Trey Warren’s symptoms began in the cockpit of a supersonic fighter jet. 

He flew in jets off aircraft carriers for the U.S. Navy, accelerating from zero to 200 mph in less than 10 seconds. Warren sat behind the pilot, managing weapons and operating targeting sensors on missions over Iraq and Afghanistan. 

Every takeoff rattled his brain. Every time he fired a cannon, he felt his eyes vibrate. Every landing left him shaking out the cobwebs.

Today, 16 years out of the service, Warren struggles to work more than 15 hours per week as an adjunct at a St. Louis community college, where he teaches introductory political science courses. He picks his teenage twins up from school and gets dinner on the table, but even that drains him. 

Treatments offered through the U.S. Department of Veterans Affairs haven’t worked for Warren. He left the military as a lieutenant commander in 2009, after 13 years of service. A graduate of the Navy’s elite Top Gun flight academy, he flew 192 combat missions over four deployments.

Since leaving the military, there have been periods when Warren had to take six to eight prescription medications daily. Most were antidepressants and drugs to treat side effects he describes as “wicked.”

He now pays roughly $2,000 per month for therapy and supplements not covered by insurance.

Seeking alternative treatments beyond those offered by the VA, Warren and other veterans experiencing mental-health crises pay out of pocket or travel abroad. Many are advocating for state governments to foot the bill and change laws to expand treatment options in the absence of federal action. 

Bills working their way through state legislatures seek to expand access to two treatment alternatives: hyperbaric oxygen therapy and psilocybin, a psychedelic compound found in mushrooms. Dozens of other bills would create or fund other programs related to veteran mental health, or study the issue. 

At least 14 measures in nine states this year seek to expand access to or fund hyperbaric oxygen therapy for veterans with post-traumatic stress disorder or traumatic brain injury. Patients sit in a sealed chamber and breathe 100% medical-grade oxygen—the earth’s atmosphere is made up of about 21%t oxygen. 

The federal Food and Drug Administration has not cleared the treatment for those disorders, so many insurance companies do not cover it. 

Another 19 measures introduced across 10 states relate to psilocybin, including efforts to expand access to it. Of those, at least eight specifically refer to veteran mental health. Approximately 18 veterans take their lives each day in the United States, according to VA statistics from 2022.  

For Warren, what started as small lapses in memory have grown to severe depression, confusion, ringing in his ears and brain fatigue. 

Then there’s the forgetfulness. 

“I can’t remember stuff,” Warren said. “I’ve gotten confused in intersections when I’m driving and I’ve driven the wrong way down a road with my kids in the car. Scared the sh– out of me.” 

States may add more to millions invested in oxygen therapy

Like Warren, Blake Richardson grew frustrated with the VA’s mental-health treatment options. “The pills and therapy weren’t addressing the root cause,” said Richardson, whose nonprofit Help Our Heroesadvocates for hyperbaric oxygen therapy for veterans. 

After four years as a diesel mechanic in the Marines, where Richardson said he was exposed to burn pits and blasts, and one year in the reserves, he was diagnosed with post-traumatic stress disorder in 2009. He took eight to 10 pills every day for years, changing medications and doses with no success. He couldn’t sleep or concentrate. Angry outbursts and mood swings affected his family life. Like many veterans, anxiety and depression became fixtures in his life. 

Last year, he began hyperbaric oxygen therapy. 

Over three months, Richardson sat in the chamber 37 days for 90 minutes each time. After his second session, he started sleeping without medication. By the end of the treatment, he no longer needed his prescription medications. “After about 12 to 15 dives, it was like a lightbulb going off,” he said. “It’s changed me.” 

Hyperbaric oxygen therapy was developed to treat decompression sickness in deep-sea divers. The FDA has since approved it to treat other ailments, including diabetic foot ulcers and severe burns. 

The VA studied the therapy for PTSD and brain injury in 2018 and found the evidence wanting. Findings to support the treatment are “largely based on case series and anecdotal testimonials,” the VA’s inquiry found. Still, the agency reports it offers the therapy to a “limited number” of veterans. 

