A patient — a military member — reluctantly agreed to see Kathleen McNamara, a therapist. McNamara was used to this drill. An Air Force member herself, she was accustomed to military members and veterans who believed seeking mental health care signaled weakness and that therapists couldn’t help.

“He simply didn't understand that therapists are highly trained diagnosticians and clinicians,” said McNamara, an assistant professor in the UNLV School of Social Work. Her research includes mental health among service members and veterans.

McNamara said the patient eventually agreed to work with her on modifying his thoughts and behaviors to mitigate what she had suspected was ADHD. He worked with his physician in primary care to get one part of the treatment and with McNamara for additional support. 

“Almost immediately he was blown away at how every single aspect of his life improved, from his marriage to his work performance to his sleep to his parenting, and on and on. He started out so hesitant and ended up being beyond grateful for the impact of mental health treatment on his life,” McNamara said.

Military members and veterans require tailored efforts to effectively treat their unique circumstances and life experiences, McNamara said. Patients benefit from having trained clinical social workers especially those who have served in the military.
 
A private practice can offer this treatment but the quality of care can differ so she stresses the important role of the U.S. Department of Veterans Affairs in serving this population.

While potential budget cuts to the U.S. Department of Veterans Affairs loom, McNamara cautions that downsizing the VA could disrupt mental healthcare delivery for veterans, active-duty military members, and their families. Staffing, counselor availability, and telehealth options could be impacted. 

“I hope that any reduction in force and spending is done thoughtfully, with veterans' health as the top priority,” McNamara said. “We can't yet say how this would affect mental health care at the VA., however I do worry that Frankensteining VA services with non-VA services will end up increasing already high wait times, will dilute the potency of Veteran-centric care, and will lose the wrap-around, medical home environment that fosters the right setting for veterans to finally seek therapy.” 

VA Services Provide an Important Need

McNamara served in the U.S. Air Force for 12 years, leading teams across the U.S., Europe, and Africa. She was the only psychotherapist for a joint military base in the Horn of Africa and served as the director of behavioral medicine for a family medicine residency program where she helped physicians treat behavioral health issues.

She says programs like those offered at the VA are instrumental in suicide prevention.

Suicide rates among active-duty miliatry members increased in 2023 from the previous year, according to a Department of Defense report published in 2024.  

A Pentagon study released in June 2024 found that from 2014 to 2019, U.S. active-duty soldiers were nine times as likely to die by suicide than enemy fire. 

Among its mental health programs the VA offers include counseling for posttraumatic stress disorder, psychological effect of military sexual trauma, depression, grief, and anxiety. Counseling is available for individuals, groups, couples, and families. 

Counselors are vital to ensuring military members, veterans, and their families receive mental health care. Embedding therapists in the military, including clinical social workers, is common.

“This is a special therapist-patient relationship that can be found in Vet Centers, VHAs, on military installations, and I would argue, in very very few private practices,” McNamara said. 

Welcomed Among Peers

Getting past the stigma is the first step in seeking care, McNamara said. 

“For years we've been fighting this stigma of veterans and military members seeking mental health care. And while we have seen some of the stigma decrease over the years, it's definitely still present,” McNamara said. “There are really good reasons people have for not wanting to seek mental health care.”

McNamara says service members may worry they will lose their job, won’t be able to move to a new location or get deployed. 

Military members have the option to seek care at private clinics, however, McNamara says service members go to a VA facility for mental healthcare because they will be most-likely treated by people who have been in their shoes.

“Veterans often feel a sense of camaraderie with one another due to the unique nature of military life, which civilians can't fully understand, try as they might. Being in the military can strip you of your defenses, identity, and old community, in such an extreme way that it's hard to recognize your former civilian self anymore,” McNamara said. 

For example the VA offers the BeThere peer assistance program to assist military members, and their families with a peer coach who are Veterans, service members, or military spouses. Crisis hotlines are free and available 24 hours a day, seven days a week. 

“We go through often grueling, degrading, demanding trials, some of which we literally cannot talk about with anyone, which can lead to a sense of isolation and separateness from non-military people. Because of this, it can be simpler to work with other veterans, especially in the context of potentially vulnerable conversations such as a therapy session. No one wants to feel negatively judged by someone, especially not by a therapist, and let's face it many people did engage in distressing acts during their military service.”