Page 11 Complete Your CE Test Online - Click Here Reasons veterans do not seek help for mental health problems Despite the impact of mental health problems, many veterans do not seek help for mental health problems. Considering the sobering statistics pertaining to the impact of stressors experienced by veterans as well as the consequences of such stress (e.g. mental illness, homelessness) it is critical that the healthcare community facilitate appropriate screening and treatment for veterans. Even if services are available, healthcare professionals must ask themselves, “Why don’t veterans seek the help they need?” Nursing Consideration: Compounding the problem of mental illness in veterans is that they sometimes have specific reasons for not seeking help. Nurses and other health care professionals must not only be aware of such reasons, but remain objective as they work to get veterans the help needed. Reasons some veterans give for not seeking help for mental health problems include (U.S. Department of Veterans Affairs, 2015a): ● ● Concern that they will be seen as weak. ● ● Concerns about side effects of treatment. ● ● Concerns that other people will lose confidence in them. ● ● Concerns about privacy. ● ● Fear of being treated differently. ● ● Prefer to rely on family members and friends. ● ● Do not believe that treatment is effective. ● ● Problems with access to treatment such as the cost of treatment or the location where it is available. Mental illness can be cyclical in nature. It is not generally something that has a definitive ending like strep throat, for example. The sore throat is treated with appropriate antibiotics and the problem is resolved. Mental illnesses such as PTSD and depression can be treated but may be ongoing or have symptoms that wax and wane. Additionally, there is still a stigma about mental illness in some facets of the public, especially in the military. Veterans may also be reluctant to seek help for mental health problems for fear of discrimination, loss of job, or fear that a diagnosis or treatment may compromise interpersonal relationships (Jackson, 2013; Jordan, 2018; U.S. Department of Veterans Affairs, 2015a). There are also aspects of military culture that can interfere with a veteran’s ability to seek help for mental health issues. Veterans may believe that they must be strong and cope with all manner of stress since they had dealt with life-threatening conditions for considerable periods of time. They may also believe that, having seen comrades killed or wounded, they should consider themselves fortunate to be alive and not allow themselves to feel frightened, helpless, or unable to cope with life upon returning home. Veterans who have sustained injury have additional physical problems that may coexist with mental health issues (Jackson, 2013; Jordan, 2018; U.S. Department of Veterans Affairs, 2015a). In summary, metal health problems such as PTSD and depression can lead to substance abuse, loss of income, damaged interpersonal relationships, homelessness, and the development of other disorders, as well as suicide. Nurses (and the entire health care community) must be able to effectively screen for mental health disorders among veterans, facilitate effective treatment for this population, and emotionally support veterans’ loved ones, friends, and colleagues as they, too, work to help veterans achieve and maintain mental and physical health. EBP alert! Research shows that a number of factors may interfere with a veteran’s willingness to seek help for mental health problems (U.S. Department of Veterans Affairs, 2015a). It is critical that nurses are able to identify these factors in order to help veterans obtain the mental health services that they need. PTSD: Screening and treatment PTSD is defined as “characteristic psychological consequences that persist for at least one month after a traumatic event (Durkin, 2013).” Psychologists classify PTSD as an anxiety disorder that can occur after almost any traumatic event including natural (e.g., tornado, blizzard) or man-made disasters (e.g., mugging, terrorist attack), serious accident or physical injury, combat, physical or sexual abuse, assault, or rape (American Psychiatric Association, 2017) PTSD causes feelings of intense fear, helplessness, and loss of control. The disorder can be acute, chronic, or delayed (Durkin, 2013). Nursing consideration: PTSD is more severe and more persistent when the event precipitating the disorder is of human design such as rape, assault, and combat situations (Durkin, 2013). About half of those who initially experience PTSD recover within relatively short periods of time with or without treatment. However, about one-third of people who have initial symptoms of PTSD continue to have persistent symptoms (, 2015a;, 2015b). Symptoms of PTSD usually start soon after the initial traumatic event. However, sometimes symptoms do not appear for months or even years after the event (, 2015a). Nursing consideration: Nurses must remember that PTSD symptoms may not appear until years after the traumatic event. Therefore, they should be alert to signs and symptoms during the assessment process, even if considerable time has gone by since the veteran experienced traumatic events. Statistics related to veterans and PTSD According to recent studies on the incidence and treatment of PTSD in the military, Army and Marine veterans are those most likely to have PTSD. However, exposure to combat trauma is the best predictor of PTSD. High rates of PTSD were also found in service members who were no longer on active duty, including members of the Reserves and retired military (, 2015b). PTSD statistics have been described as “moving targets.” When researching the effects of this disorder, investigators must try to determine at what point data should be gathered. Should veterans be assessed within one year of return from battle? Within five years? Some veterans may go undiagnosed for as long as 30 years. Should they be included in current research studies (, 2015a)? Should all incidences of PTSD be studied or should they be studied only if they cause specific effects such as interfering with return to combat situations, holding a post-military job, or maintaining important interpersonal relationships (, 2015a)? There are no simple answers to these kinds of questions. Generally agreed facts are that PTSD is a significant problem among veterans, is diagnosed at widely varying points in the veterans’ lives, and can cause chronic difficulties for veterans and their families (Veteransandptsd. com, 2015a;, 2015b). Veterans’ PTSD statistics are continually revised. For example, the findings from the National Vietnam Veterans’ Readjustment Study (NVVRS) commissioned by the U.S. government in the 1980s first found that for “Vietnam theater veterans,” 15% of men had PTSD at the time of the study, and 30% of men had PTSD at some point in their lives. However, a 2003 reanalysis of the data found that “contrary to the initial analysis of the NVVRS data, a large majority of Vietnam veterans struggled with chronic PTSD symptoms, with 4 out of 5 reporting recent symptoms when interviewed 20 to 25 years after Vietnam (, 2015a).” A summary of veterans’ statistics for those who served in Iraq and Afghanistan included (, 2015a): ● ● According to a RAND corporation study, at least 20% of veterans had PTSD and/or depression. Some military counselors believe that this percentage is much higher and that it increases with traumatic brain injury (TBI). ○ ○ 19.5 % of veterans that met criteria for a PTSD and/or depression diagnosis reported experiencing a TBI.