On November 17, 2021, the New York City Council Committees on Veterans and Mental Health, Disabilities and Addiction held a joint hearing on mental health services for veterans in response to the COVID-19 pandemic. Mr. Coy presented the following testimony highlighting what we know about New York veterans’ mental health needs and work underway by NYSHealth grantees to meet those needs:

Chairperson Dinowitz, Chairperson Louis, and distinguished members of the Committee on Veterans and Committee on Mental Health, Disabilities and Addiction:

My name is Derek Coy, and as a former sergeant in the United States Marine Corps and veteran of the Iraq War, I appreciate the opportunity to provide testimony on behalf of the New York State Health Foundation (NYSHealth) focused on mental health services for veterans in response to COVID-19.

NYSHealth’s Work to Improve Veterans’ Health
NYSHealth is a private, independent foundation that works to improve the health of all New Yorkers, including the approximately 700,000 veterans who call New York home. Our Veterans’ Health program area seeks to underscore that the health care, mental health, and social services issues returning veterans and their families face are not solely military issues, but public and community health issues that should be addressed by local and national government agencies, community-based organizations, and health funders. Our grantmaking in this area provides us with in-depth knowledge of the mental health challenges facing veterans, interventions that improve the mental well-being of veterans, and barriers to care. You can learn more about our work at our website, www.nyshealth.org.

Veterans’ Mental Health
Most veterans return from deployments and transition to civilian life relatively smoothly; they are healthy, ready to work or go to school, and eager to settle back into life at home. But for some, the adjustment is not as easy. They may struggle with physical injuries and disabilities and they may also be dealing with the invisible wounds of war: mental health issues including post-traumatic stress disorder (PTSD), suicidal ideation, and substance use.

Before the COVID-19 pandemic, veterans in New York State were already experiencing unique mental health challenges.

  • Between 2015 and 2018, approximately 20% of veterans in New York State identified as ever feeling sad, empty, or depressed for several days or longer. Over the same time period, about 6% of New York veterans reported having experienced serious psychological distress in the past year.[1]
  • Over that same time period, 10% of New York State veterans reported ever receiving treatment for drug or alcohol use, a rate about twice as high as for the nonveteran population.[2]
  • Nationally, the rate of PTSD in the veteran population has been found to be double that of the general population (12.9% compared with 6.8%).[3]
  • Veterans in New York State die by suicide at nearly twice the rate as the general State population. 156 veterans died by suicide in New York State in 2019—one nearly every other day.[4] In New York City, 86 veterans died by suicide between 2016 and 2018.[5]

The COVID-19 pandemic has since exacerbated existing mental health challenges and introduced new ones.

  • We know that social isolation and loneliness are associated with poor mental health outcomes.[6] In a recent national survey, a majority of veterans said their mental health worsened since socially distancing.[7]
  • Factors associated with living through a pandemic (e.g., losing friends and family, loss of perceived control, and uncertainty about the future) are risk factors for poor mental health.[8],[9] Other risk factors for poor mental health—including food insecurity, housing instability, and economic hardship—have also increased during the pandemic.[10],[11] For example, the unemployment rate among New York State veterans increased during the pandemic, from 4% in 2019 to 7.1% in 2020.[12]
  • We also hear from our grantees and partners who have witnessed firsthand the mental health challenges veterans are facing during the pandemic. For example, NYU Langone’s Military Family Center has reported higher diagnosis rates of depressive disorders, relationship stress, and substance use disorder.
  • The pandemic has made access to mental health care more challenging for many veterans. Half of veterans in a national survey reported having a mental health appointment canceled or postponed during the pandemic.[13]
  • Finally, aging veterans are at a particularly high risk of social isolation during the pandemic.[14] More than 70% of New York’s veterans are age 55 or older.[15]

NYSHealth-funded Initiatives to Improve Veterans’ Mental Health
To address these mental health challenges faced by veterans in New York City, the Foundation has invested in programs focused on three critical areas:

  1. identify and stabilize veterans experiencing a mental health crisis and at highest risk of dying by suicide,
  2. expand high-quality mental health care to those in need, and
  3. conduct outreach to ensure veterans in need have access to a full range of health and social services that can alleviate a mental health challenge they may be experiencing.

Stop Solider Suicide
First, we have helped Stop Solider Suicide’s (SSS) Disrupt Military Suicide program expand into all five boroughs of the City. This program rapidly identifies those at greatest risk for dying by suicide, using cutting-edge marketing and client acquisition techniques, and then connects clients to comprehensive support services based on their unique physical and mental health needs. Since the first months of the COVID-19 pandemic, SSS has served more than 141 at-risk service members and veterans in crisis. Compared with clients nationally, veteran clients in New York City are at higher risk of dying by suicide, generally older, more likely to be African American or Latino, and more likely to have housing issues. Since engaging in the program, clients on average reported a 57% reduction in self-hate, a 33% reduction in psychological pain, and an 18% reduction in hopelessness.

NYU Langone’s Military Family Center
For veterans and family members who are in need of mental health care but not in crisis, NYU Langone’s Military Family Center is providing free telemental health services to veterans and their families in hard-to-reach, under-resourced areas of New York State. Thanks to the expansion of their services and increased presence in new markets, the Military Family Center has seen a 50% increase in client intakes compared with pre-pandemic levels.

