Jan Dyer

A recent worldwide survey found the United States to have the highest reported prevalence of type 2 diabetes mellitus (T2DM) among young people aged 10 to 19 years. Research on the prevalence of the disease among Indigenous populations is scarce, however, leaving these individuals at a potentially greater risk.

The estimated prevalence of T2DM has nearly doubled over the past 2 decades, with cases per 1000 youths aged 10 to 19 years increasing from 0.34 in 2001 to 0.46 in 2009 to 0.67 in 2017, a relative increase of 95.3% over 16 years. In 2012, the SEARCH study of youth-onset T2DM found American Indians and non-Hispanic Black individuals had the highest incidence (46.5/100,000/year in American Indians and 32.6/100,000/year in non-Hispanic Black individuals), compared with non-Hispanic White individuals (3.9/100,000/year).

About 28,000 US youth aged < 20 years had T2DM in 2017, a figure expected to reach 48,000 in 2060 based on increasing prevalence and incidence rates. Assuming the trends observed between 2002 and 2017 continue, an estimated 220,000 young people will have T2DM. 

However, the lack of recent research of T2DM in young indigenous populations may have masked a serious problem among Native Americans. A 2025 literature review of 49 studies call it a “type 2 diabetes crisis” among Indigenous communities; not because of the disease, but due to high rates of complications. Though Indigenous peoples are estimated to inhabit > 90 countries and collectively represent > 370 million people, the studies included in the review involved individuals from 6 countries and 2 self-governing states (US, Canada, Australia, Aotearoa New Zealand, Nauru, Argentina, the Cook Islands, and Niue) and at least 45 Indigenous populations after search criteria were satisfied. Data were derived from population-based screening and health databases, including from 432 IHS facilities and 6 IHS regions.

Of the study populations, 27 (75%) reported diabetes prevalence above 1 per 1000. Age-specific data, available in 44 studies, showed increased prevalence with age: 0 to 4 per 1000 at age < 10 years; 0 to 44 per 1000 at age 10 to 19 years; and 0 to 64 per 1000 at age 15 to 25 years. 

In young adults aged 15 to 25 years, prevalence was highest in Akimel O’odham and Tohono O’odham Peoples from the Gila River Indian Community in Arizona. Among children aged < 10 years, the highest prevalence was reported in Cherokee Nation children. Some groups reported no diabetes, such as the Northern Plains Indians from Montana and Wyoming.

Statistics showing the speed of expanding prevalence were particularly notable. For Akimel O’odham and Tohono O’odham Indian youth, diabetes prevalence increased more than eightfold over 2 decades (particularly in those aged < 15).

A 2021 study of 500 participants who were diagnosed with T2DM in youth were followed for a mean of 13 years. By the time they were 26, 67.5% had hypertension, 51.6% had dyslipidemia, 54.8% had diabetic kidney disease, and 32.4% had nerve disease. 

Indigenous North American children may also have an even greater risk for later complications. A Canadian study found that among Canadian First Nations Peoples the incidence of end-stage kidney disease was 2.8 times higher and the mortality rate was double that of non-Indigenous people with youth-onset T2DM despite similar age at diagnosis and duration of disease. 

To combat the steady increase of T2DM prevalence among Indigenous youth, researchers advise “urgent action” to improve data equity through the inclusion of Indigenous populations in health surveillance, routine disaggregation by Indigenous status, and culturally safe research partnerships led by Indigenous communities. Standardized age group classifications, age- and gender-specific reporting, and assessment of comorbid obesity are essential, they add, to define health care needs and identify regions that would benefit from enhanced early detection and management.

A recent worldwide survey found the United States to have the highest reported prevalence of type 2 diabetes mellitus (T2DM) among young people aged 10 to 19 years. Research on the prevalence of the disease among Indigenous populations is scarce, however, leaving these individuals at a potentially greater risk.

The estimated prevalence of T2DM has nearly doubled over the past 2 decades, with cases per 1000 youths aged 10 to 19 years increasing from 0.34 in 2001 to 0.46 in 2009 to 0.67 in 2017, a relative increase of 95.3% over 16 years. In 2012, the SEARCH study of youth-onset T2DM found American Indians and non-Hispanic Black individuals had the highest incidence (46.5/100,000/year in American Indians and 32.6/100,000/year in non-Hispanic Black individuals), compared with non-Hispanic White individuals (3.9/100,000/year).

About 28,000 US youth aged < 20 years had T2DM in 2017, a figure expected to reach 48,000 in 2060 based on increasing prevalence and incidence rates. Assuming the trends observed between 2002 and 2017 continue, an estimated 220,000 young people will have T2DM. 

However, the lack of recent research of T2DM in young indigenous populations may have masked a serious problem among Native Americans. A 2025 literature review of 49 studies call it a “type 2 diabetes crisis” among Indigenous communities; not because of the disease, but due to high rates of complications. Though Indigenous peoples are estimated to inhabit > 90 countries and collectively represent > 370 million people, the studies included in the review involved individuals from 6 countries and 2 self-governing states (US, Canada, Australia, Aotearoa New Zealand, Nauru, Argentina, the Cook Islands, and Niue) and at least 45 Indigenous populations after search criteria were satisfied. Data were derived from population-based screening and health databases, including from 432 IHS facilities and 6 IHS regions.

Of the study populations, 27 (75%) reported diabetes prevalence above 1 per 1000. Age-specific data, available in 44 studies, showed increased prevalence with age: 0 to 4 per 1000 at age < 10 years; 0 to 44 per 1000 at age 10 to 19 years; and 0 to 64 per 1000 at age 15 to 25 years. 

In young adults aged 15 to 25 years, prevalence was highest in Akimel O’odham and Tohono O’odham Peoples from the Gila River Indian Community in Arizona. Among children aged < 10 years, the highest prevalence was reported in Cherokee Nation children. Some groups reported no diabetes, such as the Northern Plains Indians from Montana and Wyoming.

Statistics showing the speed of expanding prevalence were particularly notable. For Akimel O’odham and Tohono O’odham Indian youth, diabetes prevalence increased more than eightfold over 2 decades (particularly in those aged < 15).

A 2021 study of 500 participants who were diagnosed with T2DM in youth were followed for a mean of 13 years. By the time they were 26, 67.5% had hypertension, 51.6% had dyslipidemia, 54.8% had diabetic kidney disease, and 32.4% had nerve disease. 

Indigenous North American children may also have an even greater risk for later complications. A Canadian study found that among Canadian First Nations Peoples the incidence of end-stage kidney disease was 2.8 times higher and the mortality rate was double that of non-Indigenous people with youth-onset T2DM despite similar age at diagnosis and duration of disease. 

To combat the steady increase of T2DM prevalence among Indigenous youth, researchers advise “urgent action” to improve data equity through the inclusion of Indigenous populations in health surveillance, routine disaggregation by Indigenous status, and culturally safe research partnerships led by Indigenous communities. Standardized age group classifications, age- and gender-specific reporting, and assessment of comorbid obesity are essential, they add, to define health care needs and identify regions that would benefit from enhanced early detection and management.

A recent worldwide survey found the United States to have the highest reported prevalence of type 2 diabetes mellitus (T2DM) among young people aged 10 to 19 years. Research on the prevalence of the disease among Indigenous populations is scarce, however, leaving these individuals at a potentially greater risk.

The estimated prevalence of T2DM has nearly doubled over the past 2 decades, with cases per 1000 youths aged 10 to 19 years increasing from 0.34 in 2001 to 0.46 in 2009 to 0.67 in 2017, a relative increase of 95.3% over 16 years. In 2012, the SEARCH study of youth-onset T2DM found American Indians and non-Hispanic Black individuals had the highest incidence (46.5/100,000/year in American Indians and 32.6/100,000/year in non-Hispanic Black individuals), compared with non-Hispanic White individuals (3.9/100,000/year).

About 28,000 US youth aged < 20 years had T2DM in 2017, a figure expected to reach 48,000 in 2060 based on increasing prevalence and incidence rates. Assuming the trends observed between 2002 and 2017 continue, an estimated 220,000 young people will have T2DM. 

