Military Families

Domestic Violence

And PTSD

Three Phases

• Active Duty

• Combat Veterans

• Veterans

Veteran’s Courts

Civilian Response to Military FV

Past Preservation of career

Anger mgt. + ANP = Dismissal

Present Building a better Military

Reduction in Force (RIF)

Behavioral health emphasis = Justice - PTSD, TBI, Reunion and Reintegration Issues

The Surge Where did they find all of these people? And how?

FEAR Led by Isaac Aguigui

- Wife found dead in home

- Stockpiling weapons

- Charged with killing two teenagers to conceal a plot to use $87,000 worth of munitions

- Blow up a fountain

- Bomb a dam

- Kill President

- Overthrow government

Pled Guilty to Murder (Life in Prison)

Forever

Enduring

Always

Ready

The Soldier Defendants

Sgt. Anthony Peden

• 26 years old

• 3 combat tours

• Sent home from Iraq in 2010 for threatening to shoot fellow soldier

• At home, pointed loaded rifle at wife

• Defense claiming TBI/PTSD

Pvt. Chris Salmon

• 25 years old

• Charged with 12 misdemeanors before enlisting in 2006

• Received a “moral conduct waiver”

• Demoted from specialist in 2011

September 12, 2012

Bloomberg News Article

2006

- DoD issued 30,615 special dispensations to accept troops with criminal records

(17% of all enlistees)

- DoD reduced number of troops discharged for misconduct by 30%

Soldier Crime Wave may be fueled by Army ignoring distress

2006 – 2011

Violent crime committed by active duty soldiers

(at home and overseas)

- Rose 31%

- 399 per 100,000 troops

- A crime committed in Army every 6 minutes

- One homicide every 63 hours

September 12, 2012

Bloomberg News Article

Soldier Crime Wave may be fueled by Army ignoring distress

The Result

High Risk behavior with increasingly more severe outcomes.

“We saw this in Vietnam – you get these substandard troops and pretty soon you’re screwed.”

Retired Four Star General Barry McCaffrey

- Deaths of military children

* 14 in 2003

* 29 in 2010

* Peaked at 36 in 2008

- Child abuse was lower in military until large scale deployments

- Rate is now 2X that of civilian population

- These are “rarely discussed symptoms of stress”

Army Times September, 2011

Deployments

and

Child Deaths

An

Epidemic

Of Abuse

Army Times,

August, 2013

In 2011

Civilian Rate of Child Abuse:

27.4 per 1000 kids Army Rate of Child Abuse:

4.5 per 1000 kids

Between 2008 and 2011

1.1% Civilian Increase

28% Army Increase

Underlying Problem

Insufficient coordination between

military health care providers, law

enforcement agencies, civilian

psychiatric facilities and the chain

of command.

Ready to Prosecute?

Criminal History

Military and

Combat Experience

PTSD?

Warrior History Generation

Napoleonic Wars

U.S. Civil War

WW I

WWII

Korean War

Vietnam

Gulf War I

Label Nostalgia

Soldier’s Heart

Shell Shock/Effort Syndrome

Battle Fatigue

Acute Combat Stress Reaction

Agent Orange, Subst. Abuse, PTSD

Gulf War Syndrome

PTSD - Stress Physiology

Post-traumatic stress disorder (post-traumatic stress disorder, PTSD) is a severe anxiety disorder that can develop after exposure to any event that results in psychological trauma.

This event may involve the threat of death to oneself or to someone else, or to one's own or someone else's physical, sexual, or psychological integrity, overwhelming the individual's

ability to cope.

Post Traumatic Stress Disorder

A

Differences in Trauma

Civilian

• Home/ Illusion of Safety

• Single event

• Unprepared

Warrior

• Daily potential for trauma

• Multiple events

• Trained for it

– It’s my job

– I am “mission ready”

Potentially Traumatic Events

• Being attacked or ambushed

• Receiving incoming artillery, rocket or mortars

• Being shot at / small arms fire

• Directing fire at the enemy

• Being resp. for death of enemy combatant

• Being resp. for death of noncombatant

• Seeing dead bodies or human remains

PTE

• Handling or uncovering human remains

• Seeing dead or seriously injured Americans

• Knowing someone seriously injured or killed

• Participating in demining operations

• Seeing injured women or children and unable to help

• Being wounded or injured

PTE

• Had a close call (was shot or hit but protective gear saved you)

• Had buddy shot or hit near you

• Clearing/searching homes or buildings

• Engaged in hand-to-hand combat

• Saved the life of a civilian

Taken from “Once a Warrior, Always a Warrior”

Hoge, New England Journal of Medicine, 2004

“The Three Legged Stool” of PTSD

• Fear and Terror

• Loss and Grief

• Moral Injury – Shame, guilt and rage torture the conscience

– You didn’t do wrong by the rules of war, but by your own humanity, it was wrong.

