More help for service members

Since 2002, the APA-initiated Graduate Psychology Education (GPE) program has awarded grants to APA-accredited doctoral, postdoctoral and internship programs to work with other health professionals to provide mental and behavioral health services to underserved populations. The program, which has a mandate to serve children, older adults, chronically ill people and victims of abuse and trauma in underserved communities, is the only federal program solely dedicated to the education and training of psychologists.

Now, APA’s Education Directorate is encouraging GPE grantees to include services to meet the needs of another critical population: service members, veterans and their families.

The need for services among this group is tremendous. According to 2009 Department of Defense (DoD) data, almost 2 million U.S. service members have been deployed since the 9/11 attacks. Department of Veterans Affairs (VA) data estimate that more than 868,000 service members who served in the wars in Iraq and Afghanistan have left active duty. This recent influx of veterans, along with the anticipated return of additional service members in the coming years, will undoubtedly increase the need for services to assist with reintegration and recovery from the wounds of war.

Although the DoD and VA are working diligently to reach returning service members and veterans, many do not receive the mental and behavioral health care they need. Military families are also in need of more mental health resources. DoD estimates that almost 10 million family members of military personnel, including spouses and children, may have a direct connection to someone who has gone to war. Especially vulnerable are those service members, veterans and their families who are returning to or living in rural communities, many of whom are reservists or members of the National Guard. These communities often have fewer health-care resources for military personnel, veterans and families. In August, the GPE program awarded 19 new grants, for a total funding level of $3 million. In an effort to combat deficiencies in mental and behavioral health services, APA’s Education Government Relations Office has advocated for an increase to $7 million from Congress for fiscal year 2011 to fund 45 programs that will provide mental and behavioral health services to underserved people, including veterans and their families. The GPE program provides grants to accredited doctoral, internship and postdoctoral residency programs for interdisciplinary training. GPE psychology trainees under supervision in integrated settings such as community health centers can be helpful in assessing, diagnosing and treating mental and behavioral health problems that are experienced by some military veterans, including but not limited to depression, anxiety, post-traumatic stress disorder, traumatic brain injury, alcohol and substance abuse and interpersonal violence.

The breadth of mental health problems that affect the families of service members and veterans is significant, with specific problems including deployment-related stressors such as parental separation, and family reunification and reintegration. "These sorts of stressors put strains on families," says Rolando Diaz, PhD, a psychologist who primarily treats returning service members and their families in Northern Virginia. According to Diaz, many military children and families have difficulty coping with the fear that their parent or spouse may not come home. Readjustment challenges often persist once a service member has returned home from deployment. Diaz explains that there is a growing need for services for couples who are experiencing a difficult transition following long and often repeated separations.

These familial stressors are thought to be a contributing factor for the steady rise in the military divorce rate since 2005. Unfortunately, these family challenges can often continue once a service member has left the military. According to the VA’s National Center for PTSD, families of veterans with PTSD experience more marriage or relationship problems, parenting problems and family violence. In addition, these family stressors may lead to behavioral problems in children.

Some military children are at greater risk of mental and behavioral health problems, according to Ernestine Briggs-King, PhD, a psychologist affiliated with Duke University Medical Center and the Substance Abuse and Mental Health Services Administration-funded National Child Traumatic Stress Network. Those most at risk are young children; children with preexisting health and mental health problems; children whose parents have had multiple deployments in a short time span; children who do not live close to military communities (e.g., National Guard or Reserve) or reside in places with limited resources; children in single-parent families with the parent deployed; and children in dual-military parent families with one or both parents deployed.

"With the right tools, services and supports, military parents can help to buffer distress and promote resilience in their children," says Briggs-King. While much governmental and community attention continues to focus on care for service members, veterans and their families, more work remains ahead to ensure that they receive the services that they need and deserve, say experts.

"Long-term, long-range and complicated mental health issues will affect military families as a whole if we do not support them in a way better than we are doing," says psychologist Barbara Van Dahlen, PhD, founder and president of Give an Hour, the nonprofit organization started in 2005 to address the mental health needs of service members and their families. Psychologists, with their extensive training, have a very specific value to offer in support of veterans and their families’ mental health needs. They are uniquely trained and have the ability to help communities identify these issues, put them in context and respond to them. A program such as GPE, which focuses on preparing health service psychologists to provide needed mental and behavioral health services to underserved populations, such as veterans and their families, is essential, she says.

Whitney Warrick, JD, is legislative and federal affairs associate in the Office of Education Government Relations in APA’s Education Directorate.