PTSD and Veteran Care: Lessons from 15 Years of Clinical Practice

Veterans and Mental Health: A Changing Landscape

For more than 15 years, I’ve worked closely with combat veterans across the Greater St. Louis area, rural Southern Illinois, and rural Southern Missouri. During that time, I’ve witnessed significant shifts in both the challenges veterans face and the quality of care available through the U.S. Department of Veterans Affairs and private practice settings.

While every veteran’s story is unique, certain themes consistently emerge: frustration with the system, misdiagnosis or underdiagnosis of PTSD, and treatment gaps that leave veterans and their families searching for more effective answers.

Early Challenges in Veteran Care

In the early 2010s, many veterans I worked with were in their 30s, struggling to reintegrate into civilian life while navigating marriage, parenting, and work after combat deployments.

Common Issues at the Time

Negative VA experiences. Long wait times, limited continuity of care, and rushed appointments often resulted in another prescription rather than meaningful treatment.

Families excluded. Spouses—frequently the primary support system—were rarely involved in therapy, despite their central role in daily functioning and recovery.

PTSD overlooked. Clinical records often reflected multiple psychiatric diagnoses instead of recognizing PTSD as the core issue, leading to confusion, ineffective treatment plans, and a sense of hopelessness.

Treatment that didn’t fit. Prolonged Exposure (PE) and EMDR, widely used in VA settings, felt overwhelming for many veterans. The intensity and pacing caused a significant number to disengage from treatment altogether.

Progress Since 2024

In recent years, I’ve observed meaningful improvements in veteran mental health care:

Better VA interactions. Many veterans report more professional, respectful, and collaborative interactions with staff.

Less overmedication. Fewer veterans present heavily medicated, and some are actively tapering medications under medical supervision.

Greater openness about PTSD. Veterans in their 40s and beyond are more willing to acknowledge symptoms and seek help.

Medical issues still overlooked. Conditions such as low testosterone and sleep apnea remain under-screened, despite their significant impact on mood, cognition, and trauma symptoms.

Helpful medications underused. Prazosin, which can significantly reduce trauma-related nightmares, is rarely prescribed unless veterans specifically request it.

Ongoing and Emerging Challenges in Veteran PTSD Treatment

Moral Injury

Standard therapies such as CPT, CBT, and ACT often fail to adequately address moral injury—the deep psychological distress that comes from violating one’s moral or ethical code. In my experience, psychedelic-assisted psychotherapy is the only intervention that has consistently helped veterans work through this dimension of trauma.

Traumatic Brain Injury (TBI)

Repeated exposure to helicopters, explosions, and high-caliber weapons has left many veterans with lingering symptoms such as brain fog, depression, irritability, and emotional volatility—even without a documented loss of consciousness.

Aging Veterans and Dementia

Among Vietnam-era veterans, PTSD symptoms frequently resurface as memory declines. The combination of trauma and cognitive impairment is devastating, and current systems remain ill-equipped to manage it effectively.

Generational Disconnect

Many younger clinicians lack training in combat psychology, leading veterans to feel misunderstood and disengaged from care. This disconnect can undermine trust and long-term treatment outcomes.

Homelessness and Poverty

For veterans who enlisted as a means of escaping poverty, the return to civilian life can bring instability, limited resources, and economic hardship—factors that significantly complicate mental health recovery.

Why This Matters

The phrase “thank you for your service” is well-intentioned, but for many veterans it feels hollow without meaningful, effective support. The VA—America’s largest healthcare system—has the opportunity to lead in developing and studying innovative treatments such as psychedelic-assisted therapy and hyperbaric oxygen therapy.

Historically, wartime medicine has driven advances in surgical and emergency care. Today’s veteran mental health crisis could similarly drive breakthroughs—if the opportunity is taken seriously.

Final Thoughts

Working with combat veterans has been the most challenging and rewarding part of my clinical career. While progress has been made, substantial gaps remain. Veterans deserve treatment that goes beyond symptom management and medication alone—care that restores dignity, purpose, and quality of life.

Call to Action

If you are a veteran—or the spouse of a veteran—struggling with PTSD, depression, or moral injury, support is available. I offer telehealth appointments across Missouri and provide services through PSYPACT in participating states. Reach out today to begin the process of rebuilding your life.