History of Mental Health Access for Veterans

“In war, there are no unwounded soldiers” is a quote often attributed to Argentinian writer and aphorist José Narosky. It rings true; veterans put their lives on the line to protect others, often at great personal sacrifice. Mental health for veterans is a fundamental piece of overall veteran health care that must be understood and well-funded.

How has mental health care for veterans changed over time? Answering that question entails exploring the history of mental health access for veterans and how historical events, the arts and sciences, and public opinion have shaped current support systems for veterans in the United States.

Veteran Mental Health: By the Numbers

The rage, guilt, sorrow and pain of combat — and the sharp transition from military to civilian life — are well-documented and borne out in sobering statistics of veteran mental health.

According to the National Alliance on Mental Illness (NAMI), upward of 1 in 5 veterans experience post-traumatic stress disorder (PTSD) each year — compared with just 1 in 25 civilians who experience PTSD. Additionally, suicide rates of military service members and veterans reached an all-time high in 2020, with deaths by suicide increasing by 25% by the end of that year.

U.S. Census reports from 2020 estimated that there were around 18 million veterans and 2.1 million active-duty and reserve service members — not to mention the millions of family members affected by military service.

“The mental and physical burdens we carry is a lifelong cost,” said NAMI chief strategy officer Sherman Gillums Jr., a veteran himself, in a 2021 interview.

History of Veteran Mental Health: Veterans and PTSD

While not all current and former service members have experienced PTSD, the history of PTSD provides a lens for understanding how veteran mental health support has evolved over time.

Pre-WWI

Although PTSD became an official mental health diagnosis in 1980, trauma and the horrors of war have affected soldiers throughout history.

Homer’s Iliad depicts the warrior Achilles, who, upon learning about the death of his dear friend, despairs: “Nothing matters to me now / But killing and blood and men in agony.” William Shakespeare and Charles Dickens depicted the psychological aftermath of traumatic wartime experiences through theater (Henry IV) and literature (A Tale of Two Cities), respectively.

Texts like these illustrate the complex, painful reactions to war — the prolonged grief, guilt, anger, sadness, numbness and disorientation — that so many soldiers have faced without treatment and recovery.

WWI and WWII

During World War I, medical professionals described soldiers as experiencing “shell shock” and “war neuroses” from reactions to exploding artillery shells. Soldiers suffered sleep disruptions and other chronic symptoms and were often prescribed only a few days of rest before returning to battle.

Combat stress reaction (CSR) replaced the shell shock diagnosis in World War II, and treatment focused on developing and maintaining strong relationships among military units as both a preventive measure and a treatment. Yet some military leaders disbelieved “battle fatigue” (another name for CSR), which complicated veterans’ roads to recovery by adding undue shame and stress to psychological war wounds.

Emergence of the PTSD Diagnosis

The American Psychiatric Association (APA) produced a diagnosis of “gross stress reaction” in the first Diagnostic and Statistical Manual of Mental Disorders (DSM-I) published in 1952. According to the U.S. Department of Veteran Affairs, mental health experts refined this diagnosis over time, replacing it in the 1968 DSM-II with a trauma diagnosis exemplified by a fear linked to military combat.

It was only in 1980, in response to a decade of research on Vietnam War veterans, that the APA added PTSD to the DSM-III. This diagnosis was the first of its kind to directly connect the trauma of war with the challenges of thriving in post-military civilian life. The science of PTSD also drew from studies of Holocaust survivors and sexual trauma survivors. It has since become a widely recognizable phenomenon and a top priority for veteran mental health treatment.

Survivors of violent events (such as terror attacks, natural disasters, assault and war) are at risk of experiencing PTSD, but so are those who experience secondhand exposure by learning about threats or accidents experienced by a family member, close friend or fellow soldier. Symptoms interfere with a person’s ability to function and raise the risk of incurring additional trauma.

Mental Health Access for Veterans Today

The history of mental health access for veterans shows an evolving awareness of and ability to address mental health issues. What about mental health access for veterans today? Many resources offer treatment and support for veterans, and social workers can be instrumental in connecting veterans with these resources.

Veteran Mental Health Resources

Veterans struggling with mental health challenges, or who have a family member or friend experiencing mental health challenges, can take advantage of a variety of organizations specializing in veteran mental health.

• Crisis hotlines. In crisis situations, calling 911, the National Suicide Prevention Hotline at 1-800-273-TALK (8255) or the Domestic Violence National Hotline at 1-800-799-7233 can provide confidential assistance to veterans.
• U.S. Department of Veterans Affairs. The VA has many resources for veterans seeking support. In addition to resources for PTSD, substance misuse, suicide prevention, military sexual trauma, depression and a host of other common mental health challenges that veterans face, the VA also has specific resources for transitioning service members, women veterans, LGBTQ+ veterans and older veterans. The VA also offers telehealth services so that veterans can connect with support systems from home.
• Clinics and outreach programs. Beyond the VA, national programs such as the Soldiers Project, Give an Hour and Homecoming for Veterans provide free mental health services for veterans.
• Online communities. Certain websites can help veterans seek support from fellow veterans; PatientsLikeMe, Vets4Warriors and Mission Reconnect host websites where veterans can connect.

Fighting Stigma

Stigma around experiencing mental health issues and seeking support continues to affect veterans both in civilian life and within the military community. According to a 2019 article published in the Journal of Veterans Studies, although veteran services were “at an all-time high,” with a “staggering” number of veteran service and support organizations, veterans with PTSD still face challenges getting the mental health support they needed.

Even as depictions of veterans as “wounded warriors” who “suffer in silence” pervade pop culture and media, many veterans still struggle with the stigma surrounding mental health treatment and lack sufficient support. Veterans argue that it is especially important for military leaders to recognize and prioritize mental health in the military community. Part of that work involves actively combating the stigma of experiencing mental health issues in military and post-military contexts.

Support Veterans in a Social Work Career

Are you passionate about supporting mental health access for veterans? Learn more about Virginia Commonwealth University’s School of Social Work, the highest-ranking school of social work in Virginia.

In our online Master of Social Work format, students can gain the experience needed to become clinical practitioners through evidence-based and trauma-informed approaches to care. The program provides support for graduates to become licensed practitioners — all with the flexibility of online learning. Discover how to take the next step in your social work career at Virginia Commonwealth University.