Transcript After They Have Served

Veteran’s Issues
After They Have Served
The Effects of Combat Stress
& Post Traumatic Stress on the Home Front
Covered Today
Situation
– Who was Deployed
– Significant Events That
They Saw
– Magnitude of the
Problem
Challenges That They Face
• Battle Zone Skills That
Interfere with
Readjustment
• Potential Triggers
Covered Today
Good News!
Research indicates that 7580% of veterans who are
exposed to combat and/or
served in combat
environments return from
deployment and transition
into civilian life very
productively.
Healthy Transitions
Certainly the transition from
war zone to home is a
unique experience for each
veteran and their family.
Most move through and
beyond this transition with
a true sense of meaning and
purpose for their lives.
Family support, education,
and awareness are keys to
successful homecomings.
The Situation
•
Who was Deployed
•
Significant Events That They Saw
•
Magnitude of the Problem
Operations in Support of the Global War on Terrorism
Operation Iraqi Freedom
(OIF)
Mar 20, 2003 - Sept 1, 2010
Operation New Dawn
(OND)
Sept 1, 2010 – Dec 15, 2011
Operation Enduring
Freedom (OEF)
Oct 7, 2001- Current Date
PERCENTAGE OF US POPULATION AGE 18-34 WHO
SERVED
Veterans
Total Population
WWI - 14%
WWII - 36%
Korean War - 12%
Vietnam War 14%
Global War on
Terrorism - < 2%
Status of Forces
Stationed in the U.S.
2003
2004
2005
Source: Defense Manpower Data Center
2006
Serving Overseas Non-Combat
2007
2008
2009
Serving in Combat Zone
2010
2011
2012
2013
Asymmetrical Warfare
No Safe Place
No Safe Role
Global War on Terrorism 2001-2007
•
94% - Received small-arms fire
•
86% - Know someone who was seriously injured or
killed
•
77% - Shot at or directed fire at the enemy
•
68% - Saw dead or seriously injured Americans
•
51% - Handled or uncovered human remains
•
48% - Responsible for the death of an enemy
combatant
•
28% - Responsible for the death of a noncombatant
•
(New England Journal of Medicine)
New England Journal of Medicine
July 2004
• Examined mental health problems among 3671 Soldiers and
Marines 3 to 4 months after their return from Afghanistan or
Iraq. They Found:
• Up to 17.1% screened positive for major depression,
generalized anxiety and/or PTSD.
• Of those who screened positive for a mental disorder, as few
as 23% sought treatment.
• Those with a mental disorder were twice as likely to report
concern about stigmatization should they report their
problems.
• Combat veterans are at high risk for PTSD and other MH
problems, but unlikely to report them.
NEJM, July 1, 2004—Vol. 351, No. 1
Journal of the American Medical Association
March 1, 2006
• 303,905 Army soldiers and Marines screened from 5/1/03 to
4/30/04, on return from deployments to GWOT (Iraq,
Afghanistan, Other Locations)
• Those who screened positive for a mental health concern
were significantly more likely to leave service for any reason
during the year after deployment than those who screened
negative
• Service members are twice as likely to report mental health
concerns 3 to 4 months after returning from deployment
compared with reporting immediately on return
JAMA, March 1, 2006—Vol. 295, No. 9
Global War on Terrorism Casualty Summary
KIA, 6784
WIA, 51908
Source: Defense Casualty Analysis System
Global War on Terrorism 2001-2007
• Two thirds of the casualties in the Global War on Terrorism occurred
between 2001-2007
• Increased operational (OP) tempo early in the war
• Mental health issues not formally addressed until 2007
• Changes to addressing mental health issues implemented in 2008
Turning Point: Walter Reed 2007
Specialist Jeremy Duncan testifies during a hearing before the House
Subcommittee of Government Reform and Oversight Committee March 5, 2007
at Walter Reed Army Medical Center in Washington, DC. The hearing was held
to examine the treatment and living conditions at the medical center.
By Alex Wong/Getty Images.
Global War on Terrorism 2008-Present
• Experiencing stress from
combat is viewed as “normal”
rather than weak
• All ranks have similar
reactions to combat
• Stigmatism to PTSD
dramatically diminished
• Treatment for combat stress
and post traumatic stress is
encouraged
1,724,058
• Is the number of
Operation: Iraqi
Freedom, Enduring
Freedom and New
Dawn veterans who
have left active duty
since September 30,
2002
Frequency of Mental Disorders13 among OEF/OIF/OND
Veterans since 200214
Disease Category (ICD-9 290-319)
PTSD (ICD-9 309.81)16
Depressive Disorders (311)
Neurotic Disorders (300)
Affective Psychoses (296)
Alcohol Dependence Syndrome (303)
Nondependent Abuse of Drugs (305)17
Special Symptoms, Not Elsewhere Classified (307)
Specific Nonpsychotic Mental Disorder due to Organic
Brain Damage (310)
Drug Dependence (304)
Sexual Deviations and Disorders (302)
Total Number of
OEF/OIF/OND
Veterans15
299,561
239,174
217,736
144,898
68,953
51,018
44,159
38,611
32,763
35,141
VA Health Care Utilization among OEF/OIF/OND Veterans Cumulative from 1st Qtr FY 2002-4th Qtr FY 2013, Released January 2014
EFFECTS OF WAR
Combat Stress
Post Traumatic Stress
Symptoms of Post Traumatic Stress
• Symptoms of posttraumatic stress
disorder (PTSD) can be
terrifying and may
disrupt your life.
