Understanding the Health and Well-Being Needs of New York's Newest Veterans

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Many U.S. military members leave active service and return to civilian life without major problems. They attend school, work, raise families, and contribute to their communities. They put their military skills and experience to work in productive ways.

For other veterans, however, the readjustment is not easy. This group may grapple with significant mental and physical health issues related to their service. Since 2001, suicide rates among veterans have been consistently higher and increasing more rapidly than those of nonveterans. Veterans also face high rates of depression and posttraumatic stress disorder (PTSD). In addition, many also struggle with alcohol and substance misuse, further complicating the road to wellness.

As a nation, it is crucial that the United States recognize and address these challenges. States can play a major role in response because decisions made at a local level can have substantial, if not greater, impact on the daily lives of individual veterans. To better understand the challenges that veterans in the state of New York face, RAND researchers conducted a survey with a random sample of 1,122 veterans who were discharged or separated from the military between January 2018 and January 2023 and who reside in the state. The survey asked veterans about their mental and physical health needs, access to care, and additional factors that can affect well-being, such as employment assistance and food security.

The current study builds on a similar needs assessment conducted by RAND in 2010.^[1]

Findings

Recent New York veterans are a young and diverse group. Veterans who recently left active duty were relatively young, with 62 percent under age 45. Approximately 15 percent were women, and nearly 40 percent were non-White. About one-half had a college degree or higher, and 70.5 percent were employed either full- or part-time. The sample included veterans from various branches of service, with the Army being the most represented (50.9 percent). Most veterans in the sample, 79.1 percent, were enlisted personnel when they separated from military service. Approximately 60 percent of respondents were deployed to a combat operation at least once during their military service. Among those who deployed, the average number of deployments was 2.2, with a median of 2.

Many recent New York veterans face mental health challenges. Figure 1 summarizes the primary challenges faced by recently separated New York veterans. Approximately 25 percent screened positive for probable depression and probable PTSD. Those with combat deployments had lower rates of depression but higher rates of PTSD compared with those without combat deployments. The proportion of veterans who reported suicidal thoughts was twice as high as estimates for the general New York adult population.

• 25 percent of veterans had probable depression
• 26 percent of veterans had probable PTSD
• 17% of veterans had both depression and PTSD
• 9% of veterans thought about suicide in the past year

Rates of alcohol misuse were high among recent New York veterans. Nearly 30 percent of veterans in the cohort reported at least one binge-drinking episode in the past 30 days, and 10 percent reported frequent binge drinking (five or more episodes in the past 30 days). The rate of binge drinking in this sample is somewhat higher than prior estimates for the general U.S. veteran population but is very similar to estimates for the general adult population.

Many recent New York veterans face physical health challenges. Approximately 20 percent of the veterans rated their health as "fair" or "poor." This proportion is higher than estimates for the general population ages 18 to 54 but is similar to the estimates of adults between ages 55 to 64. Relatedly, this cohort of recently separated veterans scored below average compared with people of the same age and gender on measures assessing physical functioning and role limitations. Collectively, these findings demonstrate that veterans have more health problems than other people their age.

Rates of disability among recent New York veterans are very high. More than 60 percent reported being rated as fully or partially disabled by the military or the U.S. Department of Veterans Affairs (VA). Among this group, the average disability rating percentage was 68.5 percent. The level of disability in the current cohort is substantially higher than in the 2010 study, in which 31 percent of respondents reported being rated as disabled and the average disability rating among those was 38 percent.^[2]

Many recent New York veterans faced food insecurity. Approximately 25 percent of respondents said that they had worried about not having enough money for food at some point during the past year.

Most recent New York veterans had some form of health insurance but were less likely to have a provider that they typically saw. In the survey, 97 percent of participants indicated that they had health insurance. However, only 70 percent reported having a usual source of care, such as a primary doctor or clinic that they typically visited.

Many recent New York veterans had unmet physical and mental health care needs. Despite the high rate of insurance coverage and access to care through VA, many veterans in the cohort had unmet mental health or physical health needs during the past year. Figure 2 breaks this finding down into percentages. The top three barriers to care are presented for physical and mental health care.

Physical Health Care

15 percent of recently separated veterans in New York say they do not receive the care they need. Barriers include:

• Services difficult to access
• Lack of support services such as child care and transportation
• High cost of care

Mental Health Care

21 percent of recently separated veterans in New York say they do not receive the care they need. Barriers include:

• Services difficult to access
• Perceived ineffectiveness of treatment options
• Stigma of mental health challenges

Most recent New York veterans viewed VA health care services positively. Almost 77 percent of survey respondents reported having access to health care services through VA. Respondents reported that they had good experiences both in VA facilities and from providers in the community paid for by VA. Veterans noted that it was easier to schedule convenient appointments with community providers but that health providers in VA facilities were more likely to understand military culture and the unique health challenges faced by veterans.

Many recent New York veterans expressed a preference for community providers over military or VA facilities. Almost 60 percent of respondents said that if they could choose to get care anywhere, they would prefer to go to a community provider. The most common reasons for this preference were easier access, perceptions of better care quality, and maintaining established relationships with existing providers. It is interesting to note that the proportion of the current cohort preferring community physical and mental health care providers is higher than the 46 percent of respondents in 2010 who reported a preference for receiving mental health treatment from a civilian provider rather than from a VA facility.

