From deployment transitions and caregiver stress to post-traumatic stress disorder (PTSD) and moral injury, military members, veterans, and their families face unique challenges with respect to mental and emotional health, individually and within the family unit.
In the following sections, we:
Military personnel and families live among a unique culture that shapes their experiences, expectations, behaviors, values, norms, traditions, and identities. This can have an impact on their mental health care, especially when a provider does not have a strong understanding of military culture and the opportunities and challenges associated with living in a military family. When firsthand experience is lacking, thorough knowledge of military culture can help a civilian provider deliver culturally competent care to veterans, active service members, and their families.
Professionals providing mental health care for veterans and service members should be aware of the potential impact of military culture and experiences on treatment (both potentially positive and negative). For instance:
Growing awareness surrounding mental health care for service members, veterans, and their families is developing more culturally competent providers as well as increasingly effective approaches to military, veteran, and military family counseling.
One strategy for accommodating and leveraging the positive qualities of military culture is developing a strength-based practice that emphasizes the client's inherent strengths, resiliency, and available resources — as opposed to focusing on their problems and challenges. Through a strength-based lens, the client's self-reliance and community become major assets, making them an expert in their own care. The client collaborates with their mental health provider, taking an active role in designing their own treatment goals and solutions, while empowering them to mobilize their communities, families, environments, and available resources.
Depending on the individual's status, military mental health screenings and assessments will vary. Active duty members (particularly those getting ready for or returning from deployment or preparing for separation from the military) undergo routine mental health assessments that entail self-report questionnaires, follow-up questionnaires, and in-person interviews to assess mental health risks and identify the need for care referrals.
Mental health professionals rely on validated screening and assessment tools during intake, such as those for assessing depression, PTSD, and suicide risk. In addition, professionals should provide veteran-specific assessments and questionnaires designed to gain an understanding of specific military experiences and post-service triggers, along with stressors that are influencing mental health and quality of life.
Based on the findings in intake screenings, assessments, and conversations with patients, mental health providers can work with their clients to design a strength-based treatment approach that relies on evidence-based treatment modalities.
Upon separation from the military, veterans may face several challenges during the transition to civilian life that could lead to or exacerbate existing mental health issues.
Difficulties veterans commonly face as they transition from military to civilian life include:
Many veterans face these challenges while suffering from service-related physical health complications, alongside mental health issues such as anxiety, depression, PTSD, traumatic brain injury (TBI), and moral injury.
Service members have access to a variety of resources during their outprocessing and transition. Mental health counselors can work to connect veterans with practical resources for support with challenges related to education, employment, housing, healthcare, and community. Examples of resources include:
A relatively new construct in mental health, moral injury often afflicts veterans and service members. While more research is needed surrounding moral injury and its treatment, mental health professionals should understand its impact and be prepared to offer theoretically sound, evidence-based guidance.
Many misconceptions exist around moral injury. To better understand what moral injury is, health professionals must understand what it is not. Moral injury is not PTSD or a symptom of a mental health disorder.
Moral injury is a mental health condition characterized by a wound to the conscience or psychological harm that can result from:
Moral injury can increase the risk of PTSD and lead to symptoms such as:
Effective care approaches address moral injury, in addition to other mental health symptoms and diagnosed mental health disorders, using a combined treatment approach encompassing psychotherapy, medication, and participation in support groups.
As much as military life impacts service members and veterans, it also impacts their families and caregivers. This makes veteran family support integral to the well-being of the service member and their family unit.
Caregivers are more likely to suffer stress and be at risk of burning out when a veteran suffers from conditions such as PTSD or TBI and service-related injuries or illnesses or has had combat exposure. Additional factors to consider include general burdens such as financial strain, isolation or a lack of support, and the intensity of the required caregiving.
Professional counseling benefits caregivers, helping address and mitigate their stress. Also, strategies offered by the VA's Resources for Enhancing All Caregivers' Health (REACH) — such as skills training, support groups, peer mentoring, and self-care guidance — are designed to support caregivers and reduce stress.
To support the entire military family unit, mental health professionals must consider children of service members and veterans who face unique challenges due to parental deployments, frequent moves, and other factors that lead to instability. These challenges can impact development and manifest as PTSD, academic challenges, social difficulties, and sleep disturbances.
Deployment causes parental separation and is one of the most significant stressors for military children — leading to anxiety, sadness, or even attachment issues. Reintegration can impact children by disrupting a new routine and causing stress when they notice any negative impacts of deployment on the parent.
