Veterans and Active Duty

Nearly 1 in 4 active duty members showed signs of a mental health condition, according to a 2014 study in JAMA Psychiatry. On this page we focus on questions that military personnel often ask, concerning treatment resources, disclosure and staying healthy during the transition to civilian life. If you are having thoughts of suicide, the Veterans Crisis Line is available 24/7 by dialing 1-800-273-8255 and pressing 1.

Mental Health Concerns

There are three primary mental health concerns that you may encounter serving in the military.

• Postraumtic Stress Disorder (PTSD). Traumatic events, such as military combat, assault, disasters or sexual assault can have long-lasting negative effects such as trouble sleeping, anger, nightmares, being jumpy and alcohol and drug abuse. When these troubles don’t go away, it could be PTSD. The 2014 JAMA Psychiatry study found the rate of PTSD to be 15 times higher than civilians.
• Depression. More than just experiencing sadness, depression doesn’t mean you are weak, nor is it something that you can simply “just get over.” Depression interferes with daily life and normal functioning and may require treatment. The 2014 JAMA Psychiatry study found the rate of depression to be five times higher than civilians.
• Traumatic Brain Injury (TBI). A traumatic brain injury is usually the result of significant blow to the head or body. Symptoms can include headaches, fatigue or drowsiness, memory problems and mood changes and mood swings.
  In the Mental Health Conditions section of our site we discuss these conditions and others and how to recognize the symptoms of mental illness in yourself or someone else.

Who Should I Tell?

Service men and women owe it to their fellow service members to stay in good mental as well as physical health. If you’re concerned about a possible mental health condition—or if you enter the armed forces with a past or present mental health condition—know that the armed forces do not require service members to disclose mental health problems to their chain of command. The responsibility for deciding whether to disclose your condition does fall on the medical officers and care providers you consult. They receive training on military policies concerning the confidentiality of protected health information (PHI). Here are some people to consider speaking with.

• Confidential counselors are available for service members and their families through Military One Source at 1-800-342-9647. If you’re unsure whether to seek treatment or if you someone you know might need treatment, they are an excellent first stop for information and advice.
• Primary care providers can be helpful for discussing concerns and treatment options.
• Behavioral health care providers working at primary care clinics are available on many military bases so you can seek a specialist’s advice without leaving base. And at some bases, you can find convenient Embedded Behavioral Health teams—clinics separate from traditional medical facilities.
  If you, a colleague or a family member are experiencing an immediate crisis—particularly if it’s a life-threatening mental health crisis—you should proceed immediately to a military or civilian emergency room for acute care or call 911.

How Will Asking For Mental Health Treatment Affect My Career?

Military personnel have always taken care of their physical health, but in today’s armed forces, mental health is equally essential to mission success. The military has changed many of its policies in recent years to encourage better mental health. The Department of Defense acknowledges that untreated mental health conditions pose a greater safety threat than mental health conditions for which you’re seeking treatment.

Under 2014 rules, talking to a doctor about your concerns, asking if you need a diagnosis, or seeking treatment does not affect your career. If your doctor needs to disclose your condition, your career is not at risk from this disclosure.

In addition, with changes to security clearance procedures, you no longer risk losing clearance by consulting a doctor. If you seek help for combat-related issues or receive marital counseling, you do not have to worry about “question 21” regarding treatment for mental or emotional conditions.

The Dangers Of Not Disclosing

Untreated mental illness can, however, damage your career. If the symptoms are severe, your commanding officer may require duty limitations or recommend separation from the military for medical reasons.

Military records show that talking to a doctor is a good career move. According to a 2006 study in Military Medicine, 97% of personnel who sought mental health treatment did not experience any negative career impact. The same study showed that it’s risky to ignore a mental health condition. If it worsens, a commanding officer can require a mental health evaluation, which is much more damaging to your career. Among people who had command-directed evaluations, 39% had negative career impact.

Military Policy And Your Privacy

When you seek mental health care, your care provider will inform you that the Department of Defense follows the privacy guidelines set down by HIPAA and the Privacy Act. These guidelines ensure the privacy of your mental health records in most situations. If your care provider discovers that your mental health condition may endanger yourself, others or the mission, however, they are obligated to disclose this information to the chain of command.

Military policy states that care providers can only share certain information and only in those situations involving safety. The precise definition of those circumstances is different for each of the branches of the armed forces.

In the Army, for example, PHI policy states that information can only be released in situations involving an acute threat of harm to self, others or mission; upon admission or discharge from inpatient hospitalization; when entering formal substance abuse treatment; and when enrolling in personnel reliability programs.

If a medical officer or military care provider observes that your health condition poses a danger, the officer will share your medical profile with commanding officers. The information they are allowed to share includes your diagnosis and the medically recommended duty limitations. Unit commanders will decide what duties to assign you until your condition improves.

You can avoid situations requiring disclosure by discussing your concerns with providers when they first arise. Ignoring symptoms may allow them to worsen. A mental health condition may affect only you at first, but if your condition doesn’t improve, your ability to perform your duties may suffer.