– I can’t forgive myself, and the people who can forgive me are dead.

» Captain Timothy Kudo, Iraq and Afghanistan War

Excerpt from Warrior book report

My depression, anxiety and anger does not stem from my individual life threatening moments, but from decisions I made as a leader that resulted in the death of others.

» Retired Chief Warrant Officer

» After reading “Once a Warrior, Always a Warrior”

» By Charles Hoge, MD, Colonel, U.S. Army

“What It is Like to Go to War”

• Need an end to our chirpy, parade approach to veterans.

• This is NOT a football game . We are talking about killing people.

• Is like clapping for a surgeon who amputated a leg.

Solemn Parade

• We need

– recognition of the MORAL DAMAGE we all suffer when we send our fellow citizens into battle.

– a willingness to talk about it.

The good the bad and the ugly.

» Karl Malantes, Vietnam Vet

» Author of “What it is Like to go to War”

Post Traumatic Stress Disorder

Misused as a catchall term for ANY postwar behavioral problem

Is considered a mental disorder, but is actually a physical condition that effects entire body

Is best understood through emerging science of

STRESS PHYSIOLOGY

I always ask…. Have either of you deployed?

If so, how recently?

How many times? And for how long?

Is anyone deploying soon? If so, when?

Has there been any formal mental health diagnosis, such as

Traumatic Brain Injury (TBI)

or PTSD?

Is the issue . . .

• Reunion and reintegration? (2 wks – 2 mos)

• Pre Deployment Anxiety/Fear?

• Post combat stress? (acute; requires rest)

• Post traumatic stress?

• Post traumatic stress disorder?

• Family Violence Perpetrator?

Reality

Adjustment disorder with Post Traumatic & High anxiety attachment

True of ALL combat veterans AND their spouses and kids

Taking out the D…. We need a phrase that links the

impact and injury of the

combat situation and

deployment experience to the

long lasting and often permanent

effects on the body and mind . . .

to take away stigma or assumption that:

You got it because you

weren’t strong enough.

An example

• Severely in debt, seen 4 different psychiatrists, just really don’t give a f**k any more - I’m in constant physical pain unless I’m drinking – It’s the only thing I’ve got.

• Hospitalized while deployed. Fell behind when troop was moving. Fellow soldier shot by another soldier. Felt I could have prevented it because I was senior to all of them

An example

• But was arguing with my wife so I didn’t have time to mess with them. Feel guilty over my inaction.

• Angry because meds have been changed. Can’t sleep.

• Married but currently separated. Wife pregnant. Parentage uncertain.

An example

• Pending charges of family violence assault

• Can’t remember what happened – blacked out.

• Reports insomnia, chronic pain, hopelessness

• Reports drinking very little – 6 beers – just enough to get to sleep.

• I have so many bills right now that if I get kicked out of army, can’t pay them.

“NOT ONE PROFILE, BUT TWO”

Understanding PTSD As An illness With Dual Neuro-Physiological-Behavioral Profiles

Drawings and Content : Courtesy of Back To The Wall, LLC

© 2010 Chrysanthe L. Parker, All rights reserved.

Reproduction in any format is prohibited by law.

Used for the limited purpose of this presentation

with consent of the author and copyright holder

When is a criminal justice response appropriate?

Bell County Misdemeanor FV

Year Total Assaults

Active Duty

% Military Involved

2010 (May) 815 238 29%

2011 1277 292 23%

2012 1289 300 23%

2013 1312 223 17%

Monthly Military Involved (2013)

Monthly Military Involved (2013)

Military Involved - Decembers

2011 2012

DEF. 13 2

VIC. 10 4

BOTH 10 14

Child Abuse Spike 2001-2004

DURING deployments:

Female civilian spouses Child neglect quadrupled Physical abuse tripled. LACK OF SLEEP JAMA, August 2007

Child Abuse Spike

Cases of abuse and neglect in the Army:

2009: 2,626

2012: 3,698

A 40 % increase

Prosecuting Soldiers

- Four Jury Trials on six FV Charges

- Acquittals on all four assault cases

- Convictions with maximum

punishment on other charges

(Int. w. 911 and Unlawful Restraint)

Good Soldier Defense

• The accused’s general good military character is a pertinent character trait

• if there is any nexus,

• however strained or slight

• between the circumstances surrounding the crime and the military.

