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The Ongoing Veteran Healthcare Crisis – CitiesSpeak


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Millions of veterans encounter health challenges every day, often as a direct result of their service.

According to a recent survey of injured post-9/11 veterans, 94 percent experienced physical injuries that are considered severe, 91 percent live with severe mental health conditions, and nearly a third need aid and attendance with everyday activities because of their injuries. Particularly on Veterans Day, significant attention is warranted for ensuring the health, comfort and safety of veterans and their family members.

Although we’ve seen improvements in veteran homelessness and employment, several aspects of veteran healthcare frequently, and potentially fatally, fall through the cracks:

Veteran Mental Health

The prevalence of “invisible wounds” among the veteran population is growing, and the lack of a scar doesn’t make mental health concerns any less critical. One in five veterans who served in Iraq or Afghanistan experience post-traumatic stress disorder (PTSD) or major depression, but only half of those who need treatment seek medical help. Serious mental health challenges connected to military service such as depression, PTSD and anxiety have direct ties to substance abuse and homelessness, in addition to taking a toll on the individuals and their families. And sadly, despite a $1 billion federal investment in prevention efforts between 2013 and 2019, suicide rates for veterans are as high as ever.

Veterans are 1.5 times more likely to commit suicide than nonveterans and more than 6,100 veterans died by suicide in 2017. Nearly two-thirds of them had not received care recently through the Veterans Health Administration (VHA). These figures are also typically higher when reflecting former National Guard and Reserve members who may not be eligible for veteran benefits depending on their type of service. The Department of Veterans Affairs (VA) has continued efforts to support veteran mental health through initiatives such as the Mayor’s and Governor’s Challenges to Prevent Suicide, and the expansion of the Veterans Crisis Line. Additionally, the Commander John Scott Hannon Veterans Mental Health Care Improvement Act aims to expand and improve access to care, including alternative treatment options such as animal therapy and yoga that have been shown to move the needle. But challenges still exist, including a notable military and cultural stigma around mental health that claims far too many lives.

Unique Challenges Faced by Female and LGBT Veterans

Although frequently left out of the military narrative in pop culture and Hollywood, women are the fastest-growing group seeking care through the VA. They make up almost 20 percent of the active-duty armed forces, Reserve and National Guard, and roughly 10 percent of all veterans.

Former service women face unique challenges: Women veterans, particularly those with active PTSD, are at a higher risk of dangerous pregnancy complications such as pre-term birth and pre-eclampsia, and are at more than twice the risk of suicide than non-veteran women. Women are more likely to reject their upper-extremity prosthesis than men, and frequently need prosthetic realignment or modifications during pregnancy.

Additionally, one out of every five female veterans report having experienced sexual trauma while serving in the military, and some studies estimate that the actual prevalence of sexual assault and harassment in the military is significantly higher. Outside of service, one out of every four women veterans report having experienced sexual harassment by male veterans on VA grounds alone. There has been support for the Deborah Sampson Act, a mostly bipartisan bill making its way through Congress that would help to tackle some of these challenges, but more remains to be done.

It’s also estimated that there are 1 million lesbian, gay, bisexual and transgender veterans in the United States, many of whom take full advantage of the VA health services. The VA aims to offer nondiscriminatory patient care, including specifying that all veterans be “addressed based on their self-identified gender identity.” It also has a pathway for name changes. However, while gender nonbinary veterans can access hormone treatment and post-operative care, VA benefits do not cover gender confirming or affirming surgeries for individuals who are transitioning. And given higher rates of depression and other mental health challenges, alcohol and substance use, and sexually transmitted infections among LGBT veterans, ensuring that all who serve feel comfortable and are able to access the quality health care they deserve is a critical medical issue.

Bridging Regional Gaps

From addressing chemical exposure and the physical impact of military service, to the daily toll of anxiety and PTSD, all veterans need and deserve high-quality health care. And many of those who rely on VA health services have been shown to receive quality care on-par with non-VA facilities — but there is tremendous variation based on location.

The VA is working to address this, particularly for veterans in rural areas, by expanding telehealth services and by broadening access to non-VA community care facilities through the MISSION Act. However, some officials have concerns about being able to effectively provide care to all who need it, and the VA more broadly has struggled to compete with the private job market in recruiting and retaining physicians. Recent reports also demonstrate how the mishandling of claims may have cost veterans millions of dollars. But ultimately, veterans who sacrificed for their country shouldn’t have the quality of their care be dictated by where they live.

Of the roughly 18 million veterans currently living in the U.S., more than 9 million rely on the Department of Veterans Affairs and the Veterans Health Administration for their care. With more than 1,250 health care facilities across the country and as one of the only agencies to see growth in its budget, the VA is leading on providing high-quality care to the men and women who have bravely served.

But regardless of where veterans receive their medical care, their gender identity and orientation, or how they served, it’s important to remember that we still have a long way to go.

IMG_0774About the author: Natasha Leonard is a graduate student intern for the Center for City Solutions team at the National League of Cities. She is completing her master’s degree in public policy at Georgetown University’s McCourt School of Public Policy. Follow her on Twitter @NatashaJLeonard.


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