Stigma and Access to Mental Healthcare Among US Veterans

Mental health disorders, including posttraumatic stress disorder (PTSD), depression, and substance use disorders, disproportionately affect US military veterans and contribute to increased morbidity and mortality. Despite the availability of Veterans Affairs (VA) mental health services, treatment engagement remains suboptimal. National survey data indicate that while approximately one quarter of veterans screen positive for a probable mental or substance use disorder, fewer than one-third report current mental healthcare utilization. Treatment gaps are especially concerning among high-risk groups, including veterans endorsing suicidal ideation, among whom only a minority engage in current mental health treatment. Stigma, both internalized and anticipated, along with structural barriers such as rural access limitations, system navigation challenges, and concerns regarding confidentiality, significantly contributes to poor utilization of mental health services. This narrative review synthesizes peer-reviewed literature published between 2014 and 2025 examining cultural, attitudinal, and structural barriers to mental healthcare utilization among US veterans and evaluates evidence-based interventions aimed at improving engagement and reducing stigma. Findings consistently demonstrate that internalized stigma, fear of judgment, and masculine identity norms deter help-seeking behaviors, while geographic isolation, administrative complexity, and perceived lack of confidentiality further exacerbate avoidance. Interventions associated with improved engagement include integrated primary care-mental health models, peer navigator programs, tele-mental health services, and targeted anti-stigma initiatives. Addressing both cultural and structural determinants through a multifaceted approach is essential to improving mental healthcare utilization among veterans. Family medicine physicians, particularly in rural and community-based settings, are uniquely positioned to facilitate early identification, reduce stigma, and promote sustained engagement in mental healthcare.