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Surety, Readiness, Support Mission – Provide unsurpassed medical support to TEAM KIRTLAND, Expeditionary Forces and our valued patients. Mental Health.

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Presentation on theme: "Surety, Readiness, Support Mission – Provide unsurpassed medical support to TEAM KIRTLAND, Expeditionary Forces and our valued patients. Mental Health."— Presentation transcript:

1 Surety, Readiness, Support Mission – Provide unsurpassed medical support to TEAM KIRTLAND, Expeditionary Forces and our valued patients. Mental Health Services During and After Deployment Kirtland Air Force Base, New Mexico

2 Surety, Readiness, Support Overview Deployment video Mental health services in Iraq Example of the “embedded clinician” approach Determination of fitness for duty & case example Questions and answer

3 Surety, Readiness, Support Service Delivery in a Deployed Setting Maj (Dr.) Jorge G. Varela Mental Health Clinic Mission – Provide unsurpassed medical support to TEAM KIRTLAND, Expeditionary Forces and our valued patients.

4 Surety, Readiness, Support Video

5 Surety, Readiness, Support Baghdad Experience… Small installation responsible for flight line operations at International Airport Medical facility –31 Medics (ADAF/Guard) –2 large tents + smaller tents –4-7 beds –Surgical suite –Dental suite –Mental Health services –Mass casualty responses

6 Surety, Readiness, Support Baghdad Experience One psychologist Dedicated area in tent Presenting Problems –Relationship problems –Interpersonal conflicts –Repatriation –Critical Incident Stress –Tobacco cessation Services provided –Counseling/therapy –Fitness for duty evaluation –Critical Incident interventions –Consultation to Commanders

7 Surety, Readiness, Support Air Force Theater Hospital (AFTH) Experience… Three functions –Emergency surgical and other life-saving efforts –Contingency Aeromedical Staging Facility (CASF) –Outpatient medical clinic Four “wards” –Medical/surgical recovery –Intensive Care Unit –Iraqi unit Multiple medical and surgical specialties Associated support capabilities –Imaging –Emergency room –Pharmacy –Chapel

8 Surety, Readiness, Support Air Force Theater Hospital (AFTH) Experience… Psychologist, Psychiatrist, Psychiatric Nurse, three mental health technicians Clinic located in tent space, hardened building Mental health services –Outpatient therapy –Consult evaluations –Redeployment interventions –Critical incident intervention –Command consultation –Fitness for duty evaluations

9 Surety, Readiness, Support Air Force Theater Hospital (AFTH) Experience Presenting Problems –Relationship problems –Interpersonal conflicts –Critical Incident Stress –Tobacco cessation –Stability for transportation/movement

10 Surety, Readiness, Support Things worth knowing… Technology has changed the experience of the deployed Service member –Internet –Media coverage –Digital photography Enhanced capability to deliver life-saving care

11 Surety, Readiness, Support Aeromedical Staging Facility

12 Surety, Readiness, Support Theater Hospital

13 Surety, Readiness, Support Outpatient Clinic

14 Surety, Readiness, Support Embedded Clinician Approach Capt Corey Christopherson Mental Health Clinic Mission – Provide unsurpassed medical support to TEAM KIRTLAND, Expeditionary Forces and our valued patients.

15 Surety, Readiness, Support Video

16 Surety, Readiness, Support Embedded Clinician Goal: Provide mental health treatment and services for those Airman most frequently deployed and at risk for traumatic exposure in support of OIF/OEF Obstacles: Overcoming barriers to mental health treatment for this population –Stigma associated with mental health services –Career impact concerns

17 Surety, Readiness, Support Embedded Clinician Action: The Embedding and Immersion of a 377 MDG mental health provider with 377 LRS –Participation in unit activities –Outreach services Program Update –Troops and leadership have appreciated MH services –Steadily increasing utilization –Word-of-mouth referrals

18 Surety, Readiness, Support Embedded Clinician Lesson Learned: –Participation in unit activities seems to reduce negative stereotypes/apprehension –Helpful to deliver services in nontraditional manner (e.g., bring the services to them) –Success enhanced if leaders educated regarding identification and utilization –Case Example Closing Statement –Initial expectations vs. actual results –Successful outcomes

19 Surety, Readiness, Support Medical Evaluation Boards & Case Example Capt (Dr.) Parker Niemann Mental Health Clinic Mission – Provide unsurpassed medical support to TEAM KIRTLAND, Expeditionary Forces and our valued patients.

20 Surety, Readiness, Support Medical Evaluation Board Physician identifies a medical condition where worldwide qualification may be in doubt Mental Disorders –Condition precludes satisfactory performance of duties or worldwide assignability –Impairment expected for longer than one year –Recurrent impairment or recurrent impairment expected

21 Surety, Readiness, Support In Other Words… MEB is indicated when a mental health condition Limits occupational functioning (> 1 yr) Limits ability to be deployed (> 1 yr) Has caused or will cause recurrent impairment

22 Surety, Readiness, Support “Unfitting” Illnesses Any psychotic disorder Unless it is brief, reversible, and with good prognosis Any mental Illness with Persistent duty impairment (> 1 yr) Recurrent duty impairment (> 1 episode in 12 months) Requirement for ongoing psychiatric support to function Mood disorders requiring antipsychotics, lithium, or mood stabilizers

23 Surety, Readiness, Support Adminstrative Actions Personality Disorders (by themselves) Adjustment Disorder Sexual Perversions Alcoholism Can MEB Medical Consequences of Alcoholism Illicit Drug Use Learning Disorders ADHD “Flying Phobia”

24 Surety, Readiness, Support Other Considerations Overall reliability, judgment, and coping skills Significance of symptoms and medication side effects Availability of treatment Effect of being without treatment Risk of recurrence if exposed to trauma Ability to tolerate hostile or austere surroundings

25 Surety, Readiness, Support Requirements for Deployment Diagnosed disorders must exhibit stability for at least 3 months prior to deployment Medications prescribed within 3 months of deploying must demonstrate efficacy and tolerability Clinical judgment is involved

26 Surety, Readiness, Support What is in an MEB? Clinical assessment Supporting diagnostic data (testing, labs) Supporting clinical records Collateral data to assign military and social/industrial impairment (e.g., supervisors, family members, others)

27 Surety, Readiness, Support Case: SSgt Smith 32 year old Active Duty US Army Staff Sergeant presented as a walk-in several months ago Referred by PCM for “alcohol abuse” per screening tool Had returned from deployment 4 days prior Just finished 16 months deployed in Iraq Embedded with Iraqi military

28 Surety, Readiness, Support SSgt Smith Consumed alcohol 2 of the 3 days since back in the US, “celebrating with friends” Not surprisingly, endorsed symptoms consistent with ASD: Insomnia Hyperarousal Hypervigilance Irritability Emotionally “numb”

29 Surety, Readiness, Support SSgt Smith Insisted: “I feel fine. I’m not worried.” Ambien prescribed by PCM Immediately went on leave to Arizona, coming back every 2-3 weeks Agreed to follow-up PCSing overseas!

30 Surety, Readiness, Support SSgt Smith Returned in 2.5 weeks Stress-related symptoms worse. In addition, patient reported: Daily headaches Loss of appetite Anxiety-induced emesis Less socializing Marital conflict PCSing in 10 weeks!

31 Surety, Readiness, Support SSgt Smith Initiated treatment Prolonged Exposure Therapy (1-2 sessions / week) Psychotropics Celexa Ambien Improvement SUDS: Initial = 100/100 After several sessions 60/100 Similar improvements in BAI Functioning: Driving Eating Out Dating


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