NH Legislative Commission on PTSD and TBI
Issue Overview
New Hampshire has the 5 th highest veteran population (per capita) in the United States. Veterans
account for almost 11% of our State’s population. Our State has many citizen soldiers (1,099 NH Air
National Guard members, 1,720 NH Army National Guard members, in addition to Reservists across
all other branches), wounded warriors, veterans from all eras, and their families. We have local
communities, facilities, professionals and organizations able to provide health services for veterans,
particularly for Post-traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI).
Yet, the health needs of many veterans in our State are going unmet.
Barriers to care
It has long been proposed that when a veteran is struggling, he or she may prefer to talk to another
veteran about his or her challenges. The results of Survey Helping to Advance Recovery Efforts
(SHARE), a survey that was responded to by 1,170 NH Veterans (1/3 of whom identified as Post 9-11
era and 1/3 of whom identified as Vietnam era), validated this sentiment. The unique task of meeting
their clinical needs was captured in the survey by veteran selection of “I have not felt understood by
the providers I have met” as being among the top barriers to their obtaining services.
Veterans, of course, do seek health services from non-veteran providers with general success.
However, the greater challenge comes when the injuries are invisible, and the struggles deeply
personal. The challenge of stigma with regard to disorders of mental health and TBI are not unique to
veterans, but the trauma of combat, war, and the experience of military culture is exclusive to a small
fraction of the population. When the risk for misguided inference is twofold, as both a veteran and a
person with a mental illness or TBI, it comes as no surprise that stigma was identified by SHARE as
the number one barrier to treatment across all eras of service.
A TBI is an injury that disrupts normal brain functioning, often resulting in physical, cognitive,
behavioral and mental health disability. TBI, while not a mental health condition, often comes
packaged with symptoms of PTSD. Roughly two-thirds of all documented combat wounds, from the
wars in Iraq and Afghanistan, are the result of blasts from improvised explosive devices (IED’s). As a
result, TBI has become the “signature injury” of these conflicts and a substantial contributor to the
development and struggle with depression and PTSD facing our veterans. With no outward physical
signs and deeply intertwined symptom profiles, differentiating between TBI and PTSD is complicated
and sometimes impossible. The challenge of diagnosis, the unique nature of the military experience,
and the stigma of invisible wounds make for a difficult link to services for the veteran living in their
civilian community.
A common misconception is that all veterans receive their medical care through Veteran
Administration (VA) facilities. The truth is, not all veterans are eligible for care at the VA, and many
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