Fifteen years of war in Iraq and Afghanistan reveal the impact of sustained exposure to combat, harsh environmental conditions and extended separation from loved ones have on the psychological well-being of military personnel and their family members.
The estimates vary from study to study, but it is generally accepted that up to one-third of Iraq and Afghanistan veterans suffer some form of psychological disorder as a result of their service (Hoge, Auchterlonie & Milliken, 2006; Hoge et al, 2004).
Considering that over two-million men and women have deployed to these war zones since the wars started, this translates to approximately 700,000 men and women. Estimates of post-traumatic stress disorder (PTSD) by itself are around 15% (Hoge, Terhakopian, Castro, Messer, & Engel, 2007; Tanielian & Jaycox, 2008).
A related issue associated with the increase in mental health needs of our veterans is the demand placed on the military and Veterans Administration (VA) health care systems. Recently, a variety of organizations have issued critical reports of both systems regarding their ability to meet the emotional needs of service members and veterans. As a result, more attention has been paid to better understand the challenges faced by combat veterans and develop more effective approaches to these problems (GAO, 2014).
The proliferation of privately funded civilian programs is an important consequence associated with the concerns mentioned above.
It is also a result of society’s desire to support those who have served their country. Although the exact number is not known, it is estimated that there are approximately 46,000 military and veteran-focused organizations in existence that support the variety of needs of veterans and their families (Armstrong, McDonough, & Savage, 2015).
And instead of reproducing programs already found in the military and VA systems, many of these organizations embrace complementary and alternative treatments. These include, but are certainly not limited to, mindfulness, recreation, art and equine therapies.
And in most cases, these services are not meant to replace existing governmental services, but rather fill in the “gaps” believed to exist within current programs. These civilian programs are often found within local communities, and are funded almost exclusively by private citizens, foundations and corporations.
A variety of important benefits are associated with community-based, non-traditional, civilian programs. First, these programs have more flexibility with regard to exploring alternative treatment options as opposed to adhering to a relatively rigid menu of manualized treatments.
This thought is by no means an attempt to minimize the importance of evidence-based psychosocial and pharmacological interventions, but rather highlight the idea that many service members and veterans may prefer different treatment options for various reasons (Kearney & Simpson, 2015; Steenkamp, Litz, Hoge, Marmar, 2015).
Secondly, community-based programs can act as “laboratories” or pilot programs, which can be scaled up (or back) as required.
And lastly, the grassroots nature of these organizations affords greater opportunity for veterans and their family members, non-governmental affiliated clinicians and community leaders to bring unique perspectives and renewed passion into the topic of serving the mental health needs of veterans and their families.
However, limitations to this model do exist. As with many non-profit, community-based organizations, finding funding sources is often a challenge, particularly for those who are unfamiliar with the grant writing process. With little notice, even once thriving programs can decompose rapidly when funding streams disappear.
Also, and inextricably tied to the above-mentioned limitation, there is often a paucity of program evaluation and outcome research expertise that is crucial for making the case to the community and donors regarding program success.
In an age of tough economic times and skepticism about novel grassroots programs with little scientific support available, well-developed, executed and articulated outcomes are a necessity.
My purpose in this article is not to denigrate or criticize the military and VA healthcare systems. I believe that they provide much needed care to thousands of men and women each day. And the care provided is effective for and well-tolerated by many.
Unfortunately, a proportion of those who seek services receive do not get better. Or, as a result of the side effects of medications and trauma-focused talk therapies, many drop out of treatment.
That is why alternative treatments are needed. Non-traditional approaches to care have a place in the overall rehabilitation of the men and women who have served their country.
So next time you hear about a privately funded civilian program, take some time to try and understand if the services it provides are effective and needed. If so, support it through time, monetary and publicity donations.
Armstrong, N.J., McDonough, J.D., & Savage, D. (2015).Driving community impact: The case for local, evidence-based coordination in veteran and military services and the America Serves initiative. Syracuse, NY: Institute for Veterans and Military Families.
Hoge, C., Auchterlonie, J., &Milliken, C. (2006). Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. JAMA: Journal of the American Medical Association, 295(9), 1023- 1032.
Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. I., &Koffman, R. L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. The New England Journal of Medicine, 351(1), 13-22.
Hoge, C. W., Terhakopian, A., Castro, C. A., Messer,S. C., & Engel, C. C. (2007). Association of posttraumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq war veterans. American Journal of Psychiatry, 164,150–153.
Kearney, D. J. & Simpson, T. L. (2015). Broadening the approach to posttraumatic stress disorder and the consequences of trauma. JAMA: Journal of the American Medical Association, 314, 453-455.
Steenkamp, M. M, Litz, B. T, Hoge, C. W, &Marmar, C. R. (2015). Psychotherapy for military-related PTSD: A review of randomized clinical trials. JAMA: Journal of the American Medical Association, 314, 489-500.
Tanielian, T., &Jaycox, L. H. (Eds.). (2008). Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica, CA: RAND Corporation.
U.S. Government Accountability Office (GAO). (2014). Better understanding needed to enhance services to veterans readjusting to civilian life. Washington, DC: GAO.
*A version of this article is scheduled to be published in the newsletter The Military Psychologist authored by Drs. Bret Moore and Richard Tedeschi.