If commanders or supervisors observe behaviors that appear to compromise safety or job performance, they can request a command-directed behavioral health evaluation. A command-directed evaluation doesn’t guarantee as much confidentiality as a medical consultation you seek yourself.

How Can I Help A Fellow Warrior?

Strengthening our fighting forces is a group effort. If you’re concerned about a friend or colleague, the most important thing you can do is to ask how they’re doing and to listen without judgment. The symptoms of a mental health condition can sometimes make individuals forget that mission success relies on staying healthy in mind as well as body. They might not realize that their worries are symptoms of mental illness. Listen patiently, offer encouragement and remind them that anyone can develop these symptoms, from privates to generals.

Remind your fellow warrior that the central mission of the armed forces is to maintain a strong fighting force. Share the information here with him or her. Emphasize that talking to a counselor or medical officer won’t hurt career or security clearance, and that every service member has a duty to build resilience by seeking advice and treatment when it’s indicated.

If someone you know tells you about a mental health concern, don’t laugh it off or promise it will get better on its own, even if you want to comfort the person. The stresses of deployment and military life put soldiers at risk for mental illness and make treating them more complicated. The military medical system can’t succeed in its mission to “restore the fighting force” without the help of all personnel to encourage treating mental health conditions swiftly before they can worsen.

For more advice, recommend that your friend call the completely confidential counselors at Military One Source (1-800-342-9647).

Making A Strong Transition To Civilian Life

Returning to civilian life can be a time of joy, but also a time of emotional upheaval. Your experiences in the service may have changed the way you look at life. You may have new abilities, new friendships or new concerns.

If you were in combat or similarly stressful situations, it’s possible some of the habits that helped you stay strong during traumatic events will be less useful in civilian life. Keeping strong in civilian life might require developing new habits. You may also be at increased risk of PTSD and other symptoms that your brain is recovering from trauma.

Some veterans find they miss the structure that the military life provides. Some miss feeling a sense of purpose in their daily work. Others may feel isolated because civilians don’t understand the experience of serving. The memories of your experiences also may take time to deal with.

Remember that readjusting takes time. Give yourself opportunities to maintain your physical and mental health during the transition. At NAMI, we understand the questions facing many service members when they return to civilian life. We’re here to help. Check out your local NAMI Affiliate to see if it offers a support program for returning vets.

Maintaining A Strong Body And Mind

Here are some important tips and suggestions for maintaining a strong body and mind:

• Reach out to other veterans or veterans’ groups. It’s much easier to make the transition when you’re not alone. Social support from non-veterans helps as well. Locate a spiritual or religious advisor you enjoy talking to, or a mental health professional.
• Talk to family and friends about your experiences. Even if they don’t fully understand what you’re going through, it helps them to understand why you may have trouble interacting at times.
• Recognize that others might not understand your military service or your views. If you talk about your experiences and get a negative response, let it go.
• Prepare ahead of time for insensitive questions or topics of conversation. You don’t need to tell anyone about your experiences unless you want to. Practice how to respond or respectfully decline to answer.
• Search the web for information on mental health and transitioning. Identify strategies ahead of time to support your transition. Real Warriors and After Deployment are great sites for all soldiers, whether they be active duty, National Guard or Reserve, or veterans and their families. The information and tools there can help with everything from budgeting and work to insomnia, PTSD and depression.
• Take care of your body and your mind by proactively finding veteran-friendly health services in your area. You can obtain information on local services through My HealtheVet, the VA’s online personal health record. This site for veterans, active duty service members, and their families provides access to health records, a personal health journal, online VA prescription refill information and details regarding federal and VA benefits and resources.
• Take your time reconnecting with family and friends. When you were serving, your role in the family was “distant service member.” Now you and your family are developing a new role for you. Since time has passed, your new role might not be identical to your role before serving. You and your family will adjust and be stronger than before, but don’t expect the adjustments to happen immediately.
• Try to be patient with your civilian coworkers and the civilian work schedule. At times you may feel frustrated that employees in civilian life leave when the work day officially ends, regardless of whether the “mission” for the day is complete. They may appear less committed than you’re used to, and less interested in team work. You may also find that you and your civilian coworkers have different modes of speech at the office. Military jargon is a complex language and you might feel like you’re having to translate yourself into “civilian English.”
• Recognize that you will feel frustrated sometimes while returning to civilian life, but frustration is normal during this transition. In fact, frustration is a sign that you’re adjusting and growing stronger.
• If you find yourself growing more frustrated or isolated over time, talk to a health professional about whether mental health care can help you increase your resilience. The Department of Defense sponsors coaching and support at In Transition (1-800-424-7877). Medical professionals can help you come out of this transition stronger than before.
  
  The important thing to remember is that you’re not alone. There are many people who want to support you. You can start preparing now, by looking at the VA’s list of common challenges and solutions, or the MilitaryOneSource database of websites offering assistance with the transition to civilian life.