David A. Porter, MA, LADC. | April 30, 2026
Note: All decisions must be made in accordance with departmental policy, medical protocol, and jurisdictional requirements. This article is for educational purposes only.
Introduction
Veteran mental health crisis response is one of the most demanding challenges facing today’s first responders and co-responder teams. According to Task & Purpose, there are approximately 18 million veterans in the United States, three million of whom served in the era of GWOT (The Global War on Terror). The mental health of veterans from this conflict has been a topic of great interest.
Combat veterans can have difficulty reintegrating into civilian life after deployment and may suffer from PTSD (Post-traumatic Stress Disorder) or sustain a TBI (Traumatic Brain Injury). Terms such as PTSD and TBI have become household words, but the gap between public and professional understanding remains vast. Stigma around mental health is less pronounced than in prior generations, but it persists, and can be a barrier to seeking treatment.
Veterans in an acute mental health crisis will bring specific challenges for first responders. A veteran in crisis may be hypervigilant and overreact to loud noises, physical proximity, or touch. This can lead to misread intent, communication breakdowns, and tragic outcomes. This article explores best practices in veteran mental health crisis response to help co-responders and first responders operate more effectively.
Defining Veteran Mental Health Crisis Response
A mental health crisis occurs when one’s coping skills are stretched to the breaking point due to an acute stressor or cumulative chronic stress. A crisis can occur due to mental illness or substance use. A person in crisis will be in an extreme emotional state and may feel hopeless, as if they have nothing to lose. A lack of access to services, or frustration with MH (Mental Health) and SA (Substance Abuse) services, can contribute to this.
A veteran’s mental health crisis may be associated with:
PTSD (Post-traumatic Stress Disorder): About 11-22% of veterans experience PTSD. Combat and exposure to combat casualties can result in long-term changes in the brain, lowering the triggering threshold for the brain’s threat response center. This does not mean everyone with PTSD is dangerous. Someone with PTSD may be in a chronic state of Fight/Flight/Freeze, the conditioned response to engage, flee, or freeze.
Moral injury: This is a concept related to PTSD. According to the Department of Veterans Affairs, a moral injury occurs when someone has either been involved with or witnessed an act that violates their core beliefs about right and wrong. This can include acts of omission or failure to take preventative action. This can cause feelings of shame and despair.
Survivor’s guilt: An irrational guilt that is experienced when one is the lone survivor of a critical incident.
TBI (Traumatic Brain Injury) can result from blunt force trauma, concussive shockwaves, and atmospheric overpressure from explosions. A TBI, depending on the location of the injury to the head, can produce impulsive, reckless, and erratic behavior.
Substance abuse and acute intoxication or withdrawal: Opiate dependence from chronic pain due to combat wounds can lead to withdrawal upon cessation of use and impact decision-making and judgment. Alcohol is also used to dull trauma, and intoxicated persons can be easily agitated and behave erratically.
Transition from military life and reintegration into the civilian world: lack of structure, homelessness, financial stressors, and prolonged separation from spouse and family can result in feeling overwhelmed and unable to cope.
Suicidality: In 2023, 6,398 veterans took their own lives — 16 to 18 every day. Suicide by cop, more formally known as LEID (Law Enforcement Induced Death), is a concern most relevant to first responders. For context on the broader volume of mental health calls police handle nationwide, see our related post.
Efforts to Manage Crises and Prevent Veteran Suicides
VMET (Veterans Mobile Evaluation Team) and VRT (Veteran Response Teams) are models for LEOs and veterans in crisis interactions. These are joint efforts between the VA and local police, which, as of 2025, have been operating in eight cities across the US. VMET and VRT both operate on a model similar to other co-responder programs: police and a veteran who is also a qualified mental health professional respond to veterans experiencing a mental health crisis.
Effective veteran mental health crisis response programs like these demonstrate that pairing clinical expertise with law enforcement presence leads to better outcomes for veterans and safer interactions for first responders. Similar patterns play out in civilian co-responder models — as explored in our piece on what Pennsylvania’s mental health crisis tells co-responders everywhere.
Unique Aspects of a Veteran in Crisis
There are subcultures where mental illness is still regarded as a source of personal shame and social disapproval. This belief can persist among members of the military and first responders, professions that place a high value on toughness, fortitude, and resilience. Some beliefs that can get in the way of treatment include:
Depression and anxiety are for weaklings. Pride and self-image may be treatment barriers. There is a strongly held belief among military and first responders that mental illness is weakness; if you are tough enough, you can withstand anything. Mental health issues are more accurately thought of as a form of neurological injury. Our brain is very responsive to the environment and malleable. A deployment in a combat zone, chronic stress, sleep deprivation, grief and loss, and separation from home and family can all change our neurological wiring.
Drinking hard is an acceptable way to manage stress. Heavy alcohol consumption will do nothing but enhance whatever problems you have and create a variety of new problems.
These beliefs can make treatment unpalatable, delayed, or dismissed, leading to issues escalating to a crisis point. Part of being resilient and capable is regular maintenance. Just as the body has to be trained and fit, and gear well maintained, so must the mind. It is not a weakness to tend to the mind when it does not function correctly. Mental health care is about restoring and maintaining resilience; it does not diminish it.
Main Objectives in a Veteran Crisis Intervention
The safety of the first responders and bystanders takes precedence. Access to and proficiency with firearms have to be a consideration for the safety of first responders, the veteran, and bystanders.
Crisis stabilization and prevention of further behavioral escalation can occur at the scene with co-responders working with LEOs or EMS.
Co-responders can facilitate referral to clinical, case management, or other services. Understanding the two goals of crisis intervention helps responders stay grounded during high-stakes interactions.
Engagement, Connection and De-escalation in Veteran Mental Health Crisis Response
All departmental protocols, including use-of-force and medical protocols, take precedence.
One person talks. When multiple officers are shouting, someone in an extreme emotional state will be overwhelmed and further stressed. This can confuse and escalate the situation.
Keep your commands and instructions short, concrete, and repetitive. Avoid abstract statements. Someone in an extreme emotional state cannot process complex or abstract information.
Keep distance and hands off until you cannot. Somebody with PTSD may be very sensitive to physical proximity and contact, and this can exacerbate their symptoms.
LEOs and EMS may also be veterans, so that you may have common ground. Shared experiences can be an effective way to build rapport in a crisis. The detriment of common ground can be too much empathy and identification, leading to unwarranted leniency rather than accountability.
For broader de-escalation techniques applicable beyond veteran-specific calls, see our guide on de-escalation and referral for mental illness and addiction.
Conclusion
Encountering veterans in crisis presents unique problems for first responders. Co-responders and first responders can play a critical role in de-escalating situations that can result in loss of life. A well-trained approach to veteran mental health crisis response — combined with appropriate outreach and referral — can mitigate suffering and prevent situations from reaching a crisis level.
Veterans in need of immediate support can reach the Veterans Crisis Line by dialing 988 and pressing 1.
