Tervuren, Belgium—The following opinion piece is authored by Thomas K. Murphy, Ph.D., an educator, a long-time Department of Defense civilian with significant experience having worked on several U.S. military locations overseas, and a regular contributor to the Democrats Abroad Veterans and Military Families (VMF) Caucus. Dr. Murphy is a Maryland UOCAVA voter, resident of Belgium, and member of the Global VMF Caucus.
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Stresses on overseas American military personnel are high at present. Trump Administration policies targeting sovereign nations have created great uncertainty within military families, and within the whole military-connected community in general. As a result, it is vital that the mental health needs of the services are upheld, through adequate funding and the providing of first-rate counseling and other services.
Mental health challenges among U.S. military personnel have significant implications for both individual service members and overall military readiness. While current mental health services have made strides, there are currently critical gaps in accessibility, cultural attitudes, and provider availability that continue to hinder optimal care. Addressing these challenges requires a comprehensive, multi-pronged approach that encompasses prevention, early intervention, and treatment.
PTSD, Anxiety and Mental Health Stigma
If we look at the present U.S. active-duty military, we must acknowledge that nearly 10% suffer from pronounced psychological issues.
Among veterans, PTSD affects an even higher percentage.
Perhaps surprisingly, over 40% of military personnel in need of mental health treatment resist seeking assistance, as many often believe they will be penalized by leadership or seen as the “weak link” within their unit. These challenges reflect ongoing cultural stigma surrounding mental health care and remain significant barriers to overcome within the military.
Military culture traditionally values toughness, self-reliance, and resilience, often leading to a reluctance among service members to seek help for mental health issues due to concerns about perceived weakness or career repercussions. To combat this stigma, proactive mental health programs are essential.
Mental health issues have increased nearly fivefold since the COVID pandemic, particularly regarding PTSD and anxiety disorders. From the COVID period, 2019-2023, 966,227 diagnoses of mental health disorder were made within the U.S. military.
Female service members experience PTSD at a rate nearly twice of their male counterparts. As a result of overall increases in these disorders, efforts to relieve PTSD and anxiety related mental health issues have been enhanced both stateside and overseas in recent years.
In 2023, active-duty military members experiencing a mental health issue populated more hospital beds than any other issue – nearly 55%.
Suicide and Vets
Suicide rates have risen in recent years, and, today, U.S. military vets are nearly twice as likely to die from suicide as civilians, according to a 2023 report. In that same year, the rate of suicides among military members rose by 6%.
Veteran suicide rates have reached their highest level in recorded history, with over 6000 veterans dying by suicide annually. (It should be noted that overall suicide rates within the United States increased by 30% between 1999 and 2016.) According to a study conducted in 27 states, it was estimated that veterans committed 17.8% of reported suicide cases.
Data published by the U.S. Department of Veterans Affairs (VA) in 2016 indicated that, within the military, veteran suicide rates were 1.5 times higher than those of non-veterans. Research has shown that veterans are at significantly increased risk of suicide during their first year after leaving military service. More recently, the Veterans Crisis Line in Fiscal Year 2025 offered 1.3 million calls, chats and texts to veterans in need, a 39% increase over the prior year. Incredibly, neither VA nor any other U.S. federal agency tracks veteran suicides which occurs outside of U.S. soil. Thus, it is logical to assume the actual number of those in crisis far extends past VA’s official statistics.
In 2018, a Presidential Executive Order was signed to improve suicide prevention services for veterans during their transition to civilian life. Moreover, the Department of Defense (DoD) and VA have placed significant emphasis on suicide prevention due to the observed rise in fatal and non-fatal suicide attempts during the wars in Iraq and Afghanistan.
An Interview/Discussion About Current Active Duty & Vets
How do these developments in mental health translate into the experiences of everyday military life overseas? Recently, I spoke with a seasoned Air Force representative in Europe about the current state of mental health in the U.S. military overseas:
“Several issues appeared at the forefront; the most prominent being that service members can feel isolated – culturally and socially. Some deployment sites don’t provide for inclusion of family members. And many soldiers are required to perform repeated deployments.”
With regard to mental health in combat situations, “soldiers are often placed in unwinnable situations.” What that means is that, in a context such as [the Middle East], with volatile relations between [various religious factions], American soldiers were given strict orders to hold fire, and to avoid getting caught up in local disputes. In these instances, U.S. soldiers were rendered incapable of controlling local violence, which they often had to witness.
As mentioned earlier, stigma about mental health can have a discouraging effect on soldiers approaching treatment. “In such circumstances, a soldier must be careful about seeking help. Why? Because they might be ‘coded,’ another way of describing being revealed as one receiving or in need of therapy. ‘Coding’ (or ‘flagging’) is a term used in the military by therapists to identify a service member who possesses a condition that could compromise their job performance.”
One who is coded may face a variety of issues, including an inability to deploy, disqualifications from certain responsibilities (such as not being able to carry a firearm), and the potentially accompanying social disapproval from peers. Coding is often a temporary status and can be lifted as circumstances dictate.
Consistency of treatment is another major concern in the overseas theater: “The U.S. military promotes mental health – but they don’t follow through on consistent treatment.”
(Author’s note: This issue of consistency treatment resonates with me – as some years ago, I had an experience at an American base in Europe, where a clearly self -destructive and potentially suicidal individual (a student of mine) was temporarily removed from duty and sent to counseling, only to have his therapist transferred a month into his therapy, without any warning or notice to him or to other clients.)
