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Indian Affairs Staffing Fell 11% in 2025
The US Department of the Interior Bureau of Indian Affairs (BIA) workforce shrunk 11% through the first 6 months of 2025, a result of executive orders, hiring freezes, a voluntary deferred resignation program (DRP), and terminations of probationary employees, according to a recently US Government Accountability Office (GAO) report. Though these reductions are complete, GAO said it has not yet analyzed projected cost savings or operational impacts from these staff reductions, and the department has shown signs of growth so far in 2026.
The reduction in force (RIF) from 7470 to 6624 employees aligns with the February 2025 executive order aimed at “restoring accountability, eliminating waste, bloat, and insularity” and reforming the federal workforce to maximize efficiency and productivity. The directives also instructed agencies to develop plans for large-scale RIFs and reorganizations. GAO auditors reviewed workforce data from January 25, 2025, through July 31, 2025, interviewed BIA officials, and reviewed comments from Native American tribal representatives to compose the report.
All BIA regions experienced a reduction in staff: 10% in the Western and Rocky Mountain regions, 29% in the Pacific region, and > 20% each in the Alaska, Midwest, and Southern Plains regions. Positions within law enforcement and social work agencies were excluded from the May program due to job functions and responsibilities.
A small portion of separations included resignations and retirements outside of the DRPs; of the staff separating from BIA after January 25, 2025, while 24% left for other reasons. Although the downsizing was not unexpected and some staff were already planning to retire, repercussions were felt immediately.
“Some remaining staff took on additional responsibilities to mitigate the effects of reductions,” the GAO report said. “Some Indian Affairs staff said the reductions would exacerbate preexisting staffing limitations in their offices and make it more difficult to carry out their responsibilities serving Tribes.”
Tribal leaders voiced concerns, claiming BIA already was understaffed to effectively carry out its responsibilities and that service delivery was impaired. Some BIA staff reported that departures forced them to take on duties beyond their main area of responsibility, compromising their primary work. Regional BIA staff also described confusion about which employees were leaving, which limited their ability to effectively plan for impending departures, and reported receiving limited guidance from superiors about how to cover the responsibilities of those departing, particularly those in leadership positions. As of June 2, 2025, 6 of 12 BIA regional directors were serving in an acting capacity, and 12 of the 24 deputy regional director positions were either vacant or acting.
BIA officials have said there are no plans to reorganize or enact additional RIFs, but existing functions “might need to be restructured or realigned to achieve administration priorities.”
As of 2024, the Indiana Health Service (IHS) had a near 30% vacancy rate. In 2025, it awarded > 1800 scholarships and loan repayments under programs aimed at educating and training health professionals for careers at IHS facilities. And in January 2026, IHS announced it was launching the “largest hiring effort in agency history.”
“[O]ur top priority is filling vacancies for positions essential to keeping our health care facilities operating smoothly, especially in some of the more rural and remote locations,” said IHS Chief of Staff Clayton Fulton.
The US Department of the Interior Bureau of Indian Affairs (BIA) workforce shrunk 11% through the first 6 months of 2025, a result of executive orders, hiring freezes, a voluntary deferred resignation program (DRP), and terminations of probationary employees, according to a recently US Government Accountability Office (GAO) report. Though these reductions are complete, GAO said it has not yet analyzed projected cost savings or operational impacts from these staff reductions, and the department has shown signs of growth so far in 2026.
The reduction in force (RIF) from 7470 to 6624 employees aligns with the February 2025 executive order aimed at “restoring accountability, eliminating waste, bloat, and insularity” and reforming the federal workforce to maximize efficiency and productivity. The directives also instructed agencies to develop plans for large-scale RIFs and reorganizations. GAO auditors reviewed workforce data from January 25, 2025, through July 31, 2025, interviewed BIA officials, and reviewed comments from Native American tribal representatives to compose the report.
All BIA regions experienced a reduction in staff: 10% in the Western and Rocky Mountain regions, 29% in the Pacific region, and > 20% each in the Alaska, Midwest, and Southern Plains regions. Positions within law enforcement and social work agencies were excluded from the May program due to job functions and responsibilities.
A small portion of separations included resignations and retirements outside of the DRPs; of the staff separating from BIA after January 25, 2025, while 24% left for other reasons. Although the downsizing was not unexpected and some staff were already planning to retire, repercussions were felt immediately.
“Some remaining staff took on additional responsibilities to mitigate the effects of reductions,” the GAO report said. “Some Indian Affairs staff said the reductions would exacerbate preexisting staffing limitations in their offices and make it more difficult to carry out their responsibilities serving Tribes.”
Tribal leaders voiced concerns, claiming BIA already was understaffed to effectively carry out its responsibilities and that service delivery was impaired. Some BIA staff reported that departures forced them to take on duties beyond their main area of responsibility, compromising their primary work. Regional BIA staff also described confusion about which employees were leaving, which limited their ability to effectively plan for impending departures, and reported receiving limited guidance from superiors about how to cover the responsibilities of those departing, particularly those in leadership positions. As of June 2, 2025, 6 of 12 BIA regional directors were serving in an acting capacity, and 12 of the 24 deputy regional director positions were either vacant or acting.
BIA officials have said there are no plans to reorganize or enact additional RIFs, but existing functions “might need to be restructured or realigned to achieve administration priorities.”
As of 2024, the Indiana Health Service (IHS) had a near 30% vacancy rate. In 2025, it awarded > 1800 scholarships and loan repayments under programs aimed at educating and training health professionals for careers at IHS facilities. And in January 2026, IHS announced it was launching the “largest hiring effort in agency history.”
“[O]ur top priority is filling vacancies for positions essential to keeping our health care facilities operating smoothly, especially in some of the more rural and remote locations,” said IHS Chief of Staff Clayton Fulton.
The US Department of the Interior Bureau of Indian Affairs (BIA) workforce shrunk 11% through the first 6 months of 2025, a result of executive orders, hiring freezes, a voluntary deferred resignation program (DRP), and terminations of probationary employees, according to a recently US Government Accountability Office (GAO) report. Though these reductions are complete, GAO said it has not yet analyzed projected cost savings or operational impacts from these staff reductions, and the department has shown signs of growth so far in 2026.
The reduction in force (RIF) from 7470 to 6624 employees aligns with the February 2025 executive order aimed at “restoring accountability, eliminating waste, bloat, and insularity” and reforming the federal workforce to maximize efficiency and productivity. The directives also instructed agencies to develop plans for large-scale RIFs and reorganizations. GAO auditors reviewed workforce data from January 25, 2025, through July 31, 2025, interviewed BIA officials, and reviewed comments from Native American tribal representatives to compose the report.
All BIA regions experienced a reduction in staff: 10% in the Western and Rocky Mountain regions, 29% in the Pacific region, and > 20% each in the Alaska, Midwest, and Southern Plains regions. Positions within law enforcement and social work agencies were excluded from the May program due to job functions and responsibilities.
A small portion of separations included resignations and retirements outside of the DRPs; of the staff separating from BIA after January 25, 2025, while 24% left for other reasons. Although the downsizing was not unexpected and some staff were already planning to retire, repercussions were felt immediately.
“Some remaining staff took on additional responsibilities to mitigate the effects of reductions,” the GAO report said. “Some Indian Affairs staff said the reductions would exacerbate preexisting staffing limitations in their offices and make it more difficult to carry out their responsibilities serving Tribes.”
Tribal leaders voiced concerns, claiming BIA already was understaffed to effectively carry out its responsibilities and that service delivery was impaired. Some BIA staff reported that departures forced them to take on duties beyond their main area of responsibility, compromising their primary work. Regional BIA staff also described confusion about which employees were leaving, which limited their ability to effectively plan for impending departures, and reported receiving limited guidance from superiors about how to cover the responsibilities of those departing, particularly those in leadership positions. As of June 2, 2025, 6 of 12 BIA regional directors were serving in an acting capacity, and 12 of the 24 deputy regional director positions were either vacant or acting.
BIA officials have said there are no plans to reorganize or enact additional RIFs, but existing functions “might need to be restructured or realigned to achieve administration priorities.”
As of 2024, the Indiana Health Service (IHS) had a near 30% vacancy rate. In 2025, it awarded > 1800 scholarships and loan repayments under programs aimed at educating and training health professionals for careers at IHS facilities. And in January 2026, IHS announced it was launching the “largest hiring effort in agency history.”
“[O]ur top priority is filling vacancies for positions essential to keeping our health care facilities operating smoothly, especially in some of the more rural and remote locations,” said IHS Chief of Staff Clayton Fulton.
Research Focuses on Mental Health Needs of Women Veterans
The more than 2 million women US veterans are the fastest-growing military population. While research into women veterans has traditionally lagged, more recently studies have begun to focus on their needs impacts of combat and service on women. These studies have found that women veterans preferred tailored solutions focused on women veterans.