• Taken from “Officer Basic Course, Military Rules of Evidence”

regarding Rule 404, emphasis by the author (not me)

Plea Bargains

Deferred adjudication

- Frequently more than 12 months

Dismissals for BIPP

- PTSD assessment

- Ft. Hood program

Military Points of Contact

Chiefs of Military Justice Fort Hood – Maj. Dan Everett – 254.287.3651

Ft. Sam Houston – Capt. Patrick Barrett – 210.295.9402

Fort Bliss – Maj. Christopher Glascott – 915.744.6949

Lackland AFB – Maj. Sophia Carrillo – 210.671.5756

Goodfellow AFG – Capt. John Gelzer – 325.654.3203

Sheppard AFB – Capt. Leslie Bartow – 940.676.7203

Dyess AFB – Capt. John Newten – 325.696.3305

Naval Air Station Corpus Christi – Lt. Alex Homme -361.961.1605

Naval Air Station Ft. Worth – Lt. Lauren Hugel– 817.782.7992

Unique Military Victims Far from home

No local friends or family

Employable? (length of stay)

MM controls all pertinent info

MM is source of all benefits

Military Benefits

1. BAH (basic allowance for housing)

2. Tri Care and Dental (health ins.)

3. Access to Post/Base

- Commissarry

- Post/Base Exchange

4. Command and spousal support

Command & Spouse Support

Past - Formal greeting process

- Coffees

- Social rosters

Present - All is optional

- Social media

- Crisis????????

On Post/Base Resources

Family Advocacy Program (FAP)

- Classes (Conflict Res., Anger Mgt.)

Social Work Department

- BIPP

Readiness Centers

- “Soldier” “Airman and Family”

Family Advocacy Program

4000 Defense Pentagon

Room 5A725

Washington D.C. 20301-4000

Air Force AFMOA/SG300

2664 Flight Nurse Building 801

Brooks AFB, TX 78235-5135

(210)536-2031/32

Army HQ DA, FMWR Command

Department of the Army

4700 King St., 4th Floor

Alexandria, VA 22302-4418

Navy Navy Personnel Command P6661

Department of the Navy

5720 Integrity Drive

Millington, TX 38055-6610

(901)874-4355

Marines HQMC M&RA (MRO)

3280 Russell Road

Quantico, VA 22134-5009

(703)784-9546

Militaryacronyms.com

Know the Language

–TDY (temporary duty)

–PCS (perm. change of station)

–ETS (expiration of term of serv)

–MOS (mil. occupation specialty)

Online Resources

Military One Source

- Militaryonesource.com

- (800)342-9647

Army One Source

Military Child Educ. Coalition

Military Protective Order

Department of Defense Form 2873 Lawful order - Commander to Service Member Enforceable on and off base No minimum or maximum duration Has menu or boiler plate provisions

– No contact, communication, etc. – Order to vacate on base residence – Provision of temporary residence in barracks – Mandatory Counseling – No Firearms

Military Justice Options Court Martial

– Confinement

– Punitive Discharge

Non Judicial Punishment (Article 15, UCMJ)

– Loss of Rank

– Loss of Pay

– Extra duty/restriction

Adverse Administrative Actions

– Official Reprimand

– Negative Evaluation Reports

– Bar to Reenlistment

– Administrative Separation

Transitional Compensation

Authorizes payments for “abused family members of military personnel.” (MM)

MM Must be

1. Separated administratively or

2. Court martial for dependent abuse

(child abuse or domestic violence)

TC Benefits

1. Tri Care Benefits - Includes behavioral health

2. Dental Benefits 3. Commissary and Post/Base Exchange Access 4. Monthly payments

For THREE years

How to Apply

Contact: Family Advocacy Program Manager

- FAP

Victim Advocate

- Army Community Service Center

Victim Witness Liaison

- Staff Judge Advocate

Victims of Abuse Monthly Rates

Spouse Spouse only $1,215

With one child $1,516

With two $1,817

With three $2,118

With four $2,419

With five $2,720

With six $3,021

With seven $3,322

With eight $3,623

Child Only One child $513

Two children $738

Three children $963

Four children $1,146

Five children $1,329

Six children $1,512

Seven children $1,695

Eight children $1,878

Fiscal Year 2013

Branch Population

Army 552,100

Navy 322,700

Marines 197,300

Air Force 329,460

Navy Res . 62,500

Total Reduction by 10/13

Must Reduce by:

