The Desert Institute Las Vegas, NV

 Battle of Fallujah (2004) Anbar Province, Iraq To educate and help prepare mental health professionals who want to learn more about military culture and veteran reintegration and provide insight to those who will be working with today's returning war veterans. PURPOSE

USS Arizona Memorial – Pearl Harbor, Hawai’i

Getting down to the basics

 Military Culture  Branches and Components  Rank & Grade  Unit Structure  Training  Occupational Specialties  Statistics

3D ID Memorial Ceremony - Iraq

 Branches & Components  Army - Soldiers  Navy - Sailors  Marine Corps – Marines  Air Force - Airmen  Coast Guard – Coast Guardsmen/Guardians

 Rank & Grade  Enlisted pay grades begin at E-1 and go up to E-9  General Officer pay grades begin at 0-1 and go up to 0-10  Warrant Officer pay grades begin at W-1 and go up to W-5

Ground Forces: Army – Marine Corps Squad Platoon Company Battalion Regiment Brigade Division Corps

Navy & Marine Corps Flotilla Squadron Task Force Strike Groups Fleet Ship “Classes”

Navy & Marine Corps (Continued) Carrier Air Wing Marine Air Ground Task Force (MAGTF) Marine Expeditionary Unit (MEU) Marine Expeditionary Brigade (MEB) Marine Expeditionary Force (MEF) Float

Air Force Flight Squadron Group Wing “Numbered” Air Forces Major Commands

 Training Basic Training or “Boot Camp” AIT, A-School, etc. Focusing on your specialty Specialized Training  Ranger School  BUDS  Special Forces  And many more…

 Occupational Specialties MOS, NEC, AFSC Specialized occupational training is received after Basic Training or “Boot Camp.” Adaptability on deployment: From cook to MP? Combat Arms, Combat Support, Combat Service Support Combat Arms & the gradual integration of females

 Military Age:  Active Duty: 1,430,895  Reserve & National Guard: 833,616  Females represent 14% Active Duty & 17% in National Guard & Reserves.

 Active Component Males Starting at age 18, AC males more likely to be married than civilian counterparts through age 44. Greatest gap occurs at age 27.  Active Component Females Starting at age 18, AC females are more likely to be married than civilian counterparts through age 33. From age 33 on, AC females less likely to be married than female civilians.

 Hooah? Oorah?  Military time?  What does GI stand for, really?  Which is the oldest branch in the military?  Can anyone recite the phonetic alphabet?  Who has a loved one serving overseas?  How many veterans are here today?

Overseas and beyond

The Seven Stage Cycle Model:  Anticipation of Departure  Detachment and Withdrawal  Emotional Disorganization  Recovery and Stabilization  Anticipation of Return  Return Adjustment and Renegotiation  Reintegration and Stabilization

The Seven Stage Cycle Model:  1. Anticipation of Departure In this stage, spouses, relatives, friends, and loved ones may alternately feel denial and anticipation of loss. As reality sinks in, tempers may flare as loved ones attempt to take care of all the items on a family pre-deployment checklist, while striving to make time for "memorable" moments. In the new emotional cycles of deployment, Stage 1 may begin again before a couple or family has even had time to renegotiate a shared vision of who they are after the changes from the last deployment.

The Seven Stage Cycle Model:  2. Detachment and Withdrawal In this stage, service members become more and more psychologically prepared for deployment, focusing on the mission and their unit. Bonding with their fellow service members is essential to unit cohesion, but this may create emotional distance within interpersonal or family relationships. Sadness and anger occur as couples attempt to protect themselves from the hurt of separation. In the new emotional cycles of deployment, as this stage happens more often and more frequently, marital problems may escalate. When a loved one must repeatedly create emotional "distance,“ they may gradually shut down their emotions. It may seem easier to just feel "numb" rather than sad, but the lack of emotional connection to your spouse can lead to difficulties in a marriage.

The Seven Stage Cycle Model:  3. Emotional Disorganization With back to back deployments, one might think that this stage of adjusting to new responsibilities and being alone would get easier. Although a military spouse may be familiar with the routine, (s)he may also be experiencing "burn-out" and fatigue from the last deployment, and feel overwhelmed at starting this stage again.

The Seven Stage Cycle Model:  4. Recovery and Stabilization Here, loved ones realize they are fundamentally resilient and able to cope with the deployment. They develop increased confidence and a positive outlook. With back to back deployments, however, families and loved ones may find it hard to muster the emotional strength required, but many resources are available to provide needed support.

