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.