Veteran Mental Health

1. Veteran Mental Health Beckley VA Medical Center Beckley, WV (304) 255-2121

2. Today’s Speakers Jennifer Paugh, LICSW Tracie Hamb, LICSW Anna Verschoore, LISW-C

3. Today’s Agenda Session I Understanding the Veteran Experience Session II Understanding the Needs of Military Families

4. Warrior Ethos a code of conduct that embodies a life where integrity, loyalty, honor, selflessness and courage are one’s guide

5. Warrior Ethos a code of conduct acknowledges the strength of the group over that of the individual, enabling survival of the group

6. Warrior Ethos * I will always put the mission first * I will never accept defeat * I will never quit * I will never leave a fallen comrade

7. Conditions Often Experienced by Military Members • Grief • Anxiety (acute stress reaction) • Anger • Depression • Post Traumatic Stress • Substance Abuse

8. Conditions Often Experienced by Military Members • Grief • A normal reaction to loss • Loss is a broad term; we experience grief from events other than death of a loved one • “normal” to grieve for 6 months • 5 stages: denial, anger, bargainning, depression, acceptance (Kubler-Ross)

9. Conditions Often Experienced by Military Members • Anxiety • a normal experience for everyone • a functional experience • clinical anxiety (i.e. PTSD, panic disorder, etc) hinders daily functioning

10. Conditions Often Experienced by Military Members • Anger • a normal emotionoften experienced when we lack control • there is no ‘time to think’/process events during a war, afterwards it’s hard to reconcile the events emotionally • feelings of being victimized by the government, the system, lack of understanding from family/friends

11. Conditions Often Experienced by Military Members • Depression • Not just being sad • Depression is a clinically significant and persistent pattern • MDD dx requires low mood everyday for 2 weeks, decreased/no interest in activities, weight loss or gain (unintentional), significantly decreased or increased sleep, psychomotor agitation or retardation, fatigue, persistent feelings of worthelessness or guilt (sometimes delusional), diminished ability to concentrate, recurrent thoughts of death/SI.

12. Conditions Often Experienced by Military Members Acute Stress Reaction • Most of us have experienced this as a result of car accident, witnessing violence/medical emergency, dog bite, combat • 9/11 • Acute Stress Reaction is short term, lasting one month • Involves PTSD types of symptoms

13. Conditions Often Experienced by Military Members Post Traumatic Stress Disorder *Triggers *Hyper arousal *Re-experiencing (INTRUSION) *Nightmares *Dissociation *Anxiety/Panic *Avoidance (of people, places, things, any trigger)

14. DSM-V Criteria for PTSD Requires exposure to an event that involved or held the threat of death, violence or serious injury. You experienced the traumatic event, witnessed, in person, the traumatic event, learned someone close to you experienced or was threatened by the traumatic event or you are repeatedly exposed to graphic details of events

15. DSM 5 Criteria (Continued) One or more of these following the event: • You relive experiences of the traumatic event, such as having distressing images and memories. • You have upsetting dreams about the traumatic event. • You experience flashbacks as if you were experiencing the traumatic event again. • You experience ongoing or severe emotional distress or physical symptoms if something reminds you of the traumatic event. • In addition, for more than one month after the traumatic event you may: • Try to avoid situations or things that remind you of the traumatic event • Not remember important parts of the traumatic event • View yourself, others and the world in a negative way • Lose interest in activities you used to enjoy and feel detached from family and friends • Feel a sense of emotional numbness, feel irritable or have angry or violent outbursts • Engage in dangerous or self-destructive behavior • Feel as if you're constantly on guard or alert for signs of danger and startle easily • Have trouble sleeping or concentrating • Your symptoms cause significant distress in your life or interfere with your ability to go about your normal daily tasks. • For children younger than 6 years old, signs and symptoms may include: • Reenacting the traumatic event or aspects of the traumatic event through play • Frightening dreams that may or may not include aspects of the traumatic event

16. Conditions Often Experienced by Military Members • Substance Abuse • Service members, once returning, often given narcotics (pain, panic, emotional/medical crisis) • Self-medicating due to barriers of treatment • Easier to mute symptoms than address them

