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What are the biggest problems facing veterans returning home from conflict?

The majority readjust to life off the battlefield with few difficulties. But a significant number—44% who’ve served in Iraq and Afghanistan, according to one survey—say they’ve had problems readjusting after their return.

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What kinds of problems do they face after their return?

Some of the most significant are health related. A considerable number of veterans who served in Iraq and Afghanistan have suffered traumatic brain injuries (TBIs), with about one in five experiencing a mild form of TBI commonly known as a concussion. Other common problems include posttraumatic stress disorder, depression, anxiety, problematic alcohol use, and thoughts of suicide. Many veterans suffer from more than one health condition.

In addition, many women and men experienced sexual trauma, including harassment and assaults, while in the military. That can have both mental and physical effects.

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Three military service members share their stories of what it’s like returning home.

Are veterans getting the help they need?

In many ways, the Veterans Health Administration (VHA), which provides health care to a great number of veterans, offers care that is as good as or better than that provided by private or non-VHA public practices. But the accessibility and quality of services vary across the system. Several studies have shown, for example, that a large number of veterans don’t receive any treatment following diagnoses of posttraumatic stress disorder, substance use disorder, or depression. Many veterans don’t know how to apply for veterans’ mental health care benefits, are unsure if they are eligible, or are unaware that mental health care benefits are available.

Are there other barriers to getting good care?

Yes. Veterans have reported other barriers to seeking VHA health care services, including:

  • difficulty getting to medical facilities because of their inconvenient location or a lack of transportation;
  • concerns about taking time off work and potentially harming their careers; and
  • fear that discrimination (due to the stigma around mental health issues) could lead to a loss of contact with or custody of their children or to a loss of medical or disability benefits.

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Specifically, what services do veterans need?

They need a full spectrum of health care services—including prevention, diagnostics, treatment, rehabilitation, education, counseling, and community support—to deal with a wide-ranging set of physical and medical issues.

These services need to be focused on the problems specific to veterans. In some cases, that means increasing the number of health care providers offering a particular service. For example, many veterans don’t have access to mental health care professionals, so increasing the number of clinicians with expertise in this area could be helpful. In other cases, focusing specifically on veterans’ needs means providing more effective treatments, which may require new research to accomplish. For instance, improved treatments for posttraumatic stress disorder, depression, and substance use disorders need to be developed.

How can we make sure veterans get good health care?

There are a number of ways, including:

  • Continuing education for health care professionals and periodic evaluations of their treatment methods to help ensure that patients are receiving high-quality, evidence-based services. If clinicians don’t provide care based on scientific evidence, patients may receive poor quality care.
  • A so-called “interoperable” electronic health record (one that makes it possible for different systems to exchange information) used by all health care providers.
  • Greater communication and coordination among the dozens of public and private programs that serve veterans and their families.

What about problems apart from health-related issues?

In addition to health problems, some returning service members have other difficulties—such as economic or social challenges—readjusting to civilian life. For example, at times the unemployment rate for veterans who served after September 11, 2001, has been almost twice the rate for non-veterans who are about the same age. But overall, there is a lack of data and research to assess the economic, social, and health impacts of deployment on military service members and their families, which makes it difficult to know exactly their needs.

Several federal departments and agencies collect data on the physical, psychological, social, and economic challenges facing veterans, but no database combines demographic and deployment data with health outcomes, treatment, access to care, or employment before and after deployment. If these data were linked and integrated, many key questions about the reintegration of veterans into civilian life could be answered.

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How many U.S. veterans are there?

There are more than 18 million veterans, per the 2017 American Community Survey from the U.S. Census Bureau. About half of those veterans are enrolled in the U.S. Department of Veterans Affairs health care program.

How do recent veterans differ from veterans of previous conflicts?

The troops engaged in Iraq and Afghanistan have included more women, parents of young children, and reserve and National Guard troops than in previous conflicts. Troops have been younger, more diverse, and have had a wider range of family backgrounds. They often served longer deployments with shorter intervals at home between missions.

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What’s the impact of those differences?

The greater diversity of recent troops has created new kinds of needs among veterans. For example, women veterans who served in Iraq and Afghanistan have a higher need for mental health care compared with women who served in other wars, likely due to the differences in the types of roles they had in the military. They are also more likely than male veterans to believe that they are not entitled to or eligible for veterans’ mental health services. Similarly, tailoring treatment to racial, ethnic, sexual minority, and homeless groups has been a challenge.

What’s the view down the road?

The depth and breadth of challenges faced by veterans varies and are the result of a complex interaction of many factors. Previous wars have demonstrated that veterans’ needs peak several decades after their war service. VHA needs to be ready to deliver the services veterans and their families will need in the years ahead.

Take a Deep Dive

To learn more about this important topic, see Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families and Evaluation of the Department of Veterans Affairs Mental Health Services.

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