Transcript Veteran Mental Health

Veteran Mental Health
Beckley VA Medical Center
Beckley, WV
(304) 255-2121
Today’s Speakers
Jennifer Paugh, LICSW
Tracie Hamb, LICSW
Anna Verschoore, LISW-C
Today’s Agenda
Session I
Understanding the Veteran Experience
Session II
Understanding the Needs of
Military Families
Warrior Ethos
a code of conduct that embodies a life where
integrity, loyalty, honor, selflessness and
courage are one’s guide
Warrior Ethos
a code of conduct acknowledges the
strength of the group over that of the
individual, enabling survival of the group
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
Conditions Often Experienced by
Military Members
Grief
 Anxiety (acute stress reaction)
 Anger
 Depression
 Post Traumatic Stress
 Substance Abuse
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Conditions Often Experienced by
Military Members
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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)
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
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Conditions Often Experienced by
Military Members
Anger
 a normal emotion often 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
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Conditions Often Experienced by
Military Members
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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.
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
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)
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
DSM 5 Criteria (Continued)
One or more of these following the event:
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You relive experiences of the traumatic event, such as having distressing images and memories.
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You have upsetting dreams about the traumatic event.
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You experience flashbacks as if you were experiencing the traumatic event again.
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You experience ongoing or severe emotional distress or physical symptoms if something reminds you of
the traumatic event.
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In addition, for more than one month after the traumatic event you may:
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Try to avoid situations or things that remind you of the traumatic event
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Not remember important parts of the traumatic event
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View yourself, others and the world in a negative way
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Lose interest in activities you used to enjoy and feel detached from family and friends
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Feel a sense of emotional numbness, feel irritable or have angry or violent outbursts
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Engage in dangerous or self-destructive behavior
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Feel as if you're constantly on guard or alert for signs of danger and startle easily
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Have trouble sleeping or concentrating
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Your symptoms cause significant distress in your life or interfere with your ability to go about your
normal daily tasks.
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For children younger than 6 years old, signs and symptoms may include:
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Reenacting the traumatic event or aspects of the traumatic event through play
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Frightening dreams that may or may not include aspects of the traumatic event
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
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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
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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?,
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Suicide Risk Assessment (cont)
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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
Resources for Assistance
 Case
Management- A collaborative process of
assessment, planning, facilitation, coordination, evaluation and
advocacy.
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, inpatient or out patient
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
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
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End of Session I
The Community’s Role in Recovery
Empathy
 Unconditional positive regard
 Reducing stigma
 Encouraging early intervention
 Know local resources
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Conditions Often Experienced by
Military Families
Grief
 Anxiety (acute stress reaction)
 Anger
 Depression
 Post Traumatic Stress
 Substance Abuse
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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.
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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
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Anger
Caused by fear and the unknown
situations
 Anger towards the other parent
 Angry at the “Military”
 Angry at the parent that is deployed
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Depression
Displayed as anger or other symptoms
 Clinical symptoms are different in children
than in adults
 Effects school, family, activities
 Accompanied by medical issues.
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PTSD
Effects the entire family
 Sympathy
 Negative feelings
 Avoidance
 Depression
 Anger and guilt
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Substance abuse
Used to self medicate
 Often begins with trauma or injury in
military
 Vast effects on family
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Resources for Assistance
VA resources
 Veterans Choice Act
 Local Vet Centers
 Give an Hour
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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
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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
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http://www.bing.com/videos/search?q=Ma
rines+Ethos+Creed&&view=detail&mid=3
DC74C0BC2EFCCA405773DC74C0BC2
EFCCA40577&FORM=VRDGAR
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