SMI Adviser Offers Care Guide for Veterans With Serious Mental Illness

SMI Adviser, APA’s clinical support system for serious mental illness, has developed a new guide, “Critical Components for Understanding Veterans With Serious Mental Illness.”

“Given the demanding nature of military service and the early age at which many veterans begin their careers, there is a heightened vulnerability to serious mental illness (SMI), which includes major depression, schizophrenia, and bipolar disorder,” according to the guide. “These challenges are exacerbated by the unique stressors that veterans face, such as combat-related trauma, the complexities of multiple deployment tours, and the intricacies of transitioning from military to civilian life.”

SMI Adviser is funded by the Substance Abuse and Mental Health Services Administration and administered by APA. The guide was developed in collaboration with Jason Phillips, L.C.S.W., a therapist with extensive experience working with veterans and active duty military personnel. Phillips worked as a clinical director for an embedded behavioral health clinic at Fort Liberty (formerly Fort Bragg) from 2017 to 2021.

Phillips told Psychiatric News, “The guide will help mental health professionals, patients, and family members better understand what veterans with SMI are experiencing, how their mental illness may have progressed from early adulthood through later years in life, and how life experiences—including those in the military— may impact how veterans experience their illness and their care and treatment.

The guide notes that there is a significant need for specialized and culturally competent care for veterans, stating, “A tailored, trauma-informed approach that considers the military culture, the impact of service-related trauma, and the importance of camaraderie is essential to effectively care for veterans who have SMI.”

Included in the guide are the following components of care for veterans with SMI:

• Understanding symptom and treatment history: In the military, service members may not acknowledge experiencing symptoms of mental illness, often prioritizing the mission over their own needs. Consequently, service members frequently decline or delay care to avoid diverting time from their unit or jeopardizing their military careers.

• Understanding stressors and supports: After discharge from the military, veterans may encounter distinct challenges. This transition from active duty to civilian life involves a significant readjustment period, in which military rank no longer has the same importance or impact on daily life.

• Awareness of suicide rates and weapon expertise: Veterans exhibit higher suicide rates than their civilian counterparts and are more likely to die from self-inflicted firearm injuries, according to the 2022 National Veteran Suicide Prevention Report.

• Communicating with primary care team: Active duty takes a physical toll on the body. Collaborative care, involving primary care providers and mental health clinicians, employs a holistic approach by addressing mental illness symptoms and physical health concerns simultaneously.

• Recognizing stigma: Approximately 60% of military personnel who face mental health problems choose not to seek professional help because of associated stigma, according to a 2015 report in the journal Epidemiologic Reviews on stigma as a barrier to seeking care among military personnel.

• Considering treatment: Mental health professionals can support veterans in seeking care by fostering open communication and engaging veterans in shared decision-making.

• Strengthening self-care and coping strategies: Veterans may try to cope by using maladaptive strategies they have learned related to combat experience and avoiding certain experiences that are associated with heightened psychological distress and suicidal ideation.

• Recognizing spirituality: Veterans who are managing SMI often turn to religion and spirituality as sources of support, which are associated with improved health-related quality of life and reduced depression levels.

• Leveraging physical activity as coping: In response to mental health challenges after deployment, veterans often adopt exercise to address the impact of exposure to violence. These activities serve as effective coping mechanisms and contribute to enhanced cardiovascular health.

• Building resilience resources: Resilience plays a crucial role in enhancing the well-being of veterans who are managing SMI. Research consistently underscores its significance as a protective factor against the adverse effects of SMI, leading to improved relationship building, social skills, and overall quality of life.

Phillips noted that resilience, a trait that is often fostered in military training, is an asset that veterans may bring to their care. And he emphasized the crucial importance of encouraging veterans to advocate for themselves.

SMI Adviser offers free continuing education credit, expert consultations, and resources to help frontline clinicians and staff—including physicians, nurses, pharmacists, psychologists, social workers, counselors, and peer recovery specialists—provide evidence-based care to individuals with SMI. The latter include those living with schizophrenia, bipolar disorder, or major depressive disorder. ■