• Usually begin soon after
the traumatic event
• May occur months or
years later
• May come and go over
many years
http://psychewizard.com
Symptoms of Post Traumatic Stress
• Four Types of
Symptoms
1.
2.
3.
4.
http://psychewizard.com
Avoidance symptoms
Numbing symptoms
Feeling Keyed Up
Reliving symptoms
Avoidance
• You may try to avoid
situations or people that
trigger memories of the
traumatic event.
• You may even avoid talking
or thinking about the event.
• Some people may keep very
busy or avoid seeking help.
• This keeps them from
having to think or talk about
the event.
Feeling Numb
• You may find it hard to
express your feelings. This is
another way to avoid
memories
• You may not have positive or
loving feelings toward other
people and may stay away
from relationships
• You may not be interested in
activities you used to enjoy
• You may forget about parts
of the traumatic event or
not be able to talk about
them
Feeling Keyed Up
• You always may be alert and
on the lookout for danger.
This is known as increased
emotional arousal. It can
cause you to:
– Suddenly become angry or
irritable
– Have a hard time sleeping
– Have trouble concentrating
– Fear for your safety and
always feel on guard
– Be very startled when
someone surprises you
Reliving The Event
• Bad memories of the
traumatic event can come
back at any time. You may
feel the same fear and
horror you did when the
event took place.
• You may feel like you're
going through the event
again. This is called a
flashback.
• Sometimes there is a
trigger: a sound or sight
that causes you to relive the
event.
Leatherneck Magazine. www.leatherneck.com
Reliving Traumatic Stress Injuries
• Abrupt injuries to the
brain and mind
• Due to specific events)
that cause:
– Terror, horror, or
helplessness
– Physiological hyperarousal
– Dissociation (abrupt and
transient loss of mental
integrity)
– Damage to necessary or
deeply-held beliefs
– Shame or guilt
CRISIS INTERVENTION
Identifying a crisis
The Goal of Intervention
What is a Crisis
• A crisis is an overwhelming reaction to a threatening
situation in which a person’s usual problem solving
strategies fail to resolve the situation resulting in a
state of disequilibrium.
• A crisis is a perception or experiencing of an event or
situation as an intolerable difficulty that exceeds the
person’s current resources and coping mechanisms.
Goal of Intervention
• The goal of intervention is to restore the person to
pre-crisis level of equilibrium, not of personality
changes.
• Attempt to mobilize the veteran’s internal and
external resources.
• Exact nature of the intervention will depend on the
veteran’s pre-existing strengths and supports and
your level of creativity and flexibility
The Crisis State
Assessment
Intervention
Resources
Crisis Intervention Balancing Factors
Intervention
------ SMS Text -----From: **********
Received: Mar 9, 2011 6:50 PM
Subject: So if I have a gun in my
mouth...
So if I have a gun in my mouth...does
That mean I have a plan, or am I just
thinking about killing myself?
A process to assist individuals in finding adaptive
solutions to unsettling events
Do’s and Don’ts
DO …say things like:
DON’T …say things like:
• “You are safe now (if true).”
• “I’m glad you’re talking with me
now.”
• “I am sorry it happened.”
• “Your reaction is not an
uncommon response to such a
terrible thing.”
• “I can’t imagine how terrible you
are feeling.”
• “You are not going crazy.”
• “Things may never be the same,
but they can get better.”
• “I understand.”
• “I’m glad you can share those
feelings.”
• “You’re lucky that. . .”
• “It’ll take some time but you’ll
get over it.”
• “I can imagine how you feel.”
• “Don’t worry; it’s going to be
alright.”
• “Calm down and try to relax.”
CHALLENGES
Battle Zone Skills That May Interfere with
Readjustment
In Combat: Unpredictable, fast, rapid lane changes, straddling
the middle line, keeping other vehicles at a distance, designed
to avoid IEDs and VBIEDs.
Triggers
•
•
•
•
Road Construction
Traffic Jams
Stress
Confusion
Examples
• Aggressive Driving
• Speeding
• Erratic driving in congested
areas
In Combat: Countless split-second decisions are made to
apply deadly force in dangerous and highly ambiguous
environments.
Triggers




Bar Scene
Alcohol
Family Issues
Marital Issues
Examples
 Overreactions to minor
insults
 Inappropriate
aggressiveness
 Assault
 Domestic violence
In Combat: Carrying your weapon at all times was
mandatory and necessary.
Trigger
 Feeling naked without a
firearm
 Traveling outside of your
element
 Anxiety
 Stress
Examples
 Armed without a reason
 Firearm in vehicle
In Combat: Controlling your emotions during combat is
critical for mission success
Trigger
 Detachment from battle
buddies/Adapting to a new
environment
 Anniversary Dates
 Holidays
 Patriotic Holidays/Rally’s
Examples
 “Black and White”
perspective
 Anger over minor issues
 Avoiding crowds or public
 Avoiding family/friends
SUCCESSFUL HOMECOMINGS
Keys to successful homecomings
Keys to Successful Homecomings
•
•
•
•
Family Support
Education
Awareness
Early Action
Getting Help
• Even if you always have some symptoms, counseling
can help you cope.
• Your symptoms don't have to interfere with your
everyday activities, work, and relationships.
• Most people who go through a traumatic event have
some symptoms at the beginning but don't develop
PTSD.
RESOURCES
National Suicide Prevention Hotline
• Call the toll-free National Suicide Prevention hotline
and indicate you are a veteran. You'll be immediately
connected to VA suicide prevention and mental
health professionals. We can help-- If you feel you
are in Crisis--Call the Suicide hotline (1-800-273TALK).
QUESTIONS?