Background
As of 2023, there are approximately 15.8 million military veterans in the United States, comprising 6.1% of the civilian population. Among these veterans, many face significant mental health challenges, with posttraumatic stress disorder (PTSD) and depression being the most widely recognized. Research reveals that approximately 14% to 16% of U.S. service members deployed to Afghanistan and Iraq have experienced these conditions. Other mental health issues, such as suicide, traumatic brain injury (TBI), substance use disorder (SUD), and interpersonal violence, also profoundly impact this population.
A 2021 report found that veterans’ usage of mental health services at the Department of Veterans Affairs (VA) increased by 90% in the past decade. Moreover, in 2023 alone, nearly 2 million veterans turned to the VA for mental health support. This demand reflects not only the physical and psychological toll of combat but also the significant challenges veterans face when transitioning into civilian life. The consequences of untreated mental health issues are dire. One 2017 study found that “more than 107,000 veterans are homeless on any given night…[and] on average, at least 21 veterans die by suicide each day.”
Barriers to Accessing Care
According to a report from Rand, a nonprofit and nonpartisan research organization, veterans face multiple barriers to accessing quality mental health care. For example, shortages in the mental health workforce can create significant barriers for veterans, making it harder for them to secure timely appointments. Additionally, some providers may lack sufficient training in evidence-based psychotherapy (EBP) (such as Cognitive Behavioral Therapy for depression), resulting in lower-quality care for veterans in the private sector. Beyond these systemic issues, certain military attitudes also deter veterans from seeking help. A study found that there is a pervasive belief within military culture that asking for help signifies weakness, and veterans also worry that seeking treatment could impact their career prospects.
Need for Peer Support
As the veteran population continues to grow, there is an increasing recognition of the need for alternative approaches to mental health care that complement clinical treatments. Peer support has emerged as a promising strategy. It involves individuals who have navigated mental health challenges and recovery journeys, offering guidance and support to others facing similar situations. By building trust and sharing empowerment, peer support can keep clients engaged in treatment, reducing the likelihood of relapse.
What is the PFC Joseph P. Dwyer Peer Support Program Act?
The PFC Joseph P. Dwyer Peer Support Program Act (H.R. 438) was introduced by Representative Nick LaLota (R-NY) on January 15, 2025. The bill authorizes the VA to issue grants of up to $250,000 to local nonprofits, veterans service organizations, and state or tribal entities for the development and implementation of peer-led mental health support programs. It also proposes the creation of a VA advisory committee responsible for establishing best practices and ensuring confidentiality within the peer support programs. With a funding allocation of $25 million over three years, the bill has garnered substantial bipartisan support, with 20 sponsors (11 Democrats and 9 Republicans). Currently, it is under review by the House Committee on Veterans’ Affairs and its Subcommittee on Health.
H.R. 438 is inspired by the success of the original Dwyer Program, which was launched by then-State Senator Lee Zeldin. This local initiative served as the catalyst for national legislation, the PFC Joseph P. Dwyer Peer Support Program Act, aiming to provide care to veterans across the U.S.
Arguments in Favor
Cost-Effectiveness
Peer support has been shown to reduce the overall cost of mental health services by lowering re-hospitalization rates, reducing inpatient days, and increasing engagement with outpatient care, such as therapy, medication management, and group support. This ongoing encouragement from peers with lived experience helps people stay connected to these less expensive and more preventive services. Rather than replacing clinical care, peer support improves continuity and stability, allowing individuals to remain in low-cost care settings and maintain their recovery over time. For instance, a Federally Qualified Health Center (FQHC) in Denver that implemented peer support programs reported a Return on Investment (ROI) of $2.28 for every $1 spent. This demonstrates that investments in peer support can create measurable financial value for the healthcare system.