A November 2025 study is one of the first to examine the impact of combat on women veterans. It found that those in combat roles had higher levels of depression, posttraumatic stress disorder (PTSD), dissociation, and overall poorer health compared with civilians and noncombat women military personnel. Previous research had found that women veterans had higher rates of lifetime and past-year PTSD (13.4%) compared with female civilians (8.0%), male veterans (7.7%), and male civilians (3.4%). A 2020 US Department of Veterans (VA) study of 4,928,638 men and 448,455 women similarly found that women had nearly twice the rates of depression and anxiety compared with men.
For many veterans, mental health issues may develop or be exacerbated in their return to civilian life. That transition can be especially confusing and isolating for women veterans, according to a 2024 study: “They neither fit in the military due to gendered relations centered on masculinity, or civilian life where they are largely misunderstood as ‘veterans.’ This ‘no woman’s land’ is poorly understood.” Few programs for transitioning veterans have been found effective for women veterans because they’ve been developed for a largely male veteran population. That includes mental health support programs.
Some women may prefer women-only groups, and even that choice may be dependent on their background, service history, socioeconomic level, and other factors. They may feel more comfortable in women-only groups if they’ve experienced MST. Others who have served in combat may choose mixed-gender programs. One study found that some women benefited from being in a mixed-gender group because it enabled them to work on difficulties with men in a safe environment. Other research has found that women veterans with substance use disorders are reluctant to seek help alongside men in the same facilities.
Accessing care may be especially challenging for rural women veterans. However, separate facilities and women-only groups are not always available, particularly in rural areas where there may be very few women veterans. And even if they are available, rural women are often up against barriers that urban women do not face, such as having to travel long distances to get care. Clinicians also may be hard to find in rural areas. Some participants in a 2025 study were hampered not only by a lack of female practitioners, but practitioners who were well trained to understand and treat the unique needs of female veterans: “[It’s] incredibly difficult to find a mental health practitioner that understands a veteran’s unique experience as a woman,” a participant said.
The more than 2 million women US veterans are the fastest-growing military population. While research into women veterans has traditionally lagged, more recently studies have begun to focus on their needs impacts of combat and service on women. These studies have found that women veterans preferred tailored solutions focused on women veterans.
A November 2025 study is one of the first to examine the impact of combat on women veterans. It found that those in combat roles had higher levels of depression, posttraumatic stress disorder (PTSD), dissociation, and overall poorer health compared with civilians and noncombat women military personnel. Previous research had found that women veterans had higher rates of lifetime and past-year PTSD (13.4%) compared with female civilians (8.0%), male veterans (7.7%), and male civilians (3.4%). A 2020 US Department of Veterans (VA) study of 4,928,638 men and 448,455 women similarly found that women had nearly twice the rates of depression and anxiety compared with men.
For many veterans, mental health issues may develop or be exacerbated in their return to civilian life. That transition can be especially confusing and isolating for women veterans, according to a 2024 study: “They neither fit in the military due to gendered relations centered on masculinity, or civilian life where they are largely misunderstood as ‘veterans.’ This ‘no woman’s land’ is poorly understood.” Few programs for transitioning veterans have been found effective for women veterans because they’ve been developed for a largely male veteran population. That includes mental health support programs.
Some women may prefer women-only groups, and even that choice may be dependent on their background, service history, socioeconomic level, and other factors. They may feel more comfortable in women-only groups if they’ve experienced MST. Others who have served in combat may choose mixed-gender programs. One study found that some women benefited from being in a mixed-gender group because it enabled them to work on difficulties with men in a safe environment. Other research has found that women veterans with substance use disorders are reluctant to seek help alongside men in the same facilities.
Accessing care may be especially challenging for rural women veterans. However, separate facilities and women-only groups are not always available, particularly in rural areas where there may be very few women veterans. And even if they are available, rural women are often up against barriers that urban women do not face, such as having to travel long distances to get care. Clinicians also may be hard to find in rural areas. Some participants in a 2025 study were hampered not only by a lack of female practitioners, but practitioners who were well trained to understand and treat the unique needs of female veterans: “[It’s] incredibly difficult to find a mental health practitioner that understands a veteran’s unique experience as a woman,” a participant said.
The more than 2 million women US veterans are the fastest-growing military population. While research into women veterans has traditionally lagged, more recently studies have begun to focus on their needs impacts of combat and service on women. These studies have found that women veterans preferred tailored solutions focused on women veterans.
A November 2025 study is one of the first to examine the impact of combat on women veterans. It found that those in combat roles had higher levels of depression, posttraumatic stress disorder (PTSD), dissociation, and overall poorer health compared with civilians and noncombat women military personnel. Previous research had found that women veterans had higher rates of lifetime and past-year PTSD (13.4%) compared with female civilians (8.0%), male veterans (7.7%), and male civilians (3.4%). A 2020 US Department of Veterans (VA) study of 4,928,638 men and 448,455 women similarly found that women had nearly twice the rates of depression and anxiety compared with men.
For many veterans, mental health issues may develop or be exacerbated in their return to civilian life. That transition can be especially confusing and isolating for women veterans, according to a 2024 study: “They neither fit in the military due to gendered relations centered on masculinity, or civilian life where they are largely misunderstood as ‘veterans.’ This ‘no woman’s land’ is poorly understood.” Few programs for transitioning veterans have been found effective for women veterans because they’ve been developed for a largely male veteran population. That includes mental health support programs.
Some women may prefer women-only groups, and even that choice may be dependent on their background, service history, socioeconomic level, and other factors. They may feel more comfortable in women-only groups if they’ve experienced MST. Others who have served in combat may choose mixed-gender programs. One study found that some women benefited from being in a mixed-gender group because it enabled them to work on difficulties with men in a safe environment. Other research has found that women veterans with substance use disorders are reluctant to seek help alongside men in the same facilities.
Accessing care may be especially challenging for rural women veterans. However, separate facilities and women-only groups are not always available, particularly in rural areas where there may be very few women veterans. And even if they are available, rural women are often up against barriers that urban women do not face, such as having to travel long distances to get care. Clinicians also may be hard to find in rural areas. Some participants in a 2025 study were hampered not only by a lack of female practitioners, but practitioners who were well trained to understand and treat the unique needs of female veterans: “[It’s] incredibly difficult to find a mental health practitioner that understands a veteran’s unique experience as a woman,” a participant said.
Nine VA Facilities to Open Research Trials for Psychedelics
Nine VA Facilities to Open Research Trials for Psychedelics
On Nov. 22, 2014, 8 years after he came back from Iraq with “crippling” posttraumatic stress disorder (PTSD), Jonathan Lubecky took his first dose of the psychedelic compound methylenedioxymethamphetamine (MDMA). Lubecky, a Marine, Army, and National Guard veteran, described his path to MDMA therapy in in the New Horizons in Health podcast.
After 5 suicide attempts and “the hundreds of times I thought about it or stood on a bridge or had a plan,” he felt he had run out of options. Then, in a counseling session, a psychiatric intern slid a piece of paper across the table to him. It read “Google MDMA PTSD.”
Luckily for Lubecky, a space in a clinical trial opened up, in which he had 8 hours of talk therapy with specially trained therapists, combined with MDMA. “MDMA is a tool that opens up the mind, body and spirit,” he said, “so you can heal and process all those memories and traumas that are causing yourissues. It puts you in a middle place where you can talk about trauma without having panic attacks, without your body betraying you, and look at it from a different perspective.” said he added, “It’s like doing therapy while being hugged by everyone who loves you in a bathtub full of puppies licking your face.” In 2023, 9 years after that first dose, Lubecky said, “I’ve been PTSD free longer than I had it.”
And now, in 2025, the research into psychedelic therapy for veterans like Lubecky is taking another step forward according to a report by Military.com. Nine VA facilities, in the Bronx, Los Angeles, Omaha, Palo Alto, Portland (Oregon), San Diego, San Francisco, West Haven, and White River Junction, are participating in long-term studies to test the safety and clinical impact of psychedelic compounds for PTSD, treatment-resistant depression, and anxiety disorders.
Early trials from Johns Hopkins University, the Multidisciplinary Association for Psychedelic Studies (MAPS), and others found significant symptom reductions for some participants with chronic PTSD. MAPP2, the multisite phase 3 study that extended the findings of MAPP1, found that MDMA-assisted therapy significantly improved PTSD symptoms and functional impairment, compared with placebo-assisted therapy. Notably, of the 52 participants (including 16 veterans) 45 (86%) achieved a clinically meaningful benefit, and 37 (71%) no longer met criteria for PTSD by study end. Despite the promising findings, a US Food and Drug Administration (FDA) advisory panel recommended against approving the treatment.
In 2024 the VA issued a request for applications for proposals from its network of VA researchers and academic institutions to gather “definitive scientific evidence” on the potential efficacy and safety of psychedelic compounds, such as MDMA and psilocybin, when used in conjunction with psychotherapy. It would be the first time since the 1960s that the VA had funded research on such compounds.
