Right To Treat: Veterans' Healthcare Freedom and Comprehensive Treatment Access

Executive Summary

Veterans suffering from PTSD and related disorders face an unprecedented mental health crisis. Conservative estimates indicate over 30,000 post-9/11 veterans have died by suicide—more than four times the number killed in combat operations. Current treatment paradigms have failed to address this crisis adequately, with traditional approaches showing limited success in reducing suicide rates despite widespread implementation.

The Right To Treat initiative advocates for medical freedom and systemic reform to ensure veterans can access the full spectrum of effective mental health treatments, including integrative, alternative, and emerging therapies. We call for legislative action to remove regulatory barriers, expand treatment options, and honor the dignity and sacrifice of those who served through personalized, comprehensive care.

The Crisis: Understanding the Scope and Scale

The numbers tell a devastating story. When Thomas Howard Suitt III analyzed veteran suicide data for his groundbreaking 2021 study, he uncovered a crisis that dwarfs combat casualties. His research revealed that an estimated 30,177 active duty service members and veterans of the post-9/11 wars have died by suicide—significantly more than the 7,057 service members killed in Global War on Terror operations.

The VA's official count shows approximately 6,364 veteran suicides per year between 2005 and 2018, leading to a total estimated 95,460 veteran suicides between 2005 and the present day. The often-cited figure of 22 veterans per day has been revised downward to 17 per day due to methodology changes, specifically the VA's decision to only count federally activated veterans, excluding many National Guard and Reserve members.

Post-9/11 veterans face particularly alarming rates. Despite representing only 3.764 million veterans—just 21 percent of all veterans in the United States today—their suicide rates far exceed those of previous generations. For post-9/11 veterans aged 18-34, the suicide rate reached 45.9 per 100,000 in 2018, approximately 2.5 times the rate of the adjusted general population.

The discrepancies between different estimates arise from several factors. Definitional changes have significantly impacted counts, as the VA now excludes many National Guard and Reserve members who weren't federally activated. Tracking inconsistencies plague the system, with different agencies using different methodologies and timeframes. Underreporting remains problematic, as many veteran suicides may not be identified as veteran-related in official records.

What matters most is the consistent pattern showing veterans dying by suicide at rates significantly higher than the general population. This represents a systemic failure that demands comprehensive reform through the Right To Treat initiative.

Building a Coalition for Change

Creating meaningful change requires understanding who needs to be part of the solution. The veteran suicide crisis affects multiple communities, each bringing unique perspectives, resources, and motivations to potential reform efforts.

Veterans and military families form the heart of any effective coalition. Post-9/11 veterans experiencing treatment-resistant PTSD know firsthand the limitations of current care. Families who have lost loved ones to suicide carry both profound grief and powerful motivation for systemic change. Active-duty service members watching their treatments fail seek alternatives before it's too late.

Healthcare providers represent another crucial constituency frustrated by current limitations. Psychiatrists and psychologists treating veterans often feel constrained by regulatory barriers that prevent them from offering potentially effective treatments. Alternative and integrative medicine practitioners possess expertise in treatments that could help veterans, but which face obstacles in providing care within the current system. Researchers studying innovative treatments see promising results that translate slowly, if at all, into clinical practice.

Veterans service organizations bring established networks, political influence, and deep commitment to veteran welfare. Organizations like Victory For Veterans, VALOR Clinic Foundation, DAV, and VFW have existing relationships with veterans and proven advocacy capabilities. Iraq and Afghanistan Veterans of America represents younger veterans most affected by the current crisis.

Policy makers and legislators hold the key to systemic reform but need education about the scope of the problem and the potential solutions. Members of House and Senate Veterans' Affairs Committees have direct oversight responsibility but often lack detailed knowledge about alternative treatments. Appropriations and Armed Services Committee members control funding that could support expanded treatment options.

Research and academic institutions provide the evidence base necessary for credible reform efforts. Universities conducting PTSD research generate data supporting alternative treatments but struggle to translate findings into policy. Medical schools with veteran treatment programs train the next generation of providers who could implement expanded treatment options.

Building an effective coalition requires avoiding the trap of top-heavy organizational structures that stifle grassroots energy. Instead, the Right To Treat initiative embraces decentralized models where regional partners maintain autonomy while sharing resources and coordinating on specific issues. This approach allows organizations to engage at their comfort level rather than demanding wholesale commitment to every aspect of the reform agenda.