Back stateside, no legitimate mental health agency or organization would ever allow such an abrupt, unannounced separation of therapist from client. “There is the issue of the ‘wash and rinse cycle’ of therapy,” my interviewee added. “There is no consistency in therapy. Now you see the doctor, now they are gone. Because of this rotational schedule, medication is often used as a surrogate or substitute for meaningful therapy.”
Consistency of treatment is not, however, merely an issue of the military medical community. Both therapists and soldiers are in constant rotation, as that is the fluid nature of military life.
And speaking of military life and culture, some of the issues related to availability and engagement on mental health by service members may, to some extent, reflect attitudes and norms within that culture. “Civilians tend to be more sensitive to mental health issues. In military culture, we are very task oriented; we are very independent – you make your own way. You earn your own future. There is a natural resistance among many to address mental health issues. It can be isolating. Certainly, the military is not for everybody in this regard.”
What resources and support are available to vets in Europe? “The care afforded to U.S. military vets differs dramatically in Europe, depending on location. “The VSOs (Veteran Service Organizations) such as Veterans of Foreign Wars (VFW) and The American Legion have limited resources in Europe – and, aside from Ramstein Base in Germany and a few others, support facilities for vets are quite limited.”
Is health care generally and mental health care specifically improving in the European Theater? “To be frank about the overall medical infrastructure in Europe right now, the culture and quality of medical attention to overseas soldiers seems to be lagging. We see a ‘ghettoization’ of medical care, even at the biggest bases, like Ramstein. Doctors rotate location, soldiers are sent back into the field too early, and medication is overprescribed for mental health treatment. Perhaps the biggest problem is seeing the same doctor consistently over a period of time.”
Symptoms of Distress
An estimated four in ten active-duty U.S. military personnel were, by 2023, diagnosed with a condition indicating significant psychological distress. Symptoms were correlated with, among other things, drug use, binge drinking and inadequate sleep. Interestingly, several studies, from 2010 and 2021 suggest that sleep deprivation may dwarf alcohol and drug abuse as a contributor to lack of performance and overall well-being.
Some studies suggest that paygrade is correlated with mental health; lower pay grades tend to have higher rates of more severe mental health issues. This may relate to promotion potential and overall income.
A 2018 DoD survey represents the primary source of data regarding the health-related behaviors and well-being of service members in the Army, Navy, Marine Corps, Air Force and Coast Guard. The 2018 HRBS total sampling frame was 1,357,219 active-duty service members.
Of the 199,996 active-duty service members invited to participate, 17,166 responded (a response rate of 9.6 %). Of these, 4428 respondents had sought help from medical or religious professionals for mental health concerns in the past 12 months and constitute the final analytical sample.
War and Mental Health
As the United States has endured several decades of ongoing warfare, both the media and individuals with personal military connections have raised significant public and professional concerns about the mental health of veterans and service members. The most widely publicized mental health challenges veterans and service members encounter are post-traumatic stress disorder (PTSD) and depression. Research indicates that approximately 14% to 16% of the U.S. service members deployed to Afghanistan and Iraq have been affected by PTSD or depression.
Although these mental health concerns are prominently highlighted, it is crucial to acknowledge that other issues, such as suicide, traumatic brain injury (TBI), substance use disorder (SUD), and interpersonal violence, can be equally detrimental within this population. These challenges can have far-reaching consequences, significantly affecting service members and their families.
Although combat and deployments are known to be associated with increased risks for these mental health conditions, general military service can also give rise to challenges. The presentation of these mental health concerns may not follow a specific timeline. However, there are particularly stressful periods for individuals and families, especially during periods of close proximity to combat or when transitioning from active military service.
PTSD was officially recognized and codified in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-3 in 1980, driven partly by the sociopolitical aftermath of the Vietnam War. However, its manifestations have been alluded to in different forms throughout history, with terms such as “soldier's heart” during the Civil War, “shell shock” in the First World War, and “combat fatigue” around the Vietnam War.
As a result of two decades of ongoing warfare in Afghanistan, there is a rising population of veterans seeking mental health treatment, with a significant portion having experienced combat and deployment. While caring for veterans, healthcare providers should consider the physical injuries they may have sustained during their service period and the emotional – often invisible – wounds they may be experiencing presently, including PTSD, acute stress disorder, and depression. Although depression does not garner the same level of attention as PTSD, this condition remains a prevalent mental health condition in the military. Research shows that depression is responsible for up to 9% of all ambulatory military health network appointments.
The Role of the Chaplain
One of the primary barriers to effective mental health care is accessibility. Chaplains serve a vital function, and are available throughout the military community, but they are not typically trained in counseling level psychotherapy and often may not be qualified or able to handle serious mental health issues. They are confidential sources but retain authority to report potentially life-threatening issues up the chain of command.
In Summary
The issue of mental health in the military reflects cultural attitudes and stigmas present in American society. But the overseas military community has its own specific needs, stresses and situation-specific circumstances that require high grade medical care that may not, at present, always be available. One hopes that future military budgets will give equal weight to the well-being of soldiers and military families as they would to weapons procurement, as a high functioning service population is key to a secure America.
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U.S. citizens living abroad, both civilian and military, are highly encouraged to check your voter registration status and request your ballot for any upcoming elections in your home voting state that you are eligible to vote in.
The Global VMF Caucus has over 1,400 members in dozens of countries and proudly includes veterans, military family members, Department of Defense civilians, other national security professionals, and strong allies of veterans and military family causes.