Navigating the postsecondary educational pathway can be an intimidating process for post-9/11 veterans struggling with mental health concerns that may alter learning styles and negatively impact performance.1-4 When significant interference with learning ability is anticipated for more than 6 months, these veterans may qualify for formal academic “reasonable” accommodations under federal disability laws that include the Americans with Disabilities Act (ADA) of 1990 as amended in 2008 and Section 504 of the Rehabilitation Act of 1973. These accommodations enable students to compensate for learning disabilities and help support the transition to student life. Student veterans often are not aware of the existence of academic reasonable accommodations, because military separation classes, civilian postdeployment orientation, and popular media do not routinely cover information on this subject.
With an overall objective to ease veteran reintegration into the civilian world and promote emotional stability, health care providers (HCPs) are in a unique position to promote the use of formal academic accommodations for post-9/11 veterans with psychiatric conditions. However, HCPs must have basic information regarding these interventions before initiating discussions with patients. Current peer-reviewed medical literature has scant information regarding specific aspects of academic reasonable accommodations for individuals with psychiatric diagnoses.
The purpose of this 2-part article (part 2 will be published in May 2016) is to promote a greater understanding of academic accommodations for post-9/11 veterans with psychiatric diagnoses. Part 1 provides a brief background regarding issues pertinent to the post-9/11 student veteran role transition and reviews information regarding various aspects of academic reasonable accommodations, including details on the definition, request process, medical documentation requirements, and common accommodation examples.
Although the focus of the article is on the characteristics of post-9/11 veterans who have separated from military service, it also is relevant for providers involved with service members who have not yet separated. The impact of mental health issues, traumatic brain injury (TBI), and psychosocial stressors on learning ability are potentially applicable to many post-9/11 active-duty soldiers and reservists who are pursuing a secondary education. The academic reasonable accommodations discussed are available to any adult who meets the eligibility criteria—regardless of military status.
Influence of Psychiatric Symptoms on Learning
Although each mental health diagnosis is unique, mental health conditions involving mood share the common symptoms of impaired learning ability.3-8 Problems frequently experienced include decreased concentration, shortened attention span, difficulty in making new memories or storing new information, and the inability to recall information previously learned.6-8 Other reported conditions include difficulty with prioritization of tasks, losing track of time, difficulty focusing on tasks, and taking longer to complete assignments.3,4 Increased irritability accompanies many of these issues. Low tolerance to frustration may occur as evidenced by an outburst of anger or resignation to defeat when minor barriers are encountered, especially when authority figures or bureaucratic rules create those perceived barriers.3,4 Persistent impaired ability to articulate ideas or thoughts and difficulty performing abstract thinking also are often noticed when moderate-to-severe mental health symptoms are present.4,8
Medications commonly used to control psychiatric symptoms and stabilize underlying mental health also can produce adverse effects (AEs) that impact learning ability.9,10 Drug AEs vary but often include significant fatigue, impaired memory, and impaired executive function involving insight, judgment, and/or abstract thinking. Depending on the medication, the individual may experience restlessness or insomnia.
Factors Complicating Successful Integration
The transition period from military service to civilian life presents unique complications for student veterans with symptomatic psychiatric concerns.1,11 Veterans who separate from military service go through a civilian transition period of variable intensity influenced by readjustment difficulties and comorbid conditions.11,12 During this time, veterans are reintegrating into civilian life and assuming new roles that include partner, parent, employee, and family member. This transition can cause many symptoms to appear that potentially influence learning to varying degrees. A summary of impediments to learning in post-9/11 veterans is found in Table 1.
Common transition symptoms include irritability, decreased ability to store and recall information, decreased concentration, decreased attention, and slowed executive functioning.13,14 Sleep disturbances such as altered sleep-wake cycles, nonrestful sleep, inadequate sleep, and nightmares also may occur.13,14 Veterans experiencing these transition period symptoms may face significant difficulties with time management skills, organization, and task execution. If the veteran successfully assimilates into his or her new roles and becomes self-confident within those roles, the symptoms may abate. However, if moderate-to-severe psychiatric symptoms also are present, all transition symptoms likely will have an unpredictable time frame for resolution.3,13,14
Understanding the role responsibilities of student veterans is important in recognizing the added stressors veterans with psychiatric diagnoses have within the academic setting. In general, demographic data indicate that student veterans lead far more complex lives than those of 18- to 22-year-olds who enter postsecondary education without military experience. Student veterans are older, have a broader life experience, and may feel less connected to nonveteran students.15,16 Compared with typical younger college students, undergraduate student veterans are more likely to be married but somewhat less likely to be parents.17 Student veterans who are pursuing graduate degrees are more likely to be married and/or have dependents.17 Those roles imply that student veterans often are juggling multiple responsibilities that are constantly competing for student veterans’ time and attention.