caring for all who serve ptsd, tbi & suicide in the military and veteran population 16 may 2011...
TRANSCRIPT
CARING FOR ALL WHO CARING FOR ALL WHO SERVESERVE
PTSD, TBI & SUICIDE IN THE MILITARY PTSD, TBI & SUICIDE IN THE MILITARY
AND VETERAN POPULATIONAND VETERAN POPULATION
16 MAY 201116 MAY 2011
LON MORRIS COLLEGELON MORRIS COLLEGE
JACKSONVILLE, TEXASJACKSONVILLE, TEXASPLANNING PARTNERS
Anderson-Cherokee Community Enrichment Services • Andrews Center The Burke Center • Community Healthcore • Lon Morris College
Lone Star Military Resource Group
MILITARY CULTURE
INVISIBLE WOUNDS OF WAR
WAYMON STEWARTANDREWS CENTER CEO
31 YEARS CAREER SERVICE WITH 1 OIF TOUR
RETIRED 1ST SERGEANT
Slides reprinted with permission of Austin Travis County Integral Care and Western Interstate Commission for Higher Education
PEOPLE DON’T UNDERSTAND
Understanding the nature of the military culture, the stresses of working in a war zone, and the journey of adjusting from combat to the community can:
» Reduce Stigma» Enhance Outreach» Increase Military And
Provider Satisfaction
OPERATION IRAQI FREEDOM (OIF)
OPERATION ENDURING FREEDOM (OEF)
– Over 2 million soldiers have been deployed to GWOT– 867,003 have been deployed more than once (39%)– Over 5900 deaths– Over 42,000 wounded in action– Over 54,000 evacuated due to injury or disease– Almost 300 casualties due to suicideVeterans for Common Sense, March 2011
*AS OF NOVEMBER 27, 2006, “THE WAR IN IRAQ HAS BEEN GOING ON LONGER THAN WORLD WAR II”DoD Task Force on Mental Health, June 2007
THE OIF/OEF COMBAT EXPERIENCE
• 78% received incoming rocket or mortar fire
• 33% handled or uncovered human remains• 72% knew someone seriously injured or killed• 60% saw dead bodies or human remains• 56% had a member of their unit become a casualty• MST - military sexual trauma - of 5,777,169
veterans screened, 61,126 (1.1%) male veterans and 59,690 (19.9%) female veterans experienced MST
WOMEN VETERANS
• Over 235,000 women served in OIF/OEF• Women currently comprise 15% of military• There are an estimated 1.8 million living female
veterans of all eras• Women have had difficulty gaining recognition for
their combat service
“Combat to Community: Facts and Figures of Post-9/11 Veterans and Their Families” - Sword to Plowshares, January 2011
Colorado’s Military/Veteran Population
Consider some of the
unique aspects
of military life...
MILITARY CULTURE
High standard of discipline helps organize and structure the armed forces
Professional ethos of loyalty and self‐sacrifice maintains order during battle
Distinct set of ceremony and etiquette creates shared rituals and common identities
Emphasis on group cohesion & esprit de corps connects service members to each other.
From Painting a Moving Train
MILITARY CULTURE - ACRONYMS
If you don’t know, it’s okay to ask (or to Google!)
MILITARY CULTURE – RANK STRUCTURE
Enlisted
Noncommissioned Officers (NCOs)
Warrant Officers
Commissioned Officers
MILITARY CULTURE – RANK STRUCTURE
What you need to know:
Chain of Command is key to day to day operations. ‐ ‐
Understand how rank structure influences decision making.
KEY ISSUES
– Military related trauma and stress
– Traumatic Brain Injury (TBI)
– Substance Abuse
– Suicide
– Employment/Education
– Family/relationships/parenting
MILITARY CULTURE - BRANCHES
Army Navy
Air Force Marines
Airman
Marine Coast Guard
Soldier Service
Sailor
Veteran
Coastie
Member
Barriers to Accessing Help
Stigma
Concerns about impact on career
Need for civilian partners and providerstrained in military/veteran culture & key issues
Complexity of systems of care
Military Culture – Connecting Points
Maintain interactive neutrality
Honor ideals
Understand social structure
Attune to communication differences
Have awareness of accepted norms of behavior
Keep up to date on new trends in military culture
Military Culture – DISconnecting Points
Making assumptions (e.g. presupposing PTSD)
Being focused on deployment/non deployment ‐
Lack of sensitivity regarding experiences
Assumption that if they are non infantry, they did not ‐see action
Discussion of politics and war
MILITARY/VETERAN SYSTEMS OF CARE
MILITARY ‐Military TX Facilities
‐TRICARE
GOVERNMENT ‐US Department of
Veterans Affairs
COMMUNITY ‐Private Providers Community Mental ‐
Health Centers & Clinics
MILITARY/VETERAN SYSTEMS OF CARE MILITARY/VETERAN SYSTEMS OF CARE
MILITARY -Military TX Facilities (MTFs)
-TRICARE
•Limited confidentiality for Active Duty Service Members
•Command and control over care, even outside of MTFs
•Treatment decisions can impact fitness for duty
•Eligible dependents are covered for care
MILITARY/VETERAN SYSTEMS OF CARE
MILITARY/VETERAN SYSTEMS OF CARE
GOVERNMENT ‐US Department of
Veterans Affairs
Veterans Health Administration
• Hospitals
• Community Based Outpatient Clinics (CBOSs)
• Vet Centers
Veterans Benefits Administration
• Disability Compensation
• Survivors’ Benefits
• Education Benefits
• Home Loans
• Vocational Rehabilitation
Most services are only for the veteran (with some exceptions).
MILITARY/VETERAN SYSTEMS OF CARE
COMMUNITY ‐Private Providers Community Mental ‐
Health Centers & Clinics
•Individuals may access providers via their private insurance, TRICARE, Medicaid, private pay, etc.
•There is significant need for providers trained and equipped to work with service members, veterans & their families
IMPORTANT FACTORS & QUESTIONS
A service member, veteran or family member will have different benefits, programs and resources available according to their branch, current status and past service.
Has this individual ever served in the military?
What is the person’s current military/veteran status?
Active Duty Activated National Guard Activated Reserves Non activated National Guard ‐Non activated Reserves ‐Veteran (less than 20 years service) Medically Retired Veteran Retired (20+ years service‐ )
IMPORTANT FACTORS & QUESTIONS
Based on their status, what is their eligibility for benefits and care in the different systems?
Are they already receiving care in any of these systems?
Who do you need to be in contact with to coordinate care within or across the systems?
If they are currently serving, what do you need to be aware of as you provide care?
Military Culture Reintegration - Military Culture Reintegration - Military Culture Reintegration -
5 critical tasks service members need to master:
1. Overcome alienation‐from family, friends, coworkers, community
2. Move from simplicity to complexity: – from self to others
– from surviving to thriving – from others thinking for you to responsibility
– from no choices to overwhelming choices
Military Culture Reintegration - Military Culture Reintegration -
3.Replace war with another form of high war is an ‐ adventure, nothing in civilian life matches the
intensity
4.Move beyond war and find meaning in life
5.Come to peace with self/God/others
Documentaries & Films on the Military Experience
Restrepo – A documentary that chronicles a one year ‐deployment of a platoon in Afghanistan.
Carrier – A 10 part documentary that follows the ‐crew of an aircraft carrier over six months.
Band of Brothers – A miniseries based on the true story of Easy Company during WWII.