Service Comes with High Cost


Our nation’s veterans make great sacrifices to ensure our freedoms, often serving in combat and doing so diligently and bravely. Military service is not without its consequences, among them are issues with mental wellbeing.

According to a 2014 study*, nearly 1 in 4 active duty members showed signs of a mental health condition. “We lose about 23 veterans to suicide each day,” said Chris Epperson, chair of the Arkansas chapter of the American Foundation for Suicide Prevention (AFSP).

The AFSP has identified a number of factors associated with suicide. They include stressful life events, such as job loss or unemployment, depression and substance abuse. Statistically, the unemployment rate for veterans outpaces that of civilians, and veterans often return with serious mental health issues, such as post-traumatic stress disorder (PTSD), alcohol dependence syndrome and substance abuse disorder, according to the American Psychological Association (APA).

According to the National Alliance on Mental Illness, the three primary mental health concerns military personnel experience are PTSD, traumatic brain injury and depression.

The stigma associated with mental illness often plays a role in veterans’ hesitancy to seek professional help. The APA found service members fear “embarrassment, disappointing their comrades, losing the opportunity for career advancement, and dishonorable discharge as motivations to hide mental illness from their family, friends and colleagues.”

Nicole Hart, founder and CEO of ARVets, has personally dealt with two of the most prominent mental health issues facing veterans: PTSD and traumatic brain injury. A veteran of Operation Iraqi Freedom, she said veterans’ attempt to deal with issues themselves is due to a mindset. “The military teaches resiliency. So many times, military personnel internalize their problems versus seeking help. We are taught to focus on the mission, accomplish it and move on to the next mission.”

This mindset is carried in their everyday lives. In civilian life, she said, the mission is to go to work, get the kids to school and take care of the family, and while the overall message from the higher level has been to help military personnel understand that if you’re having trouble you should get help, that message isn’t always embraced on the command level.

“Everything about the military centers around strength, and soldiers are seen as warriors and heroes; vulnerability is not part of that image,” Hart said. “So any issues that someone may be facing are pushed to the background, often for so long that when problems do come to light the ramifications have long-term effects.”

She said the message must change. “I’ve been in combat. I dealt with PTSD and traumatic brain injury, and I’m strong in spite of that. We must address mental health issues from a place of knowledge and power, and take care of our battle buddies, our families and ourselves. Everybody in your circle needs you to take care of yourself, completely.” 

According to Statistics from the APA:

  • Veterans are “more likely to be unemployed than their civilian counterparts.”
  • Of the 1.7 million veterans who served in Iraq and Afghanistan, 20 percent suffer from PTSD or major depression. And nearly 13,000 have alcohol dependence syndrome.
  • More than 7 percent of all veterans meet criteria for a substance abuse disorder.
  • Fifteen percent of Iraq soldiers suffered concussions or traumatic brain injuries, and they were significantly more likely to be diagnosed with PTSD three months after returning home than soldiers without brain injuries.
  • Female veterans are more likely to suffer from mental health issues as 1 in 5 have PTSD related to “military sexual trauma,” which includes everything from sexual harassment to rape.
*Source: National Alliance on Mental Illness.

Preparing for a Mental Health Crisis

If you are an adult who lives with the challenges of a mental illness, you may want to consider a psychiatric advance directive, better known as a “PAD.” A PAD is a legal document that specifies an individual’s instructions for mental health treatment during a psychiatric emergency or crisis.

According to the Arkansas Department of Human Services Division of Behavioral Health Services, in Arkansas you must name a person, an agent, to express those instructions for you. You can use a durable power of attorney to name the agent and include the PAD in that document. The PAD “acts as your voice, allowing you to provide information such as treatment, medications and more.”

For more information, log on to and search for “psychiatric advance directive.” There you’ll find a pamphlet that provides details as well as a sample PAD.