The most effective structure centers around issue-based coordination, focusing on specific legislative goals rather than organizational hierarchy. This coalition model, anchored by Help 22's Veterans' Right to Treat as an umbrella organization, provides coordination without control while allowing regional partners to continue their essential work.

Current Treatment Failures and Regulatory Barriers

The standard approach to treating veteran PTSD has remained remarkably static despite mounting evidence of its inadequacy. The VA's primary treatment protocol relies heavily on antidepressants, particularly SSRIs, combined with various forms of cognitive behavioral therapy and group therapy sessions. When these approaches fail, the system often responds with crisis intervention and hospitalization rather than exploring alternative treatment modalities.

This one-size-fits-all approach ignores the fundamental reality that different veterans respond to different treatments. Veterans face significant access barriers including long wait times, geographic limitations, and bureaucratic hurdles that delay or prevent treatment entirely. Perhaps most troubling, many veterans simply don't respond to conventional approaches, leaving them with few options within the current system.

These treatment failures are perpetuated by a regulatory framework that creates multiple layers of barriers preventing veterans from accessing potentially life-saving treatments. The FDA's lengthy approval process requires years-long trials even for promising treatments, reflecting a risk-averse culture that prioritizes avoiding potential harm over helping patients access potentially life-saving treatments. The expensive approval process effectively limits smaller treatment developers who might bring innovative approaches to market.

VA implementation creates additional barriers through bureaucratic inertia that slows adoption of even FDA-approved treatments. Budget constraints limit funding for non-traditional therapies, while lack of staff trained in alternative approaches creates capacity problems. Liability concerns drive preference for standard treatments over potentially more effective alternatives, even when those alternatives have strong safety profiles and superior outcomes for specific patients.

TRICARE limitations compound these problems through formulary restrictions that exclude many effective treatments and prior authorization requirements that delay access even to approved therapies. Limited coverage for alternative therapies means veterans must often pay out of pocket for treatments that might be more effective than covered alternatives. The lack of appropriate CPT codes prevents billing for many alternative therapies, creating financial barriers for both providers and patients.

State-level obstacles further complicate access through professional licensing laws that restrict scope of practice and may not recognize alternative treatment approaches. Continuing education requirements often fail to include training on innovative treatments, leaving providers unprepared to offer expanded options. Cross-state practice limitations prevent veterans from accessing specialized providers in other states, particularly problematic in rural areas with limited local resources.

Insurance regulations at the state level may not recognize alternative therapies, making reimbursement difficult or impossible. Coverage mandates typically don't include comprehensive mental health options, leaving significant gaps in available treatments. Reimbursement rate limitations discourage provider participation in alternative treatment modalities. Private insurers typically follow VA and Medicare coverage decisions, meaning limitations in government programs cascade throughout the healthcare system.

The existing Right-to-Try framework provides a model for expanding access but currently falls short of addressing veteran needs. The federal Right-to-Try law, passed in 2018, allows terminally ill patients access to experimental therapies that have completed Phase I trials. However, PTSD typically isn't considered "terminally ill" despite its deadly consequences. State Right-to-Try laws, enacted in 41 states, vary significantly in scope and implementation. Most exclude mental health conditions from coverage, creating a significant gap for veterans suffering from PTSD and related disorders.

The regulatory landscape reflects a system designed to avoid risk rather than maximize benefit for patients. This approach becomes counterproductive when applied to treatments with established safety records and growing evidence of effectiveness. Veterans suffering from treatment-resistant PTSD face life-threatening conditions that warrant access to every potentially effective treatment.

These systemic problems create a treatment environment where veterans must often "fail" multiple conventional treatments before accessing potentially more effective alternatives. This barrier-first approach not only delays recovery but may worsen outcomes by subjecting veterans to treatments likely to fail while withholding treatments more likely to succeed. The result is a system that prioritizes bureaucratic convenience over veteran welfare, contributing directly to the ongoing suicide crisis.

The Full Spectrum of Treatment Options

Veterans deserve access to every treatment that might help them heal, not just those that fit within current bureaucratic constraints. The Right To Treat initiative recognizes that effective PTSD treatment extends far beyond traditional approaches, encompassing FDA-approved advanced therapies, evidence-based psychotherapies, and emerging treatments that show remarkable promise. #HELP 22 has singled out a few promising treatments that have shown to be efficacious. 