However, the lack of recent research of T2DM in young indigenous populations may have masked a serious problem among Native Americans. A 2025 literature review of 49 studies call it a “type 2 diabetes crisis” among Indigenous communities; not because of the disease, but due to high rates of complications. Though Indigenous peoples are estimated to inhabit > 90 countries and collectively represent > 370 million people, the studies included in the review involved individuals from 6 countries and 2 self-governing states (US, Canada, Australia, Aotearoa New Zealand, Nauru, Argentina, the Cook Islands, and Niue) and at least 45 Indigenous populations after search criteria were satisfied. Data were derived from population-based screening and health databases, including from 432 IHS facilities and 6 IHS regions.

Of the study populations, 27 (75%) reported diabetes prevalence above 1 per 1000. Age-specific data, available in 44 studies, showed increased prevalence with age: 0 to 4 per 1000 at age < 10 years; 0 to 44 per 1000 at age 10 to 19 years; and 0 to 64 per 1000 at age 15 to 25 years. 

In young adults aged 15 to 25 years, prevalence was highest in Akimel O’odham and Tohono O’odham Peoples from the Gila River Indian Community in Arizona. Among children aged < 10 years, the highest prevalence was reported in Cherokee Nation children. Some groups reported no diabetes, such as the Northern Plains Indians from Montana and Wyoming.

Statistics showing the speed of expanding prevalence were particularly notable. For Akimel O’odham and Tohono O’odham Indian youth, diabetes prevalence increased more than eightfold over 2 decades (particularly in those aged < 15).

A 2021 study of 500 participants who were diagnosed with T2DM in youth were followed for a mean of 13 years. By the time they were 26, 67.5% had hypertension, 51.6% had dyslipidemia, 54.8% had diabetic kidney disease, and 32.4% had nerve disease. 

Indigenous North American children may also have an even greater risk for later complications. A Canadian study found that among Canadian First Nations Peoples the incidence of end-stage kidney disease was 2.8 times higher and the mortality rate was double that of non-Indigenous people with youth-onset T2DM despite similar age at diagnosis and duration of disease. 

To combat the steady increase of T2DM prevalence among Indigenous youth, researchers advise “urgent action” to improve data equity through the inclusion of Indigenous populations in health surveillance, routine disaggregation by Indigenous status, and culturally safe research partnerships led by Indigenous communities. Standardized age group classifications, age- and gender-specific reporting, and assessment of comorbid obesity are essential, they add, to define health care needs and identify regions that would benefit from enhanced early detection and management.

According to the National Institute on Drug Abuse, > 1 in 10 veterans have been diagnosed with substance use disorder (SUD). Additionally, 7 out of every 100 veterans will have posttraumatic stress disorder (PTSD) at some point in their life, per research from the US Department of Veterans Affairs (VA). However, a common and perhaps unsuspected parallel is found in those statistics: loneliness.

Of the 4069 veterans who participated in the 2019-2020 National Health and Resilience in Veterans Survey, 56.9% reported they felt lonely sometimes or often, while 1 in 5 reported feeling lonely often.

An Epidemic

In his 2023 advisory, Former US Surgeon General Vivek Murthy called it an epidemic noting that when he spoke with veterans during a cross-country listening tour, he heard how they felt “isolated, invisible, and insignificant.” About 1 in 2 adults in America experience loneliness, even before the COVID-19 pandemic isolation.

Loneliness can have individual and synergistic ill effects, including a greater risk of cardiovascular disease, dementia, stroke, depression, anxiety, and premature death. It also can both trigger and exacerbate substance use and PTSD.

A study using data from the RAND Health and Retirement Study Longitudinal File 2020 (N = 5259) found significant associations between loneliness and being unmarried/unpartnered, and greater depressive symptoms for both veterans and civilians, as well as significant negative associations between loneliness and greater life satisfaction and positive affect. Health conditions that limited an individual's ability to work was a “unique risk factor for loneliness among veterans.”

The National Health and Resilience in Veterans Study found that those aged ≤ 50 years were 3 times more likely to screen positive for PTSD compared to older veterans. In a survey of 409 veterans, many who engaged in problematic substance use during the COVID-19 pandemic reported that despite having social supports they still felt lonely. In regression analyses, higher levels of loneliness were associated with more negative impacts of the pandemic, greater substance use, and poorer physical and mental health functioning.

Addressing Loneliness

Researchers believe an answer to some mental health and substance abuse problems may lie in addressing loneliness. Positive psychology is providing promising results in the treatment of SUD. Bryant Stone, from the Johns Hopkins Bloomberg School of Public Health, emphasizes focusing on well-being and quality of life rather than solely on abstinence with “positive psychological interventions,” or activities and behavioral interventions that target positive variables to promote adaptive functioning.

Veterans can face tough challenges as they rejoin civilian life. How successfully they meet and conquer those challenges, especially if they include drug problems, may directly relate to their general feeling of well-being.

The PERMA model outlines 5 core elements to assess well-being: Positive emotions, Engagement, Relationships, Meaning, and Accomplishment. A study based on that model found loneliness to be a “particularly significant factor” among key variables influencing the prevention and treatment of SUDs. The study of 156 veterans with self-reported mental health conditions found the ability to engage in social roles and activities was positively correlated with overall well-being and negatively correlated with degree of problems related to drug abuse. 

Rural Veterans

The estimated 4.4 million veterans living in rural communities may benefit most from interventions that tackle isolation. Compared with urban counterparts, they’re more likely to be older, have more complex medical issues, have a service-connected disability, and be unemployed. Those factors, compounded by geographical and social isolation, can have a substantial impact on well-being.

A study centered on the initial validation of a short (5-item) version of PERMA found that individuals who scored higher on the short form tended to report higher levels of optimism, resilience, and happiness. Thus, the short form may be particularly useful for rural veterans who do not always have easy access to health care.

VA has instituted a variety of programs to encourage and support social connection. During the COVID-19 pandemic, telehealth interventions targeted social support and loneliness among veterans—albeit with mixed results. VA CONNECT, a 10-session group telehealth intervention that integrated peer support, did not show significant changes in loneliness, but did significantly reduce perceived stress. 

Another initiative, Compassionate Contact Corps, trained volunteers made weekly phone calls aimed at reducing loneliness and fostering social connection. Started in Columbus, Ohio, in 2020, > 80 sites had adopted the initiative by 2021, with 310 volunteers, 5320 visits, and 4757 hours spent with veterans.

In 2014, VA peer specialists developed and co-hosted Veterans Socials through community partnerships between VA, veteran-serving organizations, and veteran community leaders. As of 2025, 178 known Veterans Socials were spread across 26 states and territories.

The researchers say their case examples collectively demonstrate that Veterans Socials have the potential to serve as a vital platform for peer support, resource sharing, and health service use among veterans. Virtual Veterans Socials also provided hosts with a channel to reach potentially isolated veterans who might not otherwise access services while simultaneously offering veterans an opportunity for social connection.

According to the National Institute on Drug Abuse, > 1 in 10 veterans have been diagnosed with substance use disorder (SUD). Additionally, 7 out of every 100 veterans will have posttraumatic stress disorder (PTSD) at some point in their life, per research from the US Department of Veterans Affairs (VA). However, a common and perhaps unsuspected parallel is found in those statistics: loneliness.

Of the 4069 veterans who participated in the 2019-2020 National Health and Resilience in Veterans Survey, 56.9% reported they felt lonely sometimes or often, while 1 in 5 reported feeling lonely often.

An Epidemic

In his 2023 advisory, Former US Surgeon General Vivek Murthy called it an epidemic noting that when he spoke with veterans during a cross-country listening tour, he heard how they felt “isolated, invisible, and insignificant.” About 1 in 2 adults in America experience loneliness, even before the COVID-19 pandemic isolation.

Loneliness can have individual and synergistic ill effects, including a greater risk of cardiovascular disease, dementia, stroke, depression, anxiety, and premature death. It also can both trigger and exacerbate substance use and PTSD.

A study using data from the RAND Health and Retirement Study Longitudinal File 2020 (N = 5259) found significant associations between loneliness and being unmarried/unpartnered, and greater depressive symptoms for both veterans and civilians, as well as significant negative associations between loneliness and greater life satisfaction and positive affect. Health conditions that limited an individual's ability to work was a “unique risk factor for loneliness among veterans.”

