By Mehul Mankad, MD
I was 17 years old when Coalition Forces crossed from Saudi Arabia into Kuwait to liberate the country from an occupying Iraqi force in 1991. I was a senior in high school who had applied to some fancy colleges and was anxiously awaiting responses. Although I felt a pull to serve, I did not answer the call as my mind was set on becoming a doctor. A decade later, working as a physician in the final months of my training, I watched from a hospital television as the twin towers fell. I did not answer the call then either.
When the opportunity arose in 2003 to join the Veterans Administration as a staff psychiatrist, I saw this as a chance to fulfill my obligation to serve those who have served our nation. At the time, the Veterans Administration had relatively meager mental health services. Those who were disabled from combat were given highest priority. The remainder of Veterans were accommodated as much as possible within the given resources. Realizing this approach had failed prior generations of deserving Veterans, the United States steadily grew mental health and medical services to all eligible Veterans. When I left the VA 15 years later, the VA’s mental health budget had more than tripled in size compared to the year I began. But is it enough?
The United States has about 19 million Veterans. About 6 million Veterans are served within the VA, indicating that most receive their care outside the VA system. Some may be fortunate to possess other benefits such as commercial health coverage or Medicare. Yet there are those who fall through the cracks of these other plans. Over 50,000 American Veterans ended their military service in the past decade with an other-than-honorable (OTH) discharge. These individuals served an average of three years in the military before being separated. One in six has been deployed in combat. Referred to as “bad paper” in military circles, Veterans with other-than-honorable discharges are ineligible for standard VA benefits. There are loopholes that allow some OTH Veterans to receive some VA services, but those loopholes have their limits. Studies show that this population has more mental health diagnoses, more homelessness, and higher suicide rates than the already high rates seen among eligible Veterans.
State health systems serve as the safety net for this population, and North Carolina is no exception. For those who qualify for Medicaid, they can receive an array of services through that program. The situation is more limited for those who do not qualify for Medicaid as state funding is restricted for that population. Solutions are further complicated by the preference of many of these Veterans to live in rural parts of our state where a shortage of qualified mental health providers already exists.
We should carefully consider the plight of those who began their military service with the best of intentions but were unable to complete their service commitment. These women and men put on the uniform, often served for years, and may have put their lives in harm’s way for our protection. Expansion of Medicaid benefits to cover more North Carolinians, targeted state funds for OTH Veterans, or further changes to Veteran eligibility at the VA would honor the sacrifice that those citizens made for our benefit.
[Dr. Mankad is the Chief Medical Officer for Alliance Health and an Adjunct Assistant Professor, Duke Department of Psychiatry and Behavioral Sciences]