9,900

3,000

4,800

3,340

3,700

24,700

End Strength Comparison

Fiscal Year 2001

• Army 480,000

• Navy 372,642

• Marines 172,600

• Air Force 357,000

Fiscal Year 2014

• Army 520,000

• Navy 323,600

• Marines 190,200

• Air Force 327,600

Reduction from 2013:

Army -32,100

Marines -7,100

Air Force -1,860

Eligible Veterans

Veterans who served during periods of “armed hostilities.”

Combat Veterans

WW II

Korea

Lebanon

Grenada

Panama

Persian Gulf

Somalia

Vietnam

Iraq and Global War on

Terrorism (GWOT)

Texas Veteran’s Centers

Amarillo

Arlington

Austin

Corpus Christi

Dallas and Dallas County

El Paso

Ft. Worth

Killeen Heights

Harris County

Houston

Laredo

Lubbock

McAllen

Midland

San Antonio NE

San Antonio NW

Tarrant County

Taylor County

Texas Veteran’s Centers

Veteran Centers Part of the VA

Community based

Provide broad range of counseling

Outreach and referral services

Free to eligible veterans

Vet Centers in Virginia

• 6940 S. Kings Hwy #204 Alexandria, VA 22310 Phone: 703-360-8633 Or 877-927-8387

• 4902 Fitzhugh Avenue Richmond, VA 23230 Phone: 804-353-8958 Or 877-927-8387

• 350 Albemarle Ave., SW Roanoke, VA 24016 Phone: 540-342-9726 Or 877-927-8387

Vet Centers in Virginia

• 324 Southport Circle, Suite 102 Vir. Beach, VA 23452

Phone: 757-248-3665 or

877-927-8387

• 1711 Church Street

Suites A&B Norfolk, VA 23504

Phone: 757-623-7584 or

877-927-8387

The VA

The Veteran’s Administration

What is the VJO Initiative?

Outreach to Veterans in contact with

the justice system through:

Police / local law enforcement

Courts

Jails

Goal is to provide timely access to VA services for eligible justice-involved veterans

Purpose is to avoid unnecessary criminalization and incarceration of Veterans with mental health and/or substance use disorders

Veterans charged with non-violent offenses are considered a priority population for the initiative

Who Is a Justice-Involved Veteran?

In contact with local law enforcement and can be appropriately diverted from arrest to mental health treatment

In a local jail, either pretrial or serving a sentence

Involved in adjudication or monitoring by a court

Does NOT include:

- Veterans in prisons - Veterans with a criminal background {those on

probation or parole)

Combat Insightful Books

Where Men Win Glory The Odyssey of Pat Tillman

- by Jon Krakauer

Two Wars One Hero’s Fight on Two Fronts –

Abroad and Within

- by Nate Self

De-Mystifying “PTSD”

Once a Warrior Always a Warrior Navigating the Transition from Combat to

Home – By Charles W. Hoge, M.D., Colonel, U.S. Army (Retired)

I I Always Sit With My Back to the Wall Managing Traumatic Stress and Combat PTSD

Through the R-E-C-O-V-E-R Approach for Veterans and Families

- By Harry A. Croft, M.D and Rev. Dr. Chrys Parker, J.D.

Unbelievably Accurate

You Can Tell When the Men Are Gone A Collection of Short Stories set at Ft. Hood, Texas

- By Siohban Fallon

Vietnam Combat

• What it is Like to Go to War A critical examination of how we might better prepare

our soldiers for the psychological and spiritual aspects of war.

- By Karl Marlantes, Vietnam Veteran, Graduate of Yale University,

Rhodes Scholar at Oxford University

Iraq and Beyond

• The Good Soldiers Raw, vivid account of “the surge” in Iraq in 2007 by

author embedded with 2-16 Infantry Battalion.

• Thank You for Your Service

Follows soldiers of 2-16 Infantry Battalion’s when they

return to their families and struggle daily with PTSD and loss.

- By David Finkel, Pulitzer Prize Winner

Editor and writer for the Washington Post

Anne Potts Jackson

Assistant Bell County District Attorney

Anne.Jackson@co.bell.tx.us

(254)933-5215

Lt. Colonel Michael L. Jackson, USAF