The VA did not provide specific information to the Statehouse Reporting Network.

Over the last decade, states have put millions behind treating veterans with hyperbaric oxygen therapy. Eric Koleda, who lobbies for the treatment, said his efforts have resulted in $33 million in state funds dedicated to hyperbaric oxygen therapy treatments for veterans across seven states since 2014. 

Koleda works with TreatNow, an organization helping lead the efforts across state legislatures. He also leads a nonprofit in Kentucky that administers $1.5 million in state funds to provide hyperbaric oxygen therapy to veterans. 

In December, the University of South Florida announced it will launch a five-year, $28 million study on hyperbaric oxygen therapy for veterans with traumatic brain injury using state funding. 

Some lawmakers want more done. In Tennessee, lawmakers penned a resolution urging the federal government to expand access. 

“This resolution was introduced in response to the stark reality of the veteran suicide crisis and the increasing need for improved treatment of traumatic brain injuries and PTSD,” Tennessee state Rep. Aftyn Behn said in an email. “Our veterans deserve every opportunity to access the best therapies available, including innovative treatments.”

Similar resolutions were introduced in North Dakota and New Jersey.

A request from a veteran in his constituency prompted Kansas City, Missouri Rep. Chris Brown to introduce a bill funding HBOT treatments for veterans. He wants fellow lawmakers to put at least $2 million behind it, but ideally as much as $10 million. 

“The number of our veterans that die by suicide, those numbers are alarming,” Brown said. “Talking to vets who have had this treatment, I’m convinced that this will save lives.” 

Legalizing the trip 

While psilocybin is still illegal under federal law, two states and a growing list of cities have decriminalized psychedelics. Not all these efforts are related to veteran mental health. 

Last year, the VA announced its efforts to study the potential of psilocybin and another psychedelic compound, MDMA, to treat PTSD and depression in veterans. The VA hasn’t funded studies on these compounds since the 1960s. 

In 2022, the Maryland legislature put $1 million behind similar efforts, and lawmakers this year in Arizona, California and Missouri are considering similar efforts.  

Similar measures have failed in the Virginia legislature, a state with one of the highest veteran populations per capita. Nearly 10% of adults in Virginia have served in the military, according to Census data. 

On Feb. 17, a Virginia House committee killed a bill to create a Veteran Suicide Prevention Advisory Council within the state’s health department, even after the Senate unanimously passed it. The council would have helped implement FDA-approved, so-called “breakthrough” therapies for Virginians.

“It is unfortunate that the legislation faces such a hurdle in our House of Delegates, especially when it has strong support in the Senate and last year was endorsed by the Military Veterans Caucus,” Virginia Sen. Ghazala Hashmi, who introduced the bill, said in an email.

Hashmi introduced a similar bill last session, along with Del. Michael Jones, whose bill called for a report on how to best implement breakthrough therapies. Jones hoped to soften the burden for people like his father, who served in the Navy.

“Our veterans deserve every resource available for the traumas they’ve endured protecting our country,” Jones said in an email. 

At least three bills in the New York State Assembly this year would create pilot programs offering veterans and first responders psilocybin-assisted therapy. 

Ayahuasca treatment in 2022 offered Warren immediate relief. The hallucinogenic tea, traditionally used by indigenous tribes in the Amazon, enabled him to finish his dissertation in political science. But the effects slowly wore off after six months. “I’m really bad again,” he said. 

For the last four months, suicidal thoughts and severe depression have brought him back to the edge. 

In mid-February, as a snowstorm approached his St. Louis home, Warren boarded a flight to San Diego and drove to Tijuana for ibogaine therapy. A 2024 study published in Nature Medicine found the psychedelic alleviates symptoms in special operations military veterans with traumatic brain injury. 

Some funding for Warren’s trip came from veterans’ organizations, but he had to ask for loans from friends and family to make up the difference. 

“Our government needs to be held accountable for this,” he said. “They need to fix this. I volunteered to go protect the country and help the country and the government, and now I need some help from my government, and I’m not getting it.”