Presentation on theme: "Alliance of Information and Referral Systems (AIRS)"— Presentation transcript:
1 Coming Home – Current concerns facing our returning veterans and their families. Alliance of Information and Referral Systems (AIRS)I&R Training and Education ConferenceMay 23rd – May 26th, 2010Rochester, New YorkMichele Lukacik, MA, LMHC, LPC, NCC, CCHT, Veteran
2 Terms OIF OEF TDY Deployment Active Duty Guard Reserve Discharged DependantRetiredDD-214Service Connected DisabilityVetVet Center
3 Deployment NumbersChallenge with finding those we serve and calculating how many in any given area because:Guard/reserve issueSeparated and returned to areaFamily members who live in service area but loved one could be stationed anywhere.
4 Deployment Numbers Cont. Over 2 Million Soldiers have deployed OIF/OEF and over 500,000 of those have served 2 or more tours.1 in 10 serving in Iraq or Afghanistan are women.Total Service members (Worldwide) (as of Sep. 30, 2009) 1,471,008Deployed to Iraq (as of Sep. 30, 2009) 164,100Deployed to Afghanistan (as of Sep. 30, 2009) 66,400Battle Deaths (as of March 10, 2010) 4,201Other Deaths (In Theater) (as of March 10, 2010) 1,175Non-mortal Woundings (as of March 10, 2010) 36,906
5 Impact On The Community Increased need for ResourcesIncreased need for specialized careIt is estimated that 6.5 to 9.5 million Americans are likely to know someone who has been killed or injured in the war in Iraq and Afghanistan
6 Pre-Deployment Emotional Distance Preparing for Deployment TrainingPackingPreparing FamilyLiving ArrangementsTelling the ChildrenSaying Good Bye
7 During Deployment Adjusting to Life in a Combat Zone Frustration at serving in combat without having any idea of when they’ll be able to come home.Worry over leaving loved ones behind.Anger that civilian contractors get paid three times more for similar jobs and have superior gear.Guard and Reserves fear losing civilian jobs or businesses while in combat.Survivors GuiltShifts in Values and Belief Systems.Stress Related to Combat Experiences.
8 Common OIF/OEF Experiences According to an article by The New England Journal of Medicine in 2004 soldiers surveyed reported:Being attacked or ambushed (89%)Receiving incoming artillery, rocket or mortar fire (86%)Being shot at (93%)Shooting or directing fire at the enemy (77%)Being responsible for the death of an enemy combatant (48%)Being responsible for the death of a non-combatant (14%)Seeing dead bodies or human remains (95%)Seeing dead or seriously injured Americans (65%)Knowing someone seriously injured or killed (86%)Seeing ill or injured women and children they were unable to help (69%)Wounded or Injured themselves (14%)Had a close call, but protective gear saved them (8%)Had a buddy shot near them (22%)Engaged in hand-to-hand combat (22%)
9 The Family Left Behind Stress of Deployment Changes in Communication Changes in RoutineHead of HouseholdFinancial ConcernsBecoming Primary ParentChildren Acting Out
10 The Homecoming Couples Communication Family Interactions Roles Case ExampleFamily InteractionsRolesChanges in RoutineAdjustment to Visible and Invisible Injuries
11 Understanding the Returning Soldier The soldier is returning from a life of danger to a life of uncertainty.In combat the military guided and provided.In civilian life the soldier will have to live by a complex code.In combat the soldier bonded with a few, in civilian life the soldier will be expected to interact with a myriad of networks of people; family, friends, co-workers, relatives, etc…In combat the soldier was "safe" within the confines of the forward operating base and the company, squad or team.At home the soldier will often feel vulnerable, not sure where he/she is "safe and secure".
12 Understanding the Returning Soldier The soldier may feel alienation because of the unique experiences (both good and bad) of combat and the inability to adequately express those experiences to those who haven't been there.The soldier may feel that friends and co-workers have "leapt ahead" while he/she was "frozen in time". Others have gone to school, married, been promoted, learned new skills and advanced in their careers and the soldier is faced with trying to "catch up" in a world that the combat veteran may feel he/she is out of synch with.
13 The Returning SoldierDon't overwhelm the soldier and his/her family with attention, but at the same time don't ignore them.Listen and support but don't condemn. Accepting the soldier does not mean you need to be in support of foreign policy.Be alert for signs of distress.Don’t expect them to step right back into life like it was when they left. They will have questions. Being in a life or death situation like war will raise these questions.
14 The Stigma of Mental Health Security Clearance application (Question 21) As of April 18, 2008 applicants no longer have to acknowledge they received counseling if it was related to service in a military combat zone (or non-court ordered family, marital, or grief counseling (unless related to violence).Post Deployment Health ReassessmentsVA increasing number of OIF/OEF Veteran CounselorsThese are all great steps in the right direction, but the stigma is ingrained and it will take time for change to happen.
