Helping Veterans and Families with Invisible Injuries: It’s Ok not to be OK

Spotlight: Home Base Program Team Members

Massachusetts General Hospital

Understanding & Addressing Barriers to Care

Accessing appropriate and timely care can affect the opportunities for Veterans and family members to cope, heal and thrive.

To better understand barriers to care and how to minimize them, we turned to the experts at the MGH Home Base Program. Home Base is on the forefront of caring for veterans and family members, providing nationwide clinician training, and developing treatment innovation. Their expert team for this news feature includes:

• Louis Chow, PhD – Senior Director, Home Base Training Institute & Network Development
• Bill Davidson – Senior Director, Outreach, Peer Support & Volunteers
• Kelly Field – Communications Director
• Lauren Richards-Donegan, PhD – Director of Education & Training

Help is more accessible when “red tape” is limited. Bill Davidson explains that Home Base works to eliminate “excuses for care,” by providing assistance, regardless of:

• Insurance coverage
• Discharge status
• Veteran or active military status
• Era of service
• Ability to access transportation
• Proximity to care

Stigma related to needing and seeking help

Dr. Richards-Donegan highlights that the worth placed on stoicism and competence, and devaluation of  weakness in the military contribute to stigmatizing beliefs about mental illness and treatment among Veterans. Home Base finds that beliefs related to self reliance are often reported among Veterans, such as concerns about being perceived as weak by others (family, friends, fellow Veterans and command), for having a mental illness, the perception that therapy is a sign of weakness,  and the belief that one should handle one’s own problems. These internalized values can be potent deterrents to seeking mental health treatment.

Reducing stigma

The team recommends the following:

• Create opportunities in which veterans can see themselves in their care team 
  Dr. Chow indicates that this is helpful for anyone in a group who may feel marginalized in care systems. Having veterans on the team can break through barriers, bolster the perception of being understood, and add an extra dimension of engagement.
• Provide specialized services for unique populations, such as women Veterans
  Female veterans have endured unique stigma, particularly centered around seeking care in VA settings, which have historically accommodated the male population.  Female Veterans have expressed concerns about fitting in, and lack of specialized services which have negatively impacted seeking treatment for mental health.  As a result, there has been a focus on the provision of specialized gender-specific mental health care, including the development of the Women’s Stress Disorder Treatment Team within the VA. Some resources are listed below:

– Women Veterans Call Center
– Mental health resources for women
– Gender match for providers

• Reframe the concept of seeking help: getting healthy is being strong
  Dr. Richards-Donegan describes this paradigm shift as an acknowledgment that tackling mental health challenges is probably one of the hardest things Veterans have ever done, so going through it is a sign of strength
• Employ education-based interventions to help veterans and families understand the value of seeking assistance
  – Use real life, relatable examples to demonstrate that needing help is OK and intervention can lead to a more fulfilling life
  – Highlight that professional help can be lifesaving and provide a set of tools for coping and thriving
  – Offer a clear explanation of care pathways and how to access them

Addressing system issues with accessing care

• Increase identification of the veteran population 
  Dr. Chow explains that we need to expand outreach to veterans and their family members

– Identify the communities where veterans are living and could benefit from care
– Resist the presumption that all veterans are being seen by the VA. This belief reduces the urgency and the incentive to increase outreach to service members in these communities
– At a basic level, screen for military service routinely and in a comprehensive way.  Instead of simply asking “Are you a Veteran”, ask “Have you or a family member ever served in the military”?

• Emphasize and be inclusive of family care 
  Focus on identifying those who serve, but also those who are military connected
  – Effects of service go beyond those in uniform
  – We need to establish thoughtful ways of engagement via education, availability of resources and normalizing experiences of those who are related to Veterans

• Increase access to providers
  – Expand the pool of veteran-knowledgeable providers. Veterans may be more comfortable with entering care with providers from their military community This is not always feasible or necessary. Having a provider who understands the unique challenges Veterans and families face can enhance the therapeutic relationship and encourage veterans to engage with care
  – Telehealth access (made more available during the Pandemic) has made a difference for those who cannot or prefer not to access in-person care
  – According to Bill Davidson, the above measures are particularly important in remote or rural areas.  As of Fall 2022, Home Base has trained over 70 clinicians across Massachusetts in evidenced based treatments

Understanding Confidentiality

Anyone considering mental health treatment may have concerns about confidentiality. This may impact willingness to seek care. This is definitely a relevant issue for Veterans and active military personnel.

• Veterans
  Mental health care for veterans is guided by the same HIPAA and privacy regulations as those for all civilians. Communications and information are typically kept confidential, except for instances of safety risk of the client or others, which mandate reporting by the clinician
• Active military
  The Home Base team indicates that confidentiality in mental health treatment for active military members is more complex. Things have evolved in recent years and many communications are protected by HIPAA. Information is typically not automatically disclosed and when there are reports outside the therapeutic relationship, the provider should discuss this with the service member. Essentially, privacy is determined on a case-by-case basis. Kelly Field points out that there may be individuals in certain roles who may fear job repercussions or stigma, but she stresses that it’s always worthwhile to engage in a conversation about connecting to care.