Milwaukee VA Medical Center
Getting them in the door: Vets and mental health
Veterans can be a stubborn lot – and no more so than when it comes to their mental health.
Research has shown that Veterans are less likely to seek mental health treatment than the civilian population, even though 30% of Veterans develop mental health challenges within three or four months of returning home, according to Dr. Bert Berger, head of mental health services at the Milwaukee VA Medical Center.
Meanwhile, he noted that Veterans die by suicide at a rate of about 20 per day, and most Veterans who die by suicide are not connected to mental health services.
So why don’t Veterans seek help for their mental health needs? A panel of experts tackled that question – and proposed possible solutions – during a virtual discussion last month, which was Mental Health Awareness Month.
The discussion was hosted by Heroes for Healthcare, which helps connect Veterans with resources they need after their military service to continue to work in health care.
Much of Veterans’ reluctance to seek help stems from the military culture, panelists said.
“There are a lot of barriers for care for veterans,” said Dr. Greg Burek, a psychiatrist with Aurora Veterans Mental Health and a U.S. Marine Corps Veteran.
"We have a population that won't go in the door, and that's a problem. How do we get people to use the resources?" Dr. Erich Roush, Aurora psychologist
Among those is the perception that Veterans should just “suck it up” and keep going, he said, never appearing to be weak.
“So when we see Vets, they tend to be in more crisis than their civilian counterparts,” he said.
There’s also a general mistrust of government and institutions, especially among Veterans who feel they were mistreated by such institutions in the past, Burek said.
And there’s often a power dynamic at play; doctors and clinicians are sometimes viewed as higher-ups, which is a problem for Veterans who may have soured on being given orders.
So while a civilian may have implicit trust in a doctor, that’s not the case with Veterans.
“Trust is earned,” Burek said, noting that when a Veteran does meet with a health-care professional, there is still a “feeling out” process. “A lot of veterans have had bad experiences with clinicians before.”
In addition, there are daily commitments of work and family, which eat up everyone’s schedules.
It all adds up to Veterans waiting too long to seek help or not seeking help at all.
“We have a population who won’t go in the door – that’s a problem,” said Dr. Erich Roush, a psychologist with the Veteran Track Aurora Psychiatric Hospital and an officer in the U.S. Army Reserves. “How do we get the people to use the resources?”
Normalizing mental health
Despite strides in recent years, mental health is still stigmatized, especially by Veterans, the panelist agreed.
“We’ve come a long way in reducing the stigma of mental health, but we but we have a long way to go,” said Gina Bartoszewicz, clinical coordinator for the VA’s Veteran Outreach and Recovery Program. “I talk about mental health whenever I have the opportunity so we can normalize it.”
"Getting the word out to Veterans -- that's our focus. We're trying to change the culture (to show) that seeking help is OK."Dr. Bert Berger, Milwaukee VA chief of mental health services
“Getting the word out to Veterans – that’s our focus,” he said. “We’re trying to change the culture (to show) that seeking help is OK.”
To change the perception of mental health, Roush compares it to a soldier on a military base that is getting overrun: That soldier’s instinct is to reach out for help.
“Are you viewed as weak in that moment? No. You’re viewed as smart,” he said. “It’s important to know when to ask for help. That’s normal. That’s what you’re supposed to do.”
He said a soldier who charges up a hill in the face of machine gun fire is seen as courageous.
“In my view, courage is doing anything you’re afraid of,” he said. “If you are afraid to see a therapist, that requires courage. The road to recovery requires courage, asking for help and reframing these things that keep people from doing it.”
“Just reach out, and we’ll get you where you need to go,” Bartoszewicz said.
Knocking down barriers
To get Veterans the help they need, VA and other health-care providers are doing more to knock down the barriers Vets face.
VA provides urgent care for mental health, similar to urgent care clinics for physical injuries.
Berger said a Veteran experiencing a mental health crisis can walk into the VA hospital at any time and be seen.
“If a veteran comes to the VA, we have services to provide for them,” he said.
VA also works in partnership with various community and governmental groups that reach out to Veterans.
