Veteran Health Care: Ongoing Issues for Diverse Groups

Traditionally, the Veterans Health Administration (VHA) has faced many debates and questions concerning the health care treatment of new identity groups within Veterans. Becoming a national problem, the rise of more diverse groups within the United States has made it difficult for these groups of Veterans to receive equal and sufficient health care treatment as the VHA has struggled to adjust quickly. Of these groups, the most prevalent ones for concern are women, LGBTQ+, and those with mental illnesses, as they often have specific needs not included in primary general care. With the Veteran population being 7.5% of residents in Scioto County according to the U.S. Census Bureau, this is a significant issue that consistently needs to be addressed. Locally, the Chillicothe VA Medical Center has created a variety of programs and services that seek to fulfill the needs of these distinguished groups. With an even closer Portsmouth Clinic, health care for Veterans is a concern for all and even for college students who have the ability to make an impactful change with the foundation of progress already made. 

In the United States, women make up about 10% of the Veteran population. Research shows that women Veterans experience multiple vulnerabilities that need special attention toward. For women using VHA benefits, they are three-and-a-half-times more likely to have active post-traumatic stress disorder and five-and-a-half-times more likely to experience depression than women not under Veteran health care. When considering pregnancy, these factors cause a high amount of complications, including “a higher rate of pre-eclampsia and gestational diabetes compared to the expected rate” which “can be life-threatening for both mother and child,” says a Disabled American Veterans report. Women Veterans also experience higher rates of mental illness than the general population, with 33% experiencing some form of mental illness and 8% having suicidal thoughts. Furthermore, one out of every five women Veterans report having experienced sexual assault or harrassment while in military, greatly affecting their mental and physical states. The combination of this variety of issues creates a strong need for specialized programs and services catered toward the needs of women.

For many decades now, women have been fighting for improved treatment, with just one of these groups being Veterans. Created through the U.S. Department of Veterans Affairs in 1988, the Women Veterans Health Care Program was made to “streamline services for women Veterans in order to provide more cost-effective medical and psychosocial care,” as stated on the program’s webpage.  Provided through the program is the typical primary care (health evaluations and counseling) which includes gender-specific primary care as well. These care services include cervical and breast cancer screens, preconception counseling, maternity healthcare, and menopausal support.  Furthermore, primary care for mental illnesses is provided along with treatment or counseling for any physical or mental issues related to any sexual trauma experienced. Detailed by the Chillicothe VA Medical Center, they offer all said services and even have special “Well-Being Programs” which are explained as “proactive, integrative health approaches.” The Well-Being Programs vary from health coaching to mindfulness to peer support. Offering these catered programs and services, there is also a Community-Based Outpatient Clinic (CBOC) located in New Boston as a branch from Chillicothe. 

Not only do women Veterans experience these differentiating issues and gender-based concerns, but those who identify as LGBTQ+ have also encountered problems with equitable access to health care. According to the VHA, research shows that there are an “estimated 1 million lesbian, gay, and bisexual Veterans in the United States” and “transgender identity is about five times more common among Veterans than non-Veterans.” Despite forming a large portion of the Veteran population, these Veterans often face discrimination and injustice. Dealing with the impacts of this, lesbian, gay, or bisexual veterans are two times as likely to have an alcohol use disorder and are five times as likely to develop post-traumatic stress disorder as their straight counterparts. Furthermore, according to the United States Department of Veterans Affairs, transgender Veterans “have significantly higher rates of serious mental illness, suicidal ideation, PTSD, and major depression than non-identifying Transgender Veterans.” Of these, the most significant comparisons is of serious mental illnesses (53% for transgender Veterans versus 29% for non-transgender Veterans), though all statistics display major differences. 

Over the years, the VHA has implemented several policies concerning the treatment and care of LGBTQ+ Veterans, committing themselves to providing fair and quality services. While most of the programs and policies are straightforward and are based around not discriminating any patients for their identity, there are some policies directed toward specific services for transgender Veterans. The VHA Directive 1341: Providing Health Care for Transgender and Intersex Veterans policy details the medical services offered to transgender Veterans which includes “medically necessary care.” More specifically, hormone therapy, preoperative evaluation, mental health care, and post-operative and long-term care following gender confirming surgery are all covered by Veteran health care through the VHA. However, gender confirming surgery itself is not covered. The Chillicothe VA Medical Center ensures that their policies and practices “focus on ensuring a safe, welcoming, and affirmative environment.” Also, Chillicothe VA has offered a LGBTQ+ Support Group since 2013. These services and demonstrated ideals are very progressive and inclusive to the growing diversity of Veterans. While more progress can always be made to create more stable care for Veterans, many beneficial ideas have been implemented into the VHA system in past years.

While women, LGBTQ+, and those with mental illnesses often face uncommon challenges in the world, it can be seen that this also often translates to issues within Veteran health care. Nationally, Veterans make up a large portion of our population and locally, that is no different. Many programs have been created for these diverse groups and have done fairly well as seen through the Chillicothe VA Medical Center and the Portsmouth Clinic. However, challenges and issues for these Veterans will continue to persist unless more changes continue to be made, especially with the harmful effects from the COVID-19 pandemic. This is not to say that other groups of Veterans do not face health care issues as well, as they historically have, but these groups explored experience very specific and identity-based challenges on a daily basis. The general population may not always realize these unnecessary problems our Veterans go through. Recognizing and discussing these issues within the health care system for Veterans can help influence and create positive changes for the future. As Veterans have once served us, we need to take the stand and ensure that we are serving them.