Funding proposals for such research have cycled in and out of Congress for years, but have gathered more steam in the last few years. The 2024 National Defense Authorization Act directed the US Department of Defense to establish a process for funding clinical research into the use of certain psychedelic substances to treat PTSD and traumatic brain injury. In April 2024, Representatives Lou Correa (D-CA) and Jack Bergman (R-MI), cochairs of the Psychedelics Advancing Therapies (PATH) caucus, introduced the Innovative Therapies Centers of Excellence Act of 2025, bipartisan legislation that would increase federally funded research on innovative therapies to treat veterans with PTSD, substance use disorder, and depression. It would also, if enacted, direct the VA to create ≥ 5 dedicated centers of excellence to study the therapeutic uses of psychedelic substances. The bill has also been endorsed by the American Legion, Veterans of Foreign Wars, Iraq and Afghanistan Veterans of America, Disabled American Veterans, and the Wounded Warrior Project.
The current administration has two strong high-level supporters of psychedelics research: VA Secretary Doug Collins and US Department of Health and Human Service Secretary Robert F. Kennedy Jr. Sec. Kennedy has castigated the FDA for what he calls “aggressive suppression” of alternative and complementary treatments, including psychedelics. This, although the FDA granted breakthrough therapy status for MDMA for treating PTSD and psilocybin for treating depression in 2018 and 2019, respectively, as well a pivotal draft guidance in 2023 for the development of psychedelic drugs for psychiatric disorders, substance use disorders, and various medical conditions.
Collins, citing an “eye-opening” discussion with Kennedy, enthusiastically backs the research into psychedelics. In a May 2025 hearing that was mainly a series of testy exchanges about his proposed budget slashing, he emphasized the importance of keeping and expanding VA programs and studies on psychedelic treatments, something he has been advocating for since the beginning of his appointment. “We want to make sure we’re not closing off any outlet for a veteran who could be helped by these programs,” he said.
Taking the intern’s advice to look into MDMA, Jonathan Lubecky said, was one of the best decisions he’d ever made. But “it’s not the MDMA that fixes you,” he said. “It’s the therapy. It’s the therapist working with you and you doing the hard work.”
On Nov. 22, 2014, 8 years after he came back from Iraq with “crippling” posttraumatic stress disorder (PTSD), Jonathan Lubecky took his first dose of the psychedelic compound methylenedioxymethamphetamine (MDMA). Lubecky, a Marine, Army, and National Guard veteran, described his path to MDMA therapy in in the New Horizons in Health podcast.
After 5 suicide attempts and “the hundreds of times I thought about it or stood on a bridge or had a plan,” he felt he had run out of options. Then, in a counseling session, a psychiatric intern slid a piece of paper across the table to him. It read “Google MDMA PTSD.”
Luckily for Lubecky, a space in a clinical trial opened up, in which he had 8 hours of talk therapy with specially trained therapists, combined with MDMA. “MDMA is a tool that opens up the mind, body and spirit,” he said, “so you can heal and process all those memories and traumas that are causing yourissues. It puts you in a middle place where you can talk about trauma without having panic attacks, without your body betraying you, and look at it from a different perspective.” said he added, “It’s like doing therapy while being hugged by everyone who loves you in a bathtub full of puppies licking your face.” In 2023, 9 years after that first dose, Lubecky said, “I’ve been PTSD free longer than I had it.”
And now, in 2025, the research into psychedelic therapy for veterans like Lubecky is taking another step forward according to a report by Military.com. Nine VA facilities, in the Bronx, Los Angeles, Omaha, Palo Alto, Portland (Oregon), San Diego, San Francisco, West Haven, and White River Junction, are participating in long-term studies to test the safety and clinical impact of psychedelic compounds for PTSD, treatment-resistant depression, and anxiety disorders.
Early trials from Johns Hopkins University, the Multidisciplinary Association for Psychedelic Studies (MAPS), and others found significant symptom reductions for some participants with chronic PTSD. MAPP2, the multisite phase 3 study that extended the findings of MAPP1, found that MDMA-assisted therapy significantly improved PTSD symptoms and functional impairment, compared with placebo-assisted therapy. Notably, of the 52 participants (including 16 veterans) 45 (86%) achieved a clinically meaningful benefit, and 37 (71%) no longer met criteria for PTSD by study end. Despite the promising findings, a US Food and Drug Administration (FDA) advisory panel recommended against approving the treatment.
In 2024 the VA issued a request for applications for proposals from its network of VA researchers and academic institutions to gather “definitive scientific evidence” on the potential efficacy and safety of psychedelic compounds, such as MDMA and psilocybin, when used in conjunction with psychotherapy. It would be the first time since the 1960s that the VA had funded research on such compounds.
Funding proposals for such research have cycled in and out of Congress for years, but have gathered more steam in the last few years. The 2024 National Defense Authorization Act directed the US Department of Defense to establish a process for funding clinical research into the use of certain psychedelic substances to treat PTSD and traumatic brain injury. In April 2024, Representatives Lou Correa (D-CA) and Jack Bergman (R-MI), cochairs of the Psychedelics Advancing Therapies (PATH) caucus, introduced the Innovative Therapies Centers of Excellence Act of 2025, bipartisan legislation that would increase federally funded research on innovative therapies to treat veterans with PTSD, substance use disorder, and depression. It would also, if enacted, direct the VA to create ≥ 5 dedicated centers of excellence to study the therapeutic uses of psychedelic substances. The bill has also been endorsed by the American Legion, Veterans of Foreign Wars, Iraq and Afghanistan Veterans of America, Disabled American Veterans, and the Wounded Warrior Project.
The current administration has two strong high-level supporters of psychedelics research: VA Secretary Doug Collins and US Department of Health and Human Service Secretary Robert F. Kennedy Jr. Sec. Kennedy has castigated the FDA for what he calls “aggressive suppression” of alternative and complementary treatments, including psychedelics. This, although the FDA granted breakthrough therapy status for MDMA for treating PTSD and psilocybin for treating depression in 2018 and 2019, respectively, as well a pivotal draft guidance in 2023 for the development of psychedelic drugs for psychiatric disorders, substance use disorders, and various medical conditions.
Collins, citing an “eye-opening” discussion with Kennedy, enthusiastically backs the research into psychedelics. In a May 2025 hearing that was mainly a series of testy exchanges about his proposed budget slashing, he emphasized the importance of keeping and expanding VA programs and studies on psychedelic treatments, something he has been advocating for since the beginning of his appointment. “We want to make sure we’re not closing off any outlet for a veteran who could be helped by these programs,” he said.
Taking the intern’s advice to look into MDMA, Jonathan Lubecky said, was one of the best decisions he’d ever made. But “it’s not the MDMA that fixes you,” he said. “It’s the therapy. It’s the therapist working with you and you doing the hard work.”
On Nov. 22, 2014, 8 years after he came back from Iraq with “crippling” posttraumatic stress disorder (PTSD), Jonathan Lubecky took his first dose of the psychedelic compound methylenedioxymethamphetamine (MDMA). Lubecky, a Marine, Army, and National Guard veteran, described his path to MDMA therapy in in the New Horizons in Health podcast.
After 5 suicide attempts and “the hundreds of times I thought about it or stood on a bridge or had a plan,” he felt he had run out of options. Then, in a counseling session, a psychiatric intern slid a piece of paper across the table to him. It read “Google MDMA PTSD.”
Luckily for Lubecky, a space in a clinical trial opened up, in which he had 8 hours of talk therapy with specially trained therapists, combined with MDMA. “MDMA is a tool that opens up the mind, body and spirit,” he said, “so you can heal and process all those memories and traumas that are causing yourissues. It puts you in a middle place where you can talk about trauma without having panic attacks, without your body betraying you, and look at it from a different perspective.” said he added, “It’s like doing therapy while being hugged by everyone who loves you in a bathtub full of puppies licking your face.” In 2023, 9 years after that first dose, Lubecky said, “I’ve been PTSD free longer than I had it.”
And now, in 2025, the research into psychedelic therapy for veterans like Lubecky is taking another step forward according to a report by Military.com. Nine VA facilities, in the Bronx, Los Angeles, Omaha, Palo Alto, Portland (Oregon), San Diego, San Francisco, West Haven, and White River Junction, are participating in long-term studies to test the safety and clinical impact of psychedelic compounds for PTSD, treatment-resistant depression, and anxiety disorders.
Early trials from Johns Hopkins University, the Multidisciplinary Association for Psychedelic Studies (MAPS), and others found significant symptom reductions for some participants with chronic PTSD. MAPP2, the multisite phase 3 study that extended the findings of MAPP1, found that MDMA-assisted therapy significantly improved PTSD symptoms and functional impairment, compared with placebo-assisted therapy. Notably, of the 52 participants (including 16 veterans) 45 (86%) achieved a clinically meaningful benefit, and 37 (71%) no longer met criteria for PTSD by study end. Despite the promising findings, a US Food and Drug Administration (FDA) advisory panel recommended against approving the treatment.
In 2024 the VA issued a request for applications for proposals from its network of VA researchers and academic institutions to gather “definitive scientific evidence” on the potential efficacy and safety of psychedelic compounds, such as MDMA and psilocybin, when used in conjunction with psychotherapy. It would be the first time since the 1960s that the VA had funded research on such compounds.
