Veteran and Refugee Mental Health Care: Support & Resources

What’s Happening

The American Psychiatric Association released a statement in support of veterans and refugees returning to the US as a result of the American evacuation from Afghanistan and the ending of the war. The association expressed concern about the mental health needs of veterans, people in the foreign service and their families, and refugees, and it called for support for these individuals through this traumatic event.

As APA President Vivian Pender, MD, said in a news release, “The needs of returning soldiers, Americans and allies stationed in Afghanistan, and Afghan refugees are liable to be profound. We know that the effects of trauma are long-lasting and take many forms. The APA wants to extend its knowledge and resources around trauma-based care, grounded in years of research, to assist all those coming from Afghanistan.”

The American Psychiatric Association recommends crisis hotlines for individuals, and for clinicians, the Stress & Trauma Toolkit for Treating Undocumented Immigrants in a Changing Political and Social Environment and this Immigrant and Refugee Mental Health video.

Why It Matters Now

This September is not only Suicide Prevention Month but also the 20th anniversary of the September 11th attacks on the US, which continues to have a mental health impact on families and members of the US armed services across the country.

The VA provides a page on ways to reach out and a report on substance abuse and suicide. Veterans are at increased risk for suicide relative to the general population due to factors such as higher rates of mental illness like PTSD and depression, according to research by Nichter et al, which notes that the suicide rate among veterans has risen 30% since 2010 and is at its highest point in US history. The Veterans Crisis Line experienced an increase of calls, texts, and chat messages in the past several weeks – more than this same timeframe last year (August through October tends to be the busiest time of the year.) VA officials attributed the increase to possible stress about the withdrawal from Afghanistan and the upcoming 20th anniversary of 9/11, but also said that it shows an encouraging sign that people are seeking help, according to a report by Military.com.

Resources & Perspectives

  • The VA issued a statement that explains how veterans may be feeling and reacting to the news about Afghanistan, and it recommends several resources for veterans in addition to the Veterans Crisis Line, including how to find local mental health care; finding community-based VA Vet Centers; and MaketheConnection which connects veterans, families and supporters with resources. The VA’s blog published a four-part series on how veterans can reconcile their service, PTSD, family support, and how veterans can learn from Vietnam veterans.
  • The American Psychological Association published an article focused on how psychologists can help refugees, which discusses understanding the context of immigration and approaching treatment in a trauma-informed way.
  • The Give An Hour organization offers free counseling to veterans and their families from providers who donate their services. An FAQ page for providers explains the details for getting involved.
  • If you have patients wondering how they can help, Today offers ways to support veterans and how to help US allies in Afghanistan through charitable organizations.
  • @WVNationalGuard (the West Virginia National Guard) tweeted, “Sept. 5-11, 2021, marks National Suicide Prevention Week, a part of National Suicide Awareness Month. This year’s theme – ‘Connect to Protect: Support is Within Reach’ – emphasizes connections with others & the community, along with suicide prevention resources.”
  • @Lexi_Lonas (reporter for The Hill) tweeted, “I got to speak with Afghanistan war veterans and veterans groups to discuss how the end of the Afghanistan war has impacted those who have served.”
  • @Sam_L_Shead (reporter for CNBC) tweeted, “Businesses are rushing to support the thousands of refugees that have been evacuated from Afghanistan in recent days and are now faced with the difficult task of building a new life in an unfamiliar country.”
  • @8NEWS (WRIC Richmond) tweeted a story about a licensed counselor offering pro bono emotional support services, “Virginia man’s family stuck in Afghanistan, offers free mental health services to Afghan community.”

In Practice

Opioid Use Disorder: Telemedicine Unit Meets Rural Treatment Needs

What’s Happening

To help expand care for opioid use disorder (OUD), a telemedicine mobile treatment unit (TM-MTU) used in rural areas of Maryland demonstrated not only feasibility, but the outcomes of retention and opioid use were similar to those found in office-based TM medications opioid use disorder (MOUD) programs. The study, led by Weintraub et al, utilized a modified recreational vehicle staffed by a peer recovery specialist, a substance use counselor, and a nurse; a doctor saw patients remotely and could prescribe buprenorphine if needed. On average, visits to the TM-MTU were 6.5 miles and 10 minutes closer for patients than the nearest brick-and-mortar treatment facility. Figure 1 of the published paper shows photos of the TM-MTU.

For more about the TM-MTU, see our interview with Dr. Weintraub in this week’s Psy-Q below.

Why It’s Complicated

The team had previously set up an office-based TM MOUD program in the same rural area of Maryland but transportation to the brick-and-mortar facility remained a problem for patients. The current study cites an example of one participant using a tractor to reach the treatment facility. The idea for the TM-MTU arose due to the “persistent issue” of transportation as a barrier to accessing care in this population, the authors wrote.