The Department of War School Liaison Program is designed to connect families with local resources within their schools and communities. These resources provide specialized support for children during transitions and other difficult periods (like parental deployments).
Several evidence-based treatments and therapies have been shown to help with military-related mental health issues for both individuals and families.
Trauma-informed care for veterans and their families is key to providing culturally competent care. Some evidence-based treatment modalities include:
Veterans and service members often suffer from co-occurring conditions, with a combination of issues such as:
The Department of Veterans Affairs (VA) and community organizations offer several resources for service members and veterans.
Mental health providers should be aware of VA resources and how clients can access them through various VA access points. In addition to the Veterans Crisis Line (988), resources include online access, physical VA offices, telehealth through ATLAS, and women veterans services through the Center for Women Veterans (CWV).
Beyond the VA, tens of thousands of nonprofit organizations exist to support service members, veterans, and their families. Additionally, social workers with experience working with veterans and service members are uniquely positioned for roles in advocacy to influence policy change on a macro scale.
Depending on whether a client is an active duty service member or a veteran, their care coordination and benefits processes will differ. Either way, they require special consideration to ensure access to full benefits and care.
Every veteran and service member's benefits and eligibility can differ (especially depending on whether they are active duty, in transition, or fully outprocessed). Therefore, mental health providers must coordinate with their clients and clients' benefits managers to ensure optimal access to care.
Veterans and service members benefit from a collaborative, interprofessional approach to care when an entire team of mental and physical health providers coordinates to offer holistic care and treatment.
While some veterans have access to travel vouchers for care, physical VA offices do not exist everywhere, making telehealth a necessity for many veterans. Unfortunately, not all veterans have access to the resources that make telehealth possible. However, these individuals can access telehealth through community hubs, mobile clinics, and asynchronous tools (such as secure messaging or psychoeducation).
Considerations for veterans that can affect their access to telehealth resources include:
As with all mental health services, ethics, cultural humility, and compliant documentation are vital to care for veterans and service members.
Establishing a professional, compliant, and ethical practice that maintains health boundaries between the client and provider improves care and helps build trust.
The need for evidence-based assessment tools is crucial for objectively charting and documenting a patient's care as well as for patient records and access to benefits.
The military provides several tools for improving resiliency and implementing mental health care. This includes deployment assessments, reintegration assessments, and separation assessments — in addition to tools designed for managing mood, strengthening relationships, setting and accomplishing goals, and improving mission readiness.
A variety of tools, guides, and checklists are available on Military OneSource. These are designed to meet a wide range of needs of service members, veterans, and their families.
PTSD is primarily fear-based, entailing re-experiencing and hyperarousal. Moral injury centers on guilt, shame, or betrayal after value violations. They can co-occur and often require complementary treatments (such as cognitive process therapy, prolonged exposure, and values/meaning work).
Schedule short, predictable breaks, and teach brief stress tools (such as CBT-I, sleep hygiene, and 4-7-8 breathing). Connect to the VA Caregiver Support Program or community respite services.
For acute risk, contact 911 with veteran designation when it is safe to do so; for immediate support, call the Veterans Crisis Line at 988 and then press 1. Activate local crisis teams and create a same-week follow-up plan.
Use a military occupation specialty (MOS) translator to convert tasks to civilian competencies, build STAR (situation, task, action, and result) stories with metrics, and connect with VA vocational rehab state workforce centers and veteran-friendly employers.
Ask permission, use client language, and coordinate (with consent) with chaplains and faith leaders for moral injury or grief. Avoid expressing personal opinions, keeping interventions client-directed.
Leverage telehealth at community hubs, mobile clinics, travel vouchers, and asynchronous tools like secure messaging. Coordinate with VA travel benefits or local nonprofits.
Cognitive process therapy (CPT) and prolonged exposure (PE) have strong evidence. Eye movement desensitization and reprocessing (EMDR) and acceptance and commitment therapy (ACT) show benefits as well. Pair with sleep hygiene, pain management, and substance use disorder (SUD) treatments when indicated, and integrate families and couples work.
Becoming equipped to provide mental health counseling and guidance to service members, veterans, and their families begins with a strong foundation in behavioral sciences. At Indiana Wesleyan University, we offer a wide variety of undergraduate and graduate degrees in this field, including a Bachelor of Science in Social Work and hybrid or advanced programs to earn a Master of Social Work.
To begin your educational journey in behavioral sciences, social work, and psychology, request more information or apply to IWU today.