Among FDA-approved advanced therapies, Transcranial Magnetic Stimulation (TMS) and Deep TMS represent breakthrough approaches that use magnetic pulses to reactivate underactive brain regions. Multiple scientific studies have proven their efficacy, yet veterans currently must "fail" multiple antidepressant trials before accessing these treatments. This barrier-first approach defies medical logic and denies veterans potentially effective treatment when they could benefit most.

Ketamine IV treatments offer another powerful tool in the fight against veteran suicide. These treatments' ability to stop suicidal thinking has been well-documented in numerous scientific studies. Esketamine, available as a nasal spray, already has FDA approval for treating major depression. Veterans experiencing suicidal thinking should be able to choose these treatments based on their clinical needs and personal preferences rather than navigating bureaucratic obstacles.

Electroconvulsive therapy (ECT), while more invasive, has shown significant success in reducing suicide risk among patients with depressive disorders. Though side effects like memory loss and confusion require careful consideration, ECT remains an important option for severe, treatment-resistant cases. Repetitive transcranial magnetic stimulation (rTMS) offers similar benefits with fewer side effects, using low-intensity magnetic signals to target brain areas involved in executive function and emotional regulation.

Evidence-based psychotherapies extend treatment options beyond medication-focused approaches. Eye Movement Desensitization and Reprocessing (EMDR) has proven effective for healing trauma and other distressing experiences. Veterans diagnosed with major depression, PTSD, or anxiety disorders should be able to choose EMDR without navigating additional approval processes. The therapy's effectiveness stems from its ability to help process traumatic memories through bilateral stimulation, allowing veterans to integrate difficult experiences rather than remaining trapped by them.

Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP) targets the specific thought patterns leading to suicidal behavior. This specialized approach has demonstrated success in reducing suicide attempts among high-risk populations, but requires specialized training that many VA providers lack. Dialectical Behavioral Therapy (DBT) teaches emotional regulation and distress tolerance skills particularly valuable for veterans with co-occurring conditions.

Emerging and alternative therapies represent the frontier of PTSD treatment, offering hope for veterans who haven't responded to conventional approaches. Hyperbaric Oxygen Therapy (HBOT) involves breathing pure oxygen in a pressurized chamber, potentially leading to increased oxygen levels in the blood and brain. This treatment may improve neuroplasticity, reduce inflammation, and enhance brain function. Growing research supports HBOT's effectiveness for treatment-resistant PTSD, particularly among veterans dealing with traumatic brain injuries common in post-9/11 conflicts.

Neurofeedback therapy offers a non-invasive approach using real-time brain activity monitoring to train optimal brainwave patterns. This treatment shows promise for PTSD, anxiety, and depression while avoiding medication side effects that often plague conventional treatments. Veterans can learn to regulate their own brain activity, providing a sense of control often lacking in their recovery journey.

Animal-assisted interventions, including service dogs, equine therapy, and therapeutic animal programs, address the social and emotional dimensions of healing that purely clinical approaches often miss. These programs have demonstrated effectiveness in reducing PTSD symptoms while improving social functioning. The human-animal bond provides unconditional acceptance and companionship that can be particularly healing for veterans struggling with isolation and trust issues.

Arts and creative therapies, encompassing art therapy, music therapy, and writing therapy, offer accessible approaches for processing trauma and building resilience. These treatments allow veterans to express experiences that may be difficult to verbalize while engaging creative capacities that promote healing.

A Path Forward: Legislative Strategy and Reform

The Right To Treat initiative requires strategic legislative action that addresses immediate needs while building the foundation for comprehensive change. The approach must be simultaneously bold enough to create real impact and practical enough to navigate political realities.

Immediate actions should focus on expanding VA treatment options through legislative mandates requiring coverage for FDA-approved alternative therapies. The current practice of forcing veterans to "fail" multiple treatments before accessing potentially more effective alternatives violates basic medical ethics and delays healing when time is critical. Legislation should eliminate these "fail-first" requirements for treatments like TMS and ketamine that have demonstrated safety and efficacy.

Establishing pilot programs for promising treatments provides a pathway for introducing innovative approaches while building evidence for broader implementation. These programs should include comprehensive outcome tracking to demonstrate effectiveness and guide expansion decisions.