The National Health and Resilience in Veterans Study found that those aged ≤ 50 years were 3 times more likely to screen positive for PTSD compared to older veterans. In a survey of 409 veterans, many who engaged in problematic substance use during the COVID-19 pandemic reported that despite having social supports they still felt lonely. In regression analyses, higher levels of loneliness were associated with more negative impacts of the pandemic, greater substance use, and poorer physical and mental health functioning.

Addressing Loneliness

Researchers believe an answer to some mental health and substance abuse problems may lie in addressing loneliness. Positive psychology is providing promising results in the treatment of SUD. Bryant Stone, from the Johns Hopkins Bloomberg School of Public Health, emphasizes focusing on well-being and quality of life rather than solely on abstinence with “positive psychological interventions,” or activities and behavioral interventions that target positive variables to promote adaptive functioning.

Veterans can face tough challenges as they rejoin civilian life. How successfully they meet and conquer those challenges, especially if they include drug problems, may directly relate to their general feeling of well-being.

The PERMA model outlines 5 core elements to assess well-being: Positive emotions, Engagement, Relationships, Meaning, and Accomplishment. A study based on that model found loneliness to be a “particularly significant factor” among key variables influencing the prevention and treatment of SUDs. The study of 156 veterans with self-reported mental health conditions found the ability to engage in social roles and activities was positively correlated with overall well-being and negatively correlated with degree of problems related to drug abuse. 

Rural Veterans

The estimated 4.4 million veterans living in rural communities may benefit most from interventions that tackle isolation. Compared with urban counterparts, they’re more likely to be older, have more complex medical issues, have a service-connected disability, and be unemployed. Those factors, compounded by geographical and social isolation, can have a substantial impact on well-being.

A study centered on the initial validation of a short (5-item) version of PERMA found that individuals who scored higher on the short form tended to report higher levels of optimism, resilience, and happiness. Thus, the short form may be particularly useful for rural veterans who do not always have easy access to health care.

VA has instituted a variety of programs to encourage and support social connection. During the COVID-19 pandemic, telehealth interventions targeted social support and loneliness among veterans—albeit with mixed results. VA CONNECT, a 10-session group telehealth intervention that integrated peer support, did not show significant changes in loneliness, but did significantly reduce perceived stress. 

Another initiative, Compassionate Contact Corps, trained volunteers made weekly phone calls aimed at reducing loneliness and fostering social connection. Started in Columbus, Ohio, in 2020, > 80 sites had adopted the initiative by 2021, with 310 volunteers, 5320 visits, and 4757 hours spent with veterans.

In 2014, VA peer specialists developed and co-hosted Veterans Socials through community partnerships between VA, veteran-serving organizations, and veteran community leaders. As of 2025, 178 known Veterans Socials were spread across 26 states and territories.

The researchers say their case examples collectively demonstrate that Veterans Socials have the potential to serve as a vital platform for peer support, resource sharing, and health service use among veterans. Virtual Veterans Socials also provided hosts with a channel to reach potentially isolated veterans who might not otherwise access services while simultaneously offering veterans an opportunity for social connection.

According to the National Institute on Drug Abuse, > 1 in 10 veterans have been diagnosed with substance use disorder (SUD). Additionally, 7 out of every 100 veterans will have posttraumatic stress disorder (PTSD) at some point in their life, per research from the US Department of Veterans Affairs (VA). However, a common and perhaps unsuspected parallel is found in those statistics: loneliness.

Of the 4069 veterans who participated in the 2019-2020 National Health and Resilience in Veterans Survey, 56.9% reported they felt lonely sometimes or often, while 1 in 5 reported feeling lonely often.

An Epidemic

In his 2023 advisory, Former US Surgeon General Vivek Murthy called it an epidemic noting that when he spoke with veterans during a cross-country listening tour, he heard how they felt “isolated, invisible, and insignificant.” About 1 in 2 adults in America experience loneliness, even before the COVID-19 pandemic isolation.

Loneliness can have individual and synergistic ill effects, including a greater risk of cardiovascular disease, dementia, stroke, depression, anxiety, and premature death. It also can both trigger and exacerbate substance use and PTSD.

A study using data from the RAND Health and Retirement Study Longitudinal File 2020 (N = 5259) found significant associations between loneliness and being unmarried/unpartnered, and greater depressive symptoms for both veterans and civilians, as well as significant negative associations between loneliness and greater life satisfaction and positive affect. Health conditions that limited an individual's ability to work was a “unique risk factor for loneliness among veterans.”

The National Health and Resilience in Veterans Study found that those aged ≤ 50 years were 3 times more likely to screen positive for PTSD compared to older veterans. In a survey of 409 veterans, many who engaged in problematic substance use during the COVID-19 pandemic reported that despite having social supports they still felt lonely. In regression analyses, higher levels of loneliness were associated with more negative impacts of the pandemic, greater substance use, and poorer physical and mental health functioning.

Addressing Loneliness

Researchers believe an answer to some mental health and substance abuse problems may lie in addressing loneliness. Positive psychology is providing promising results in the treatment of SUD. Bryant Stone, from the Johns Hopkins Bloomberg School of Public Health, emphasizes focusing on well-being and quality of life rather than solely on abstinence with “positive psychological interventions,” or activities and behavioral interventions that target positive variables to promote adaptive functioning.

Veterans can face tough challenges as they rejoin civilian life. How successfully they meet and conquer those challenges, especially if they include drug problems, may directly relate to their general feeling of well-being.

The PERMA model outlines 5 core elements to assess well-being: Positive emotions, Engagement, Relationships, Meaning, and Accomplishment. A study based on that model found loneliness to be a “particularly significant factor” among key variables influencing the prevention and treatment of SUDs. The study of 156 veterans with self-reported mental health conditions found the ability to engage in social roles and activities was positively correlated with overall well-being and negatively correlated with degree of problems related to drug abuse. 

Rural Veterans

The estimated 4.4 million veterans living in rural communities may benefit most from interventions that tackle isolation. Compared with urban counterparts, they’re more likely to be older, have more complex medical issues, have a service-connected disability, and be unemployed. Those factors, compounded by geographical and social isolation, can have a substantial impact on well-being.

A study centered on the initial validation of a short (5-item) version of PERMA found that individuals who scored higher on the short form tended to report higher levels of optimism, resilience, and happiness. Thus, the short form may be particularly useful for rural veterans who do not always have easy access to health care.

VA has instituted a variety of programs to encourage and support social connection. During the COVID-19 pandemic, telehealth interventions targeted social support and loneliness among veterans—albeit with mixed results. VA CONNECT, a 10-session group telehealth intervention that integrated peer support, did not show significant changes in loneliness, but did significantly reduce perceived stress. 

Another initiative, Compassionate Contact Corps, trained volunteers made weekly phone calls aimed at reducing loneliness and fostering social connection. Started in Columbus, Ohio, in 2020, > 80 sites had adopted the initiative by 2021, with 310 volunteers, 5320 visits, and 4757 hours spent with veterans.

In 2014, VA peer specialists developed and co-hosted Veterans Socials through community partnerships between VA, veteran-serving organizations, and veteran community leaders. As of 2025, 178 known Veterans Socials were spread across 26 states and territories.

The researchers say their case examples collectively demonstrate that Veterans Socials have the potential to serve as a vital platform for peer support, resource sharing, and health service use among veterans. Virtual Veterans Socials also provided hosts with a channel to reach potentially isolated veterans who might not otherwise access services while simultaneously offering veterans an opportunity for social connection.

Despite the ongoing shutdown of the US federal government, the Indian Health Service (IHS) continues to maintain the status quo while operating on an island of relatively insulated stability.

“IHS will continue to operate business-as-usual during a lapse of appropriations,” US Department of Health and Human Services press secretary Emily G. Hilliard said at a recent meeting with the National Congress of American Indians (NCAI). “100% of IHS staff will report for work, and health care services across Indian Country will not be impacted.” 

