Understanding Veterans in New York: A Needs Assessment of Veterans Recently Separated from the Military

Over the past decade, there has been increased awareness that U.S. military veterans often grapple with significant mental and physical health issues related to their service. In response, many policies and programs have been put in place to support veterans and improve access to needed services. Despite these efforts, prevalence rates for physical and mental health problems and concerns about the health and overall well-being of veterans remain high. Because the specific needs of veterans and the barriers to accessing care likely differ across areas, data at the state level are critical for tailoring policies and programs to make them more effective.

This study focuses on veterans in New York, specifically individuals discharged or separated from the military between January 2018 and January 2023. RAND researchers fielded and analyzed responses from a survey of 1,122 veterans designed to assess the mental and physical health of this cohort of veterans and their access to, and experiences with, health care and other veteran benefits.

Recently Separated Veterans in New York: A Closer Look at the Study Sample

Of the 1,122 recently separated veterans living in New York who participated in the study approximately

• 39 percent were under age 35
• 62 percent were under age 45
• 15 percent were women and nearly 40 percent were non-White
• half had a college degree or higher
• 70 percent were employed either full- or part-time
• 51 percent served in the Army, although individuals from all services participated in the study.

Findings

Many surveyed New York veterans face mental health challenges. Figure 1 summarizes the primary challenges faced by New York veterans. Those with combat deployments had lower rates of depression but higher rates of posttraumatic stress disorder (PTSD) compared with those without combat deployments. Veterans in the survey reported suicidal thoughts twice as much than the estimates for the general New York adult population.

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

Many also face physical health challenges. Approximately 20 percent rated their health as “fair” or “poor.” This proportion is higher than estimates for the general population ages 18 to 54, but like those for ages 55 to 64. In addition, nearly two-thirds reported having a Department of Veterans Affairs (VA) disability rating. This suggests veterans experience a greater health burden than the general population of the same age.

Many face challenges getting enough food. Approximately one-quarter of respondents experienced food insecurity in the past year.

Most have some form of health insurance, but this does not necessarily translate into health care access. Ninety-seven percent of respondents had some form of health insurance coverage and over three-quarters can access care through VA, but only 70 percent reported having a “usual” source of care—that is, a primary professional or location that they usually go to when they need health care services.

Many have unmet physical and mental health care needs. Figure 2 breaks this finding down into percentages and the top three barriers to care in each category. The rate of unmet need for mental health services is even higher (39 percent) among those with a probable mental health diagnosis.

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Left panel:

Physical health care: 15% 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

Right panel:

Mental health care: 21% 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 view VA health care services positively. Respondents reported that they had good experiences in both VA facilities and those in the community paid for by VA. Veterans noted that it was easier to schedule convenient appointments with community facilities but that health providers in VA facilities were more likely to understand military culture and the unique health challenges faced by veterans.

A significant proportion reported a preference for community providers over military or VA facilities. The most common reasons included easier access (48.5 percent), better perceived quality of care (43.9 percent), and established relationships with existing providers (39.5 percent).

Many see veterans' benefits helpful but don't use them. Almost 46 percent of survey respondents said that veteran housing assistance and loans are helpful, yet only 20 percent used them. Similarly, job training was seen as helpful (34 percent), while fewer had accessed it (10 percent).

Comparison with 2010 Needs Assessment of Veterans Living in New York

The current study builds on a similar needs assessment conducted in 2010 among recently separated veterans in New York. The comparison of the current survey results with our 2010 study reveals several notable differences in the health and well-being of veterans living in New York. The current cohort of veterans reports higher rates of mental health problems, with 24.5 percent screening positive for depression and 25.5 percent for PTSD, compared with 16 percent for each condition in the prior study. This could represent a higher prevalence of mental health problems, greater awareness of and reduced stigma around mental health, and/or differences in the demographics of the samples. Additionally, the current sample shows more disability, with 62.8 percent having a VA or military disability rating versus 31 percent in 2010, and a higher average percentage disability rating (68.5 percent vs. 38 percent). Despite these increases, the proportion reporting unmet mental health needs remained consistent at around 21 percent. However, the barriers to accessing mental health services have shifted, with more veterans in the current sample reporting not knowing how to find the proper services and believing that the care would not be effective.

Recommendations

Enhance access to and use of mental health services. Consider making available more health professionals trained to work with veterans, integrating mental health services into community and primary care settings, and addressing mental health stigma through innovative media campaigns to improve care uptake.

Continue to prioritize veteran-specific suicide prevention programs. Continued commitment to policies, programs, and research efforts in this area is critical. These include improving the quality and accessibility of data on veteran suicide risk and mortality and on expanding and evaluating veteran-specific approaches to suicide prevention and crisis intervention.

Support veterans' ability to access both VA-based and community-based health care services. Maintaining choice and access to the different care settings is needed to meet the diverse needs of veterans across New York.

Address logistical barriers veterans face to accessing needed health care. Transportation to appointments, more flexible appointment times and locations, and providing additional support through free resources such as the NYS [New York State] Veterans mobile app could help.

Improve and expand outreach and awareness about benefits and services. This could involve partnerships with community organizations and targeted information campaigns advertising existing VA outreach events and services to reach a broader audience, and should include information about all challenges facing veterans, including food insecurity.

Consider the growing diversity of the veteran population. Service providers should receive ongoing training on equity and cultural competence to meet the needs of the current and future veteran population. Programs that explicitly address the unique challenges faced by veteran women, LGBTQ+ veterans, and those from racial and ethnic minority backgrounds are and will be necessary going forward.