Creating veteran-specific Right-to-Try legislation represents a crucial step toward medical freedom for veterans with treatment-resistant PTSD. This approach should extend experimental treatment access to veterans with chronic mental health conditions that have proven resistant to conventional treatments. The threshold for qualifying conditions should recognize that treatment-resistant PTSD can be as life-threatening as traditionally defined terminal illnesses. Cost coverage provisions through VA or TRICARE would ensure that experimental treatments remain accessible regardless of economic circumstances.

Establishing Centers of Excellence for integrative mental health treatment would create hubs for innovation while providing training opportunities for providers across the system. These centers should be required to track outcomes and compare results with traditional approaches, building the evidence base needed for broader reform.

Long-term reform goals should center on creating a personalized treatment framework that moves away from standardized protocols toward individualized care plans. This approach integrates patient choice and provider clinical judgment rather than imposing bureaucratic restrictions on medical decision-making. Treatment partnerships between veterans and their providers should guide care decisions rather than institutional protocols designed for administrative convenience.

Comprehensive coverage mandates should require VA and TRICARE to cover evidence-based alternative therapies without discriminatory barriers. Creating new CPT codes for alternative treatments would eliminate billing obstacles that currently prevent many providers from offering these services. Fair reimbursement rates would ensure adequate provider participation in expanded treatment options.

The proposed Veterans' Healthcare Freedom Act would provide a comprehensive framework for these reforms. Treatment access expansion provisions should mandate VA coverage for all FDA-approved mental health treatments while eliminating prior authorization requirements for evidence-based therapies. Maximum wait times of 30 days for treatment initiation would address current access delays that often worsen conditions.

Right-to-Try provisions for veterans would extend experimental treatment access to veterans with chronic PTSD while creating cost-sharing mechanisms for unapproved but promising treatments. Safety monitoring and outcome tracking requirements would ensure responsible implementation while building evidence for broader adoption.

Provider training and certification components should fund training programs for alternative therapy providers while establishing competency standards for integrative treatments. Continuing education requirements for VA mental health staff would ensure the system can deliver expanded treatment options effectively.

Economic Realities: The Cost of Inaction

The current approach to veteran mental health care represents not just a human tragedy but an economic disaster. Direct costs include $2.3 billion annually for veteran mental health services that often fail to achieve desired outcomes. PTSD-related disability compensation costs $15.8 billion annually, much of which could be reduced through more effective treatments. Crisis intervention and hospitalization consume $847 million annually, largely representing failures of preventive care.

Indirect costs multiply the economic impact through lost productivity totaling $6.2 billion annually, as veterans struggle with untreated or inadequately treated conditions. The VA's FY 2021 budget allocated $10.2 billion specifically for veteran suicide prevention, representing a 7 percent increase over 2020, yet suicide rates continue to climb despite these substantial investments (Suitt, 2021). Additional costs include family support services and social services utilization as veterans and families seek help outside the healthcare system.

The total annual cost represents resources that could be redirected toward more effective treatments while improving veteran outcomes. This figure doesn't include the broader social costs of veteran suicide, family dissolution, homelessness, and other consequences of inadequate mental health care.

Alternative approaches offer significant potential savings alongside improved outcomes. Reduced hospitalization rates could decrease crisis admissions by 35-45%, saving hundreds of millions annually while indicating improved veteran stability. Lower medication costs, averaging $2,400 per veteran annually, reflect both reduced pharmaceutical expenses and improved treatment effectiveness. Improved functional outcomes could reduce disability claims by 25%, saving billions while indicating successful recovery.

The investment required for comprehensive reform through the Right To Treat initiative represents excellent value compared to current spending. Training and certification programs requiring $150 million initial investment would create the provider capacity needed for expanded treatment options. Treatment center expansion costing $500 million over five years would ensure geographic access to comprehensive care. Research and development funding of $200 million annually would accelerate treatment innovation while building evidence for broader adoption.

Conservative estimates suggest a 3:1 return on investment within five years through reduced crisis interventions and improved veteran functioning. This calculation considers only direct healthcare savings and doesn't include broader economic benefits from increased veteran productivity, reduced family support needs, and decreased social services utilization.