The protective cocoon around IHS and its services provided is largely due to advance appropriations, and lessons learned from previous government shutdowns. During the historically long 35-day government shutdown in 2018 and 2019, all federal government operations had to halt operations unless they were deemed indispensable. IHS was not considered indispensable and consequently, about 60% of IHS employees did not receive a paycheck.

In preparation for another potential shutdown in 2023, IHS was more proactive. “Because of the fact that now we have advanced appropriations for Indian Health Services, on Oct. 1, whether or not there’s a federal budget in place, will continue providing services,” then-HHS Secretary Xavier Becerra, said at the time.

The safeguards have held for the current shutdown, aided by tribal pressure. As the federal shutdown loomed in September, a delegation led by NCAI spent 3 days lobbying Congress—focusing primarily on the new leadership in the Senate Indian Affairs Committee—to guarantee some protection for federal employees who work with tribal governments.

At the quarterly meeting of the United Indian Nations of Oklahoma (UINO) in Tulsa, Rear Adm. Travis Watts, director of the IHS Oklahoma City Area and a citizen of the Choctaw Nation of Oklahoma, told attendees, “The advance appropriations allow us to keep our doors open at this particular time. We want to thank the tribal nations for their advocacy for those advance appropriations.”

IHS is funded through 2026. All 14,801 IHS staff will be paid through advance appropriations, multi-year or supplemental appropriations, third-party collections, or carryover balances. 

However, according to the proposed 2026 budget some key health-related funding is at risk, including about $128 million in Tribal set-aside funding for mental and behavioral health funding: $60 million from the Tribal Opioid Response Grants, $22.75 million from Tribal Behavioral Health Grants, $14.5 million from Medication-Assisted Treatment for Prescription and Opioid Addiction, and $3.4 million Tribal set-aside for the Zero Suicide program. Six IHS accounts are not funded by advance appropriations: Electronic Health Record System, Indian Health Care Improvement Fund, Contract Support Costs, Payments for Tribal Leases, Sanitation Facilities Construction, and Health Care Facilities Construction.

In a public statement, Cherokee Nation Principal Chief Chuck Hoskin Jr. said, “[W]e’re hopeful that Congress’ foresight to provide an advance appropriation for the Indian Health Service will prevent any severe disruptions as experienced during the 2013 and 2018 shutdowns. I urge both sides of the aisle to work on a path forward and reopen the government as soon as possible and call on the administration to honor the government’s Treaty and Trust responsibilities, avoid needless cuts to Tribal programs and personnel, and use its authorities to minimize harm to tribes and tribal citizens.”

Hoskin Jr. cautioned, though, that not every tribe has the same resources. Many smaller, direct-service tribes depend entirely on IHS to deliver care.

“Thank goodness for forward funding,” he said. “But we have to make that permanent in federal statute. No one in this country should be at the mercy of political dysfunction to get health care. “The United States can keep its lights off,” Hoskin Jr. said. “We’ll still be moving forward.”

Despite the ongoing shutdown of the US federal government, the Indian Health Service (IHS) continues to maintain the status quo while operating on an island of relatively insulated stability.

“IHS will continue to operate business-as-usual during a lapse of appropriations,” US Department of Health and Human Services press secretary Emily G. Hilliard said at a recent meeting with the National Congress of American Indians (NCAI). “100% of IHS staff will report for work, and health care services across Indian Country will not be impacted.” 

The protective cocoon around IHS and its services provided is largely due to advance appropriations, and lessons learned from previous government shutdowns. During the historically long 35-day government shutdown in 2018 and 2019, all federal government operations had to halt operations unless they were deemed indispensable. IHS was not considered indispensable and consequently, about 60% of IHS employees did not receive a paycheck.

In preparation for another potential shutdown in 2023, IHS was more proactive. “Because of the fact that now we have advanced appropriations for Indian Health Services, on Oct. 1, whether or not there’s a federal budget in place, will continue providing services,” then-HHS Secretary Xavier Becerra, said at the time.

The safeguards have held for the current shutdown, aided by tribal pressure. As the federal shutdown loomed in September, a delegation led by NCAI spent 3 days lobbying Congress—focusing primarily on the new leadership in the Senate Indian Affairs Committee—to guarantee some protection for federal employees who work with tribal governments.

At the quarterly meeting of the United Indian Nations of Oklahoma (UINO) in Tulsa, Rear Adm. Travis Watts, director of the IHS Oklahoma City Area and a citizen of the Choctaw Nation of Oklahoma, told attendees, “The advance appropriations allow us to keep our doors open at this particular time. We want to thank the tribal nations for their advocacy for those advance appropriations.”

IHS is funded through 2026. All 14,801 IHS staff will be paid through advance appropriations, multi-year or supplemental appropriations, third-party collections, or carryover balances. 

However, according to the proposed 2026 budget some key health-related funding is at risk, including about $128 million in Tribal set-aside funding for mental and behavioral health funding: $60 million from the Tribal Opioid Response Grants, $22.75 million from Tribal Behavioral Health Grants, $14.5 million from Medication-Assisted Treatment for Prescription and Opioid Addiction, and $3.4 million Tribal set-aside for the Zero Suicide program. Six IHS accounts are not funded by advance appropriations: Electronic Health Record System, Indian Health Care Improvement Fund, Contract Support Costs, Payments for Tribal Leases, Sanitation Facilities Construction, and Health Care Facilities Construction.

In a public statement, Cherokee Nation Principal Chief Chuck Hoskin Jr. said, “[W]e’re hopeful that Congress’ foresight to provide an advance appropriation for the Indian Health Service will prevent any severe disruptions as experienced during the 2013 and 2018 shutdowns. I urge both sides of the aisle to work on a path forward and reopen the government as soon as possible and call on the administration to honor the government’s Treaty and Trust responsibilities, avoid needless cuts to Tribal programs and personnel, and use its authorities to minimize harm to tribes and tribal citizens.”

Hoskin Jr. cautioned, though, that not every tribe has the same resources. Many smaller, direct-service tribes depend entirely on IHS to deliver care.

“Thank goodness for forward funding,” he said. “But we have to make that permanent in federal statute. No one in this country should be at the mercy of political dysfunction to get health care. “The United States can keep its lights off,” Hoskin Jr. said. “We’ll still be moving forward.”

Despite the ongoing shutdown of the US federal government, the Indian Health Service (IHS) continues to maintain the status quo while operating on an island of relatively insulated stability.

“IHS will continue to operate business-as-usual during a lapse of appropriations,” US Department of Health and Human Services press secretary Emily G. Hilliard said at a recent meeting with the National Congress of American Indians (NCAI). “100% of IHS staff will report for work, and health care services across Indian Country will not be impacted.” 

The protective cocoon around IHS and its services provided is largely due to advance appropriations, and lessons learned from previous government shutdowns. During the historically long 35-day government shutdown in 2018 and 2019, all federal government operations had to halt operations unless they were deemed indispensable. IHS was not considered indispensable and consequently, about 60% of IHS employees did not receive a paycheck.

In preparation for another potential shutdown in 2023, IHS was more proactive. “Because of the fact that now we have advanced appropriations for Indian Health Services, on Oct. 1, whether or not there’s a federal budget in place, will continue providing services,” then-HHS Secretary Xavier Becerra, said at the time.

The safeguards have held for the current shutdown, aided by tribal pressure. As the federal shutdown loomed in September, a delegation led by NCAI spent 3 days lobbying Congress—focusing primarily on the new leadership in the Senate Indian Affairs Committee—to guarantee some protection for federal employees who work with tribal governments.

At the quarterly meeting of the United Indian Nations of Oklahoma (UINO) in Tulsa, Rear Adm. Travis Watts, director of the IHS Oklahoma City Area and a citizen of the Choctaw Nation of Oklahoma, told attendees, “The advance appropriations allow us to keep our doors open at this particular time. We want to thank the tribal nations for their advocacy for those advance appropriations.”

IHS is funded through 2026. All 14,801 IHS staff will be paid through advance appropriations, multi-year or supplemental appropriations, third-party collections, or carryover balances. 