15 How Counseling Can Help ReintegrationHelp Couples & Families Reconnect / CommunicatePreventionAdjust to life after DeploymentReorientation to Civilian lifeDepressionAnxietyAnger ManagementCoping with injuryDriving aggressively to avoid debris in the road
16 How Counseling Can Help Cont. Feeling anxious in crowdsDifficulty readjusting to family rolesDifficulty sleepingDifficulty keeping your focusPTSD(20 to 30 % depending on the report) - A large study by the Rand Corporation in January found nearly one out of three service members reported a mental health problem or symptoms of traumatic brain injury. And only half of them sought help. That study also found that many of the returning troops thought seeking treatment would have a negative impact on their security clearance and their careers.
17 Some “gaps” in counseling services Military mental health and the VA cannot see family members without military person present.Family members during deployment.Veterans who are no longer in the militaryExtended family members who are coping with the deployment of a loved one.Some military personnel fear utilizing traditional resources because of the stigma of accessing mental health services or fear of it affecting their career.Fearing their family members going to counseling could affect their career.Outreach for those who were wounded and unable to get to services.
18 Post Traumatic Stress Disorder It has gone by different names throughout history1800’s – ExhaustionWWI – Combat FatigueWWII – Shell Shock or Soldiers HeartVietnam – Battle FatigueGulf War - PTSD
19 What is Trauma?Trauma is a profoundly threatening experience, usually involving and immediate or perceived threat to someone’s life. In trauma one’s ability to cope is overwhelmed by circumstances out of ones control.
20 Common examples include: An event can be just as devastating if: TraumaCommon examples include:Serious accident or injuryPhysical assaultRape / Sexual AbuseRobberySudden or unexpected deathNatural disasterMilitary CombatAn event can be just as devastating if:The event is witnessedIt occurred to a love oneOne feels responsible in some way
21 PTSD Anyone may have trouble recovering from a traumatic event. 8% of Americans will develop PTSD at some point in their lives50% of those who spent time in a war zone will develop PTSDWhen a traumatic event occurs, the body kicks into action, prepared for fight or flight. One may shut down to function in the moment.
22 PTSDAfter the trauma event repressed thoughts and feelings begin to emerge.If one is able to receive them for what they are, emotion is released, and the mind gains perspective.Most important element in recovery is a sense of safety.Getting in touch with traumatic emotions can be very unsettling.
23 PTSDPTSD simply means that the natural healing process from the trauma has been blocked or hampered in some way.People may feel embarrassed, ashamed, weak, crazy, or guilty.For the majority of people, especially military,it is easier to accept and understand aphysical injury than a psychological one
24 Symptoms come in 3 Groups PTSD SymptomsSymptoms come in 3 GroupsRe-living the EventAvoiding Reminders of the EventBeing on Guard (hyper-alert)
25 Re-living the EventRecurrent and intrusive, distressing recollections of the event, including images, thoughts or perceptionsNightmares or FlashbacksStrong reactions when reminded of the traumaA sense of reliving the experience through illusions, hallucinations and active flashbacksSudden fear or nervousnessPhysical reactions such as chills, panic or nauseaSudden urge to run or hide
26 Avoiding Reminders of the Event Not being able to talk about the trauma.Difficulty recalling details of the trauma.Avoiding people, places, thoughts and activities that remind you of the event.Feeling “scattered” and unable to focus on work or daily activities.Having difficulty making decisions.Feeling emotionally “numb”, “withdrawn”, or disconnected.Losing interest in everyday activities, or family and friends.Crying without reason, feeling a sense or despair and hopelessness.Feeling depressed or sad, having low energy.
27 Being on Guard (Hyper-alert) Being overly alert at all times, or easily startled (jumpy).Feeling irritable, easily agitated, or angry and resentful.Having trouble sleeping or concentrating.Irritability or outbursts of anger.Feeling extremely protective and worried about the safety of loved ones.
28 PTSD is NOT a character flaw or sign of weakness PTSD Cont.PTSD patients are 6 times more likely to attempts suicide than the general populationPTSD is NOT a character flaw or sign of weakness- Fear that they will be seen as “damaged” or emotionally unstable.
29 TBI What is a traumatic brain injury? A traumatic brain injury (TBI) is a blow or jolt to the head or a penetrating head injury that disrupts the function of the brain.Not all blows or jolts to the head result in a TBI.The severity of such an injury may range from “mild,” — a brief change in mental status or consciousness—to “severe”, an extended period of unconsciousness or amnesia after the injury.A TBI can result in short or long-term problems with independent function.
