1. Life After Active Duty For Our Veterans Jeffrey L. Jewell, MPA, MA Director/Counselor U.S. Department of Veterans Affairs Sacramento Vet Center

2. Some will experience readjustment challenges.

3. Some will struggle with mental health issues.

4. All of them have earned our help.

5. Common stereotypes about veterans: All veterans are in crisis All veterans can obtain VA services All veterans have served in combat You have to be in combat to “get” PTSD Veterans are angry Veterans are men

6. Branches of the Armed Services o Active Employed full time by the military – 24/7 o Reserves Typically 1 weekend per month and a once yearly 2-week training. o Army and Air Force National Guard Comes out of state militias, under direction of the state Governor. Available during times of national crisis or war. Responds to natural disasters, e.g. Hurricane Katrina.

7. Basic Military Terminology OIF = Operation Iraqi Freedom (Operation New Dawn) OEF = Operation Enduring Freedom (Afghanistan) GWOT = Global War on Terror MOS = A person’s job (Example: infantryman, or mechanic) IED = Improvised Explosive Device (bomb)

8. Basic Mental Health Terminology PTSD = Posttraumatic Stress Disorder TBI = Traumatic Brain Injury mTBI = Mild Traumatic Brain Injury MST = Military Sexual Trauma OND = Operation New Dawn

9. Increasingly Diverse & Complex Military More ethnic minorities  30% deployed in OIF/OEF More women  16% of Armed Services In relationships  50% married Educated  95% H.S. Diploma/GED Young & Old Active Duty  42% deployed are 17-25yrs Reserve  56% deployed are 30yrs +

10. Elements of Military Culture Chain of command means following orders Routine & Structure – what happens when this is gone? Aggression – faster, harder, louder, meaner Respect – for authority and for ones self Strength – not asking for help Honor – used to being trusted

11. American troops have deployed almost 3.3 million times to Iraq and Afghanistan. More than 2 million men and women have shouldered those deployments. How Many Have Served in OIF & OEF?

12. At least 793,000 have deployed more than once.

13. Unique Aspects of OIF/OEF Multiple Deployments Significantly more reservists and National Guard Advances in military technology and armor More urban warfare Improved screening and treatment of PTSD and readjustment related stressors. Complex social and political climate

14. As of October 2009, there were 1,824,198 * female veterans 167,086 * in California Little recognition for combat More likely to be homeless MST more likely Less likely to find appropriate treatment groups. Less likely to find a social cohort that can relate to their experiences. Female Veterans *http://www.infoplease.com/us/military/number-women-veterans.html

15. Positives of Military Service Pride Values and honor Significant responsibility, especially during war time Competency Sense of accomplishment Sense of meaning and belonging Development of close relationships/family Benefits (e.g., healthcare, education)

16. Transitioning to Civilian Life After OIF/OEF

17. Feeling separate. Vet has changed, and others too Managing expectations to be the same as before Letting down “guard” – allowing intimacy Finding employment – choosing a career Rebuilding community – connecting to old friends Lack of daily structure – what should I do today? Finding excitement in every day activities Typical Transition Challenges

18. Most Common Challenges When combat thinking comes back to the community, there are behaviors that are appropriate for the battlefield that become less useful in the civilian world.

19. Communication & Language Many vets find it very difficult to explain their experiences, their thoughts and their feelings to others who were not there.

20. Managing Aggression Combat: Aggression is encouraged and necessary. There is little time for civility and polite discourse. Home: Aggression seems out of place and can escalate to assault, spouse abuse, snap- ping at kids, buddies, or a boss.

21. Driving Combat : Keeping other vehicles at a distance, driving fast, on guard for ambush or IEDs. Home : Aggressive driving leads to speeding tickets, accidents, fatalities.

22. Accessing Care Government (VA) and Community based non- profits.

23. Barriers to Care Recognition of problems Stigma or embarrassment Bureaucracy of VA system Women Veterans not comfortable Low confidence in treatment success Time pressures

24. Barriers to Education Overwhelmed by GI Bill / Financial Aid Family / work obligations Mental Health concerns – Memory – Concentration Lack of confidence Lack of clear goals or structure

25. Mental Health Challenges for Veterans

26. Disorders in OIF & OEF Veterans ~18.5% have PTSD or depression ~19.5% a traumatic brain injury ~70% have no mental health disorder Tanielian & Jaycox, 2008

27. Common Existential Issues How can there be a higher power and such bad things happen? Why did I live and others died? Am I murderer because I killed? Because I let others kill? How can I ever get close to someone again? I will always feel alone. No one will ever understand me.

28. Post Traumatic Stress Disorder (PTSD) Posttraumatic Stress Disorder (PTSD) is an anxiety disorder that can occur following the experience or witnessing of a traumatic event. Combat Childhood Abuse or Rape Accidents Assault Disasters

29. Usually starts soon after the traumatic event, but they may not happen until months or years later. If the symptoms last longer than 4 weeks, cause great distress, or interfere with work or home life, PTSD is the likely diagnosis.

30. Reliving the Event (re-experiencing symptoms): Bad memories of the traumatic event can come back at any time. When this happens, people may feel the same fear and horror they did when the event took place. Intrusive Thoughts Nightmares Flashbacks Triggers

31. Avoiding Situations that remind one of the event: Most people with PTSD try to avoid situations or people that trigger memories of the traumatic event. They may even avoid talking or thinking about the event.

32. Feeling numb: Most people with PTSD find it hard to express their feelings, and often report feeling NUMB. Many veterans find it hard to have positive or loving feelings toward other people and may stay away from relationships.

33. Feeling keyed up or overwhelmed (also called hyperarousal): Feeling jittery, or always alert and on the lookout for danger. It can cause you to: Suddenly (VERY) angry or irritable Sleep problems. Concentration impaired. Always feel on guard. Easily startled

34. What can be a trigger?

35. Driving

36. Smells

37. Sounds

38. Anniversary Dates & Holidays

39. Television and Movies

40. Anything associated with experience

41. HOW CAN WE HELP?

42. Asking Questions Good ways to start a conversation include: What did you do in the military? Where did you go? (Don't assume all veterans served in Iraq/Afghanistan.) How are you and your family doing?

43. Asking Questions You should avoid: Pressuring a veteran regarding specifics about their service. Minimizing the challenges a veteran might face. Making assumptions about any veteran's political or foreign policy views. **This information is adapted from presentations given by Minnesota Army National Guard Chaplain Lieutenant Colonel John Morris, with additional information from other military members and veterans

44. Recommendations Maintain awareness of issues that may impact veterans. Remember that mental health & physical issues can make it difficult for veterans to understand some processes. Avoid putting the veteran on the spot, even when veteran appears comfortable doing so. Not everyone is ready to talk.

45. Recommendations Be flexible whenever possible with a veteran. Sometimes they can’t tell you what’s really bothering them. Encourage involvement Many vets lead isolated lives. Sometimes a little (sensitive) encouragement from someone they trust can make all the difference

46. Qualities of our Veterans Resiliency and Strength Alternative perspectives & life experiences = DIVERSITY Motivation & determination Leadership Maturity

47. Remember, when you are not sure what to say to a veteran, just say…

48. Welcome Home.