The emerging needs of veterans: a call to action for the social work profession.

The needs of the nation's veterans are changing, and as such, the profession of social work will need to adapt to the increasing demand for our services. The U.S. Department of Veterans Affairs (VA) is the largest employer of master's-level social workers in the nation. Social workers have been serving veterans since 1926, when the first social work program in the Veterans Bureau was established. According to Manske (2008), the VA originally hired 36 hospital social workers, with the number increasing to 97 by 1930, and they treated patients with psychiatric illness and tuberculosis. Manske (2008) further stated that "in 1989, Congress elevated the VA to Cabinet status, creating the Department of Veterans Affairs. At that time, more than 3,000 social workers were providing psychosocial and mental health services at 175 VA hospitals" (p. 255). Today, social workers offer a variety of services to veterans and their families, including resource navigation, crisis intervention, advocacy, benefit assistance, and mental health therapy for conditions such as depression, posttraumatic stress disorder (PTSD), and drug and alcohol addiction. Social workers in the VA also ensure continuity of care through admission, evaluation, treatment, and follow-up processes, and they provide assessment, crisis intervention, high-risk screening, discharge planning, case management, advocacy, and education to veterans and their families. THE CHANGING FACE OF WAR The United States has been engaged in Operation Enduring Freedom (OEF) in Afghanistan since 2001 and in Operation Iraqi Freedom (OIF) in Iraq since 2003, with 1.64 million troops serving in these wars (Jaycox & Tanielian, 2008). As of May 2008, more than 4,100 American troops had died in Iraq and Afghanistan, and 31,850 troops had been physically wounded in the two wars (Give an Hour, 2009). In past conflicts, such as World War II, people who experienced serious physical and mental trauma often did not survive long enough to deal with the repercussions of the event. With advances in medical technology and body armor, more service members are surviving experiences that would have led to death in prior wars (Jaycox & Tanielian, 2008). Nearly all U.S. soldiers wear 16-pound Interceptor body armor, and as a result, 15 out of 16 seriously wounded service members survive injuries that would have been fatal in previous wars. During the Vietnam era, only five out of eight injured soldiers survived (Stiglitz & Bilmes, 2008). New casualties are emerging in the form of veterans with mental health conditions and cognitive health impairments. Another issue of deep concern is the length of deployments and numerous redeployments facing soldiers who may already be dealing with a mental health disorder. Deployments have become longer, redeployment to combat is common, and breaks between deployments are infrequent (Jaycox & Tanielian, 2008). Williamson and Mulhan (2009) stated that since September 11,2001, troops have regularly had their tours extended and as of June 2008, more than 638,000 troops have been deployed more than once. U.S. soldiers serving in Iraq have essentially spent their entire deployment engaged in round the clock combat operations. According to the Army's Mental Health Advisory Team, soldiers deployed to Iraq for more than six months, or deployed more than once, are much more likely to be diagnosed with psychological injuries (Mental Health Advisory Team V, 2008). In surveys of troops redeploying to Iraq, 20 percent to 40 percent "still had symptoms of past concussions, including headaches, sleep problems, depression, and memory difficulties. Even after getting home, those who had deployed for longer periods are still at higher risk for PTSD" (Williamson & Mulhall, 2009). THE EMERGING NEEDS OF VETERANS Because of the often traumatic experience of serving in combat, our nation's veterans have unique mental health needs related to PTSD, traumatic brain injury (TBI), depression, and anxiety, among other issues. …