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WOUNDED WARRIORS: PROVIDING BEHAVIORAL HEALTH SERVICES FOR ACTIVE MILITARY SERVICE MEMBERS

This presentation discusses the importance of diversity in the military, the characteristics of active duty service members, the impact of PTSD, and available resources, programs, and agencies. It also highlights the challenges of diagnosing and treating wounded warriors and the barriers they face in seeking behavioral health services.

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WOUNDED WARRIORS: PROVIDING BEHAVIORAL HEALTH SERVICES FOR ACTIVE MILITARY SERVICE MEMBERS

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  1. WOUNDED WARRIORS:PROVIDING BEHAVIORAL HEALTH SERVICES FOR ACTIVE MILITARY SERVICE MEMBERS Major Tim P. Brown, M.D. Psychiatrist, US Army

  2. DISCLAIMER The presenter has no financial bias or associations to declare. This presentation contains information from various sources; opinions are those of the presenter alone, and they do not necessarily reflect the official positions held by the U.S. Army Medical Department, U.S. Army, Department of Defense or the U.S. Government

  3. INTRODUCTION • Diversity and the military • Discuss Active Duty service member characteristics • Wounded Warriors • PTSD • VA-DoD Clinical Practice Guidelines • Resources, programs & agencies

  4. DIVERSITY

  5. BIOLOGY

  6. DIVERSITY • The condition of having or being composed of differing elements; variety.

  7. A MINORITY AMONG AMERICANS • Currently less than 1% of U.S. citizens have served in the active duty military. • Fewer citizens have family members who have served. • There is a risk of “Us” versus “Them” attitudes & behavior.

  8. Following WWII, nearly 10% of Americans had served on active duty.

  9. INCREASINGLY RARE • WASHINGTON — A smaller share of Americans currently serve in the Armed Forces than at any other time since the era between World Wars I and II, a new low that has led to a growing gap between people in uniform and the civilian population... NY Times, Nov 24, 2011

  10. Military & Diversity • Contributes to the diversity of our nation • Our military is diverse itself… within its ranks

  11. Active Duty Service Members • Come from all over the nation and the world. • All races & ethnicities • Male & Female • Sexual orientation • All socioeconomic status

  12. UNIQUE MILITARY CULTURE • History & Traditions • Customs & Courtesies • Uniforms

  13. HISTORY & TRADITION

  14. HISTORY

  15. RECENT MILITARY OPERATIONS • Viet Nam • Grenada, “Urgent Fury” • Panama, “Just Cause” • Gulf War #1, “Desert Shield-Storm” • Somalia, eg. “Blackhawk Down” • Balkans • OIF- Iraq • OEF- Afghanistan • Syria • Africa • Ebola

  16. HISTORY

  17. TRADITIONS

  18. UNIQUE LANGUAGE • Mess hall; latrine; head; tank; Stryker • Abbreviations & Acronyms- LT, OP, LZ, WLC, WRAMC, BAMC, LAPES, HALO, etc.

  19. MESS HALL/DFAC

  20. HEAD

  21. HEAD

  22. LTLieutenant

  23. LP/OPListening Post/Observation Post

  24. WRAMC

  25. Being aware of military history, traditions and language will improve opportunities for building rapport with active duty Warriors or Veterans.

  26. DIVERSE PSYCHIATRY PATIENTS • Bipolar Disorders • Depressive Disorders • Schizophrenia, Psychotic Disorders • Anxiety Disorder • Eating Disorders • Neurodevelopmental Disorders • Trauma- & Stressor-Related Disorders

  27. PTSD IS THE STEREOTYPICAL MILITARY DISORDER.

  28. WHAT IS AWOUNDED WARRIOR?

  29. WOUNDED The immediate image is likely that of a soldier with GSW, shrapnel injury or amputation. We don’t immediately think of those with psychological injuries.

  30. WAR WOUNDED http://37.media.tumblr.com/63cec9066644fc89a21f5b794c409b3e/tumblr_n1fm3nP14D1rd3evlo1_500.jpg

  31. INVISIBLE TRAUMA • Without getting to know the patient’s story, most would overlook internal wounds. • May manifest in overt behavioral problems: • Agitation • Aggression • Decreased performance • Reporting to work late

  32. DIAGNOSIS • 5 Criteria clusters • Traumatic event • Intrusion symptoms (nightmares, images, etc.) • Persistent avoidance of perceived triggers • Disturbed cognition & mood • Marked alterations in arousal & reactivity

  33. One of the biggest challenges is getting the soldiers to seek and accept treatment.

  34. WARRIORS AVOID TREATMENT • According to published studies, active duty troops expressed the following concerns that affect their decision to seek behavioral health care: • Perceived Barriers to Seeking Behavioral Health Services Among Soldiers and Marines: • 65% “I would be seen as weak.” • 63% “My unit leadership might treat me differently.” • 59% “Members of my unit might have less confidence in me.” • 51% “My leaders would blame me for the problem.” • 50% “It would harm my career.”

  35. STIGMA & CAREER • Studies conducted by The Walter Reed Army Institute of Research (WRAIR) show… approximately 63% struggling with reintegration issues will not seek mental health assistance due to the stigma and career consequences. • Many drop out before they can benefit from treatment.

  36. WHY DOES THIS MATTER? • Functional impairment affects all realms of life- Family; financial, emotional, spiritual • Invaluable life experiences may be wasted • Potential to contribute versus depend upon society; recovery versus lifelong patient. • Stewardship of our nation’s wealth & precious human resources. How can we best use limited resources?

  37. IMPACT OF PTSD • Depression (>50% of warriors with PTSD also suffer MDD) • Educational & occupational impairment • In addition, it has been well documented that active duty military readiness and retention is severely impacted by these concerns. • Domestic violence • Broken homes • Homelessness • Homicide, Suicide

  38. AS THE WARS WIND DOWN • Warriors are seeking behavioral heath in increasing numbers now that operational tempo has decreased with withdrawal from Iraq and significant drawdown in Afghanistan.

  39. Increased need for treatment leads to increased need for behavioral health resources during a time of dwindling national resources.

  40. WHAT WE DO NOW • Acute assessments/triage • Comprehensive Intake • Psychotherapy: CBT • Psychiatric medications (SSRI/SNRI, prazosin, etc.) • Group psychotherapy & education • Intensive Outpatient Programs • Inpatient psychiatric services

  41. VA/DoDCLINICAL PRACTICE GUIDELINES • CBT: Prolonged Exposure, Cognitive Processing Therapy, EMDR (Eye Movement Desensitization & Reprocessing) • SSRI/SNRI & CBT have the most evidence • Remeron, trazodone, prazosin, TCA’s • Avoid atypical antipsychotics & benzodiazepines • Other supportive activities, therapeutic programs • Groups • Education • Acupuncture • Massage • Yoga

  42. There are numerous support and treatment resources available both inside and outside the military.

  43. Federal & DoD Efforts • Administration’s program, “Joining Forces” • U.S. Dept of Veterans Affairs • Suicide/homicide Awareness Programs • National Center for PTSD • Resiliency Programs • Embedded Behavioral Health Teams • Intensive Outpatient Programs • Intensive combat-related PTSD Programs

  44. “Joining Forces” • JoiningForces.gov • Employment Resources: Jobs for Vets • Education Programs: Training for Vets • Wellness Access • Call attention to critical issues. • Amplify wellness programming & resources. • Encourage & facilitate commitments to train and educate HCPs on the unique needs of SM’s, veterans, FM’s and caregivers.

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