However, according to the proposed 2026 budget some key health-related funding is at risk, including about $128 million in Tribal set-aside funding for mental and behavioral health funding: $60 million from the Tribal Opioid Response Grants, $22.75 million from Tribal Behavioral Health Grants, $14.5 million from Medication-Assisted Treatment for Prescription and Opioid Addiction, and $3.4 million Tribal set-aside for the Zero Suicide program. Six IHS accounts are not funded by advance appropriations: Electronic Health Record System, Indian Health Care Improvement Fund, Contract Support Costs, Payments for Tribal Leases, Sanitation Facilities Construction, and Health Care Facilities Construction.

In a public statement, Cherokee Nation Principal Chief Chuck Hoskin Jr. said, “[W]e’re hopeful that Congress’ foresight to provide an advance appropriation for the Indian Health Service will prevent any severe disruptions as experienced during the 2013 and 2018 shutdowns. I urge both sides of the aisle to work on a path forward and reopen the government as soon as possible and call on the administration to honor the government’s Treaty and Trust responsibilities, avoid needless cuts to Tribal programs and personnel, and use its authorities to minimize harm to tribes and tribal citizens.”

Hoskin Jr. cautioned, though, that not every tribe has the same resources. Many smaller, direct-service tribes depend entirely on IHS to deliver care.

“Thank goodness for forward funding,” he said. “But we have to make that permanent in federal statute. No one in this country should be at the mercy of political dysfunction to get health care. “The United States can keep its lights off,” Hoskin Jr. said. “We’ll still be moving forward.”

Veterans at risk of suicide may not share their suicidal ideation with their psychotherapists or may choose not to disclose enough detail to illustrate the depths of those thoughts due to feelings of shame or embarrassment, according to a newly published study. These individuals may view suicidal thoughts as a sign of weakness, fear involuntary hospitalization or prescriptions, or belong to marginalized groups who do not feel comfortable (or safe) to reveal their thoughts or intentions. This can make it difficult for mental health professionals to identify the exact details of a patient’s mindset and provide appropriate care. 

A veteran’s first—and sometimes only—stop may be their primary care practitioner (PCPs) rather than a mental health professional. A review of 40 studies found that although 45% of individuals who died by suicide had contact with PCPs within 1 month of their death, only 19% had contact with mental health services. Studies have also found that veterans disclose suicidal ideation during primary care visits closest to the actual suicide less than half the time.

Patients may have an appointment for medical, but not psychological reasons. In a study conducted at Portland Veterans Affairs Medical Center (VAMC), researchers reviewed the medical records of 112 veterans who died by suicide and had contact with a VAMC within 1 year prior to death. Of those last contacts, 32% were patient-initiated for new or exacerbated medical concerns, and 68% were follow-ups. 

In that study, health care professionals (HCPs) noted that 41 patients (37%) were experiencing emotional distress at the last contact, but 13 of 18 patients (72%) who were assessed for suicidal ideation at their last contact denied such thoughts. The study says this finding “highlights the complexity of addressing suicidal ideation and associated risk factors in health care settings.” Additionally, a number of veterans who died by suicide either did not have suicidal thoughts  at the time of their last contact with HCPs or denied such thoughts even when questioned. 

In 2018, the Veterans Health Administration (VHA) implemented the Suicide Risk Identification Strategy (Risk ID), an evidence-informed assessment that includes initial screening and subsequent evaluation. Veterans receiving VHA care are screened annually for suicidal ideation and behaviors. Most screening takes place in primary care and mental health specialty settings, but timely screening may not be enough to assess who is at risk if the patients aren’t being forthcoming about their thoughts and plans.

A recent cross-sectional national survey examined the frequency of self-reported “inaccurate disclosure” of suicidal ideation during initial screening and subsequent evaluation among 734 VHA patients screened in primary care.

Using the Risk ID process with the Columbia Suicide Severity Rating Scale Screener (C-SSRS), the study asked respondents about their previous suicide screening in 2021. Of the 734 respondents, 306 screened positive and 428 screened negative. One survey item asked about the extent to which veterans had accurately responded to the HCP when asked about suicidal thoughts, while another asked how likely they would discuss when they felt suicidal with their PCP.

The study found that inaccurate disclosure is not uncommon: When asked about suicidal thoughts, about one-fifth of screen-negative participants and two-fifths of screen-positive participants said they responded, “less than very accurately.”

In the screen-positive group, women and those who reported more barriers to care were less likely to discuss feeling suicidal. Veterans who had lower ratings of satisfaction with the screening process, patient-staff communication, and the therapeutic relationship reported being less likely to discuss times they were suicidal. Notably, among C-SSRS-negative patients, Black, American Indian/Alaska Native, Hispanic, Asian, and multiracial veterans were more likely than White veterans to inaccurately report suicidal thoughts. 

This is consistent with studies on medical mistrust and other research suggesting that veterans who have experienced identity-based discrimination may be less inclined to discuss suicidal thoughts with VHA HCPs. A large 2023 study surveyed veterans about why they might hold back such information. One Gulf War-era veteran, a Black woman, had encountered discrimination when filing her VA benefits claim, leading her to feel like the care system was not interested in helping her.

“It’s one of the main reasons why when I do go in, they don’t get an honest response,” she wrote in her survey response. “I feel that you’re not for me, you’re not trying to help me, you don’t wanna help me, and why even go through it, go through the motions it seems. So, I can come in feeling suicidal and I leave out feeling suicidal then.” 

Veterans typically welcome screening for suicidal risk. In a 2023 study, > 90% of veterans reported that it is appropriate to be asked about thoughts of suicide during primary care visits, and about one-half agreed that veterans should be asked about suicidal thoughts at every visit. 

For many, though, the level of trust they have with HCPs makes or breaks whether they discuss their suicidal ideation. Higher ratings of the therapeutic relationship with clinicians are associated with more frequent disclosure. However, the screen-positive group demonstrated higher rates of inaccurate disclosure than the screen-negative group. While this may seem counterintuitive, it is possible that screen-positive individuals did not fully disclose their thoughts on the initial screen, or did not fully disclose the severity of their thoughts during follow-up evaluations. Individuals who disclose suicidal thoughts during initial screening may be ambivalent about disclosure and/or become more concerned about consequences of disclosure as additional evaluation ensues. 

A 2013 study of 34 Operation Enduring Freedom/Operation Iraqi Freedom veterans found that veterans felt trying to suppress and avoid thoughts of suicide was “burdensome and exhausting.” Despite this, they often failed to disclose severe and pervasive suicidal thoughts when screened. Among the reasons was that they perceived the templated computer reminder process as “perfunctory and disrespectful.”

Research has found that HCPs who focuses on building relationships, demonstrates genuineness and empathy, and uses straightforward and understandable language promotes the trust that can result in more honest disclosure of suicidal thoughts. In the “inaccurate disclosure” study, some veterans reported they did not understand the screening questions, or the questions did not make sense to them. This aligns with prior research, which demonstrates that how HCPs and researchers conceptualize suicidal thoughts may not fit with patients’ experiences. A lack of shared terminology, they note, “may confound how we think about ‘under-disclosure,’ such that perhaps patients may not be trying to hide their thoughts so much as not finding screening questions applicable to their unique situations or experiences.”

Veterans at risk of suicide may not share their suicidal ideation with their psychotherapists or may choose not to disclose enough detail to illustrate the depths of those thoughts due to feelings of shame or embarrassment, according to a newly published study. These individuals may view suicidal thoughts as a sign of weakness, fear involuntary hospitalization or prescriptions, or belong to marginalized groups who do not feel comfortable (or safe) to reveal their thoughts or intentions. This can make it difficult for mental health professionals to identify the exact details of a patient’s mindset and provide appropriate care. 

A veteran’s first—and sometimes only—stop may be their primary care practitioner (PCPs) rather than a mental health professional. A review of 40 studies found that although 45% of individuals who died by suicide had contact with PCPs within 1 month of their death, only 19% had contact with mental health services. Studies have also found that veterans disclose suicidal ideation during primary care visits closest to the actual suicide less than half the time.

Patients may have an appointment for medical, but not psychological reasons. In a study conducted at Portland Veterans Affairs Medical Center (VAMC), researchers reviewed the medical records of 112 veterans who died by suicide and had contact with a VAMC within 1 year prior to death. Of those last contacts, 32% were patient-initiated for new or exacerbated medical concerns, and 68% were follow-ups. 

