National Academies report: ‘Substantial unmet needs’ for veterans’ mental health care

Accessibility and quality of services vary across the U.S. Department of Veterans Affairs (VA) health system, leaving a substantial unmet need for mental health services among veterans of the recent wars in Afghanistan and Iraq. That’s according to a new congressionally mandated report from the National Academies of Sciences, Engineering and Medicine, co-authored by Colorado State University statistician Jay Breidt.

Jay Breidt, professor of statistics
Jay Breidt, professor of statistics

Breidt, professor in the Department of Statistics and a leading expert in design and analysis of complex surveys, served on the national panel that included experts in statistics, mental health, nursing, psychiatry and public health. Breidt and other panelists were charged with conducting a nationally representative survey of VA-eligible veterans of recent wars, both those who use VA services and those who do not.

The committee monitored all phases of the survey work, including the sample and questionnaire design, the data collection process, and the analyses of the data.

“When the analysis of the survey results came in, our role was oversight and interpretation of the results, and translating them for the clinicians and social scientists,” said Breidt, who has served on a total of five national academies panels.

The survey Breidt worked on found that approximately half of those veterans who may have a need for mental health care do not use VA or non-VA services, indicating that a large proportion of veterans do not receive any treatment for conditions such as post-traumatic stress disorder, substance use disorder, or depression. In addition, more than half of veterans who screened positive in the survey for having a mental health care need do not perceive a need for mental health services.

Approximately 4 million U.S. service members took part in the wars in Afghanistan and Iraq.  In Afghanistan, Operation Enduring Freedom (OEF) began on Oct. 7, 2001, and ended on Dec. 31, 2014. In Iraq, Operation Iraqi Freedom (OIF) began on March 20, 2003, and on Sept. 1, 2010, operations there continued under the name Operation New Dawn (OND). To help carry out its charge, the committee sought input on the use of VA mental health services directly from veterans of these wars, their families and caregivers, health care providers, and others at each of the Veterans Integrated Service Networks across the U.S.

Lack of awareness

A lack of awareness about how to connect with the VA for mental health care is pervasive among OEF/OIF/OND veterans, the report says. Among veterans who have a mental health care need and who have not sought VA mental health services, their main reasons for not doing so are that they do not know how to apply for VA mental health care benefits, they are unsure whether they are eligible, or they are unaware that VA offers these benefits.

Other barriers to seeking VA mental health care services, the committee found, include lack of transportation options to and convenience of medical facility locations; concerns about taking time off work and potentially harming their careers; and fears that discrimination could lead to a loss of contact with or custody of their children, or lead to a loss of medical or disability benefits.

Many veterans who are aware of these services say that the process of accessing VA mental health services is burdensome. However, a majority of OEF/OIF/OND veterans who use the VA report positive experiences with its mental health services, including the availability of services, privacy and confidentiality of medical records, the ease of using VA mental health care, and the staff’s skill, expertise, and courtesy toward patients.

Goal setting

The VA should set a goal of becoming a reliable provider of high-quality mental health care services throughout its system within three to five years, the report says. It should develop a comprehensive strategic plan that addresses ways to enhance and facilitate timely access to patient-centered care, hire and retain diverse, skilled staff, expand the use of virtual care technologies, and overcome facility and infrastructure barriers to access, such as lack of parking.

The VA should also take steps to ensure that its diverse patient population – including racial and ethnic minorities, women, LGBT, rural-dwelling, and homeless veterans – receives readily accessible, high-quality, integrated mental health care services, the report says. Demographic data show that the OEF/OIF/OND veteran population is more racially and ethnically diverse and has more women than other veteran cohorts. Women veterans who served in OEF/OIF have a higher need for mental health care compared with women veterans from previous conflicts, according to the report.

The study was sponsored by the U.S. Department of Veterans Affairs. The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.  For more information, visit

Veterans on campus, in the community

Find out about resources for veterans at CSU. 

Students and non-students can also find resources at the Larimer County Veterans’ Service Office.