"We get them food, housing, health care -- whatever they need. We want to gain that rapport with them first, and hopefully proceed to mental health care." Gina Bartoszewicz, Veterans Outreach and Recovery Program coordinator
The Veteran Outreach and Recovery Program “meets Veterans where there are,” according to Bartoszewicz.
Whether a Veteran is living in a tent in the woods or living with his mother, Bartoszewicz said the goal is to provide basic needs first, and slowly progress from there.
“That could be bringing them food for a few weeks,” she said. “We get them food, housing, health care – whatever they need. We want to gain that rapport with them first, and hopefully proceed to mental health care.”
Aurora provides a specialized Veterans Track, with services tailored for current and former members of the military. It offers therapy, classes, support groups and specialized inpatient and outpatient programs.
When reaching out to Veterans, the experts agreed that Veterans sometimes grapple with their “military identity,” which means there is no one-size-fits-all approach to establishing trust and providing care.
“We all have many identities. … Some merge; some clash,” Roush said. “With each, there’s a certain amount of pride and shame,” and in the military, both are common.
"One of the hardest transitions is getting out. You don't feel like you fit in with civilians or other Vets. ... You feel isolated and alone.Dr. Greg Burek, Aurora psychiatrist
Burek noted that after leaving the military, Veterans sometimes struggle to assimilate into civilian life. They become alienated because they’ve lost the structure and sense of purpose the military provided.
“One of the hardest transitions is getting out,” he said. “You don’t feel like you fit in with civilians or other Vets. … You get stuck between identities … and you feel isolated and alone.
“Your unit is your family, so you lose a lot of your support structure when you get out. You feel like you’re cast off,” Burek said. “That’s a lot of our target population -- people who have served … but aren’t feeling connected to the Veteran community.”
Sometimes the best therapy for a Veteran is connecting him/her with other Veterans, be it through groups or one-on-one.
“That’s when the healing really starts: when one Vet connects to another,” Burek said. “Once you start to connect and re-engage with that Veteran identity, you feel you have that place where you belong, and people you can go to when you need to.”
Resources for Veterans
Milwaukee VA Medical Center: Basic health care eligibility and correct place to bring/email 10-10EZ form https://www.milwaukee.va.gov/patients/eligibility.asp
State of Wisconsin Department of Veterans Affairs Portal: Veteran Benefits, Veteran Outreach & Recovery, Health Care and Subsistence Aid, Veterans Homes: https://applications.dva.wisconsin.gov/myWisVets
Veterans Outreach and Recovery program flyer (VORP): https://dva.wi.gov/Documents/newsMediaDocuments/WDVA%20Toolkit/Brochures/VORP%20Brochure.pdf
Veteran Housing and Recovery program flyer (VHRP): https://dva.wi.gov/Documents/newsMediaDocuments/WDVA%20Toolkit/Brochures/WDVA_B0202_VHRP.pdf
U.S. Department of Veterans Affairs: Disability, pension, medical care, educational, housing/home loan, job training, Veteran Center counseling, memorials
To Apply for benefits: https://benefits.va.gov/BENEFITS/Applying.asp
VA Mental Health & Community Providers: https://www.mentalhealth.va.gov/communityproviders/index.asp
VA's newer transition program: https://benefits.va.gov/transition/solid-start.asp
Be There for Wisconsin Veterans: Resource pages: https://www.betherewis.com/veteran-resources/
Southeastern Central Wisconsin Task Force on Veteran Suicide Prevention:https://www.betherewis.com/home/about-the-veteran-suicide-prevention-task-force/
Center for Veterans Issues (CVI): https://www.cvivet.org/
Coaching into Care: www.mirecc.va.gov/coaching (888) 823-7458
County Veterans Service Officers of Wisconsin main page: www.wicvso.org/
County Veteran Service Officers of Wisconsin - Locate Your CVSO/TVSO: https://wicvso.org/locate-your-cvso/
Mental Health of America (MHA): https://mhanational.org/
Veterans Crisis Line: www.veteranscrisisline.net (800) 273-8255 (press 1)