Funding proposals for such research have cycled in and out of Congress for years, but have gathered more steam in the last few years. The 2024 National Defense Authorization Act directed the US Department of Defense to establish a process for funding clinical research into the use of certain psychedelic substances to treat PTSD and traumatic brain injury. In April 2024, Representatives Lou Correa (D-CA) and Jack Bergman (R-MI), cochairs of the Psychedelics Advancing Therapies (PATH) caucus, introduced the Innovative Therapies Centers of Excellence Act of 2025, bipartisan legislation that would increase federally funded research on innovative therapies to treat veterans with PTSD, substance use disorder, and depression. It would also, if enacted, direct the VA to create ≥ 5 dedicated centers of excellence to study the therapeutic uses of psychedelic substances. The bill has also been endorsed by the American Legion, Veterans of Foreign Wars, Iraq and Afghanistan Veterans of America, Disabled American Veterans, and the Wounded Warrior Project.
The current administration has two strong high-level supporters of psychedelics research: VA Secretary Doug Collins and US Department of Health and Human Service Secretary Robert F. Kennedy Jr. Sec. Kennedy has castigated the FDA for what he calls “aggressive suppression” of alternative and complementary treatments, including psychedelics. This, although the FDA granted breakthrough therapy status for MDMA for treating PTSD and psilocybin for treating depression in 2018 and 2019, respectively, as well a pivotal draft guidance in 2023 for the development of psychedelic drugs for psychiatric disorders, substance use disorders, and various medical conditions.
Collins, citing an “eye-opening” discussion with Kennedy, enthusiastically backs the research into psychedelics. In a May 2025 hearing that was mainly a series of testy exchanges about his proposed budget slashing, he emphasized the importance of keeping and expanding VA programs and studies on psychedelic treatments, something he has been advocating for since the beginning of his appointment. “We want to make sure we’re not closing off any outlet for a veteran who could be helped by these programs,” he said.
Taking the intern’s advice to look into MDMA, Jonathan Lubecky said, was one of the best decisions he’d ever made. But “it’s not the MDMA that fixes you,” he said. “It’s the therapy. It’s the therapist working with you and you doing the hard work.”
Nine VA Facilities to Open Research Trials for Psychedelics
Nine VA Facilities to Open Research Trials for Psychedelics
VA Revises Policy For Male Breast Cancer
Male veterans with breast cancer may have a more difficult time receiving appropriate health care due to a recently revised US Department of Veterans Affairs (VA) policy that requires each individual to prove the disease’s connection to their service to qualify for coverage.
According to a VA memo obtained by ProPublica, the change is based on a Jan. 1 presidential order titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.” VA Press Secretary Pete Kasperowicz told ProPublica that the policy was changed because the previous policy “falsely classified male breasts as reproductive organs.”
In 2024, the VA added male breast cancer (along with urethral cancer and cancer of the paraurethral glands) to its list of presumed service-connected disabilities due to military environmental exposure, such as toxic burn pits. Male breast cancer was added to the category of “reproductive cancer of any type” after experts pointed to the similarity of male and female breast cancers.
Establishing a connection between a variety of cancers and military service has been a years-long fight only resolved recently in the form of the 2022 PACT Act. The VA lists > 20 medical conditions as “presumptive” for service connection, with some caveats, such as area of service. The act reduced the burden of proof needed: The terms “presumptive conditions” and “presumptive-exposure locations” mean veterans only have to provide their military records to show they were in an exposure location to have their care for certain conditions covered.
Supporters of the PACT Act say the policy change could make it harder for veterans to receive timely care, a serious issue for men with breast cancer who have been “severely underrepresented” in clinical studies and many studies specifically exclude males. The American Cancer Society estimates about 2800 men have been or will be diagnosed with invasive breast cancer in 2025. Less than 1% of breast cancers in the US occur in men, but breast cancer is notably higher among veterans: 11% of 3304 veterans, according to a 2023 study.
Breast cancer is more aggressive in men—they’re more often diagnosed at Stage IV and tend to be older—and survival rates have been lower than in women. In a 2019 study of 16,025 male and 1,800,708 female patients with breast cancer, men had 19% higher overall mortality.
Treatment for male breast cancer has lagged. A 2021 study found men were less likely than women to receive radiation therapy. However, that’s changing. Since that study, however, the American Cancer Society claims treatments and survival rates have improved. According to the Surveillance, Epidemiology, and End Results database, 5-year survival rates are 97% for localized, 86% for regional, and 31% for distant; 84% for all stages combined.
Screening and treatment have focused on women. But the VA Breast and Gynecologic Oncology System of Excellence (BGSoE) provides cancer care for all veterans diagnosed with breast malignancies. Male veterans with breast cancer do face additional challenges in addressing a cancer that is most often associated with females. “I must admit, it was awkward every time I went [to the Women’s Health Center for postmastectomy follow-ups]” William K. Lewis, described in his patient perspective on male breast cancer treatment in the VA.
Though the policy has changed, Kasperowicz told ProPublica that veterans who previously qualified for coverage can keep it: “The department grants disability benefits compensation claims for male Veterans with breast cancer on an individual basis and will continue to do so. VA encourages any male Veterans with breast cancer who feel their health may have been impacted by their military service to submit a disability compensation claim.”
Male veterans with breast cancer may have a more difficult time receiving appropriate health care due to a recently revised US Department of Veterans Affairs (VA) policy that requires each individual to prove the disease’s connection to their service to qualify for coverage.
According to a VA memo obtained by ProPublica, the change is based on a Jan. 1 presidential order titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.” VA Press Secretary Pete Kasperowicz told ProPublica that the policy was changed because the previous policy “falsely classified male breasts as reproductive organs.”
In 2024, the VA added male breast cancer (along with urethral cancer and cancer of the paraurethral glands) to its list of presumed service-connected disabilities due to military environmental exposure, such as toxic burn pits. Male breast cancer was added to the category of “reproductive cancer of any type” after experts pointed to the similarity of male and female breast cancers.
Establishing a connection between a variety of cancers and military service has been a years-long fight only resolved recently in the form of the 2022 PACT Act. The VA lists > 20 medical conditions as “presumptive” for service connection, with some caveats, such as area of service. The act reduced the burden of proof needed: The terms “presumptive conditions” and “presumptive-exposure locations” mean veterans only have to provide their military records to show they were in an exposure location to have their care for certain conditions covered.
Supporters of the PACT Act say the policy change could make it harder for veterans to receive timely care, a serious issue for men with breast cancer who have been “severely underrepresented” in clinical studies and many studies specifically exclude males. The American Cancer Society estimates about 2800 men have been or will be diagnosed with invasive breast cancer in 2025. Less than 1% of breast cancers in the US occur in men, but breast cancer is notably higher among veterans: 11% of 3304 veterans, according to a 2023 study.
Breast cancer is more aggressive in men—they’re more often diagnosed at Stage IV and tend to be older—and survival rates have been lower than in women. In a 2019 study of 16,025 male and 1,800,708 female patients with breast cancer, men had 19% higher overall mortality.
Treatment for male breast cancer has lagged. A 2021 study found men were less likely than women to receive radiation therapy. However, that’s changing. Since that study, however, the American Cancer Society claims treatments and survival rates have improved. According to the Surveillance, Epidemiology, and End Results database, 5-year survival rates are 97% for localized, 86% for regional, and 31% for distant; 84% for all stages combined.
Screening and treatment have focused on women. But the VA Breast and Gynecologic Oncology System of Excellence (BGSoE) provides cancer care for all veterans diagnosed with breast malignancies. Male veterans with breast cancer do face additional challenges in addressing a cancer that is most often associated with females. “I must admit, it was awkward every time I went [to the Women’s Health Center for postmastectomy follow-ups]” William K. Lewis, described in his patient perspective on male breast cancer treatment in the VA.
Though the policy has changed, Kasperowicz told ProPublica that veterans who previously qualified for coverage can keep it: “The department grants disability benefits compensation claims for male Veterans with breast cancer on an individual basis and will continue to do so. VA encourages any male Veterans with breast cancer who feel their health may have been impacted by their military service to submit a disability compensation claim.”
Male veterans with breast cancer may have a more difficult time receiving appropriate health care due to a recently revised US Department of Veterans Affairs (VA) policy that requires each individual to prove the disease’s connection to their service to qualify for coverage.
According to a VA memo obtained by ProPublica, the change is based on a Jan. 1 presidential order titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.” VA Press Secretary Pete Kasperowicz told ProPublica that the policy was changed because the previous policy “falsely classified male breasts as reproductive organs.”
In 2024, the VA added male breast cancer (along with urethral cancer and cancer of the paraurethral glands) to its list of presumed service-connected disabilities due to military environmental exposure, such as toxic burn pits. Male breast cancer was added to the category of “reproductive cancer of any type” after experts pointed to the similarity of male and female breast cancers.