In that study, health care professionals (HCPs) noted that 41 patients (37%) were experiencing emotional distress at the last contact, but 13 of 18 patients (72%) who were assessed for suicidal ideation at their last contact denied such thoughts. The study says this finding “highlights the complexity of addressing suicidal ideation and associated risk factors in health care settings.” Additionally, a number of veterans who died by suicide either did not have suicidal thoughts  at the time of their last contact with HCPs or denied such thoughts even when questioned. 

In 2018, the Veterans Health Administration (VHA) implemented the Suicide Risk Identification Strategy (Risk ID), an evidence-informed assessment that includes initial screening and subsequent evaluation. Veterans receiving VHA care are screened annually for suicidal ideation and behaviors. Most screening takes place in primary care and mental health specialty settings, but timely screening may not be enough to assess who is at risk if the patients aren’t being forthcoming about their thoughts and plans.

A recent cross-sectional national survey examined the frequency of self-reported “inaccurate disclosure” of suicidal ideation during initial screening and subsequent evaluation among 734 VHA patients screened in primary care.

Using the Risk ID process with the Columbia Suicide Severity Rating Scale Screener (C-SSRS), the study asked respondents about their previous suicide screening in 2021. Of the 734 respondents, 306 screened positive and 428 screened negative. One survey item asked about the extent to which veterans had accurately responded to the HCP when asked about suicidal thoughts, while another asked how likely they would discuss when they felt suicidal with their PCP.

The study found that inaccurate disclosure is not uncommon: When asked about suicidal thoughts, about one-fifth of screen-negative participants and two-fifths of screen-positive participants said they responded, “less than very accurately.”

In the screen-positive group, women and those who reported more barriers to care were less likely to discuss feeling suicidal. Veterans who had lower ratings of satisfaction with the screening process, patient-staff communication, and the therapeutic relationship reported being less likely to discuss times they were suicidal. Notably, among C-SSRS-negative patients, Black, American Indian/Alaska Native, Hispanic, Asian, and multiracial veterans were more likely than White veterans to inaccurately report suicidal thoughts. 

This is consistent with studies on medical mistrust and other research suggesting that veterans who have experienced identity-based discrimination may be less inclined to discuss suicidal thoughts with VHA HCPs. A large 2023 study surveyed veterans about why they might hold back such information. One Gulf War-era veteran, a Black woman, had encountered discrimination when filing her VA benefits claim, leading her to feel like the care system was not interested in helping her.

“It’s one of the main reasons why when I do go in, they don’t get an honest response,” she wrote in her survey response. “I feel that you’re not for me, you’re not trying to help me, you don’t wanna help me, and why even go through it, go through the motions it seems. So, I can come in feeling suicidal and I leave out feeling suicidal then.” 

Veterans typically welcome screening for suicidal risk. In a 2023 study, > 90% of veterans reported that it is appropriate to be asked about thoughts of suicide during primary care visits, and about one-half agreed that veterans should be asked about suicidal thoughts at every visit. 

For many, though, the level of trust they have with HCPs makes or breaks whether they discuss their suicidal ideation. Higher ratings of the therapeutic relationship with clinicians are associated with more frequent disclosure. However, the screen-positive group demonstrated higher rates of inaccurate disclosure than the screen-negative group. While this may seem counterintuitive, it is possible that screen-positive individuals did not fully disclose their thoughts on the initial screen, or did not fully disclose the severity of their thoughts during follow-up evaluations. Individuals who disclose suicidal thoughts during initial screening may be ambivalent about disclosure and/or become more concerned about consequences of disclosure as additional evaluation ensues. 

A 2013 study of 34 Operation Enduring Freedom/Operation Iraqi Freedom veterans found that veterans felt trying to suppress and avoid thoughts of suicide was “burdensome and exhausting.” Despite this, they often failed to disclose severe and pervasive suicidal thoughts when screened. Among the reasons was that they perceived the templated computer reminder process as “perfunctory and disrespectful.”

Research has found that HCPs who focuses on building relationships, demonstrates genuineness and empathy, and uses straightforward and understandable language promotes the trust that can result in more honest disclosure of suicidal thoughts. In the “inaccurate disclosure” study, some veterans reported they did not understand the screening questions, or the questions did not make sense to them. This aligns with prior research, which demonstrates that how HCPs and researchers conceptualize suicidal thoughts may not fit with patients’ experiences. A lack of shared terminology, they note, “may confound how we think about ‘under-disclosure,’ such that perhaps patients may not be trying to hide their thoughts so much as not finding screening questions applicable to their unique situations or experiences.”

Veterans at risk of suicide may not share their suicidal ideation with their psychotherapists or may choose not to disclose enough detail to illustrate the depths of those thoughts due to feelings of shame or embarrassment, according to a newly published study. These individuals may view suicidal thoughts as a sign of weakness, fear involuntary hospitalization or prescriptions, or belong to marginalized groups who do not feel comfortable (or safe) to reveal their thoughts or intentions. This can make it difficult for mental health professionals to identify the exact details of a patient’s mindset and provide appropriate care. 

A veteran’s first—and sometimes only—stop may be their primary care practitioner (PCPs) rather than a mental health professional. A review of 40 studies found that although 45% of individuals who died by suicide had contact with PCPs within 1 month of their death, only 19% had contact with mental health services. Studies have also found that veterans disclose suicidal ideation during primary care visits closest to the actual suicide less than half the time.

Patients may have an appointment for medical, but not psychological reasons. In a study conducted at Portland Veterans Affairs Medical Center (VAMC), researchers reviewed the medical records of 112 veterans who died by suicide and had contact with a VAMC within 1 year prior to death. Of those last contacts, 32% were patient-initiated for new or exacerbated medical concerns, and 68% were follow-ups. 

In that study, health care professionals (HCPs) noted that 41 patients (37%) were experiencing emotional distress at the last contact, but 13 of 18 patients (72%) who were assessed for suicidal ideation at their last contact denied such thoughts. The study says this finding “highlights the complexity of addressing suicidal ideation and associated risk factors in health care settings.” Additionally, a number of veterans who died by suicide either did not have suicidal thoughts  at the time of their last contact with HCPs or denied such thoughts even when questioned. 

In 2018, the Veterans Health Administration (VHA) implemented the Suicide Risk Identification Strategy (Risk ID), an evidence-informed assessment that includes initial screening and subsequent evaluation. Veterans receiving VHA care are screened annually for suicidal ideation and behaviors. Most screening takes place in primary care and mental health specialty settings, but timely screening may not be enough to assess who is at risk if the patients aren’t being forthcoming about their thoughts and plans.

A recent cross-sectional national survey examined the frequency of self-reported “inaccurate disclosure” of suicidal ideation during initial screening and subsequent evaluation among 734 VHA patients screened in primary care.

Using the Risk ID process with the Columbia Suicide Severity Rating Scale Screener (C-SSRS), the study asked respondents about their previous suicide screening in 2021. Of the 734 respondents, 306 screened positive and 428 screened negative. One survey item asked about the extent to which veterans had accurately responded to the HCP when asked about suicidal thoughts, while another asked how likely they would discuss when they felt suicidal with their PCP.

The study found that inaccurate disclosure is not uncommon: When asked about suicidal thoughts, about one-fifth of screen-negative participants and two-fifths of screen-positive participants said they responded, “less than very accurately.”

In the screen-positive group, women and those who reported more barriers to care were less likely to discuss feeling suicidal. Veterans who had lower ratings of satisfaction with the screening process, patient-staff communication, and the therapeutic relationship reported being less likely to discuss times they were suicidal. Notably, among C-SSRS-negative patients, Black, American Indian/Alaska Native, Hispanic, Asian, and multiracial veterans were more likely than White veterans to inaccurately report suicidal thoughts. 

This is consistent with studies on medical mistrust and other research suggesting that veterans who have experienced identity-based discrimination may be less inclined to discuss suicidal thoughts with VHA HCPs. A large 2023 study surveyed veterans about why they might hold back such information. One Gulf War-era veteran, a Black woman, had encountered discrimination when filing her VA benefits claim, leading her to feel like the care system was not interested in helping her.

