When it happened, the service members may have assured healthcare professionals and those around them that they were fine. The injury seemed to be mild at the time and perhaps is now a distant memory. But maybe there was more than just one injury. And, years later, symptoms are showing up and affecting daily life.

The consequences of a TBI can manifest in slower reaction times. It takes longer to learn things. It’s easy to get distracted. Mental stamina just isn’t there. It’s exhausting to go about daily tasks. By the end of the day, the weariness sends many of those with TBIs straight to bed. But sleep isn’t restful.

These are all symptoms described by people with mild TBIs. They make up about 80% of the diagnosed military population, according to Dr. James Kelly, chief medical scientist at the Invisible Wounds Foundation. For those experiencing severe injuries, the consequences can be much worse, including comas, lasting neurological deficits, physical challenges, and even death.

“I know these symptoms all too well,” said Kelly, a neurologist and founding director at the National Intrepid Center of Excellence (NICoE). “I’ve witnessed hundreds of service members return from their back-to-back combat deployments never expecting symptoms to surface months or years after their blast injury.”

More than half a million service members have experienced TBIs in the past two decades, according to the Department of Defense. Improved screening techniques used even decades after the injuries indicate that the population diagnosed with TBIs is only going to grow. In just the past five years, TBI identification at the Department of Veterans Affairs has increased by 26%, VA data show. The military-connected community in particular must continue to invest in ways to identify it, treat it, study it, and evolve how we’re thinking about preventing it.

The good news is that effective care is available. The George W. Bush Institute’s Veteran Wellness Alliance is proud to be part of the solution, helping connect thousands of veterans to high-quality care providers, at little to no cost, and peer organizations through our Check-In tool.

While the VA required the “big five” regional Polytrauma Rehabilitation Centers (PRCs) to create mild TBI treatment programs, many of the patients who currently go through these top-tier hospitals are active-duty service members and not veterans, Kelly said. Veterans may not choose to use government-operated healthcare, but they, too, need to be able to find high-quality treatment that’s integrated with the veteran community.

Still, it’s not easy to find adequately trained providers in the private sector to care for individuals with residual effects of TBI. Improvements in the care system will benefit society as a whole – not just veterans, but football players, lacrosse players, cheerleaders, kids who fall off their bikes or trampolines, and other causes such as motor vehicle crashes.

Ensuring these improvements requires increased awareness throughout the healthcare system, including building TBI identification and treatment into curriculums for physicians and other health professions. Then, health professionals can put together a coordinated, integrated evidence-based treatment approach. To be successful, the system as a whole must be held accountable said Terri Tanielian, a nationally recognized expert on veteran and military health policy.

Identifying veterans with a potential TBI could be as simple as training primary-care providers to ask whether patients have served in the military. This could help catch people that initial military TBI screenings missed. Cooperation and coordination with the VA can also be helpful, particularly in training health professionals and making referrals to specialist providers.

“We hear stories all the time from veterans that something’s just not right – something’s wrong with me, but I can’t put my finger on it, and no one’s believing me,” Tanielian said. “We see from the research an increased risk for suicide, the increased risk for other types of health problems like substance use and depression, and those could create societal burdens and horrible potential outcomes for the veteran and their family.”

Often, family members are the first to recognize these changes from a TBI, and care programs deliberately try to incorporate family members into the healing process, both Tanielian and Kelly said.

“It’s important to pay attention to signs and symptoms, be aware of resources, and seek care,” Kelly said. Patients “often did not anticipate the road ahead and crave connections to useful resources to help them thrive and heal post-injury.”

It boils down to recognizing the problem, navigating individualized resources, and connecting patients to treatment, and delivering the best possible care.

Veterans and their families deserve no less.

If you are a service member or veteran needing care or a caregiver seeking TBI care for your loved one that has served in our military, reach out: VeteranCheckIn.Org.

It was a fair question. And at the time, we had a fair answer: we trust our clinical partners. Every organization we had brought into the Veteran Wellness Alliance (VWA) through Check-In, a tool to connect veterans and their families to high-quality mental and brain health care, had been rigorously vetted. They use evidence-based treatments. They serve veterans and military families with real commitment and cultural competency. We believed in them.

But belief and proof are different things. And the people we serve deserve both. So, at the President’s behest, we went to work.

In 2023, the VWA launched a Clinical Outcomes Working Group. We gathered clinical leaders from across the Alliance, including Road Home Program, Cohen Veterans Network, Centerstone’s Military Services, UCLA Health Operation Mend, the Emory Healthcare Veterans Program, SHARE Military Initiative, and others.

In over a dozen working sessions spanning two years, we did something that almost never happens in the nonprofit space: organizations that could reasonably view each other as competitors for finite philanthropic funding chose instead to share data.

