suicide prevention, integrating mental health care services and primary care, and updating clinical practice guidelines.
The overarching provision embodied in the legislation pertaining to the counseling profession directed the Secretary of the VA and the Federal Office of Personnel Management to develop an Occupational Series for LPMHCs and marriage and family therapists (MFTs), particularly in the VA. The Occupational Series went into effect in 2023.
https://www.opm.gov/policy-data-oversight/classification-qualifications/classifying-general-schedule-positions/standards/0100/gs0180.pdf
Creation of the new Occupational Series is a significant achievement. A separate series will now allow counselors to have recognition and professional identity throughout the federal system, facilitating simplified hiring for counselors, cross-agency movement, and increased pay and promotion potential throughout the federal enterprise. The legislation also promotes increased hiring and training of mental health counselors with the VA through a mandated study by the Inspector General.
The Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program, or Fox Grant, is a part of the Hannon Act. The Fox Grant assigns funding for community organizations that offer suicide prevention to veterans and their families. The Fox Grant contributes to the VA's Whole Health model and provides resources valuing $174 million to veteran-supported community organizations nationwide. The program is the epitome of the challenges that prevent complete success of veteran programs regardless of when a well-intended law is passed.
Congressional 2024 National Defense Authorization Act (NDAA) Legislation Includes Mental Health Provisions Affecting Active Military Personnel
On December 14, 2023, Congress passed H.R. 2670 – National Defense Authorization Act for Fiscal Year 2024.
The 63rd annual NDAA supports $883.7 billion in fiscal year 2024 funding for national defense. Within this top line, legislation authorizes $841 billion for the Department of Defense (DOD), $32 billion for national security programs within the Department of Energy (DOE), and $438 million in defense-related activities.
Some of the key provisions include cost sharing, self-initiated referral processes, programs to study the treatment of certain conditions using psychedelic substances, naloxone and fentanyl regulations, studies on opioid alternatives, and annual reporting of overdoses by certain members of the armed forces.
The DOD must submit an annual report to the congressional committees regarding the number of annual overdoses among covered members.
NBCC will monitor the work of the DOD and other agencies in implementing the mental health provisions in the NDAA legislation and report key findings reported to Congress.
Congressional Military Mental Health Legislations Under Consideration
VA, DOD, and CDC Program Activity to Address Suicide
In 2021, nearly 6,400 U.S. veterans died from suicide. The VA, DOD, and Centers for Disease Control (CDC) have multiple efforts underway to help prevent suicide among military servicemembers and veterans.
The VA uses suicide prevention teams at their hospitals and facilities to implement its Suicide Prevention Program. Such teams perform programmatic, administrative, and clinical activities ranging from tracking and reporting of veterans at high risk for suicide to conducting training, collaborating with community organizational partners, and consulting with mental health providers.
The VA has provided an opportunity for stakeholders across the country to participate in Mission Daybreak—a $20 million grant challenge designed to help the VA develop new suicide prevention strategies for veterans.
The DOD’s suicide prevention efforts are guided by its Defense Strategy for Suicide Prevention, which establishes a public health approach for suicide prevention. The approach includes both clinical and non-clinical efforts intended to reduce the risk of suicide.
Under the CDC’s Comprehensive Suicide Prevention Program, multiple states have identified veterans as a key risk group and are implementing interventions to address veteran suicide.
VA Efforts to Identify Veterans at Risk through Analysis of Health Record Information
The VA implemented the “Recovery Engagement and Coordination for Health-Veterans Enhanced Treatment (REACH VET)” program across the VA in 2017 to help identify Veterans receiving health care and mental health care services who are potentially at increased risk for suicide.
The VA’s Readjustment Counseling Service Vet Centers
Readjustment Counseling Service Vet Centers provide counseling (individual, group, couples, and family) through 300 centers to help eligible veterans, service members, and their families readjust to civilian life or to continued military service. Vet Centers use psychosocial assessments and feedback surveys to assess individual client needs and whether those needs are being met throughout the course of counseling.
New Initiatives In The Private Sector
Business leaders have been creating a culture of support for military families within their company and communities.
Johnson and Johnson’s Veterans Leadership Council has developed programs to help veteran employees reach their full potential while addressing the military-connected community's unique health and wellness needs.
CSX, a leader in national transportation, not only puts a focus on hiring veterans, but further connects employees and community members with veterans to raise critical funds and awareness through its Pride in Service initiative.
Public education also can break down stereotypes and misconceptions about veteran mental health and foster open, informative conversations that help normalize seeking mental health care. For Veterans Day 2021, the Ad Council and the VA collaborated on a campaign called “Don’t Wait, Reach Out,” to destigmatize asking for help.
The Wounded Warrior Project also runs social media campaigns using #CombatStigma to raise awareness and reduce barriers around asking for help. Participating in these conversations sends a powerful message of support and helps resources reach those in need.
The Welcome Back Veterans initiative expands access to high-quality mental health care for service members, veterans, and their families. The program provides grants to academic medical centers to offer services to veterans and their families, as well as training programs for health care providers.
The Warrior Care Network improves access to clinical care for service members and veterans with PTSD, TBI, and related conditions. The effort is a partnership between the Wounded Warrior Project and four academic medical centers: Emory, Massachusetts General Hospital, Rush, and UCLA.
The Headstrong Project offers evidence-based treatment to post 9/11 combat veterans. The initiative was developed by Weill Cornell Medical College in New York and has expanded to several other cities.
For more information about NBCC’s programs on military mental health, please visit https://nbcc.org/govtaffairs/militaryhealth.