Mission: VetCheck
Finally, because mental health challenges and crises often stem from previously unaddressed social needs and increased social isolation, we have supported the expansion of Mission: VetCheck, a unique partnership between New York City’s Department of Veteran Services, the Mayor’s Office of Community Mental Health, and New York Cares. These efforts have led to 20,000 veteran outreach calls each year. These calls serve primarily as wellness check opportunities that connect veterans in need to an appropriate service provider. But part of the value is simply having friendly phone calls that can reduce social isolation for veterans who live alone or have reduced social connectivity as a result of the ongoing pandemic.

The Future
Addressing unmet mental health needs and providing high-quality treatment, both in and out of the clinical environment, has no single solution. It requires a community-based approach that engages a variety of diverse stakeholders. The COVID-19 pandemic has laid bare many issues preventing New Yorkers from accessing the care they need. For veterans who call New York City home, a unique coalition of public and private providers has stepped up both to increase the services they provide and conduct targeted outreach to identify veterans in need of services. NYSHealth will continue to identify gaps in services for veterans and invest in organizations that address these unmet needs.

The Foundation is grateful for the committee’s recognition of the importance of delivering high-quality mental health care and social services to veterans in New York City, whether within or outside a clinical environment. We appreciate the opportunity to testify today and look forward to continuing our partnerships with the City and other like-minded organizations that are working to ensure veterans have access to the care they have earned.

Watch video of the hearing here (Derek Coy’s testimony begins at 1:22:10).

 

[1] National Survey on Drug Use and Health, “4-Year RDAS (2015 to 2018),” https://rdas.samhsa.gov/#/survey/NSDUH-2015-2018- RD04YR

[2] National Survey on Drug Use and Health, “4-Year RDAS (2015 to 2018),” https://rdas.samhsa.gov/#/survey/NSDUH-2015-2018- RD04YR 

[3] Jan Müller, Sarmila Ganeshamoorthy, and Jonathan Myers, “Risk Factors Associated with Posttraumatic Stress Disorder in U.S. Veterans: A Cohort Study,” PloS one, 2017, 12(7), e0181647. https://doi.org/10.1371/journal.pone.0181647.

[4] U.S. Department of Veterans Affairs, “2020 National Veteran Suicide Prevention Annual Report: State Data Appendix,” https://www.mentalhealth.va.gov/suicide _ prevention/data.asp.

[5] New York State Health Connector, “Suicide and Self Harm Dashboard: Deaths by Suicide by County, 2016-2018,” https://nyshc.health.ny.gov/web/nyapd/suicides-in-new-york.

[6] N. Leigh-Hunt et al., “An Overview of Systematic Reviews on the Public Health Consequences of Social Isolation and Loneliness,” Public Health 152 (November 2017): 157–71, https://doi.org/10.1016/j.puhe.2017.07.035.

[7] Wounded Warrior Project and Westat, “2020 Annual Warrior Survey,” 2020, https://www.woundedwarriorproject.org/media/zojlzv53/2020-annual-warrior-survey.pdf.

[8] Naomi Simon, Glenn Saxe, and Charles Marmar, “Mental Health Disorders Related to COVID-19–Related Deaths,” JAMA 324, no. 15 (October 20, 2020).

[9] June Gruber et al., “Mental Health and Clinical Psychological Science in the Time of COVID-19: Challenges, Opportunities, and a Call to Action,” American Psychologist, August 10, 2020, https://doi.org/10.1037/amp0000707.

[10] Patience A. Afulani, Alisha Coleman-Jensen, and Dena Herman, “Food Insecurity, Mental Health, and Use of Mental Health Services among Nonelderly Adults in the United States,” Journal of Hunger & Environmental Nutrition 15, no. 1 (January 2, 2020): 29–50, https://doi.org/10.1080/19320248.2018.1537868.

[11] Lauren Taylor, “Housing And Health: An Overview Of The Literature,” Health Affairs, June 7, 2018, https://doi.org/10.1377/ hpb20180313.396577.

[12] U.S. Bureau of Labor Statistics, “Table 6. Employment Status of the Civilian Noninstitutional Population by State and Veteran Status, Not Seasonally Adjusted,” Current Population Survey. Tables for veterans and nonveterans, 18 years of age and older in 2019 and 2020 were made available by special request from the U.S. Bureau of Labor Statistics.

[13] Wounded Warrior Project and Westat, “2020 Annual Warrior Survey,” 2020, https://www.woundedwarriorproject.org/media/zojlzv53/2020-annual-warrior-survey.pdf.

[14] Christina M. Marini et al., “Aging Veterans’ Mental Health and Well-Being in the Context of COVID-19: The Importance of Social Ties during Physical Distancing.,” Psychological Trauma: Theory, Research, Practice, and Policy 12, no. S1 (20200611): S217, https://doi.org/10.1037/tra0000736.

[15] New York State Division of Veterans’ Services, “2019 Annual Report,” https://veterans.ny.gov/sites/default/files/annual-report-2019.pdf.

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