1. Understanding Military Culture Joshua Bode, LCSW Veterans Justice Outreach Coordinator, Boise VA Medical Center

2. Knowledge and understanding of military culture can lead to: Increased ability to relate to and support your Veteran client resulting in a stronger therapeutic alliance - the strongest determinant of treatment outcome. Deeper understanding of the context for mental health symptoms and conditions. Improved treatment planning that is informed by increased military cultural knowledge. Increased appreciation for military service.

3. Learning about military culture includes a deeper understanding of both the: Structure of the military such as branches and ranks. Missions, ideals and core values of military culture.

4. Learning Objectives Become familiar with military terms and demographics Describe stressors in the military Implications for Treatment Court Teams

5. Service Branch Sizes Assigned Strength of Active Duty Force ServiceEnlistedOfficersTotalPercentage Army452,06487,610539,67537.8% Navy275,29651,388326,68422.9% Marine Corps178,21320,202198,41513.9% Air Force258,09564,805322,90022.6% Coast Guard33,2288,13441,3622.9% Total1,196,897232,1391,429,036100%

6. Female Service Members Active Duty Gender Distribution ServiceEnlisted Percent FemaleOfficer Percent Female Army13.2 %15.5 % Navy15 %15.1 % Marine Corps6.2 %5.8 % Air Force19.9 %18.3 Coast Guard11.6 %14.9 % Total14 %15.3 %

7. Race Profile of Military Active Duty Gender Distribution ServiceEnlisted Percent FemaleOfficer Percent Female Army13.2 %15.5 % Navy15 %15.1 % Marine Corps6.2 %5.8 % Air Force19.9 %18.3 Coast Guard11.6 %14.9 % Total14 %15.3 % Race Profile of Active Duty Force Service% White% Minorities% Black% Other Army73.9 %26.1 %21.5 %4.6 % Navy66.2 %33.8 %19.3 %14.4 % Marine Corps83.7 %16.3 %11.1 %5.2 % Air Force78.1 %21.9 %15.6 %6.3 % Coast Guard82 %18 %6.1 %11.9 % Total74.6 %25.4 %17.8 %7.6 %

8. Diversity 33% of Active and 25% of Reserve Guard are racial/ethnic minorities. Representation of most of these groups are parallel or higher than general population. Asian and Hispanic representation is lower than general population

9. Military Branches Army = Soldier Air Force= Airman Navy= Sailor Marine Corps= Marine Coast Guard= Guardian

10. Military Core Values Army- Loyalty, Duty, Respect, Selfless Service, Honor, Integrity, and Personal Courage Air Force- Integrity First, Service Before Self, Excellence In All We do Coast Guard- Honor and Integrity, Greater Good of the Coast Guard, Innovation, Personal Initiative, Drive for Success, and Teamwork Marines- Honor, Courage, Commitment Navy- Honor, Courage, Commitment

11. Army Mission Fight and win our Nation’s wars by providing prompt, sustained land dominance across the full range of military operations and spectrum of conflict in support of combatant commanders.

12. Air Force Mission To fly, fight, and win…in air, space and cyberspace. Distinctive Capabilities 1.Air and Space Superiority 2.Global Attack 3.Rapid Global Mobility 4.Precision Engagement 5.Information Superiority 6.Agile Combat Support

13. Coast Guard Mission The United States Coast Guard is a multi- mission, maritime military service within the Department of Homeland Security and one of the nation’s five armed services. Its core roles are to protect the public, the environment, and U.S. economic and security interests in any maritime region in which those interests may be at risk, including international waters and America’s coasts, ports and inland waterways.

14. Navy Mission The mission of the Navy is to maintain, train and equip combat-ready Naval forces capable of winning wars, deterring aggression and maintaining freedom of the seas.

15. Marine Corp Mission The Marine Corps has been America's expeditionary force in readiness since 1775. We are forward deployed to respond swiftly and aggressively in times of crisis. We are soldiers of the sea, providing forces and detachments to naval ships and shore operations. We are global leaders, developing expeditionary doctrine and innovations that set the example, and leading other countries' forces and agencies in multinational military operations. These unique capabilities make us "First to Fight," and our nation's first line of defense

16. Military Rank Enlisted Personnel (E-1 through E-9) Warrant Officers (W-1 through W-5)- highly specialized experts (2% of military) Commissioned Officers (O-1 through O-10)

17. MOS/NEC/AFSC Marines, Army, and Coast Guard use MOS or Military Occupational Specialty Navy uses Navy Enlisted Classification Air Force uses Air Force Specialty Code

18. Military Status Active Duty – Full Time Reserve/Guard – Federal/State – 39 days/year – Typically monthly drills two-week annual training – May be called to Active Duty for deployments – Lack the support system Active Duty has returning from deployment.