Implementation: From Vision to Reality

Transforming the veteran mental health system through the Right To Treat initiative requires careful planning and phased implementation that builds momentum while maintaining quality and safety standards. The approach should balance urgency with sustainability, ensuring that reforms create lasting change rather than temporary improvements.

The foundation-building phase should establish the organizational infrastructure needed for sustained reform efforts. Coalition development centered around Help 22's Veterans' Right to Treat as an umbrella organization would provide coordination without creating bureaucratic overhead. Recruiting key veterans organizations and healthcare providers builds the expertise and credibility necessary for effective advocacy.

Public education campaigns should highlight the veteran suicide crisis while showcasing promising alternative treatments. Media engagement through op-eds and policy briefs creates broader awareness while positioning the coalition as a credible voice for reform.

Legislative engagement involves presenting findings to Veterans' Affairs Committees while lobbying individual members of Congress about specific reform proposals. Organizing veteran testimony and family stories personalizes the issue while demonstrating broad support for change among those most affected by current policies.

The legislative action phase focuses on actual policy change through bill introduction and passage. Implementation preparation should begin before legislative passage to ensure smooth transition to new policies. Developing regulations and guidance for new laws provides clarity for providers and veterans while preventing implementation delays. Preparing training materials for providers ensures adequate capacity for expanded treatment options.

Effective reform requires robust accountability mechanisms tracking veteran suicide rates by treatment type, treatment completion rates, and functional improvement scores. Annual congressional reports should include outcome comparisons between traditional and alternative approaches while independent evaluation by organizations like the National Academies of Sciences brings scientific rigor to evaluation efforts.

Conclusion

The crisis facing America's veterans demands nothing less than a fundamental transformation of how we approach mental health care for those who served. The statistics are undeniable: over 30,000 post-9/11 veterans have died by suicide, a number that continues to grow daily despite billions spent on conventional treatments that have demonstrably failed to stem the tide of veteran deaths.

The Right To Treat initiative has outlined a comprehensive path forward centered on medical freedom and access to the full spectrum of effective treatments. The alternative therapies documented here offer genuine hope for veterans who have exhausted conventional options, from FDA-approved treatments like TMS and ketamine to innovative approaches like hyperbaric oxygen therapy and neurofeedback.

The regulatory barriers preventing access to these treatments represent policy choices rather than immutable obstacles. Congressional action can eliminate discriminatory coverage restrictions, streamline approval processes for veteran-specific treatments, and create Right-to-Try protections for veterans with treatment-resistant conditions.

The coalition framework presented here provides a practical model for achieving these reforms through coordinated action that respects organizational autonomy while maximizing collective impact. By avoiding top-heavy structures and emphasizing grassroots leadership, this approach can sustain momentum through the inevitable challenges of legislative and administrative reform.

The economic analysis demonstrates that comprehensive reform represents fiscal responsibility as well as moral imperative. Current spending approaches $27 billion annually with inadequate results, while proposed reforms offer conservative 3:1 return on investment alongside dramatically improved veteran outcomes.

Most importantly, the Right To Treat initiative is ultimately about honoring the service and sacrifice of America's veterans by ensuring they have access to every treatment that might help them heal. The warriors who answered their nation's call to serve deserve nothing less than access to every tool that might help them successfully complete their most important mission: returning to productive, fulfilling civilian lives.

The choice before us is clear. We can continue failed policies that sentence veterans to suffer with inadequate treatments, or we can embrace the Right To Treat initiative's vision of medical freedom and comprehensive care that recognizes veterans' right to choose their own path to healing.

The veterans have done their duty. Now it's time for us to do ours. The path forward is clear, the tools are available, and the moral imperative is undeniable. What remains is the will to act and the commitment to see reform through to completion.

The time for excuses has ended. The time for action is now. The veterans are counting on us.

Works Cited

Suitt, T. H. (2021). High suicide rates among United States service members and veterans of the post-9/11 wars. Costs of War Project, Brown University. Watson Institute for International and Public Affairs.

U.S. Department of Veterans Affairs. (2020). 2020 National Veteran Suicide Prevention Annual Report. Office of Mental Health and Suicide Prevention.

U.S. Department of Veterans Affairs. (2021). FY 2021 Budget Submission - Budget in Brief. Retrieved from https://www.va.gov/budget/docs/summary/fy2021VAbudgetInBrief.pdf