Recent New York veterans saw benefits as helpful but did not use them. Almost one-half (46 percent) of survey respondents said that veteran housing assistance and loans were helpful, yet only 20 percent used them. Similarly, although job training was seen as helpful by 34 percent, only 10 percent had accessed it.

What Has Changed Since 2010?

Comparisons with the 2010 cohort of recent New York veterans provide useful context and a sense of how things have changed over time. Compared with the 2010 study, the current cohort of recent veterans is older, more racially diverse, more likely to be female, and more educated.^[3] Figure 3 shows how the two cohorts differ in terms of demographics, mental and physical health outcomes, and use of mental health services. The differences in such outcomes as the rates of probable depression and disability likely reflect some combination of differences in the underlying prevalence, the composition of the cohort in terms of age and gender, and changes in policy and definitions over time (e.g., around disability designations).

Recommendations

The results from this survey point to potential policy and program-level changes that could improve services for veterans in New York.

• Expand access to veteran-competent mental health services. This can be done by training more health professionals to work with veterans, adding mental health services to community and primary care settings, and using creative media campaigns to reduce stigma and encourage more veterans to seek care. Nontraditional forms of mental health services, such as peer mentor programs that offer veterans support from fellow veterans who understand their unique challenges, should also be considered and invested in.
• Fund and operate veteran-specific suicide prevention programs. It is important to stay committed to policies, programs, and research related to preventing veteran suicide. This means improving the quality and accessibility of data on veteran suicide risk and deaths and expanding and evaluating approaches specifically designed for veterans to prevent suicide and handle crises. Normalizing the use of suicide screening tools in both health care and informal settings can play an important part in identifying veterans at risk and ensuring timely intervention.
• Support veterans' ability to access both VA-based and community-based health care services. Avoid false either/or dichotomies. Veterans want and use a combination of care from VA and from private providers. Maintaining choice and access to the different care settings can help meet the diverse needs of veterans across New York. This includes increased investment and training to create a culturally competent health care system that can meet the unique needs of veterans within their own communities.
• Help veterans tackle logistical barriers to health care. This can include providing transportation to appointments, offering more-flexible appointment times and locations, and providing additional support through free resources, such as the NYS Veterans mobile app. Additionally, veterans should be made aware of telehealth and audio-only appointments, which reduce the burden on veterans and provide increased accessibility to health care services.
• Increase outreach and awareness about benefits and services for veterans. This can be done by partnering with community organizations and running targeted information campaigns to promote VA events and services. It is also important to include information about all challenges that veterans face, such as food insecurity. This provides a prime opportunity for further investment and development of veteran service organizations, which are largely responsible for helping veterans navigate and access the full range of benefits and services for which they are eligible.
• Recognize the growing diversity of the veteran population. Service providers should receive ongoing training on equity and cultural competence to better serve current and future veterans. Programs should specifically address the unique challenges faced by women and lesbian, gay, bisexual, transgender, queer/questioning, and other veterans, as well as veterans from different racial and ethnic minority backgrounds.

Demographics

• Proportion of veterans under age 35
  • 2010: 54 percent
  • 2024: 39 percent
• Proportion of veterans with a college degree
  • 2010: 33 percent
  • 2024: 50 percent
• Proportion of veterans who were from racial or ethnic minority backgrounds
  • 2010: 27 percent
  • 2024: 40 percent

Compared with 11% in 2010, 15% of the 2024 sample were women.

Physical and Mental Health Characteristics

Veterans' overall physical functioning scores remained relatively consistent across the two cohorts (below-average physical health relative to nonveterans). However, rates of disability and mental health concerns were higher in 2024.

• Probable depression
  • 2024 veterans: 25 percent
  • 2010 veterans: 16 percent
• Probable PTSD
  • 2024 veterans: 26 percent
  • 2010 veterans: 16 percent
• Proportion of veterans rated as partially or fully disabled by the military or VA
  • 2010: 31 percent
  • 2024: 60 percent

Use of Mental Health Services

• Proportion of veterans who use mental health services
  • 2024 veterans: 32 percent
  • 2010 veterans: 24 percent

In both cohorts, 2 in 10 veterans reported not receiving needed mental health services.

Among veterans with unmet mental health needs, the proportion reporting certain reasons for not accessing care increased, while the proportion reporting other reasons decreased.

• Not knowing where to find the right services (Reported by 27% in 2024 vs. 12% in 2010)
• Believe mental health care will not be effective (Reported by 39% in 2024 vs. 11% in 2010)
• Concerns that seeking care will harm their career (Reported by 27% in 2024 vs. 33% in 2010)
• Concerns about side effects associated with medications (Reported by 19% in 2024 vs. 35% in 2010)

Notes

• [1] Carrie M. Farmer, Lisa H. Jaycox, Grant N. Marshall, Terry L. Schell, Terri Tanielian, Christine Anne Vaughan, and Glenda Wrenn, A Needs Assessment of New York State Veterans: Final Report to the New York State Health Foundation, ed. by Terry L. Schell and Terri Tanielian, RAND Corporation, TR-920-NYSHF, 2011. As of September 19, 2024: https://www.rand.org/pubs/technical_reports/TR920.html
• [2] Farmer et al., 2011.
• [3] Farmer et al., 2011.

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Topics

• Mental Health Treatment
• Military Health and Health Care
• New York
• Veterans Health Care