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Veterans and Mental Health: Supporting a Return to the Workforce

May 9, 2013 by YTI Web

Photo of Hannah Rudstam By Hannah Rudstam, Ph.D. Northeast ADA Center, Cornell University   The idea of mental illness conjures a wide range of meanings and images both within and outside of the veteran community. Some of these images are grounded in fact, but too often they are not. Because of the many fears and misperceptions surrounding mental illness, the tone of debate on this issue is often highly charged. While some see this issue at the forefront of veterans’ transition challenges, others actively try to distance themselves from it, perhaps fearing that drawing attention to this issue might stand in the way of the employment of returning veterans. Wading through the debate on mental illness among returning veterans, one point percolates up: Responding effectively to this issue is a pivotal part of avoiding the mistakes of the Vietnam era. Conversely, avoiding it will compromise our efforts to truly welcome returning veterans into family, work and community life. By acknowledging the critical role that employment plays in the return to civilian life, we must also begin to understand the opportunities and challenges that employers face as full partners in the reintegration process. Research findings about the prevalence of mental illness among returning veterans vary among studies. Some studies have indicated that PTSD rates may be as low as 4% or as high as 20%, while other research indicates that up to 38% of veterans returning from operations overseas have some form of depression [1]. Overall, the US Department of Veterans Affairs records show that mental health cases among returning veterans grew significantly during 2007, from 63,767 cases in 2006 to 100,580 in 2007 [2]. Despite the variation in these findings, it seems clear that recently-returning veterans are being diagnosed with mental illness at a higher rate than veterans from past engagements. There could be several reasons for this trend. Recent veterans have a greater awareness of mental illness and may be more likely to recognize and seek treatment for this disability than have previous cohorts of veterans. Similarly, efforts to improve screening and diagnosis for these types of conditions may be paying off, resulting in a greater percentage of returning veterans with mental illness diagnoses. Other possible reasons for this increase pertain to the nature of service and combat experienced by returning veterans. A hallmark of recent engagements is the stressful, unpredictable and dangerous nature of combat. With no clear location of the “enemy,” deadly attacks can come from anyone, anytime, anyplace—a situation that has been called a recipe for PTSD [3]. Finally, repeated deployments and fewer rest periods between deployments contribute to a higher incidence of mental illness among returning veterans. These and others studies show that many veterans will be coming to terms with a mental illness diagnosis as they are transitioning back to civilian life. What does this mean for our efforts to truly welcome returning veterans?  First and foremost, we need to be guided by fact, not fiction. Misperceptions and ungrounded fears swirl around the concept of mental illness: Unfounded fears of workplace violence, automatic assumptions of character weakness, the belief that people with mental illness will never recover, and the idea that people with mental illness cannot be productive in the workplace [4]. These misperceptions can drive the decisions of many different stakeholders, including potential employers. Employers who are aware of the facts, as opposed to the misperceptions, have the ability to influence positive employment outcomes and therefor the quality of life for those returning from deployment. Further, these myths give rise to a veil of shame that prevents some veterans from coming forward to seek treatment or to request an accommodation in the workplace—accommodations they could need to be effective in their jobs. A recent survey of returning veterans with disabilities[5] showed that:

  • 57% feared they would be discriminated against in hiring because of their disability.
  • 71% of veterans with a mental illness did not intend to disclose their disability to an employer.
  • 73% did not intend to ask for an accommodation for their disability during employment.

With the many studies of mental illness among returning veterans, there is no lack of research or information on this issue. Our challenge is not just in generating more knowledge, but in our willingness to apply and act upon this knowledge. Employers must become aware of the many unintended barriers to disclosing mental health issues that may exist; both within the culture of veterans, and in their own corporate cultures and practices. Despite significant research in this area, misperceptions continue to stand in the way of effective decision-making among employers, service providers and veterans themselves. References

[1] A 2008 RAND study found the rate of post-traumatic stress disorder (PTSD) among returning veterans to be about 20% (Tanielan & Jaycox, 2008). Other studies have found the rates of PTSD to be somewhat less. A critical review of the literature by Richardson, Frueh & Acierno (2010) revealed a 4% – 17% rate of PTSD among returning veterans. Studies on the rates of depression among returning veterans vary between 38% (Lapierre, Schwegler & LeBauve, 2007) and 5% (Kolkow et al., 2007). Richardson, L., Frueh, C. & Acierno, R. (2010). Prevalence Estimates of Combat-Related PTSD: A Critical Review. National Institutes of Health Public Access Manuscript. Accessed April 29, 2013 at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2891773. Lapierre, C. B., Schwegler, A. F. & LaBauve, B. J. (2007). Posttraumatic stress and depression symptoms in soldiers returning from combat operations in Iraq and Afghanistan. Journal of Traumatic Stress, 20 (6), 933–943. Kolkow, T. T., Spira, J. L., Morse, J. S. & Grieger, T. A. (2007). Post-traumatic stress disorder and depression in health care providers returning from deployment to Iraq and Afghanistan. Military Medicine, 172 (5), 451–455.
[2] National Alliance on Mental Illness (2010). Veterans Resource Center: Mental Illness and Veterans. Accessed April 29, 2013 at http://nami.org/template.cfm?section=Mental_Illnesses1.
[3] Tanielan, T. & Jaycox, L.(2008). Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica, CA: Rand Center for Military Health Policy. Accessed April 29, 2013 at  http://www.rand.org/pubs/monographs/MG720.html.
[4] Center for Reintegration (2011). Mental Illness and the Workplace. Boston, MA:  Boston University. Accessed April 29, 2013
[5] Rudstam, H., Wilson, J. & Gower, W. (2011). Beyond Goodwill:  Are Employers Prepared to Hire, Accommodate and Retain Returning Veterans with Disabilities? Paper presented at the National Council on Rehabilitation Education (NCRE) Annual Spring Conference, Los Angeles, CA.

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