Establishing a connection between a variety of cancers and military service has been a years-long fight only resolved recently in the form of the 2022 PACT Act. The VA lists > 20 medical conditions as “presumptive” for service connection, with some caveats, such as area of service. The act reduced the burden of proof needed: The terms “presumptive conditions” and “presumptive-exposure locations” mean veterans only have to provide their military records to show they were in an exposure location to have their care for certain conditions covered.
Supporters of the PACT Act say the policy change could make it harder for veterans to receive timely care, a serious issue for men with breast cancer who have been “severely underrepresented” in clinical studies and many studies specifically exclude males. The American Cancer Society estimates about 2800 men have been or will be diagnosed with invasive breast cancer in 2025. Less than 1% of breast cancers in the US occur in men, but breast cancer is notably higher among veterans: 11% of 3304 veterans, according to a 2023 study.
Breast cancer is more aggressive in men—they’re more often diagnosed at Stage IV and tend to be older—and survival rates have been lower than in women. In a 2019 study of 16,025 male and 1,800,708 female patients with breast cancer, men had 19% higher overall mortality.
Treatment for male breast cancer has lagged. A 2021 study found men were less likely than women to receive radiation therapy. However, that’s changing. Since that study, however, the American Cancer Society claims treatments and survival rates have improved. According to the Surveillance, Epidemiology, and End Results database, 5-year survival rates are 97% for localized, 86% for regional, and 31% for distant; 84% for all stages combined.
Screening and treatment have focused on women. But the VA Breast and Gynecologic Oncology System of Excellence (BGSoE) provides cancer care for all veterans diagnosed with breast malignancies. Male veterans with breast cancer do face additional challenges in addressing a cancer that is most often associated with females. “I must admit, it was awkward every time I went [to the Women’s Health Center for postmastectomy follow-ups]” William K. Lewis, described in his patient perspective on male breast cancer treatment in the VA.
Though the policy has changed, Kasperowicz told ProPublica that veterans who previously qualified for coverage can keep it: “The department grants disability benefits compensation claims for male Veterans with breast cancer on an individual basis and will continue to do so. VA encourages any male Veterans with breast cancer who feel their health may have been impacted by their military service to submit a disability compensation claim.”
Helping Veterans Ease Into Civilian Life
What does a successful military-to-civilian transition look like? How do we know if a veteran is sinking, treading water, or swimming? Two recent studies by the Penn State University Clearinghouse for Military Family Readiness sought to answer to those questions and more while determining how and when is the right time to step in to help a veteran in need.
The research analyzed The Veterans Metrics Initiative data (TVMI). This longitudinal study surveyed 9566 men and women who left active duty in 2016 over 3 years, answering questions about deployment histories, adverse childhood experiences (ACEs) and exposure to combat. They also reported whether they had symptoms related to anxiety and depression.
The TVMI study found that ACEs predicted poor outcomes early on and when combined with warfare experience dramatically increased the likelihood of mental health issues, including posttraumatic stress disorder (PTSD), anxiety, and depression; moral injury impacted adjustment to civilian life (the degree varied by gender); and, many veterans have a “growth outlook” as a result of a trauma or crisis they experienced.
The TVMI study found that almost all veterans use transition resources in the first 2 years after military separation. Beyond that, however, those in high-risk categories (eg, PTSD and cumulative trauma experiences) need continued support. This may come in the form of a universal screener and linking it to a navigation infrastructure (eg, AmericaServes), “thereby identifying risk factors early and providing targeted supports, interventions, and components.”
Veterans often face a series of simultaneous challenges as they return to civilian life. Among them include getting used to family and friends again, finding jobs, losing their military identity, structure, and perhaps leaving military friends behind. In addition, veterans are likely dealing with physical and mental health challenges, which can significantly influence how well they readjust to civilian life and lead to inconsistency experiences for each individual.
A 2019 survey from the Pew Research Center found about 40% of veterans who suffered from PTSD said they frequently had difficulty dealing with the lack of structure in civilian life, compared with 5% of those who do not have PTSD. Another survey cited a large majority (78%) of pre-9/11 veterans said their readjustment was very or somewhat easy. However, 26% said adjusting to civilian life was difficult.
In 2011, 4 variables were identified that predicted easy civilian life re-entry: being an officer; having a consistently clear understanding of the missions while in the service; being a college graduate; and, for post-9/11 veterans, attending religious services frequently. Six variables were associated with a diminished probability of an easy transition: having had a traumatic experience; being seriously injured; serving in the post-9/11 era; serving in a combat zone; serving with someone who was killed or injured; and, for post-9/11 veterans, being married while in the service.
The probabilities of an easy re-entry dropped from 82% for those who did not experience a traumatic event to 56% for those who did—the largest change noted in the 2011 study.
The second Penn State study evaluated a model framework with a lifespan development perspective. The study surveyed veterans on their self-reported satisfaction or symptoms in 7 domains of well-being: employment, education, financial, legal problems, social, physical health, and mental health. Within 3 months of separation , 41% of respondents fell into the “problematic” category for the mental health domain. However, by 30 to 33 months postseparation, this proportion dropped to 34%. During the same period, the proportion of veterans in the at risk category increased from 28% at Wave 1 to 37% at Wave 6. About 30% of veterans fell into the successful category for symptoms across the 3 examined waves. Almost 60% were in the successful category across the 3 time points.
Both Penn State studies emphasize the importance of viewing veterans as individuals on their own timelines.
“These findings underscore that the transition to civilian life is not a single moment, but a process influenced by experiences across the life span,” said Mary M. Mitchell, research professor at the Clearinghouse and lead author on the predictors study. “By following veterans over 3 years, we were able to see how patterns emerge that would be invisible in a one-time survey.”
Current conceptualization “assumes that there are commonalities across veterans when evaluating the success of the transition to civilian life,” according to the authors of the framework study. “However, each veteran likely has his or her view of what a successful transition constitutes, and he or she may weigh domains differently when considering his or her own transition.”
The research highlights the need to find ways to encourage veterans to seek help—and not just in the first year, which is often the most stressful. The Pew Research Center survey identified a “significant break from the past,” in that nearly 70% of post-9/11 veterans said their superiors made them feel comfortable about seeking help with emotional issues resulting from their military service.
However, ≤ 8% veterans in the TVMI study used any health programs, even when they screened positive for mental health problems. Veterans who did use counseling services, however, improved their depression symptoms. Engaging veterans at various time points could help keep mental health problems from worsening during—and beyond—the transition.
What does a successful military-to-civilian transition look like? How do we know if a veteran is sinking, treading water, or swimming? Two recent studies by the Penn State University Clearinghouse for Military Family Readiness sought to answer to those questions and more while determining how and when is the right time to step in to help a veteran in need.
The research analyzed The Veterans Metrics Initiative data (TVMI). This longitudinal study surveyed 9566 men and women who left active duty in 2016 over 3 years, answering questions about deployment histories, adverse childhood experiences (ACEs) and exposure to combat. They also reported whether they had symptoms related to anxiety and depression.
The TVMI study found that ACEs predicted poor outcomes early on and when combined with warfare experience dramatically increased the likelihood of mental health issues, including posttraumatic stress disorder (PTSD), anxiety, and depression; moral injury impacted adjustment to civilian life (the degree varied by gender); and, many veterans have a “growth outlook” as a result of a trauma or crisis they experienced.
The TVMI study found that almost all veterans use transition resources in the first 2 years after military separation. Beyond that, however, those in high-risk categories (eg, PTSD and cumulative trauma experiences) need continued support. This may come in the form of a universal screener and linking it to a navigation infrastructure (eg, AmericaServes), “thereby identifying risk factors early and providing targeted supports, interventions, and components.”
Veterans often face a series of simultaneous challenges as they return to civilian life. Among them include getting used to family and friends again, finding jobs, losing their military identity, structure, and perhaps leaving military friends behind. In addition, veterans are likely dealing with physical and mental health challenges, which can significantly influence how well they readjust to civilian life and lead to inconsistency experiences for each individual.
A 2019 survey from the Pew Research Center found about 40% of veterans who suffered from PTSD said they frequently had difficulty dealing with the lack of structure in civilian life, compared with 5% of those who do not have PTSD. Another survey cited a large majority (78%) of pre-9/11 veterans said their readjustment was very or somewhat easy. However, 26% said adjusting to civilian life was difficult.
In 2011, 4 variables were identified that predicted easy civilian life re-entry: being an officer; having a consistently clear understanding of the missions while in the service; being a college graduate; and, for post-9/11 veterans, attending religious services frequently. Six variables were associated with a diminished probability of an easy transition: having had a traumatic experience; being seriously injured; serving in the post-9/11 era; serving in a combat zone; serving with someone who was killed or injured; and, for post-9/11 veterans, being married while in the service.
The probabilities of an easy re-entry dropped from 82% for those who did not experience a traumatic event to 56% for those who did—the largest change noted in the 2011 study.
