Mental Health in the U.S. Military: Where Are We Now?

How is mental health typically perceived and treated within the military — and what progress has been made?

To answer these questions and more, Psych Central spoke with retired Air Force Capt. Craig Bryan, PsyD, ABPP, a clinical psychologist, professor, and director of the Division of Recovery and Resilience in the Department of Psychiatry at Ohio State University College of Medicine.

He says mental health care and access may vary across branches in the military depending on factors such as ranking and culture. But there are some commonalities as well.

Here are some of the most common shared experiences across the five branches of the military.

Stigma and perception

One of the most commonly reported reasons for poor mental health in the military may be attributed to stigma.

According to a 2015 study, about 60% of military personnel with mental health concerns don’t seek help. And research from 2021 shows a similar trend, noting that U.S. veterans who seek mental health care are a minority.

The stigma around mental health care may cause some active duty service members to worry about how they’ll be perceived if they ask for help. They might think that others see them as “weak” or “unfit” for duty.

It’s possible this mentality could continue even into retirement.

Barriers to treatment

A 2015 study suggests that most deployed soldiers with mental health disorders are not in treatment. The authors note that addressing barriers to treatment could help build outreach efforts, ultimately saving lives.

Here, Bryan addresses the following barriers to mental health care in the military:

Lack of access

According to Bryan, the availability of professional mental health care may vary by region and protocol.

For instance, larger military bases may have more professionals but also have greater demand due to a greater number of service members. And when there’s a high demand for mental health services but a lack of professionals to offer care, longer wait times for treatment and reduced continuity of care can often result.

“In some areas, the demand for mental health services exceeds the supply of mental health professionals by so much that appointments can only be scheduled once every few weeks,” Byran says.

Lack of access or care may also result in ineffective treatments, raising the risk for suicide or self-harm.

“Medications are not as effective as suicide-focused psychotherapies, like brief cognitive behavioral therapy for suicide prevention (BCBT), which typically requires appointments scheduled once per week,” Bryan says.

If a mental health clinic can meet with a service member only once every few weeks, medication may be prescribed to accommodate scheduling constraints, Bryan adds.

Too many resources

According to Bryan, there are often too many mental health resources for veterans and active duty service members.

“That’s actually one of the key problems for this community — there are so many resources available that it can be overwhelming,” he says. “Further complicating the issue is that there’s no quality assurance method available to help military personnel and veterans tease apart legitimate from questionable resources.”

Fear of consequences

“One of the unique issues about mental health issues in the military is the fear of negative consequences from reporting these problems and seeking out mental health treatment,” Bryan says.

Some fears include:

• restriction of job duties
• loss of special duty status
• medical separation from the military

Bryan adds that these are issues that civilians don’t typically have to worry about.

Yet, in recent years, the Department of Defense (DoD) has been encouraging military service members to seek mental health treatment.

Policies and procedures from 2013 set forth by the DoD aim to help reduce the stigma associated with service members who seek and receive mental health services.

“The use of mental health services is considered, whenever possible, to be comparable to the use of other medical and health services,” the DoD rules state.

In addition, the American Psychological Association cites a 2006 study, which found that 97% of personnel seeking mental health treatment didn’t experience any negative career impacts.

Not disclosing health concerns can lead to severe mental health issues. Veterans and people on active duty experience unique physical and mental health challenges.

Mental and physical health conditions

Service members are more prone to living with particular mental health conditions, including but not limited to:

• post-traumatic stress disorder (PTSD)
• substance use disorder (SUD)
• alcohol use disorder (AUD)
• depression
• suicidality

For those on active duty, a 2014 study suggests that three or more deployments positively correlate to mental health disorders, especially:

• major depressive disorder (MDD)
• bipolar disorder
• generalized anxiety disorder
• PTSD
• intermittent explosive disorder

The same study notes that those with PTSD and MDD also experience an increased risk of:

• death from homicide, injury, and cardiovascular disease
• medical illness
• smoking and substance misuse
• decreased employment and work productivity
• marital and family dysfunction
• homelessness

Physical health conditions, such as chronic pain or traumatic brain injury (TBI), can adversely impact mental health as well.

