Transcript Stop Feeding Your Stress

Mental Health Issues of Veterans
Returning from Iraq & Afghanistan
Heather Brown, PhD
Louis A Johnson VA Medical Ctr
Clarksburg, WV
[email protected]
Following this presentation, the learner will:
identify specific combat issues impacting
service members in Afghanistan and Iraq
state the mental health needs of Veterans
and their families
understand the role of community
providers in the readjustment process
Problems of returning service
members seeking VA care:
1) Musculoskeletal diseases (joint and
back), 43%
2) Mental health problems (higher in
Guard/Reserves, non-officers), 36%
3) Signs and symptoms of ill-defined
diseases, 33%
Mental Health problems of returning
service members seeking VA care:
1) Adjustment Reactions (includes Post
Traumatic Stress Disorder)
2) Drug abuse (includes nicotine)
3) Depression
Hidden Wounds:
Traumatic Brain Injuries (TBI)
Post-Traumatic Stress Disorder (PTSD)
Traumatic Brain Injuries (TBI):
80% of TBI cases are mild and involve no
loss of consciousness
Primarily due to blast injuries
29% of battle evacuees had TBI
TBI (cont’d)
TBI and PTSD symptoms often overlap
(sleep/memory problems, decreased
concentration, mood disturbance)
Unrecognized TBI leads to poor
psychosocial functioning
Have high suicide rates
TBI medical considerations
Use caution when sending TBI patients for
MRI because of metal fragments (do CT
scans first)
Wellbutrin and TBI may not mix (due to
increased seizure risk)
If have genetic markers for Alzheimer’s
disease, will develop sooner in TBI pts.
PTSD:
17% of the OEF/OIF population currently
treated at VA are diagnosed with PTSD
Among new patients, PTSD rates are
progressively higher than in previous years
Symptoms of PTSD (DSM V)
1.
2.
3.
4.
5.
Exposure to actual or threatened death, serious injury, or sexual
violence [i.e., traumatic stressor]
Presence of one (or more) intrusion symptoms associated with the
traumatic event(s) [formerly, re-experiencing]
Persistent avoidance of stimuli associated with the traumatic
event(s)
Negative alterations in cognitions and mood associated with the
traumatic event(s) [new; formerly emotional numbing only]
Marked alterations in arousal and reactivity associated with the
traumatic event(s)
Substance Abuse
 11 percent of OEF and OIF veterans have been
diagnosed with a substance use disorder (SUD)—
an alcohol use disorder, a drug use disorder, or
both
 Almost 22 percent of OEF and OIF veterans with
post-traumatic stress disorder (PTSD) also have
an SUD
 SUD may co-occur with a mental health issue for
“self-medication”
Facts about Veteran suicide
• From the total noted deaths by suicide, 22 each day are Veterans (VA
Suicide Data Report, 2012)
• Veterans are more likely than the general population to use firearms
as a means for suicide (National Violent Death Reporting System 2013)
• 35 percent of recent Veteran suicides have a history of previous
attempts (VA National Suicide Prevention Coordinator reports, 2012)
• West Virginia’s total population is 1,854,304 (2013 approx. Census
data)
West Virginia has a total Veteran population of 170,783 (Census
2010)
West Virginia has a higher population of service members who serve
or have served in the National Guard or Reserves
Operation S.A.V.E.
Operation S.A.V.E. will help you act with care and compassion if you
encounter a Veteran who is in in distress or might be experiencing a
suicidal crisis. The acronym “S.A.V.E.” helps one remember the important
steps involved in suicide prevention:
 Signs of suicidal thinking should be
recognized
 Ask the most important question of all
 Validate the Veteran’s experience
 Encourage treatment and Expedite getting
help
Signs of a person of concern
Learn to recognize these warning signs: *Remember, it is
commonly a combination of signs/symptoms rather than
just one thing
•Hopelessness, feeling like there’s no way out or no reason
to live
•Anxiety, agitation, sleeplessness or mood swings
•Rage or anger
•Engaging in risky activities without thinking
Signs of a person of concern (cont’d)
•Increasing alcohol or drug abuse
•Withdrawing from family and friends
•Talking about death, dying or suicide
•Over-focusing on giving valued belongings away and
preparing for ones death (Not mindful preparation/planning
of a person’s preference of arrangements following a natural
death)
•Overachieving, perfectionism (newer signs that clinicians
are identifying)
Ask the Question & Validate the experience
 Are you thinking of
 Talk openly about
suicide?
 Have you had thoughts
about taking your own
life?
 Are you thinking about
killing yourself?
 Are you thinking of
hurting yourself?
suicide. Be willing to
listen and allow the
Veteran to express his or
her feelings.
 Recognize that the
situation is serious
 Do not pass judgment
 Reassure that help is
available
Encourage treatment and Expedite
getting help
• Gently escort them to the closest professional person--let
the person know that you would like to walk with them to
find a professional that can help. (Complete a warm hand
off to the next professional, explaining why you are there
with the Veteran).
• Alert the nearest staff person to assist you with the
Veteran-you may wish to stay with the Veteran while the
other staff person gets more help or next necessary level of
care
Special issues of returning female
service members:
Sexual Harassment
Sexual Assault
May not self-identify as “combat vets”
Family reintegration issues (after
the “Honeymoon”):
Role changes (parenting, household
responsibilities, etc.)
Employment issues
Financial issues
Safety concerns
Family reintegration (cont’d)
Driving
Relationship w/spouse, children
Communication difficulties
Changes in support system
Seeking treatment (or not):
Stigma (military, cultural)
68% of OEF/OIF vets eligible for VA
services have NOT sought treatment
Where are they? In the community!
Role of community providers:
Awareness of Veterans needing assistance
in the community
Awareness of VA and Vet Centers as
referral sources
Understanding of why service members
may not seek treatment (i.e., consequences)
Partner with local clergy
Role of health providers:
Primary care may be service members’
only contact with treatment
Screen for common mental health
problems (e.g., depression)
Ask about exposure to blast injuries, screen
for TBI
VA Medical Centers in West Virginia
Clarksburg VAMC, 304-623-3461
Martinsburg VAMC, 304-263-0811
Beckley VAMC, 304-255-2121
Huntington VAMC, 304-429-6741
Other VA treatment locations in WV
Community Based Outpatient Clinics
(CBOC) [Multiple locations, including some rural
counties]
Vet Centers [Beckley, Charleston, Huntington,
Martinsburg, Morgantown, Princeton, Wheeling and
outreach sites]
Additional Resources
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1. Veterans Crisis Hotline (800) 273-8255, press 1.
2. Military OneSource: 24/7 Assistance and resources by phone and online for
service members and their families on many different issues. (800) 342-9647.
3. Vet Center Combat Call Center 877-WAR-VETS: 24/7 call center staffed by
combat Veterans for combat Veterans and family members to discuss their military
experience and adjustment issues. Individual & family counseling, bereavement
counseling for family members, military sexual trauma counseling. 877-WarVets or
(877) 927-8387.
4. National Care Giver Support Line: M-F 8am-8pm. VA support for anyone
providing care for Veterans coping with the effects of war, disability, chronic illness,
or aging. (855) 260-3274.
5. Coaching Into Care: 8am-8pm Mon-Fri. Call center works with family/friends
concerned about Veteran post-deployment difficulties. (888) 823-7458.