The second Penn State study evaluated a model framework with a lifespan development perspective. The study surveyed veterans on their self-reported satisfaction or symptoms in 7 domains of well-being: employment, education, financial, legal problems, social, physical health, and mental health. Within 3 months of separation , 41% of respondents fell into the “problematic” category for the mental health domain. However, by 30 to 33 months postseparation, this proportion dropped to 34%. During the same period, the proportion of veterans in the at risk category increased from 28% at Wave 1 to 37% at Wave 6. About 30% of veterans fell into the successful category for symptoms across the 3 examined waves. Almost 60% were in the successful category across the 3 time points.
Both Penn State studies emphasize the importance of viewing veterans as individuals on their own timelines.
“These findings underscore that the transition to civilian life is not a single moment, but a process influenced by experiences across the life span,” said Mary M. Mitchell, research professor at the Clearinghouse and lead author on the predictors study. “By following veterans over 3 years, we were able to see how patterns emerge that would be invisible in a one-time survey.”
Current conceptualization “assumes that there are commonalities across veterans when evaluating the success of the transition to civilian life,” according to the authors of the framework study. “However, each veteran likely has his or her view of what a successful transition constitutes, and he or she may weigh domains differently when considering his or her own transition.”
The research highlights the need to find ways to encourage veterans to seek help—and not just in the first year, which is often the most stressful. The Pew Research Center survey identified a “significant break from the past,” in that nearly 70% of post-9/11 veterans said their superiors made them feel comfortable about seeking help with emotional issues resulting from their military service.
However, ≤ 8% veterans in the TVMI study used any health programs, even when they screened positive for mental health problems. Veterans who did use counseling services, however, improved their depression symptoms. Engaging veterans at various time points could help keep mental health problems from worsening during—and beyond—the transition.
What does a successful military-to-civilian transition look like? How do we know if a veteran is sinking, treading water, or swimming? Two recent studies by the Penn State University Clearinghouse for Military Family Readiness sought to answer to those questions and more while determining how and when is the right time to step in to help a veteran in need.
The research analyzed The Veterans Metrics Initiative data (TVMI). This longitudinal study surveyed 9566 men and women who left active duty in 2016 over 3 years, answering questions about deployment histories, adverse childhood experiences (ACEs) and exposure to combat. They also reported whether they had symptoms related to anxiety and depression.
The TVMI study found that ACEs predicted poor outcomes early on and when combined with warfare experience dramatically increased the likelihood of mental health issues, including posttraumatic stress disorder (PTSD), anxiety, and depression; moral injury impacted adjustment to civilian life (the degree varied by gender); and, many veterans have a “growth outlook” as a result of a trauma or crisis they experienced.
The TVMI study found that almost all veterans use transition resources in the first 2 years after military separation. Beyond that, however, those in high-risk categories (eg, PTSD and cumulative trauma experiences) need continued support. This may come in the form of a universal screener and linking it to a navigation infrastructure (eg, AmericaServes), “thereby identifying risk factors early and providing targeted supports, interventions, and components.”
Veterans often face a series of simultaneous challenges as they return to civilian life. Among them include getting used to family and friends again, finding jobs, losing their military identity, structure, and perhaps leaving military friends behind. In addition, veterans are likely dealing with physical and mental health challenges, which can significantly influence how well they readjust to civilian life and lead to inconsistency experiences for each individual.
A 2019 survey from the Pew Research Center found about 40% of veterans who suffered from PTSD said they frequently had difficulty dealing with the lack of structure in civilian life, compared with 5% of those who do not have PTSD. Another survey cited a large majority (78%) of pre-9/11 veterans said their readjustment was very or somewhat easy. However, 26% said adjusting to civilian life was difficult.
In 2011, 4 variables were identified that predicted easy civilian life re-entry: being an officer; having a consistently clear understanding of the missions while in the service; being a college graduate; and, for post-9/11 veterans, attending religious services frequently. Six variables were associated with a diminished probability of an easy transition: having had a traumatic experience; being seriously injured; serving in the post-9/11 era; serving in a combat zone; serving with someone who was killed or injured; and, for post-9/11 veterans, being married while in the service.
The probabilities of an easy re-entry dropped from 82% for those who did not experience a traumatic event to 56% for those who did—the largest change noted in the 2011 study.
The second Penn State study evaluated a model framework with a lifespan development perspective. The study surveyed veterans on their self-reported satisfaction or symptoms in 7 domains of well-being: employment, education, financial, legal problems, social, physical health, and mental health. Within 3 months of separation , 41% of respondents fell into the “problematic” category for the mental health domain. However, by 30 to 33 months postseparation, this proportion dropped to 34%. During the same period, the proportion of veterans in the at risk category increased from 28% at Wave 1 to 37% at Wave 6. About 30% of veterans fell into the successful category for symptoms across the 3 examined waves. Almost 60% were in the successful category across the 3 time points.
Both Penn State studies emphasize the importance of viewing veterans as individuals on their own timelines.
“These findings underscore that the transition to civilian life is not a single moment, but a process influenced by experiences across the life span,” said Mary M. Mitchell, research professor at the Clearinghouse and lead author on the predictors study. “By following veterans over 3 years, we were able to see how patterns emerge that would be invisible in a one-time survey.”
Current conceptualization “assumes that there are commonalities across veterans when evaluating the success of the transition to civilian life,” according to the authors of the framework study. “However, each veteran likely has his or her view of what a successful transition constitutes, and he or she may weigh domains differently when considering his or her own transition.”
The research highlights the need to find ways to encourage veterans to seek help—and not just in the first year, which is often the most stressful. The Pew Research Center survey identified a “significant break from the past,” in that nearly 70% of post-9/11 veterans said their superiors made them feel comfortable about seeking help with emotional issues resulting from their military service.
However, ≤ 8% veterans in the TVMI study used any health programs, even when they screened positive for mental health problems. Veterans who did use counseling services, however, improved their depression symptoms. Engaging veterans at various time points could help keep mental health problems from worsening during—and beyond—the transition.
Is High Quality VA Psychiatric Care Keeping Readmissions Rates Low?
Repeated and frequent hospitalizations—sometimes referred to as the revolving door phenomenon— are a particular risk for patients during the first month after discharge. Early psychiatric readmission is a standard indicator of adverse outcomes. However, the results
The quality of previous care has long been thought to be a driver of readmission. If that’s the case, a 2025 study suggests that on average veterans received high-quality inpatient psychiatric services at Veterans Health Administration (VHA) facilities across the nation and that may have been key to keeping readmissions down. Analyzing data from 88,954 veterans who received care at VHA Inpatient Mental Health (IMH) services, the researchers found a “relatively low” rate of readmission within 30 days: 7.1% compared with 8% to 31% of other psychiatric patients in the US. With 40,220 unique patients receiving IMH care per year on average between October 2019 and September 2022, a 7.1% readmission rate means > 2800 30-day readmissions annually.
Research has found that veterans who receive care at the VA have better outcomes than those treated in the private sector. Part of that has to do with practitioners who understand the unique needs of their patients. Veterans may have posttraumatic stress disorder or multiple diagnoses, such as depression, panic disorder, and a substance use disorder. Their mental health issues may also coexist with physical health problems, such as traumatic brain injuries due to explosions.
“If you’re trained at the VA, you learn something important about veteran mental health care that you’ll never get if you’re trained someplace else,” Rodney R. Baker, PhD, retired mental health director and chief of psychology for the South Texas VA Health Care System, said recently. Community clinicians may not know how to collect and incorporate information about a patient’s military history, including details about deployments, combat exposure, injuries, military sexual trauma, and unit culture. They may also lack expertise in navigating the transition between military and veteran life, now considered a critical adjustment period.
“This is a unique population,” said Conwell Smith, the American Psychological Association’s deputy chief of military and veteran policy. “Sending veterans out to the community without requiring that mental health care providers understand them is concerning.”
IMH services aim to stabilize mental health crises and improve veterans’ functioning through patient-centered, evidence-based, and recovery-oriented approaches shown to reduce readmission rates. Treatment generally involves a minimum of 4 hours of interdisciplinary, therapeutic programming each day. And upon discharge, the inpatient care team facilitates the patient’s transition to appropriate outpatient services.
Follow-up care, particularly during the first 30 days, has proved critical in reducing readmissions. In studies that have analyzed postdischarge interventions (psychoeducation, mentoring, community-based hospital treatment, use of continuous follow-up and compulsory community treatment), all found fewer hospitalizations when compared to a control group, or a smaller number of admissions after the intervention.
Mental health care for veterans should be provided by experienced practitioners—but those practitioners are leaving VA. According to the VA Office of Inspector General, 57% of medical centers report a shortage of psychologists. And according to the VA’s monthly Workforce Dashboard, the VHA lost 234 psychologists in the first 9 months of 2025. The VA has also announced plans to cut 30,000 jobs by the end of the year and impose caps on staff at every medical center.
“This approach locks in permanent VA understaffing just as demand for mental health services is projected to continue growing through 2030,” said Russell Lemle, PhD, a clinical psychologist and senior policy analyst for the Veterans Healthcare Policy Institute. “The private sector can’t fill this gap either—over a third of Americans live in areas already facing mental health professional shortages. That’s not taking care of our veterans.
