Perspectives of Rural and Urban Veterans with Military Sexual Trauma Seeking Psychotherapy Through Community Care: A Qualitative Study.

The Veterans Community Care Program (VCCP) has become essential to how the Veterans Health Administration (VHA) delivers care. Although VCCP expands Veterans' access to community providers, ongoing process inefficiencies create barriers to timely care. Veterans affected by military sexual trauma (MST) are at heightened risk for behavioral health challenges, especially when care is delayed or fragmented. These delays may be particularly harmful for Veterans with MST living in rural communities where structural barriers exacerbate health risks. In this study, the primary author interviewed 38 Veterans with MST (29% rural-dwelling) to understand rural-urban differences in experiences with seeking psychotherapy through VCCP. Three major themes emerged: (1) emotional strain from structural barriers that influenced psychotherapy access, (2) concerns about worsening health and safety, and (3) value of timely and clear processes. While rural and urban Veterans with MST expressed similar frustrations about the VCCP process, rural Veterans raised specific concerns about the impacts of treatment delays on worsening health. By comparison, urban Veterans were emotionally burdened by administrative hurdles (such as miscommunication and billing issues). They also indicated broader concerns about the safety of Veterans facing long wait times without additional support. Study findings highlight opportunities to enhance transparency, streamline administrative procedures, and bolster support for Veterans with MST undergoing the VCCP process. In addition, developing systems to monitor at-risk Veteran groups (such as rural Veterans with MST) during care transitions is necessary to reduce the likelihood of adverse outcomes.