30 • Military duties increase the risk of sustaining a TBI TBI Cont.What causes TBI?The leading causes of TBI are:• Bullets, fragments, blasts• Falls• Motor vehicle-traffic crashes• AssaultsBlasts are a leading cause of TBI for active duty military personnel in war zones.• Males are about 1.5 times as likely as females to sustain a TBI• Military duties increase the risk of sustaining a TBI
31 Symptoms of mild TBI• Headaches• Dizziness• Excessive fatigue (tiredness)• Concentration problems• Forgetting things (memory problems)• Irritability• Sleep problems• Balance problems• Ringing in the ears• Vision changeSymptoms Often Overlap With PTSDRecovery (mild) is expected within 4-12 weeks however, some symptoms may linger for months to years
32 Post-Concussion Syndrome Symptoms immediately post in jury may include:Memory, attention, concentration deficitsFatigue, poor sleep, dizziness, headaches, irritability, depression.Anxiety – most common: free floating anxiety, fearfulness, intense worry, generalized uneasiness, social withdrawal, heightened sensitivity, related dreams.
33 Moderate or Severe TBI Symptoms A person with a moderate or severe TBI may show these same symptoms as mild TBI, but may also have:a headache that gets worse or does not go awayrepeated vomiting or nauseaconvulsions or seizuresan inability to awaken from sleepdilation of one or both pupils of the eyesslurred speechweakness or numbness in the extremitiesloss of coordinationincreased confusion, restlessness, or agitation
34 PTSD vs. TBIThe overlap between classic symptoms of post-traumatic stress disorder and those of mild traumatic brain injury is substantial. Even those who appear to have no external damage from explosions can suffer lasting brain injury that causes behavioral and other symptoms.
35 Other Trauma Related Reactions AnxietyDepressionShame/GuiltStressAlcohol
36 Can be both physical or emotional AnxietyA feeling of worry, nervousness or unease generally out of proportion to actual threat.Can be both physical or emotional
37 Anxiety Symptoms Physical Emotional Racing heart Irritability Tightness or pain in chestShortness of breathHeadacheTingling in finger tipsMuscle painsMuscle weaknessDizzinessDifficulty in swallowingAbdominal discomfortDiarrheaChills or hot flashesEmotionalIrritabilityAngerPoor memoryDifficulty concentratingFear of madnessFear of impending deathFeelings of being outside yourselfFeelings of being cut off from reality
38 Depression Persistent sad, anxious, or “empty” mood Feelings of guilt, hopelessness or worthlessnessFatigue or lethargy – being “slowed down”Loss of interest in previously enjoyable activitiesIrritability, restlessnessSudden change in appetiteMajor changes in sleep pattern (insomnia or hypersomnia)Difficulty concentrating or making decisionsThoughts of suicide or deathPersistent physical symptoms that don’t respond to treatmentLow self-esteem
39 Causes of Shame or Guilt in Traumatic Stress Injuries Surviving when others did notFailing to save or protect othersKilling or injuring othersHelplessnessFailing to actLoss of controlEven just having stress symptoms of any kind
40 Stress Physical Headaches Upset Stomach Frequent colds Lack of energy Sleep problemsForgetfulnessClumsinessEmotionalAngerIrritabilityLoss of hopeFeeling powerlessPoor concentrationTrouble making decisionsSadnessFeelings of emptiness
41 Combat StressCombat Stress: A state of mental or emotional strain or tension resulting from adverse or very demanding circumstances related to combat operations.Combat Operational Stress Reaction (COSR): A variety of physical and emotional signs related to an overwhelmingly traumatic event, or a result of ongoing combat and non-combat related stresses.
42 Ways to reduce Stress Surround yourself with friendly, positive people Take some time everyday to be still and quietEat a well-balanced diet – avoid caffeine & sugarSet realistic limits on what you expect of yourselfGet plenty of sleep, and sleep regular hoursBreak up big jobs into smaller, easier stepsSpend time doing simple thingsAvoid excessive noise, crowded areas, and clutterTake a whole day sometime just to relaxTalk to someone about what you want or enjoyLet yourself cry, even if you don’t know whyLaugh as often as possibleAvoid excessive alcohol or drugsStretch regularly throughout your dayPractice slow, deep breathingKnow you deserve to relax!!
43 Drugs and Alcohol Drugs Alcohol About 12 percent of active-duty soldiers and 15 percent of reservists had signs of alcoholism six months after returning from combat, but few were referred to treatment. It's not unusual for a soldier's body to be revved up after returning from war, so it's not unusual to self-medicate with alcohol.43 percent of active-duty military personnel reported binge drinking. Returning veterans of the Iraq and Afghan wars are at especially high risk of binge drinking and suffering alcohol-related harm.More than 25 percent of Guardsmen and Reservists began binge drinking after experiencing exposure to combat, 8.8 percent started drinking heavily, and 7.1 percent developed alcohol problems