“It’s one of the main reasons why when I do go in, they don’t get an honest response,” she wrote in her survey response. “I feel that you’re not for me, you’re not trying to help me, you don’t wanna help me, and why even go through it, go through the motions it seems. So, I can come in feeling suicidal and I leave out feeling suicidal then.” 

Veterans typically welcome screening for suicidal risk. In a 2023 study, > 90% of veterans reported that it is appropriate to be asked about thoughts of suicide during primary care visits, and about one-half agreed that veterans should be asked about suicidal thoughts at every visit. 

For many, though, the level of trust they have with HCPs makes or breaks whether they discuss their suicidal ideation. Higher ratings of the therapeutic relationship with clinicians are associated with more frequent disclosure. However, the screen-positive group demonstrated higher rates of inaccurate disclosure than the screen-negative group. While this may seem counterintuitive, it is possible that screen-positive individuals did not fully disclose their thoughts on the initial screen, or did not fully disclose the severity of their thoughts during follow-up evaluations. Individuals who disclose suicidal thoughts during initial screening may be ambivalent about disclosure and/or become more concerned about consequences of disclosure as additional evaluation ensues. 

A 2013 study of 34 Operation Enduring Freedom/Operation Iraqi Freedom veterans found that veterans felt trying to suppress and avoid thoughts of suicide was “burdensome and exhausting.” Despite this, they often failed to disclose severe and pervasive suicidal thoughts when screened. Among the reasons was that they perceived the templated computer reminder process as “perfunctory and disrespectful.”

Research has found that HCPs who focuses on building relationships, demonstrates genuineness and empathy, and uses straightforward and understandable language promotes the trust that can result in more honest disclosure of suicidal thoughts. In the “inaccurate disclosure” study, some veterans reported they did not understand the screening questions, or the questions did not make sense to them. This aligns with prior research, which demonstrates that how HCPs and researchers conceptualize suicidal thoughts may not fit with patients’ experiences. A lack of shared terminology, they note, “may confound how we think about ‘under-disclosure,’ such that perhaps patients may not be trying to hide their thoughts so much as not finding screening questions applicable to their unique situations or experiences.”

This article has been updated with a response from the US Department of Veterans Affairs.

The number of US Department of Veterans Affairs (VA) geriatric mental health professionals is failing to keep pace with a growing population of older veterans: nearly 8 million are aged ≥ 65 years. VA psychologists may treat older veterans in primary care settings or community living centers, but many lack formal training in geropsychology.

Some psychologists with the proper training to treat this population are leaving the workforce; a survey by the VA Office of Inspector General found psychology was the most frequently reported severe clinical occupational staffing shortage and the most frequently reported Hybrid Title 38 severe shortage occupation, with 57% of 139 facilities reporting it as a shortage. According to the September Workforce Dashboard, the VA has lost > 200 psychologists in 2025.

Veterans aged ≥ 65 years have higher rates of combined medical and mental health diagnoses than younger veterans and older nonveterans. Nearly 1 of 5 older veterans enrolled in US Department of Veterans Affairs (VA) health care services have confirmed mental health diagnoses, and another 26% have documented mental health concerns without a formal diagnosis in their health record. 

Older veterans also tend to have more complex mental health issues than younger adults. Posttraumatic stress nearly doubles their risk of dementia, and their psychiatric diagnoses may be complicated by co-occurring delirium, social isolation/loneliness, and polypharmacy.

According to reporting by The War Horse, the VA has been instituting limits on one-on-one mental health therapy and transitioning veterans to lower levels of treatment after having been told to stop treating them for long, indeterminate periods prior to referring them to group therapy, primary care, or discharging them altogether. In a statement to Federal Practitioner, VA Press Secretary Pete Kasperowicz refuted the reporting from The War Horse.

"The War Horse story is false. VA does not put caps on one-on-one mental health sessions for veterans with clinical care needs," he told Federal Practitioner. "VA works with veterans over an initial eight to 15 mental health sessions, and collaboratively plans any needed follow-on care. As part of this process, veterans and their health care team decide together how to address ongoing needs, including whether to step down to other types of care and self-maintenance, or continue with VA therapy."

The smaller pool of qualified mental health practitioners also may be due to medical students not knowing enough about the category. A study of 136 medical students and 61 internal medicine residents at an academic health center evaluated their beliefs and attitudes regarding 25 content areas essential to the primary care of older adults. Students and residents expressed similar beliefs about the importance of content areas, and attitudes toward aging did not appreciably differ. However, students rated lower in knowledge in areas surrounding general primary care, such as chronic conditions and medications. Residents reported larger gap scores in areas that reflected specialists’ expertise (eg, driving risk, cognition, and psychiatric symptoms).

VA does have channels for filling the gap in geriatric health care. Established in 1975, Geriatric Research, Education, and Clinical Centers (GRECCs), are the department’s centers of excellence focused on aging. Currently, there are 20 GRECCs across the country, each connected with a major research university. Studies focus on aging, for example, examining the effects of Alzheimer’s disease or traumatic brain injuries. 

Geriatric Scholars 

To specifically fill the gap in mental health care, the Geriatric Scholars Program (GSP) was developed in 2008. Initially focused on primary care physicians, nurse practitioners, physician assistants, and pharmacists, the program later expanded to include other disciplines, including psychiatrists. In 2013, the GSP–Psychology Track (GSP-P) was developed because there were no commercially available training in geropsychology for licensed psychologists. GSP-P is based on an evidence-based educational model for the VA primary care workforce and includes a stepwise curriculum design, pilot implementation, and program evaluation. 

A recent survey that assessed the track’s effectiveness found respondents “strongly agreed” that participation in the program improved their geropsychology knowledge and skills. That positive reaction led to shifts in practice that had a positive impact on VA organizational goals. Several GSP-P graduates have become board certified in geropsychology and many proceed to supervise geropsychology-focused clinical rotations for psychology practicum students, predoctoral interns, and postdoctoral fellows.

Whether programs such as GSP-P can adequately address the dwindling number of VA mental health care professionals remains to be seen. More than 160 doctors, psychologists, nurses, and researchers sent a letter to VA Secretary Doug Collins, the VA inspector general, and congressional leaders on Sept. 24 warning that workforce reductions and moves to outsource care will harm veterans.

“We have witnessed these ongoing harms and can provide evidence and testimony of their impacts,” the letter read. By the next day, the number of signees had increased to 350. 

Though these shortages may impact their mental health care, older veterans could have an edge in mental resilience. While research in younger adults has found positive linear associations between physical health difficulties and severity of psychiatric symptoms, older veterans may benefit from what researchers have called an “aging paradox,” in which mental health improves later in life despite declining physical and cognitive function. A 2021 study suggests that prevention and treatment strategies designed to foster attachment security, mindfulness, and purpose in life may help enhance psychological resilience to physical health difficulties in older veterans.

This article has been updated with a response from the US Department of Veterans Affairs.

The number of US Department of Veterans Affairs (VA) geriatric mental health professionals is failing to keep pace with a growing population of older veterans: nearly 8 million are aged ≥ 65 years. VA psychologists may treat older veterans in primary care settings or community living centers, but many lack formal training in geropsychology.

Some psychologists with the proper training to treat this population are leaving the workforce; a survey by the VA Office of Inspector General found psychology was the most frequently reported severe clinical occupational staffing shortage and the most frequently reported Hybrid Title 38 severe shortage occupation, with 57% of 139 facilities reporting it as a shortage. According to the September Workforce Dashboard, the VA has lost > 200 psychologists in 2025.

Veterans aged ≥ 65 years have higher rates of combined medical and mental health diagnoses than younger veterans and older nonveterans. Nearly 1 of 5 older veterans enrolled in US Department of Veterans Affairs (VA) health care services have confirmed mental health diagnoses, and another 26% have documented mental health concerns without a formal diagnosis in their health record. 

Older veterans also tend to have more complex mental health issues than younger adults. Posttraumatic stress nearly doubles their risk of dementia, and their psychiatric diagnoses may be complicated by co-occurring delirium, social isolation/loneliness, and polypharmacy.