“PTSD and TBI are more common among service members than civilians and are considered ‘signature injuries’ of military service,” Bryan says.

Suicide

Proper physical and mental health support is essential for suicide prevention for veterans and current service members.

When it comes to high suicide rates in the U.S. military, myriad risk factors and protective measures have been identified.

Research from 2021 shows that common risk factors include:

• stressors (e.g., physical pain, leadership conflicts, transferring duty stations)
• comorbid mental health conditions
• combat exposure
• access to lethal weapons
• being a young man (ages 17 to 19)
• being a woman veteran
• veterans who served in the Marines and Army

The same research suggests that protective factors include:

• a sense of duty to others
• belonging or identity
• strong interpersonal bonds
• access to healthcare

“Part of the reason why we’re not better at preventing suicide is that we erroneously view it as a mental health problem within individuals,” Bryan explains. “Social, organizational, and environmental factors also play a major role — possibly even a bigger role than mental health factors.”

According to Bryan, addressing environmental and organizational factors that degrade a person’s quality of life is needed to improve the health and well-being of service members.

He adds that limiting or reducing access to firearms and other lethal methods for suicide attempts could have a pronounced impact on suicide prevention as well.

Many mental health resources are available for active service members, veterans, and military families. In addition, speaking with a therapist, primary care doctor, or behavioral healthcare professional can help, too.

Resources for active service members

For currently serving military personnel, Bryan recommends the following resources:

• Department of Defense (DoD) mental health professionals
• Military Family Life Consultants (MFLCs)
• Military OneSource: 1-800-342-9647

Other resources include:

• Military Crisis Line: 1-800-273-TALK
• PTSD Coach App
• National Resource Directory (NRD)
• Moving Forward
• TRICARE®
• Connected Warriors
• National Suicide Prevention Lifeline: 800-273-8255

Resources for veterans

For veterans, Bryan says the best resource is the U.S. Veterans Affairs Department (VA). But not all veterans are eligible to receive mental health treatment from the VA.

For that reason, resources outside the DoD and VA are included below.

• U.S. Veteran Crisis Line (1-800-273-8255)
• Unhoused veterans: 877-4AID VET (1-877-424-3838)
• Text 838255 or visit VeteransCrisisLine.net
• Cohen Veterans Network
• Suicide and Trauma Reduction Initiative for Veterans (STRIVE)
• In Transition (1-800-424-7877)
• Wounded Warrior Project
• U.S. Department of Veterans Affairs Mental Health Resources
• National Suicide Prevention Lifeline for Veterans
• Wounded Warrior Project
• Stop Soldier Suicide

Resources for military families

• Tragedy Assistance Program for Survivors (TAPS)
• Project Sanctuary Family Support
• The Psychological Health Center of Excellence (PHCoE)

Those who serve their country fight battles both on and off the battlefield.

Progress has been made in military mental health care, but there’s still work to be done to help reduce the number of veterans who die by suicide.

And more progress is coming, according to Jackie Speier, chairwoman of the House Armed Services Subcommittee on Personnel who has jurisdiction over Department of Defense (DoD) policies and programs related to military healthcare.

“We must challenge ourselves and change what we are doing because it’s not working. We need to evaluate the effectiveness of the various programs across the department and make bold changes,” Speir said at the Subcommittee on Military Personnel Hearing in March 2022.

“We need to react to this reality by preventing, detecting, and treating suicide risk from the moment an individual enters the military and throughout their career.”

In the same hearing, Bonnie Carroll, president and founder of TAPS, called for the following changes:

• Mandate leadership training on suicide prevention and mental health awareness.
• Hold those accountable who stigmatize, haze, isolate, bully, or punish.
• Destigmatize help-seeking behaviors.
• Break down barriers to treatment.
• Normalize and improve access to mental health services.

Support is available if you or someone you know has served in the military and is experiencing mental health difficulties. Reaching out for help may be difficult, but it can be lifesaving.