Stigma keeps veterans away from services, N.H. study says

The health needs of veterans in New Hampshire are going unmet, according to a recent report by a legislative commission on PTSD and Traumatic Brain Injury, or TBI.

The 23-member panel issued a report in January that cited stigma as the main hindrance to treatment in a state with the fifth highest per capita population of veterans.

“Veterans, of course, do seek health services from non-veteran providers with general success. However, the greater challenge comes when the injuries are invisible, and the struggles deeply personal,” reads the report. “The challenge of stigma with regard to disorders of mental health and TBI are not unique to veterans, but the trauma of combat, war, and the experience of military culture is exclusive to a small fraction of the population.”

The committee, created by law, has been meeting once per month since the fall of 2011. During that time, the committee surveyed 1,170 veterans (38 percent Vietnam veterans, 35 percent post 9/11 veterans, 8 percent Desert Storm veterans, and 9 percent veterans from other conflicts) in New Hampshire.

The survey revealed that:

• 30 percent of veterans said they were not getting the help they need because they were embarrassed or ashamed of their need for services;

• 16 percent of veterans said they were not getting the help they need because they did not feel understood by the providers who served them;

• A significant number of veterans said they were not getting the help they need because of not knowing where to get help; feeling that there was nothing available to help them; being only willing to speak with another veteran; or believing that no one wants to help them;

• A significant number of veterans identified inadequate coordination of transportation between facilities and slow claims processing as barriers in accessing care at the VA Medical Centers.

“One of the most important things that came out is the number one barrier among veterans across all the eras is embarrassment, shame, stigma…There is a disconnect between veterans and providers,” says Nicole Sawyer, Psy. D., a psychologist with the New Hampshire Psychological Association and a member of the committee.

The committee also surveyed members of the New Hampshire Psychological Association, finding that 94 percent of private practitioners surveyed were interested in learning how to better serve veterans.

The report says that while it’s common to think that all veterans receive care through the Veteran Administration (VA) facilities, many are not eligible or do not seek treatment there. Sawyer says a new generation of veterans seeks care elsewhere. Those who responded to the survey “highlighted several concerns with the Veterans Administration, including limited services…and complications in accessing services.” The state is also the only one without a full service VA medical facility, meaning it does not have inpatient care beds, according to the report.

“Navigating a complicated VA system is only part of the problem for veterans in New Hampshire. A multitude of community services, civilian providers and healthcare entities are accessible and available for veterans. However, navigating these systems can be equally challenging,” according to the report.

Sawyer says many community practitioners do not ask about military service. “Not all veterans identify as veterans…If no one is asking, we may be missing out on a considerable amount of needs, particularly TBI or PTSD.”

She encourages practitioners to start asking, “Have you served?” a question often left off of intake forms around the state, according to the report. “Recognize that veterans and veteran family members are probably already in your practice,” Sawyer says. “Knowing can make a tremendous difference in care.”

The committee is gearing up to offer education and training to providers and most of it will be free, Sawyer says.