Proven Success
As of 2023, the Dwyer Program has expanded to 62 counties in New York, showing that peer-to-peer veteran support models are not only feasible but also widely accepted and replicated. This broad expansion supports the potential for national implementation of similar models under H.R. 438. Moreover, the Dwyer Program has facilitated over 12,000 support groups and engaged more than 300,000 veterans through individual face-to-face interactions. This scale of participation demonstrates the program’s effectiveness and demand, indicating that it has the necessary infrastructure and capacity to engage veterans meaningfully in their mental health and reintegration processes.
Broad Support from Veterans’ Organizations
H.R. 438 has garnered significant support from respected veteran organizations. The Disabled American Veterans (DAV), a nationally recognized advocacy organization, supports the bill. DAV’s endorsement signals to lawmakers and the public that H.R. 438 aligns with the priorities of organizations deeply invested in improving veterans’ mental health. Additionally, the Wounded Warrior Project (WWP) has also expressed its support for the bill, highlighting the success of peer support programs in connecting veterans to services. The WWP has found that these programs help veterans feel heard and accepted, leading to greater participation in therapy and community support services.
Critiques
Financial Fragility and Sustainability
While peer support programs like the Dwyer Project are valuable, they are financially fragile. A report notes that coalition employees are underpaid and overworked, and the coalition struggles to meet overhead expenses. Additionally, scaling the Dwyer model nationally with the allocated funds may not be enough to cover the expenses required for a robust and effective rollout. For example, the New York State Dwyer Coalition requested a budget increase to approximately $800,000 for the 2025 fiscal year. If the program is scaled to all 50 states for three years, the total would be $120 million, significantly more than the allocated $25 million. Inflation or expansion of services could drive costs even higher.
Absence of Guidelines and Supervision
The bill does not clearly define the responsibilities of peer recovery specialists. Research from the Substance Abuse and Mental Health Services Administration (SAMHSA) found that peer specialists are sometimes assigned tasks outside of their scope, leading to inefficiencies and confusion. Additionally, the bill lacks specific guidelines on the supervision of peer specialists, despite research showing that effective supervision is crucial for maintaining ethical standards, healthy boundaries, and providing necessary support to perform their work effectively. Without a structured supervisory framework, the program may struggle to foster professional development.
Challenges from Institutional Instability
The potential for widespread cuts to the VA budget, as outlined in the Trump administration, threatens the viability of peer support programs. ProPublica reports that the administration plans to eliminate at least 70,000 positions, aiming to “trim the agency to the size it was before” the PACT Act. This could hinder the VA’s ability to support programs like Dwyer, which rely heavily on institutional infrastructure such as trained supervisors, referral networks, and stable clinic partnerships. In a climate of staff reductions and financial instability, sustaining or expanding peer support initiatives could be challenging. The Center on Budget and Policy Priorities (CBPP) warns that these cuts could lead to longer wait times and backlogs, undermining the VA’s ability to serve over 7 million patients in 2025 and reducing the quality of care.
Future Prospects
The history of veterans’ mental health legislation highlights significant barriers to passing critical programs, with many bills aimed at improving care struggling to gain traction in Congress. For example, the Veterans Mental and Behavioral Health Quality of Care Act (H.R. 3811) sought to mandate an independent review of mental and behavioral health care quality between VA and non-VA providers. Despite referral to the House Veterans’ Affairs Committee, it was not advanced to the full House for a vote. Similarly, the Veterans’ Mental Health Access Act (H.R. 9427) proposed a pilot program to provide grants to outpatient mental health facilities, but it received no committee vote or floor consideration.
Historically, veterans’ mental health research and programs have been male-dominated, leading to the unique needs of women, LGBTQ+, and racial minority veterans being overlooked. As noted in a DAV report, women veterans, especially those from minority backgrounds, face challenges such as unmet sex-specific care needs and higher unemployment rates post-service. H.R. 438 could explore addressing these gaps by promoting more inclusive peer support models.
The PFC Joseph P. Dwyer Peer Support Program Act presents an opportunity to improve veterans’ mental health care. Looking ahead, collaboration between policymakers and advocacy groups will be key in addressing potential barriers and ensuring the program’s longevity. As the bill progresses, it may offer valuable insights on expanding support for veterans’ mental health services.