“Unless actions are taken quickly to reverse the trend, its mental health services could easily diminish substantially within 10 to 20 years.”
Repeated and frequent hospitalizations—sometimes referred to as the revolving door phenomenon— are a particular risk for patients during the first month after discharge. Early psychiatric readmission is a standard indicator of adverse outcomes. However, the results
The quality of previous care has long been thought to be a driver of readmission. If that’s the case, a 2025 study suggests that on average veterans received high-quality inpatient psychiatric services at Veterans Health Administration (VHA) facilities across the nation and that may have been key to keeping readmissions down. Analyzing data from 88,954 veterans who received care at VHA Inpatient Mental Health (IMH) services, the researchers found a “relatively low” rate of readmission within 30 days: 7.1% compared with 8% to 31% of other psychiatric patients in the US. With 40,220 unique patients receiving IMH care per year on average between October 2019 and September 2022, a 7.1% readmission rate means > 2800 30-day readmissions annually.
Research has found that veterans who receive care at the VA have better outcomes than those treated in the private sector. Part of that has to do with practitioners who understand the unique needs of their patients. Veterans may have posttraumatic stress disorder or multiple diagnoses, such as depression, panic disorder, and a substance use disorder. Their mental health issues may also coexist with physical health problems, such as traumatic brain injuries due to explosions.
“If you’re trained at the VA, you learn something important about veteran mental health care that you’ll never get if you’re trained someplace else,” Rodney R. Baker, PhD, retired mental health director and chief of psychology for the South Texas VA Health Care System, said recently. Community clinicians may not know how to collect and incorporate information about a patient’s military history, including details about deployments, combat exposure, injuries, military sexual trauma, and unit culture. They may also lack expertise in navigating the transition between military and veteran life, now considered a critical adjustment period.
“This is a unique population,” said Conwell Smith, the American Psychological Association’s deputy chief of military and veteran policy. “Sending veterans out to the community without requiring that mental health care providers understand them is concerning.”
IMH services aim to stabilize mental health crises and improve veterans’ functioning through patient-centered, evidence-based, and recovery-oriented approaches shown to reduce readmission rates. Treatment generally involves a minimum of 4 hours of interdisciplinary, therapeutic programming each day. And upon discharge, the inpatient care team facilitates the patient’s transition to appropriate outpatient services.
Follow-up care, particularly during the first 30 days, has proved critical in reducing readmissions. In studies that have analyzed postdischarge interventions (psychoeducation, mentoring, community-based hospital treatment, use of continuous follow-up and compulsory community treatment), all found fewer hospitalizations when compared to a control group, or a smaller number of admissions after the intervention.
Mental health care for veterans should be provided by experienced practitioners—but those practitioners are leaving VA. According to the VA Office of Inspector General, 57% of medical centers report a shortage of psychologists. And according to the VA’s monthly Workforce Dashboard, the VHA lost 234 psychologists in the first 9 months of 2025. The VA has also announced plans to cut 30,000 jobs by the end of the year and impose caps on staff at every medical center.
“This approach locks in permanent VA understaffing just as demand for mental health services is projected to continue growing through 2030,” said Russell Lemle, PhD, a clinical psychologist and senior policy analyst for the Veterans Healthcare Policy Institute. “The private sector can’t fill this gap either—over a third of Americans live in areas already facing mental health professional shortages. That’s not taking care of our veterans.
“Unless actions are taken quickly to reverse the trend, its mental health services could easily diminish substantially within 10 to 20 years.”
Repeated and frequent hospitalizations—sometimes referred to as the revolving door phenomenon— are a particular risk for patients during the first month after discharge. Early psychiatric readmission is a standard indicator of adverse outcomes. However, the results
The quality of previous care has long been thought to be a driver of readmission. If that’s the case, a 2025 study suggests that on average veterans received high-quality inpatient psychiatric services at Veterans Health Administration (VHA) facilities across the nation and that may have been key to keeping readmissions down. Analyzing data from 88,954 veterans who received care at VHA Inpatient Mental Health (IMH) services, the researchers found a “relatively low” rate of readmission within 30 days: 7.1% compared with 8% to 31% of other psychiatric patients in the US. With 40,220 unique patients receiving IMH care per year on average between October 2019 and September 2022, a 7.1% readmission rate means > 2800 30-day readmissions annually.
Research has found that veterans who receive care at the VA have better outcomes than those treated in the private sector. Part of that has to do with practitioners who understand the unique needs of their patients. Veterans may have posttraumatic stress disorder or multiple diagnoses, such as depression, panic disorder, and a substance use disorder. Their mental health issues may also coexist with physical health problems, such as traumatic brain injuries due to explosions.
“If you’re trained at the VA, you learn something important about veteran mental health care that you’ll never get if you’re trained someplace else,” Rodney R. Baker, PhD, retired mental health director and chief of psychology for the South Texas VA Health Care System, said recently. Community clinicians may not know how to collect and incorporate information about a patient’s military history, including details about deployments, combat exposure, injuries, military sexual trauma, and unit culture. They may also lack expertise in navigating the transition between military and veteran life, now considered a critical adjustment period.
“This is a unique population,” said Conwell Smith, the American Psychological Association’s deputy chief of military and veteran policy. “Sending veterans out to the community without requiring that mental health care providers understand them is concerning.”
IMH services aim to stabilize mental health crises and improve veterans’ functioning through patient-centered, evidence-based, and recovery-oriented approaches shown to reduce readmission rates. Treatment generally involves a minimum of 4 hours of interdisciplinary, therapeutic programming each day. And upon discharge, the inpatient care team facilitates the patient’s transition to appropriate outpatient services.
Follow-up care, particularly during the first 30 days, has proved critical in reducing readmissions. In studies that have analyzed postdischarge interventions (psychoeducation, mentoring, community-based hospital treatment, use of continuous follow-up and compulsory community treatment), all found fewer hospitalizations when compared to a control group, or a smaller number of admissions after the intervention.
Mental health care for veterans should be provided by experienced practitioners—but those practitioners are leaving VA. According to the VA Office of Inspector General, 57% of medical centers report a shortage of psychologists. And according to the VA’s monthly Workforce Dashboard, the VHA lost 234 psychologists in the first 9 months of 2025. The VA has also announced plans to cut 30,000 jobs by the end of the year and impose caps on staff at every medical center.
“This approach locks in permanent VA understaffing just as demand for mental health services is projected to continue growing through 2030,” said Russell Lemle, PhD, a clinical psychologist and senior policy analyst for the Veterans Healthcare Policy Institute. “The private sector can’t fill this gap either—over a third of Americans live in areas already facing mental health professional shortages. That’s not taking care of our veterans.
“Unless actions are taken quickly to reverse the trend, its mental health services could easily diminish substantially within 10 to 20 years.”
Taking Therapy Home With Mobile Mental Health Apps
For Kelly, a retired Navy operations specialist, coping with depression and anxiety hindered her ability to enjoy everyday life. Then she elected to enter therapy, a decision she calls “transformative.”
“When I started doing therapy, it was like releasing the toxins, releasing the buildup of the fear or the rage or the overwhelming feelings of shame,” she says. “We can’t just hold on to it. Just telling the truth, it helps me every single day. It is so worth it.”
Kurt, an Army veteran, tried to power through his anxiety, depression, and survivor guilt. He didn’t have much faith in mental health therapy, thinking no one could relate to him. He was surprised, though, once he started treatment, how much his life improved. He now encourages other veterans to face their own mental health challenges, be it through virtual/mental health apps or in-person care.
“From getting help, every day of my life is better,” he says, “and I couldn’t be more grateful for it.”
Stories from Kelly and Kurt are 2 of 7 the US Department of Veterans Affairs (VA) highlighted during National Recovery Month, outlining how their lives were forever changed with the support of mental health care.
But for every Kelly and Kurt, there are thousands of individuals reluctant to seek mental health care. A analysis of 2019-2020 data from the National Health and Resilience in Veterans Study found that 924 (26%) of 4069 veterans met criteria for ≥ 1 psychological disorders, but only 12% reported engagement in mental health care. The researchers considered the role of protective psychosocial characteristics, such as grit (ie, “trait perseverance that extends to one’s decision or commitment to address mental health needs on one’s own; dispositional optimism; and purpose in life”). Veterans who reported mental dysfunction but scored highly on grit were less likely to be engaged in treatment. This pattern suggests higher levels of grit may reduce the likelihood of seeking treatment, “even in the presence of clinically meaningful distress.”
A 2004 study found only 23% to 40% of service members who screened positive for a mental disorder sought care. They often believed they would be seen as weak, or their unit leadership might treat them differently, and unit members would have less confidence in them.
Given that military members and veterans are at increased risk of posttraumatic stress disorder (PTSD) in addition to mood, anxiety, and substance use disorders, any alternatives that increase their access to support and services are crucial. For those who aren’t disposed to office visits and group therapy, the answer may lie in mobile apps.
