He is 52, a machinist, and he came in for his knee. On the way out he mentions he has not been sleeping. You ask one more question, and it turns out he did two tours, has been on an antidepressant from an urgent care for a year, and "it doesn't really do anything."
That visit could end with a refill. Or it could end with a referral that actually lands. The difference is often a handful of well-chosen sentences. This script is for clinicians anywhere who see veterans, people still serving, first responders, and their families, and want the depression conversation to go somewhere useful.
Why a script for this group
Veterans and first responders are a small slice of a general panel, which makes them easy to miss. In our commissioned survey of 443 Midwesterners, veterans and active military made up 2 percent and first responders 4 percent, 29 of 443 people in all, about 7 percent. Their military-connected coverage is similarly small in aggregate: TRICARE was 5 percent of reported coverage.
Specialization was not a major draw in the overall sample either: a focus on veterans and first responders made 10 percent of top-two lists, far behind insurance at 85 percent. We cannot say how veterans themselves ranked it: they were too few in the sample to break out. What moves people, per the top-line data, is the clinician's own recommendation, which 74 percent of the sample named as their strongest push toward a new treatment.
Every figure here is final and validated.
Opening the door
"Were you ever in the service, or on a police, fire, or EMS crew? I ask everyone, because it can change what care and coverage are available to you."
If the answer is no, extend it once:
"How about anyone at home, like a spouse, parent, or child?"
Family members often carry the logistics and the worry, and may have TRICARE themselves.
Getting to the depression
Many service-connected patients minimize. Direct but low-pressure wording helps:
"A lot of people who served tell me they are fine when they are really running on fumes. On a scale of one to ten, how would you rate the last month?"
"You mentioned the medication does not really do anything. How long have you been on it, and at what dose? Have there been others before it?"
Establishing the medication history early tells you whether this may be treatment-resistant depression and gives you what any payer will later ask for. For patient reading, a short Spravato guide for patients explains the approved option.
Checking for trauma and safety
"Are there things from your service, or from calls you have run, that still come back at you, in dreams or when you are trying to relax?"
"Sometimes when people feel this worn down they think about not being around anymore, or about ending their life. Has that crossed your mind?"
If there are firearms in the home, ask about them plainly and without judgment.
Addressing stigma head-on
Some patients fear that treatment will cost them a job, a security clearance, or their standing with their unit or crew. Acknowledge it rather than dismiss it:
"I understand this can feel like it could come back on you. Treating depression is maintenance, the same as taking care of a bad knee, not a sign of weakness. And there are confidential options if that is a concern."
Naming the options
If the history suggests that two or more adequate trials have not worked:
"You have given two medications a fair shot. When that happens, we call it treatment-resistant depression, and it tells us to widen the search. That can include different medication strategies, therapy, TMS, and a supervised nasal spray called esketamine. I would like to talk through which of those might make sense for you."
Be precise if PTSD is also in the picture:
"Esketamine is approved for depression that earlier treatment could not move, but not for PTSD, so if the trauma piece is a big part of this, we should make sure that is treated directly too, usually with a trauma-focused therapy."
If the patient has seen ketamine ads aimed at veterans:
"Some of those programs use ketamine at home, which is not FDA-approved for depression and has much less supervision. Esketamine happens at a certified clinic, with staff watching you afterward. They are not the same thing, and I would want you to know the difference before deciding."
Sorting coverage
"Which coverage do you want to use for this: TRICARE, your work plan, Medicaid, or something else?"
Then route accordingly. TRICARE beneficiaries need their plan type confirmed, since referral and authorization rules differ. Work plans and Medicaid usually need an in-network destination and often prior authorization, so send the medication history with the referral.
"How far can you realistically drive for appointments? Some of these treatments mean several visits a week at first, and for esketamine you would need someone to drive you home."
Forty-three percent of respondents ranked closeness among their top two. For a patient with a demanding shift schedule, it may be the deciding factor.
Making the recommendation
Patients trust their own clinician over outreach. In our sample, an online veteran or first responder figure swayed 4 percent, while their own doctor swayed 74 percent. Use that weight:
"My recommendation is that we get you connected with this. I will send the referral today, and I want to see you back in a few weeks to hear how it is going."
Closing with safety
"If things get worse before then, do not wait for me. Dial or text 988; if you served, press 1. It costs nothing, it runs all night, and you need no insurance or referral."
Say it out loud and put it in writing. The Suicide and Crisis Lifeline covers the whole country, every hour.
Methodology
The survey cited here was hosted by Pollfish's consumer panel, which took answers through June 23, 2026, and 443 came in from adults 18 to 64 who live in Nebraska, Kansas, Indiana, Wisconsin, Missouri, Oklahoma, Iowa, Ohio, Illinois, and Minnesota. We use top-line results only and do not have figures for any subgroup, including veterans. Everything cited is from Pollfish's validated final data. The survey was ordered and paid for by the publisher. These scripts support, and do not replace, clinical judgment.