17. Screening for Mental Health Conditions • Screening needs to be done by mental health professional • You can use clinical observations and collateral information to compare to DSM-V criteria • Self-assessment can help one gain insight, but dangerous and not sufficient….focus should be on treatment, not just classification

18. Suicide Risk Assessments • Vital to have a mental health professional involved if you believe someone is suicidal • If someone discloses SI, however, it is our responsibility to take action(Don’t leave the person alone, don’t hang up the phone, don’t transfer the call) • Basic suicide risk assessment includes: Are you having suicidal ideations?, Do you have a plan?, Do you have the means to carry out that plan?,

19. Suicide Risk Assessment (cont) • Ways to help a suicidal individual: voluntary hospitalization, involuntary hospitalization, safety planning, welfare check by law enforcement. Pro-Active Safety Plans • Risk factors for suicide: Not predictors, however, the more factors an individual has, the higher the risk • Previous attempt(s), serious loss, family hx, abuse hx, depressive episode(s), SMI, dual dx, alcohol or drugs, disability/chronic illness, severe pain. • Other predisposing factors: single, white, male, living alone, same sex orientation, elderly

20. Resources for Assistance • Case Management-A collaborative process of assessment, planning, facilitation, coordination, evaluation and advocacy.

21. Resources for Assistance • Therapy • Individual • Family • Long term or brief • Evidence Based • Focus is on the goals of identified patient • Addresses mental health and social issues • Can address substance abuse Sources Veterans Administration, private provider, local mental health facility, in-patient or out patient

22. Resources for Assistance • Medication Psychotropic- to alter chemical levels in the brain to impact mood and behavior includes: anti-depressants, anxiolytics, anti psychotics and mood stabilizers

23. Barriers to Recovery • Stigma “I’m not crazy”,embarrassed • Cost Increasing cost of medical care and lack of insurance • Warrior Mentality “Only the weak need or seek help • Addiction Don’t want help and avoid painful withdrawal. No hope • Lack of Resources Limited providers, no transportation, work schedule/time constraints

24. End of Session I

25. The Community’s Role in Recovery • Empathy • Unconditional positive regard • Reducing stigma • Encouraging early intervention • Know local resources

26. Conditions Often Experienced by Military Families • Grief • Anxiety (acute stress reaction) • Anger • Depression • Post Traumatic Stress • Substance Abuse

27. Grief • Exhibited in their behavior • Experienced by children of ALL ages • May be due to loss because of deployment, and changes in personality due to other mental health issues.

28. Anxiety or Acute Stress Reaction • The families often experience these, but usually return to a previous level of functioning • Depends on how close the child was to the actual event • Caused by the Media-they see traumatic situations and worry about their loved one

29. Anger • Caused by fear and the unknown situations • Anger towards the other parent • Angry at the “Military” • Angry at the parent that is deployed

30. Depression • Displayed as anger or other symptoms • Clinical symptoms are different in children than in adults • Effects school, family, activities • Accompanied by medical issues.

31. PTSD • Effects the entire family • Sympathy • Negative feelings • Avoidance • Depression • Anger and guilt

32. Substance abuse • Used to self medicate • Often begins with trauma or injury in military • Vast effects on family

33. Resources for Assistance • VA resources • Veterans Choice Act • Local Vet Centers • Give an Hour

34. The School Nurses’ Role in Recovery • Awareness and sensitivity of military culture • Nonjudgmental assistance • Awareness of assessment resources • Awareness of local resources • Willingness to partner with community agencies

35. Sources http://www.mentalhealth.va.gov/self_help.asp Self help materials for veterans and their families http://deploymentpsyc.org/military-culture Provides training for community healthcare professionals http://homebase.org Provides veteran and family care information and training http://maketheconnection.net Connects veterans of all ages/eras and their families http://afterdeployment.dcoe.mil Very comprehensive site of resources and screening tools

36. http://www.bing.com/videos/search?q=Marines+Ethos+Creed&&view=detail&mid=3DC74C0BC2EFCCA405773DC74C0BC2EFCCA40577&FORM=VRDGARhttp://www.bing.com/videos/search?q=Marines+Ethos+Creed&&view=detail&mid=3DC74C0BC2EFCCA405773DC74C0BC2EFCCA40577&FORM=VRDGAR • Video clip