Reports & Perspectives

  • Previous studies by Dr. Weintraub’s team in Maryland include a retrospective chart review of a TM MOUD program from 2021 and from 2018, a look at lessons learned during the COVID-19 pandemic, and a literature review of patient satisfaction of TM MOUD treatment.
  • A feasibility study phase of a National Drug Abuse Treatment Clinical Trials Network Trial evaluated TM MOUD in rural areas.
  • In a viewpoint article from the Journal of General Internal Medicine, Mubeen Shakir MD, MPP, MSc, and Sarah Wakeman MD, discuss the benefits of TM for substance use disorder but warn of the potential that a shift to TM care may “exacerbate disparities already driven by racism and poverty.”
  • A study by Hughes et al looked at patterns of MOUD utilization before and during the COVID-19 pandemic in rural North Carolina and the effects of policy changes that increased treatment access.
  • Reports from the Philly Inquirer and WHYY discuss how the pandemic allowed for relaxed MOUD prescribing rules for methadone and buprenorphine, respectively.
  • @KellyCoble13 (Kelly Coble, co-author on the Weintraub et al TM-MTU study), tweeted, “Extremely proud to be part of this work, increased access to #MOUD is more critical than ever…”
  • @preventionpp (Prevention Point Philadelphia, a nonprofit public health organization) quoted the WHYY article on prescribing: “‘Buprenorphine is being extended to nurse practitioners, physicians assistants & nurse midwives…This will increase access in rural communities where there are not a lot of physicians available’—M Holliday Davis, STEP Co-Coordinator.”
  • @AZPhysician (Arizona Physician Magazine) tweeted, “The #guidelines for prescribing #Buprenorphine have been updated recently. @MICA_Insurance’s Jeanne Varner Powell, JD shares how that affects physicians in rural medicine.”

In Practice

Psy-Q Challenge

How can mobile telemedicine unit improve opioid use disorder treatment? Eric Weintraub, MD, answers.

Get the Answer

NAMI: Barriers to Mood Disorder Care Remain–Even After COVID Shift

What’s Happening

A survey from the National Alliance on Mental Illness (NAMI) found that the costs of and access to quality treatments, as well as stigma, are barriers for people seeking treatment for mood disorders. The survey, conducted by The Harris Poll, took place online between April and May 2021 and included three groups of American adults: those diagnosed with a mood disorder (n=2,093), caregivers to someone with a mood disorder (n=507), and those with no mood disorder experience (n=1,589).

Among people with mood disorders:

  • 52% said that cost prevents them from trying a treatment that they are interested in starting. In addition, 61% of those without insurance reported stopping a treatment because they could no longer afford it.
  • Reasons for not receiving desired supportive services were being unsure of eligibility (48%), cost (41%) and being unsure about how to access the service (39%).
  • 61% reported that people treated them differently after learning of their diagnosis, and 76% felt misunderstood by those around them.
  • However, 73% agreed that when they told others about their mood disorder, they were interested and supportive.

Concerning stigma and perceptions of mood disorders:

  • 86% of the general public knows mood disorders can significantly interfere with thoughts, behavior, activity, and physical health, and 70% agreed that treatment can be slow and not always work, but it can be beneficial for many people.
  • The survey also found that 37% of US adults agreed that they feel fearful of being around people with mood disorder, and 27% said that those with mood disorders could “snap out of it” if they tried.

Why It’s Noteworthy

The NAMI survey took place during the second year of the COVID-19 pandemic, and 52% said they have been more open about their mental health with others since it began. However, 30% of people said they aren’t getting the mental health help that they need during the pandemic. The survey also found that white adults are more likely than people of color to have coped well during the pandemic.

Reports & Perspectives

  • NPR’s report on the survey explores the difficulties of accessing and affording care experienced by people with mood disorders.
  • NAMI posted on its website an interview with Chief Medical Officer Ken Duckworth, MD, and Cheddar News where he discusses the survey and how to support better mental health.
  • Arkansas’s TV11 (KTHV) interviewed Dr. Duckworth about the survey’s findings.
  • @NAMIMaryland tweeted, “@NAMICommunicate’s findings from their latest #mooddisorder survey proves there is more work to be done to destigmatize #mentalhealth!”
  • @THV11 tweeted, “According to Dr. Ken Duckworth with NAMI, one of the silver linings of the survey is seeing telehealth working well for people.”
  • @NAMIAdvocacy (the policy and advocacy arm of @NAMICommunicate) tweeted, “‘The survey also found an increased openness in discussing mental health, which is a positive step, but more needs to be done to increase access to care.’ – NAMI Chief Medical Officer Ken Duckworth, M.D.”

In Practice

Last Updated: Sep 9, 2021