In a recent randomized controlled trial, 201 veterans who screened positive for PTSD and alcohol use disorder were divided into 2 groups: a mobile mindfulness-based intervention group enhanced with brief alcohol intervention content (Mind Guide), and an active stress management program group. Mind Guide engagement was excellent, according to the study, with averages of > 31 logins and 5 hours of app use. At 16 weeks, the Mind Guide group showed significant reductions in PTSD symptoms (no differences emerged for alcohol use frequency). Mind Guide may be a valuable adjunct to more intensive in-person PTSD treatment by facilitating interest in services, integration into care, and/or sustainment of posttreatment improvements. The VA currently offers 16 apps, including MHA for Veterans, an app designed for patients to complete mental health assessments after their clinician assigned them. Other apps address a variety of issues, such as anger management, insomnia, chronic pain, and PTSD.
Two apps were created with an eye toward specific communities. One, Veterans Wellness Path, was designed for American Indians and Alaska Natives with input from those veterans, their family members, and health care practitioners. It supports the transition from military service to home and encourages balance and connection with self, family, community, and environment. Similarly, WellWithin Coach was designed by the VA National Center for PTSD with input from women veterans and subject matter experts in women’s mental health.
Whatever form it takes—in-person or virtual—finding support that works can make all the difference for veterans. Kelly founded and serves as the executive director of Acta Non Verba: Youth Urban Farm Project, an organization that brings together > 3000 low-income youth and families annually to learn about urban farming, aiming to fill a gap in an area known as a food desert: “We do have the power and the right to wake up the next day and try to do something different,” she said.
For Kelly, a retired Navy operations specialist, coping with depression and anxiety hindered her ability to enjoy everyday life. Then she elected to enter therapy, a decision she calls “transformative.”
“When I started doing therapy, it was like releasing the toxins, releasing the buildup of the fear or the rage or the overwhelming feelings of shame,” she says. “We can’t just hold on to it. Just telling the truth, it helps me every single day. It is so worth it.”
Kurt, an Army veteran, tried to power through his anxiety, depression, and survivor guilt. He didn’t have much faith in mental health therapy, thinking no one could relate to him. He was surprised, though, once he started treatment, how much his life improved. He now encourages other veterans to face their own mental health challenges, be it through virtual/mental health apps or in-person care.
“From getting help, every day of my life is better,” he says, “and I couldn’t be more grateful for it.”
Stories from Kelly and Kurt are 2 of 7 the US Department of Veterans Affairs (VA) highlighted during National Recovery Month, outlining how their lives were forever changed with the support of mental health care.
But for every Kelly and Kurt, there are thousands of individuals reluctant to seek mental health care. A analysis of 2019-2020 data from the National Health and Resilience in Veterans Study found that 924 (26%) of 4069 veterans met criteria for ≥ 1 psychological disorders, but only 12% reported engagement in mental health care. The researchers considered the role of protective psychosocial characteristics, such as grit (ie, “trait perseverance that extends to one’s decision or commitment to address mental health needs on one’s own; dispositional optimism; and purpose in life”). Veterans who reported mental dysfunction but scored highly on grit were less likely to be engaged in treatment. This pattern suggests higher levels of grit may reduce the likelihood of seeking treatment, “even in the presence of clinically meaningful distress.”
A 2004 study found only 23% to 40% of service members who screened positive for a mental disorder sought care. They often believed they would be seen as weak, or their unit leadership might treat them differently, and unit members would have less confidence in them.
Given that military members and veterans are at increased risk of posttraumatic stress disorder (PTSD) in addition to mood, anxiety, and substance use disorders, any alternatives that increase their access to support and services are crucial. For those who aren’t disposed to office visits and group therapy, the answer may lie in mobile apps.
In a recent randomized controlled trial, 201 veterans who screened positive for PTSD and alcohol use disorder were divided into 2 groups: a mobile mindfulness-based intervention group enhanced with brief alcohol intervention content (Mind Guide), and an active stress management program group. Mind Guide engagement was excellent, according to the study, with averages of > 31 logins and 5 hours of app use. At 16 weeks, the Mind Guide group showed significant reductions in PTSD symptoms (no differences emerged for alcohol use frequency). Mind Guide may be a valuable adjunct to more intensive in-person PTSD treatment by facilitating interest in services, integration into care, and/or sustainment of posttreatment improvements. The VA currently offers 16 apps, including MHA for Veterans, an app designed for patients to complete mental health assessments after their clinician assigned them. Other apps address a variety of issues, such as anger management, insomnia, chronic pain, and PTSD.
Two apps were created with an eye toward specific communities. One, Veterans Wellness Path, was designed for American Indians and Alaska Natives with input from those veterans, their family members, and health care practitioners. It supports the transition from military service to home and encourages balance and connection with self, family, community, and environment. Similarly, WellWithin Coach was designed by the VA National Center for PTSD with input from women veterans and subject matter experts in women’s mental health.
Whatever form it takes—in-person or virtual—finding support that works can make all the difference for veterans. Kelly founded and serves as the executive director of Acta Non Verba: Youth Urban Farm Project, an organization that brings together > 3000 low-income youth and families annually to learn about urban farming, aiming to fill a gap in an area known as a food desert: “We do have the power and the right to wake up the next day and try to do something different,” she said.
For Kelly, a retired Navy operations specialist, coping with depression and anxiety hindered her ability to enjoy everyday life. Then she elected to enter therapy, a decision she calls “transformative.”
“When I started doing therapy, it was like releasing the toxins, releasing the buildup of the fear or the rage or the overwhelming feelings of shame,” she says. “We can’t just hold on to it. Just telling the truth, it helps me every single day. It is so worth it.”
Kurt, an Army veteran, tried to power through his anxiety, depression, and survivor guilt. He didn’t have much faith in mental health therapy, thinking no one could relate to him. He was surprised, though, once he started treatment, how much his life improved. He now encourages other veterans to face their own mental health challenges, be it through virtual/mental health apps or in-person care.
“From getting help, every day of my life is better,” he says, “and I couldn’t be more grateful for it.”
Stories from Kelly and Kurt are 2 of 7 the US Department of Veterans Affairs (VA) highlighted during National Recovery Month, outlining how their lives were forever changed with the support of mental health care.
But for every Kelly and Kurt, there are thousands of individuals reluctant to seek mental health care. A analysis of 2019-2020 data from the National Health and Resilience in Veterans Study found that 924 (26%) of 4069 veterans met criteria for ≥ 1 psychological disorders, but only 12% reported engagement in mental health care. The researchers considered the role of protective psychosocial characteristics, such as grit (ie, “trait perseverance that extends to one’s decision or commitment to address mental health needs on one’s own; dispositional optimism; and purpose in life”). Veterans who reported mental dysfunction but scored highly on grit were less likely to be engaged in treatment. This pattern suggests higher levels of grit may reduce the likelihood of seeking treatment, “even in the presence of clinically meaningful distress.”
A 2004 study found only 23% to 40% of service members who screened positive for a mental disorder sought care. They often believed they would be seen as weak, or their unit leadership might treat them differently, and unit members would have less confidence in them.
Given that military members and veterans are at increased risk of posttraumatic stress disorder (PTSD) in addition to mood, anxiety, and substance use disorders, any alternatives that increase their access to support and services are crucial. For those who aren’t disposed to office visits and group therapy, the answer may lie in mobile apps.
In a recent randomized controlled trial, 201 veterans who screened positive for PTSD and alcohol use disorder were divided into 2 groups: a mobile mindfulness-based intervention group enhanced with brief alcohol intervention content (Mind Guide), and an active stress management program group. Mind Guide engagement was excellent, according to the study, with averages of > 31 logins and 5 hours of app use. At 16 weeks, the Mind Guide group showed significant reductions in PTSD symptoms (no differences emerged for alcohol use frequency). Mind Guide may be a valuable adjunct to more intensive in-person PTSD treatment by facilitating interest in services, integration into care, and/or sustainment of posttreatment improvements. The VA currently offers 16 apps, including MHA for Veterans, an app designed for patients to complete mental health assessments after their clinician assigned them. Other apps address a variety of issues, such as anger management, insomnia, chronic pain, and PTSD.
Two apps were created with an eye toward specific communities. One, Veterans Wellness Path, was designed for American Indians and Alaska Natives with input from those veterans, their family members, and health care practitioners. It supports the transition from military service to home and encourages balance and connection with self, family, community, and environment. Similarly, WellWithin Coach was designed by the VA National Center for PTSD with input from women veterans and subject matter experts in women’s mental health.
Whatever form it takes—in-person or virtual—finding support that works can make all the difference for veterans. Kelly founded and serves as the executive director of Acta Non Verba: Youth Urban Farm Project, an organization that brings together > 3000 low-income youth and families annually to learn about urban farming, aiming to fill a gap in an area known as a food desert: “We do have the power and the right to wake up the next day and try to do something different,” she said.
T2DM Prevalence Rising in Native American Youth
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.
Veterans and Loneliness: More Than Just Isolation
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.
Indian Health Service: Business as Usual During Shutdown
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.
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.
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.