Veterans face many barriers to seeking help. Some are obvious, while others are much harder to recognize. One of the least visible barriers is what happens after a veteran finally decides to walk through the door for help.

As a U.S. Army veteran and a former anti-human trafficking undercover operator turned trauma therapist who has spent more than two decades working with veterans, first responders and other high-stress populations, I have seen firsthand how often veterans disengage from care when providers misunderstand military trauma. In my work treating trauma and training current and new clinicians, this gap appears far more often than many realize.

In one recent case, a veteran told me he sought treatment for insomnia, anger and constant hypervigilance. During his first session, he described scanning every room he enters for exits. The clinician interpreted this behavior as paranoia rather than a learned survival response. As the veteran spoke about anger and irritability, the clinician suggested a possible personality disorder instead of recognizing a nervous system shaped by chronic stress and repeated trauma. The veteran never returned. Unfortunately, stories like this occur far more often than most people realize.

Veterans across the United States die by suicide at significantly higher rates than non-veterans, and in Utah, the rate is nearly double. Due to this, state health officials continue to identify veteran suicide as a major public health concern in Utah. While Utah has taken important steps to support veterans’ mental health, a critical gap remains: ensuring that clinicians who treat veterans understand the culture and trauma associated with military service.

The Department of Veterans Affairs provides care to millions of veterans nationwide. However, provider shortages, long wait times and travel distances led Congress to expand care through the VA Community Care Program under the VA MISSION Act of 2018. Today, many veterans receive mental health care from civilian clinicians in their communities.

These clinicians are often well-trained and licensed, but most have limited exposure to military culture or combat-related trauma. Research has shown that veterans are more likely to disengage from civilian mental healthcare when they feel misunderstood by their providers. When veterans disengage from treatment, symptoms often worsen, and opportunities for early intervention are lost. In a state where veteran suicide rates remain alarmingly high, this gap deserves serious attention.

Many behaviors that appear problematic in civilian life originally developed as adaptive survival strategies in combat environments. Without an understanding of military culture, these behaviors can easily be misinterpreted. Scanning entrances may be seen as paranoia rather than situational awareness. Emotional restraint may be labeled avoidance. Moral injury may be misdiagnosed as a personality disorder. Military culture also emphasizes mission-first thinking, loyalty to the team, clear chains of command and emotional control under intense pressure. When clinicians lack familiarity with these cultural realities, veterans often feel misunderstood and disengage from care.

In Utah, policymakers have made meaningful efforts to support veterans. Recent initiatives have focused on improving access to services, recognizing military experience in professional licensing and exploring new approaches to treating PTSD and trauma. These efforts reflect a genuine commitment to supporting those who served.

However, improving outcomes requires more than expanding access to services. It requires ensuring that the professionals delivering those services are prepared to understand military trauma. If veterans believe clinicians do not understand their experiences, simply increasing access to care will not close the gap and may, in fact, increase it.

One area to look at is licensing. Mental health professionals in Utah are licensed through the Utah Division of Professional Licensing (DOPL). To maintain licensure, clinicians must complete continuing education in areas such as ethics, suicide prevention and professional competency. These requirements exist because they improve the quality of care and protect the public. Yet Utah does not currently require training in military cultural competency for clinicians treating veterans. Given the large number of veterans living throughout the state, this represents a missed opportunity to strengthen the mental health system.

Utah could address this gap with a practical policy change. The Division of Professional Licensing should require military cultural competency training as part of continuing education for licensed mental health professionals. A modest requirement, such as four hours of training per licensure cycle for social workers, counselors, psychologists and psychiatrists, would help ensure clinicians better understand the unique experiences of military populations.

Utah could also lead nationally by establishing a “Veteran-Ready Provider” designation, allowing veterans to identify clinicians who have completed additional training in military culture and trauma.

Utah communities often express deep gratitude for those who have served. That gratitude matters, but it does not by itself improve mental health outcomes or reduce suicide rates. Veterans need clinicians who understand the realities of military service, combat trauma and the culture that shapes their experiences. Utah policymakers and licensing boards should work together to establish military cultural competency training requirements for mental health professionals.

Veterans give a great deal of themselves in service to this country. They deserve more than appreciation. They deserve a mental health system prepared to understand the realities they carry with them long after the uniform comes off.

Joseph Gleed, LCSW, CCTP, CGP, is a Licensed Clinical Social Worker, educator and Clinical Director of Renova Wellness & Consulting. He is an adjunct instructor teaching social work courses, including Human Behavior in the Social Environment, Crisis Intervention, Clinical Interviewing and Group Therapy, and he currently teaches at the University of Utah and Utah Valley University. He is also a Doctor of Social Work (DSW) candidate at the University of Kentucky, with a scholarly focus on trauma recovery, psychological flexibility and integrative, process-based treatment models.

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