Each organization agreed to share its outcomes in the same report because they care more about the people they serve than about looking better than each other. That alone is worth recognizing and celebrating.

We agreed on three categories of measurement: clinical outcomes, client satisfaction, and process outcomes (specifically, timely access to care). For clinical outcomes, we aligned on two industry-standard tools used across all participating programs: the PCL-5, which measures PTS symptom severity, and the PHQ-9, which tracks depression. Both are brief, scientifically validated, and widely used in clinical settings. They gave us a common language.

Here’s the good news: The data confirmed that these programs are truly effective.

On the PHQ-9, between 57% and 72% of clients experienced clinically significant improvement in depression symptoms. On the PCL-5, 59% of clients in outpatient programs and 68% of clients in intensive inpatient programs saw clinically significant reductions in PTS symptoms. Across every participating organization, the overwhelming majority of clients said they would recommend the program to a fellow veteran or family member, and satisfaction scores were consistently high.

On the process side, VWA outpatient clinical partners average just under 20 days from intake to a first therapy appointment. That’s an impressive number in a mental health landscape where wait times ordinarily can stretch to months.

None of this surprised us. But it changed the conversation. Because now, when someone asks whether veterans are actually getting better, we don’t have to say “we think so.” We can say yes, and here is how we know.

What these organizations did is uncommon. The philanthropic funding landscape is competitive. Every grant dollar that goes to one organization does not go to another. There is a real incentive to protect your data, your brand, your story. These organizations set that incentive aside because the mission was bigger than the competition.

It is also a signal to anyone in the veteran and military family community who is on the fence about seeking care. The programs accessible through Check-In are not just well-intentioned. They are accountable. They are measuring their results, sharing them honestly, and continuing to raise the bar.

If you are a veteran or military family member who has been hesitant to reach out for mental or brain health support, this data is for you. It is not a marketing pitch. It is what happened when a group of serious clinicians agreed to hold themselves accountable to the same standard and share what they found. The results speak clearly: the care is working, the people receiving it are satisfied, and you will not be waiting long.

You can visit veterancheckin.org to connect with a high-quality clinical partner in your area or even get to know some of the incredible peer networks we partner with to get involved in your community. President Bush asked how we know people are getting better. Now we can show him. And we’d be very happy to show you.

______________________

Blayne Smith is Director of Health and Wellbeing at the George W. Bush Institute’s Veterans and Military Families program and co-founder of Applied Leadership Partners. He is a West Point graduate and former Army Special Forces officer.

Finding meaningful employment, overcoming barriers to education, a lack of social connectedness and engagement with family, and financial hardships are frequently caused or made worse by stress, anxiety, and depression. That can lead to things like substance abuse.

Getting the care to address these issues has probably never been as easy as it is today, but many veterans still don’t reach out for support. The military teaches service members to be tough and push through pain, which can be helpful in combat or training during service, but hurt other aspects of life. It can convince veterans that asking for help is a sign of weakness.

But the truth is, asking for help takes courage, and it’s one of the strongest things a person can do. Putting aside ego and pride and seeking and accepting care can be life-changing, not only for the veteran but their loved ones. A good place to start navigating a confusing mental and brain health care landscape is the Check-In tool from the George W. Bush Institute’s Veteran Wellness Alliance. It connects veterans and their family members to high-quality and military competent mental and brain health services – and it’s free.

Check-In helps people quickly find trained professionals who truly understand military life. Whether you need someone to talk to, help managing stress, or support for something more serious, Check-In can get you to the most appropriate care anywhere in the United States.

Many veterans avoid mental health care because they think no one could possibly understand what they’ve been through. Military experiences, including deployments, combat, loss, and stress, can be hard to explain. Many veterans worry that a counselor or practitioner won’t “get it,” especially if they themselves haven’t served.

That’s why military cultural competence is so important – that the person helping you knows the challenges service members and their families face. That they understand the language, the structure, and the unique pressures that come with serving or being the family member of a veteran.

When care providers understand your background, it’s easier to trust them – and trust is key when dealing with mental health.

One of the best things about Check-In is that it’s simple and confidential. There’s no judgment, no long wait, and no need to explain everything from scratch. Just real help, when and where you need it.

Mental health is just as important as physical health. Depression, anxiety, and post-traumatic stress are treatable medical conditions, just like physical issues. Using tools like Check-In, veterans can take care of themselves and show others that it’s OK to ask for help.

If you’re a veteran or someone who cares about one, know that you aren’t alone. Taking that first step can make a huge difference – whether it’s talking to a friend, reaching out to a support group, or connecting through Check-In. It can change and save your life.

Together, let’s make sure every veteran and every military family knows it’s OK not to be OK, and that help is always within reach when you’re ready.

Christopher Vidaurre is Senior Program Manager of Veterans and Military Families at the George W. Bush Institute.