Funding Veteran PTSD Care: Why Treatment Engagement Matters as Much as Access

Veterans living with PTSD often face complex and interconnected psychological, physical, and social challenges that require ongoing support and care.

Recent changes announced in the Federal Budget have generated considerable concern across the veteran community.

On the one hand, the Government has committed additional funding to increase allied health provider fees and maintain access to services for veterans.

But on the other hand, the Budget also includes measures designed to achieve savings, including the introduction of a $5,000 annual cap on allied health expenditure from July 2027, subject to provisions for additional funding where "clinically indicated".

While much of this discussion has focussed on access to care, an equally important question concerns treatment engagement, especially where funding arrangements are concerned: once veterans access treatment, will they be able to remain engaged long enough to benefit from it?

A recently published meta-analysis examining PTSD treatment retention among more than 124,000 serving and ex-serving military personnel provides some timely insights into this question.

Why This Matters in Australia

Veteran mental health has received unprecedented national attention through the Royal Commission into Defence and Veteran Suicide

The Final Report handed down 122 sweeping recommendations aimed at reforming the "culture, systems and processes across the Defence and veteran ecosystem to prevent suicide and improve the mental health and wellbeing of serving personnel and veterans."

Since the release of the report, a number of recommendations have been accepted and implemented, but the pace and nature of reform remains a significant concern among veterans, advocates and clinicians.

Many remain sceptical and continue to question whether the changes are actually translating into meaningful improvements in access to care, continuity of support and the lived experiences of veterans seeking help.

PTSD and Veteran Health

Post-traumatic stress disorder (PTSD) is a significant veteran health issue.

It is estimated to affect approximately 8% of currently serving Australian Defence Force (ADF) personnel and between 18% and 20% of ex-serving members.

These rates are often higher among veterans exposed to multiple or prolonged deployments, particularly where operational experiences involve sustained periods of high stress, repeated exposure to potentially traumatic events, or threats to life and physical safety.

Collectively, these estimates exceed those observed in the broader Australian population, where the prevalence of PTSD is approximately 5%.

Veterans experiencing PTSD are often dealing with a range of co-occurring physical health, psychological, and psychosocial difficulties.

These may include depression and anxiety disorders, difficulties with emotion regulation, substance use and gambling-related problems, chronic sleep disturbances, musculoskeletal and cardiovascular conditions, relationship strain or breakdown, and occupational impairment.

Consequently, treatment for PTSD in veterans often extends beyond trauma-focussed psychological therapy alone, requiring coordinated, multidisciplinary care delivered by a range of health and support services over an extended period of time.

Given the often chronic and complex nature of PTSD, ensuring veterans can access and remain engaged in effective treatment is a critical priority.

This responsibility sits with government, veteran support organisations, healthcare providers, and the broader systems responsible for delivering care to serving and ex-serving members.

Why Engagement Matters in PTSD Treatment for Veterans

PTSD is a serious mental health condition that impacts multiple facets of a person's life.

Effective treatment often requires veterans to remain engaged over time, yet a significant proportion drop out before achieving their treatment goals.

Furthermore, engagement means more than just attendance; it requires active participation, collaboration and a strong degree of trust in the therapeutic process.

For veterans who remain in treatment, research consistently demonstrates overall better outcomes, including reduced symptom severity, improved daily functioning, better psychosocial wellbeing and a higher quality of life.

When engagement falters, PTSD symptoms and associated co-morbidities may become increasingly entrenched, contributing to persistent psychological distress and vulnerability to further deterioration.

In some cases, this may include heightened risk factors associated with self-harm and suicide.

Challenges Veterans Face in Staying Engaged

Remaining engaged in PTSD treatment is not an easy task.

Therapy often requires individuals to engage with traumatic memories or reminders, confront difficult emotions, and actively challenge beliefs about themselves and the world.

While these approaches can be highly effective, they are also emotionally demanding and many veterans may temporarily experience more distress before feeling benefits.

Added to this are the practical barriers to treatment, including work and family commitments, financial pressures, geographical isolation, sleep disturbance and other co-occurring health conditions.

Previous experiences with healthcare systems or providers, fears of stigma and difficulties establishing a strong therapeutic relationship may further affect engagement.

Together, these factors highlight that treatment retention is influenced by a range of personal, clinical and systemic factors.

Nonetheless, a significant issue persists regarding whether certain treatment methods are more effective than others at keeping veterans engaged in care.

What the Latest Research Reveals About Treatment Approaches

The November 2025 study compared several PTSD treatment approaches to determine which were most successful at retaining veterans.

Several findings stood out:

• Approximately one in four participants (25.6%) dropped out of treatment

• Weekly Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) therapy were associated with the highest dropout rates (40.1% and 34.7%, respectively).

• Present-Centred Therapy (PCT) and Mindfulness-Based Stress Reduction (MBSR) demonstrated comparatively lower dropout rates (16.1% and 20%, respectively).

• Intensive outpatient programs achieved strong retention rates.

  
  

These insights suggest that a one-size-fits-all approach is unlikely to meet the diverse needs of veterans, and that therapies aimed at processing traumatic experiences may face a unique challenge.

While trauma-focussed therapies are widely regarded as among the most effective and evidence-based approaches for PTSD, they also appear to be among the most difficult for veterans to stay engaged with.

The findings therefore highlight the importance of striking a balance between treatment effectiveness and treatment retention.

They also reinforce the importance of delivering treatment in a manner that promotes therapeutic trust, veteran agency and treatment readiness.

What This Means for Veteran PTSD Care

The research suggests that treatment effectiveness should not be the sole consideration when planning care.

Approaches that help veterans remain in treatment may ultimately contribute to better long-term outcomes than interventions that, despite strong evidence for efficacy, prove difficult for some individuals to sustain.

This is especially relevant given the co-occurring physical, psychological and psychosocial difficulties experienced among most veterans.

The findings therefore point to the critical need for healthcare systems and funding arrangements that not only prioritise access to care, but also support the continuity of care necessary for veterans to remain connected to the right care, for the right duration, and in a manner that supports meaningful and lasting recovery.

Source Research: Penix-Smith, E. A., & Swift, J. K. (2025). The protocol matters: A meta-analysis of psychotherapy dropout from specific PTSD treatment approaches in U.S. service members and veterans. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. https://doi.org/10.1037/tra0002070

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By Katherine Hurrell, Ph.D.

Clinical Psychologist, Sydney, Australia