According to reporting by The War Horse, the VA has been instituting limits on one-on-one mental health therapy and transitioning veterans to lower levels of treatment after having been told to stop treating them for long, indeterminate periods prior to referring them to group therapy, primary care, or discharging them altogether. In a statement to Federal Practitioner, VA Press Secretary Pete Kasperowicz refuted the reporting from The War Horse.

"The War Horse story is false. VA does not put caps on one-on-one mental health sessions for veterans with clinical care needs," he told Federal Practitioner. "VA works with veterans over an initial eight to 15 mental health sessions, and collaboratively plans any needed follow-on care. As part of this process, veterans and their health care team decide together how to address ongoing needs, including whether to step down to other types of care and self-maintenance, or continue with VA therapy."

The smaller pool of qualified mental health practitioners also may be due to medical students not knowing enough about the category. A study of 136 medical students and 61 internal medicine residents at an academic health center evaluated their beliefs and attitudes regarding 25 content areas essential to the primary care of older adults. Students and residents expressed similar beliefs about the importance of content areas, and attitudes toward aging did not appreciably differ. However, students rated lower in knowledge in areas surrounding general primary care, such as chronic conditions and medications. Residents reported larger gap scores in areas that reflected specialists’ expertise (eg, driving risk, cognition, and psychiatric symptoms).

VA does have channels for filling the gap in geriatric health care. Established in 1975, Geriatric Research, Education, and Clinical Centers (GRECCs), are the department’s centers of excellence focused on aging. Currently, there are 20 GRECCs across the country, each connected with a major research university. Studies focus on aging, for example, examining the effects of Alzheimer’s disease or traumatic brain injuries. 

Geriatric Scholars 

To specifically fill the gap in mental health care, the Geriatric Scholars Program (GSP) was developed in 2008. Initially focused on primary care physicians, nurse practitioners, physician assistants, and pharmacists, the program later expanded to include other disciplines, including psychiatrists. In 2013, the GSP–Psychology Track (GSP-P) was developed because there were no commercially available training in geropsychology for licensed psychologists. GSP-P is based on an evidence-based educational model for the VA primary care workforce and includes a stepwise curriculum design, pilot implementation, and program evaluation. 

A recent survey that assessed the track’s effectiveness found respondents “strongly agreed” that participation in the program improved their geropsychology knowledge and skills. That positive reaction led to shifts in practice that had a positive impact on VA organizational goals. Several GSP-P graduates have become board certified in geropsychology and many proceed to supervise geropsychology-focused clinical rotations for psychology practicum students, predoctoral interns, and postdoctoral fellows.

Whether programs such as GSP-P can adequately address the dwindling number of VA mental health care professionals remains to be seen. More than 160 doctors, psychologists, nurses, and researchers sent a letter to VA Secretary Doug Collins, the VA inspector general, and congressional leaders on Sept. 24 warning that workforce reductions and moves to outsource care will harm veterans.

“We have witnessed these ongoing harms and can provide evidence and testimony of their impacts,” the letter read. By the next day, the number of signees had increased to 350. 

Though these shortages may impact their mental health care, older veterans could have an edge in mental resilience. While research in younger adults has found positive linear associations between physical health difficulties and severity of psychiatric symptoms, older veterans may benefit from what researchers have called an “aging paradox,” in which mental health improves later in life despite declining physical and cognitive function. A 2021 study suggests that prevention and treatment strategies designed to foster attachment security, mindfulness, and purpose in life may help enhance psychological resilience to physical health difficulties in older veterans.

This article has been updated with a response from the US Department of Veterans Affairs.

The number of US Department of Veterans Affairs (VA) geriatric mental health professionals is failing to keep pace with a growing population of older veterans: nearly 8 million are aged ≥ 65 years. VA psychologists may treat older veterans in primary care settings or community living centers, but many lack formal training in geropsychology.

Some psychologists with the proper training to treat this population are leaving the workforce; a survey by the VA Office of Inspector General found psychology was the most frequently reported severe clinical occupational staffing shortage and the most frequently reported Hybrid Title 38 severe shortage occupation, with 57% of 139 facilities reporting it as a shortage. According to the September Workforce Dashboard, the VA has lost > 200 psychologists in 2025.

Veterans aged ≥ 65 years have higher rates of combined medical and mental health diagnoses than younger veterans and older nonveterans. Nearly 1 of 5 older veterans enrolled in US Department of Veterans Affairs (VA) health care services have confirmed mental health diagnoses, and another 26% have documented mental health concerns without a formal diagnosis in their health record. 

Older veterans also tend to have more complex mental health issues than younger adults. Posttraumatic stress nearly doubles their risk of dementia, and their psychiatric diagnoses may be complicated by co-occurring delirium, social isolation/loneliness, and polypharmacy.

According to reporting by The War Horse, the VA has been instituting limits on one-on-one mental health therapy and transitioning veterans to lower levels of treatment after having been told to stop treating them for long, indeterminate periods prior to referring them to group therapy, primary care, or discharging them altogether. In a statement to Federal Practitioner, VA Press Secretary Pete Kasperowicz refuted the reporting from The War Horse.

"The War Horse story is false. VA does not put caps on one-on-one mental health sessions for veterans with clinical care needs," he told Federal Practitioner. "VA works with veterans over an initial eight to 15 mental health sessions, and collaboratively plans any needed follow-on care. As part of this process, veterans and their health care team decide together how to address ongoing needs, including whether to step down to other types of care and self-maintenance, or continue with VA therapy."

The smaller pool of qualified mental health practitioners also may be due to medical students not knowing enough about the category. A study of 136 medical students and 61 internal medicine residents at an academic health center evaluated their beliefs and attitudes regarding 25 content areas essential to the primary care of older adults. Students and residents expressed similar beliefs about the importance of content areas, and attitudes toward aging did not appreciably differ. However, students rated lower in knowledge in areas surrounding general primary care, such as chronic conditions and medications. Residents reported larger gap scores in areas that reflected specialists’ expertise (eg, driving risk, cognition, and psychiatric symptoms).

VA does have channels for filling the gap in geriatric health care. Established in 1975, Geriatric Research, Education, and Clinical Centers (GRECCs), are the department’s centers of excellence focused on aging. Currently, there are 20 GRECCs across the country, each connected with a major research university. Studies focus on aging, for example, examining the effects of Alzheimer’s disease or traumatic brain injuries. 

Geriatric Scholars 

To specifically fill the gap in mental health care, the Geriatric Scholars Program (GSP) was developed in 2008. Initially focused on primary care physicians, nurse practitioners, physician assistants, and pharmacists, the program later expanded to include other disciplines, including psychiatrists. In 2013, the GSP–Psychology Track (GSP-P) was developed because there were no commercially available training in geropsychology for licensed psychologists. GSP-P is based on an evidence-based educational model for the VA primary care workforce and includes a stepwise curriculum design, pilot implementation, and program evaluation. 

A recent survey that assessed the track’s effectiveness found respondents “strongly agreed” that participation in the program improved their geropsychology knowledge and skills. That positive reaction led to shifts in practice that had a positive impact on VA organizational goals. Several GSP-P graduates have become board certified in geropsychology and many proceed to supervise geropsychology-focused clinical rotations for psychology practicum students, predoctoral interns, and postdoctoral fellows.

Whether programs such as GSP-P can adequately address the dwindling number of VA mental health care professionals remains to be seen. More than 160 doctors, psychologists, nurses, and researchers sent a letter to VA Secretary Doug Collins, the VA inspector general, and congressional leaders on Sept. 24 warning that workforce reductions and moves to outsource care will harm veterans.

“We have witnessed these ongoing harms and can provide evidence and testimony of their impacts,” the letter read. By the next day, the number of signees had increased to 350. 

Though these shortages may impact their mental health care, older veterans could have an edge in mental resilience. While research in younger adults has found positive linear associations between physical health difficulties and severity of psychiatric symptoms, older veterans may benefit from what researchers have called an “aging paradox,” in which mental health improves later in life despite declining physical and cognitive function. A 2021 study suggests that prevention and treatment strategies designed to foster attachment security, mindfulness, and purpose in life may help enhance psychological resilience to physical health difficulties in older veterans.