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Home from the War: How Can We Provide Holistic Support?

Kathryn J. Kotrla, M.D. Vice Dean Texas A&M Health Science Center College of Medicine – Round Rock. Home from the War: How Can We Provide Holistic Support? . Today’s Goals. OIF/OEF PTSD TBI Understanding Their Experience Linking to Available Resources. OIF/OEF.

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Home from the War: How Can We Provide Holistic Support?

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  1. Kathryn J. Kotrla, M.D. Vice Dean Texas A&M Health Science Center College of Medicine – Round Rock • Home from the War: • How Can We Provide Holistic Support?

  2. Today’s Goals • OIF/OEF • PTSD • TBI • Understanding Their Experience • Linking to Available Resources

  3. OIF/OEF

  4. “No one comes home from war unchanged.” • Iraq and Afghanistan Veterans of America, January 2008

  5. Scope of Issue

  6. Female Soldiers

  7. Scope of Issue

  8. OIF Soldiers

  9. APA Harris Interactive Survey: 2008 • NOT Knowledgeable about MH warning signs • 49% Military Service Members • 52% Military Spouses • Insufficient Information about Treatment options for MH • 59% Military Service Members • 66% Military Spouses • 10% have sought treatment; STIGMA prevents MH Care

  10. Scope of Problem • 30-40% Iraq Veterans will face depression, anxiety, or PTSD • Multiple tours and prolonged deployments increase combat stress by 50% • National Guard and Reserve at increased risk for MH issues and Suicide • Amount of TBI: Unknown • Interaction between PTSD and TBI: Unknown

  11. Troops, Veterans and Family Focus

  12. PTSD

  13. Diagnosis of PTSD • Individuals may RE-EXPERIENCE the event in a variety of ways: May experience intrusive thoughts of the event • May have distressing dreams or nightmares of the event • May feel very uncomfortable when confronted with a reminder of the event • May act or feel as if the traumatic event were recurring (“flashback”)

  14. Diagnosis of PTSD • Individuals may experience INCREASED AROUSAL: May be irritable and/or have angry outbursts • May experience insomnia (problems falling or staying asleep) • May be hypervigilant • May have difficulty concentrating • May startle easily and excessively

  15. Diagnosis of PTSD

  16. Diagnosis of PTSD

  17. Traumatic Brain Injury

  18. What Is A Traumatic Brain Injury? External force applied to the head Disruption of brain function Alteration of consciousness • incomplete memory of the event • “dazed” or confused • loss of consciousness Adapted from ACRM Special Task Force on TBI

  19. Combat TBI Blast Induced Injury

  20. Psychiatric Diagnoses Due To TBI

  21. Major Depression Job Loss • ~25% jobless Domestic Violence • Up 177% Alcohol Abuse Narcotic Addiction Military Sexual Trauma Suicide • 18/Day • 950 attempts/month Child Abuse • 30% increase with each 1% deployment • Children’s academic, physiological, • and psychological issues Post Deployment Health:It’s not just PTSD and/or TBI Violence Toward Others Homelessness • ~30% Divorce • 2/3 marriages Incarceration Shadow Warriors

  22. Family Caregiver Needs Medical Care Psychological Health Military Considerations Service Member/ Veteran & Family Spirituality Transportation Education/ Training Assistive Devices Technology Career Employment Housing Support is Multi-Faceted • Benefits • & • Compensation

  23. The Problem…

  24. Good News!

  25. Remember that reintegration is a journey… “The journey home marks the beginning of an internal war for the Marines. Give them the space they require to slowly turn the switch. The switch from violence to gentle. The switch from tension to relaxation. The switch from suspicion to trust. The switch from anger to peace. The switch from hate to love...” LT. Col. Mark Smith, WISHTV Feb 18, 2005 Down Range to Iraq and Back (Cantrell & Dean)

  26. The Return Home is Shaped By: • Traumatic events that can be challenging to process and talk about. • Identification and closeness with their military unit and comrades who have shared similar experiences. • Regimentation in the form of highly structured and efficient routines. • Heightened sensory experiences including sights, sounds and smells. • Expanded self-importance and identity shaped by war.

  27. Texas Response Create an organized repository of all needed Federal, State, and Local services for Military Service Members, Veterans, and their Families: TexVet www.TexVet.org

  28. Outreach

  29. Talking To Someone Who Understands • Warrior-Mentor Programs • Student Veteran Associations • Veterans County Service Officers • Bring Everyone In the Zone • Community groups (Austin, San Antonio, Houston) • Vet Centers • VHA

  30. Let Them Know YOU Understand • Listen to what Warriors need, not what we think they need • Educate yourself about their experiences to build trust • Achilles in Viet Nam; Odysseus in America by Jonathon Shay • A Warrior’s Guide to Insanity; A Warrior’s Guide to World’s at War by SGT. (Ret) Andrew Brandi • Prove that you’ve got their backs

  31. For us…… • Prepare for the long haul • Watch for and respect secondary traumatization • Build relationships across silos • Remember you have the expertise to shape the future for our Warriors and for Texas

  32. Questions?

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