The Seven Stage Cycle Model:  5. Anticipation of Return This is generally a happy and hectic time spent preparing for the return of the service member. Spouses, children and parents of the service member need to talk about realistic plans and expectations for the return and reunion.

The Seven Stage Cycle Model:  6. Return Adjustment and Renegotiation Families and loved ones must reset their expectations and renegotiate their roles during this stage. The key to successful adjustment and renegotiation is open communication. Families also need to be prepared to deal with the effects of combat stress on the returning service member. Such stress and trauma can be difficult to deal with. Troops with combat stress are often irritable, guarded, and want to be alone. Some may use increased alcohol or drugs in a failed attempt to "numb" the emotional pain they are experiencing. Attempts at renegotiation may result in increasing arguments.

The Seven Stage Cycle Model:  7. Reintegration and Stabilization This stage can take up to 6 months as the families stabilize their relationships anew. As noted with Stage 6, the presence of combat stress can severely disrupt the stabilization process. Reintegration and stabilization can hit more roadblocks when a Family must make a Permanent Change of Station (PCS) move immediately upon the return of the service member. Back to back deployments create stress as families stabilize only to begin Stage 1 once again.

 Dealing with overseas obstacles as a service member: Homefront issues Combat exposure Death & dying Physical injury Psychological trauma Changes in emotion and response

That old “Alice in Wonderland” feeling…

 Addressing Emotion Everyone’s military experience is different and may range greatly in emotional and/or physical trauma Not everyone is ready to share and may need time to process difficulties Sharing experiences may be difficult to do with those who may not understand  Emotional issues include: Sadness Excitement Anger Anticipation Vulnerability Confidence Loneliness New challenges Lack of sense of belonging

 Post-Traumatic Stress Disorder Combat-related stress Similar to symptoms of Traumatic Brain Injury (TBI) Affects men and women veterans alike and all ages Non-combat-related trauma

 MST: Military Sexual Trauma Sexual harassment and assault while serving in the military 1 in 3 women in the military will face sexual assault and 66% will face harassment 181 (8%) out of 2,212 MST cases go to trial Affects both men and women:11% of women and 1.2% of men are raped in service

 TBI: Traumatic Brain Injury Blast injuries  IED’s  Mortar & Rocket attacks  Symptoms are similar to PTSD and present both physiological and psychological affects. TBI should especially be taken into account for recently returning veterans.

 Psychological and Physiological Issues Confronting trauma faced while serving overseas Burn pits, chemical exposure, and depleted uranium Non-combat-related trauma Legal issues dealt with while in theater Family and relationship problems

 Interpersonal Relationships Similar to Kubler-Ross stages of death and dying Long periods of separation, physical and emotional distance Adjustment to everyday life and romantic contact with partner Loved ones and families sense change in the veteran

 Employment Current economic problems Employers facing the hiring of “war veterans” Stigma in the workplace Translation of military experience onto a civilian resume Feelings of self-worth and contribution Missing the adrenaline of combat and how to cope

 Adjustment Homelessness: 33% of the homeless population are veterans Suicide: recent spikes in military & veterans suicide Military & VA medical & mental health barriers Education & employment opportunities

Dos and Don'ts for Civilian Mental Health Providers

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 Health professionals can use tools, training and other resources to develop skills in creating and maintaining open lines of communication with service members. As many health care professionals know, establishing a relationship based on trust and respect is a key step in counseling service members. Such a relationship includes: Actively listening Encouraging questions and concerns Speaking clearly and deliberately Being honest and truthful

 Judge a person on their military service. Like diagnoses, keep things in first- person language. There is more to the veteran than their military experience.  Ask them if they’ve killed anyone.  Be flippant in your personal views on current events, politics, etc. Avoid it.  Ask them to explain the basics of military structure and facts…Google it!

 Be patient  Respectful if they do not want to talk about traumatic events right away  Let them know they are respected and valued  Become familiar with veteran resources in your area  Keep up-to-date on military & veteran mental health initiatives

 The emotions veterans experience during the cycles of deployment are a normal reaction to an abnormal situation unique to the military  If a service member or veteran experiences combat stress, it can interfere with community reintegration and rehabilitation  No veteran should have to go it alone! Become more aware of effective coping mechanisms and various networking and veteran assistance resources in your area

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