1. Responding to the PTSD Crisis Among Returning Vets Session 5065.0 Ron Manderscheid, PhD Constella Group, LLC & Johns Hopkins University

2. Short History Spring 2006 – Initial White Paper, Helping Veterans Return. Spring 2006 – Initial White Paper, Helping Veterans Return. White Paper published in Archives of Psychiatric Nursing and Behavioral Healthcare. White Paper published in Archives of Psychiatric Nursing and Behavioral Healthcare.

3. Nature of the Problem Problem is significant (35-40%), with expected large numbers 450-500 thousand. Problem is significant (35-40%), with expected large numbers 450-500 thousand. Most will suffer from PTSD, Depression, Anxiety, and Substance Use Disorders. Most will suffer from PTSD, Depression, Anxiety, and Substance Use Disorders. Epidemiology confirmed by the DoD Mental Health Report, issued in June 2007. Epidemiology confirmed by the DoD Mental Health Report, issued in June 2007.

4. Key Elements of the White Paper Recommended Approach: Recommended Approach: –GIS and mapping. –Outreach to public and not-for-profit mental and substance use services (new partnerships). –Availability of a call center for anonymous care. –Creation of a virtual support group, with care elements. –Testing in key sites, with appropriate evaluation.

5. Key Service Issues in Project Area DoD vs. VA vs. National Guard DoD vs. VA vs. National Guard Units vs. VAMCs vs. States Units vs. VAMCs vs. States Need for a Fusion Center Need for a Fusion Center

6. Potential Future Research Epidemiology and Surveillance: How many vets have problems, how severe are the problems, and how are these vets distributed? Epidemiology and Surveillance: How many vets have problems, how severe are the problems, and how are these vets distributed? Volunteers vs. Draftees: Volunteer army personnel come predominantly from poverty areas and poor families. Volunteers vs. Draftees: Volunteer army personnel come predominantly from poverty areas and poor families.

7. Potential Future Research Large Scale Analytical Studies: Who is using what services with what effects? Large Scale Analytical Studies: Who is using what services with what effects? DoD and VA VistA Electronic Health Records DoD and VA VistA Electronic Health Records State encounter records. State encounter records.

8. Potential Future Research Evaluation Studies: Are the clinical interventions working as planned? What needs to be improved? Evaluation Studies: Are the clinical interventions working as planned? What needs to be improved? Field studies vs. controlled studies Field studies vs. controlled studies

9. Potential Future Research Family Impact Studies: What impact does the ill vet have on the family unit? On spouse? On children? Family Impact Studies: What impact does the ill vet have on the family unit? On spouse? On children? 20 suicides of vets/day. 20 suicides of vets/day.

10. Potential Future Research Preventive Interventions within a Public Health Framework: How can these problems be prevented before they occur? Preventive Interventions within a Public Health Framework: How can these problems be prevented before they occur? Resiliency Theory Resiliency Theory Social Support Theory Social Support Theory Analogues from other major stress situations. Analogues from other major stress situations.

11. Potential Funding Sources DOD – CDMRP DOD – CDMRP VISN/VAMC—Services Research Funds VISN/VAMC—Services Research Funds Targeted HHS Projects Targeted HHS Projects Projects Authorized by State Legislatures Projects Authorized by State Legislatures

12. Contact Information Ron Manderscheid, Ph.D. Ron Manderscheid, Ph.D. Director, Mental Health and Substance Use Programs Director, Mental Health and Substance Use Programs Constella Group, LLC Constella Group, LLC 6003 Executive Boulevard, Room 416 6003 Executive Boulevard, Room 416 Rockville, Maryland 20852 Rockville, Maryland 20852 240-514-2607 (Voice) 240-514-2607 (Voice) 301-787-1414 (Cell) 301-787-1414 (Cell) 240-514-2601 (Fax) 240-514-2601 (Fax) rmanderscheid@constellagroup.com rmanderscheid@constellagroup.com rmanderscheid@constellagroup.com www.constellagroup.com www.constellagroup.com www.constellagroup.com Enhancing human health around the world, every day Enhancing human health around the world, every day