19. Military Acronyms and Terms FRG = Family Readiness Group ARNG = Army National Guard FAC = Family Assistance Center TAG = The Adjutant General MOBEX = Mobilization Exercise ANG = Air National Guard TDY = Temporary Duty FOB= Forward Operations Base OIC = Officer In Charge NCO = Noncommissioned Officer NCOIC= Non-Commissioned Officer in Charge JAG = Judge Advocate General KIA = Killed In Action MRE = Meals Ready to Eat AIT= Advanced Individual Training UCMJ= Uniformed Code Military Justice SARC= Sexual Assault Response Coordinator NBC= Nuclear, Biological, Chemical Weaponry

20. Military Stressors Life Threat (combat/deployment) Loss Inner Conflict Wear and tear/lack of control

21. Military Sexual Trauma Active Duty personnel (with reference to the past year) have experienced: – Offensive sexual behavior: 52% of women and 29% of men – Unwanted sexual attention: 31% of women and 7% of men – Sexual Coercion: 9% of women and 3% of men – Unwanted sexual contact: 6.8% of women and 1.8% of men VA population (with reference to their entire military service) experienced: – MST: 21.4% of women (48,106) and 1.1% of men (43,693)

22. MST Consequences Distress and Mental Illness Lower physical health and self esteem More severe PTSD symptoms. More severe consequences because: – Interpersonal Trauma – Perpetrated by someone who is presumably supposed to be protecting your life – It may not be possible to report the crime, for a variety of reasons – It may be coupled with combat exposure as well

23. Impact of Combat The level of combat is the main determinant of mental health status Deployment Length, family seperation, and number of deployments also a major factor Soldiers/Marines with mental health problems were more likely to mistreat non-combatants.

24. What’s Soldiers and Marines Experienced Saw dead bodies Had been shot at Know someone who was wounded or killed Saw injured or killed Americans Was responsible for enemy deaths Army Marines 93% 94% 93 97 86 87 65 75 48 65

25. Rates of Mental Health Issues Self-reported PTSD: 14.1% PTSD, Depression, or anxiety: 16.7% More than half of members positive for mental health problems would not seek care. 60-90 days post deployment, mental health issues reported at following rates: – Army 38% – Marines 31%

26. Family Strain Examples are Divorce and Family Violence High marital satisfaction typically but problems have increased over years due to deployments. Families are crucial for recovery and are often the first to recognize stress problems in service members.

27. Substance Use No tolerance in Military for drug use Alcohol use is very acceptable and often times encouraged in some military units Prescription Drugs (narcotics particularly) have been used to keep people fighting Veterans tend to be more likely to abuse alcohol or prescription drugs due them being legal and accepted during military service

28. Battlemind Buddies (cohesion) vs. Withdrawal Accountability vs. Controlling Targeted Aggression vs. Inappropriate Aggression Tactical Awareness vs. Hypervigilance Lethally Armed vs. “Locked and Loaded” at Home Emotional Control vs. Anger/Detachment Mission Operational Security (OPSEC) vs. Secretiveness Individual Responsibility vs. Guilt Non-Defensive (combat) Driving vs. Aggressive Driving Discipline and Ordering vs. Conflict

29. Military Acronyms and Terms FRG = Family Readiness Group ARNG = Army National Guard FAC = Family Assistance Center TAG = The Adjutant General MOBEX = Mobilization Exercise ANG = Air National Guard TDY = Temporary Duty FOB= Forward Operations Base OIC = Officer In Charge NCO = Noncommissioned Officer NCOIC= Non-Commissioned Officer in Charge JAG = Judge Advocate General KIA = Killed In Action MRE = Meals Ready to Eat AIT= Advanced Individual Training UCMJ= Uniformed Code Military Justice SARC= Sexual Assault Response Coordinator NBC= Nuclear, Biological, Chemical Weaponry

30. What do we learn from this? Veterans have a history of pro-social behavior in most cases They bring along a set of values instilled in them through military training They are trained to a point in which their reaction is at times without thought. This is crucial in a combat situation Often times, the mental health issues we are dealing with are the result of trauma

31. How do we apply this? Veterans have not lost those core values they have been taught Understanding and emphatically addressing trauma history will reduce substance use and symptoms of PTSD Retraining is needed to allow veterans to step away from training that kept them safe in combat

32. How do we apply this? (cont.) Sense of purpose is a major key in recovery for these veterans Family is extremely important Listening is often times more important than understanding Veterans will strive in a situation where there are clear policies and structure