1. NAMI July 2006 OEF/OIF; PTSD/War Related Disorders; Research

2. Returning Veterans Outreach, Education & Care Teams (OEF/OIF)

3. OIF/OEF MH Data, 5/2006 555,478 returnees, 168,421 in VA care 56,304 with provisional MH diagnosis 25,317 PTSD, 1,784 ASD 17,560 Depression/ 9,157 affective psychoses Drug/ alc abuse/ dep 27,315

4. Poly Trauma Centers Rehabilitation/ re-integration of those with polytraumatic & blast related injuries 4 Centers: Richmond, Tampa, Minneapolis, Palo Alto + VISN support sites Incorporate psychosocial/ mental health issues in care

5. Orientation to Care Health promotion, preventive care Avoid over-pathologizing, teach coping skills Assess for PTSD depression, SUD, suicide/ (domestic) violence risk Rehabilitation/ recovery approach to those with mental disorders (involve family)

6. Orientation to Care Public health approach: –repeat contacts over time, –Public Service Announcements on availability of care –6 months, 1 or 2 years for problems to arise

7. OEF/ OIF RFP FY 05/ 06 Tasks: Outreach, Education & Care Goals: Health promotion, recovery, rehabilitation Engagement of VHA/ RCS, VBA, VSOs, DoD, State Agencies, community at large Vision: Mental Health as a part of overall health and functioning is valued. 80+ programs; FY06 = $6,932,646

8. RVOEC Training The Public Health Approach Community outreach/ VA ‘inreach’ Training modules address functional problems (driving, family issues) Satellite, web-based, local workshops

9. RVOEC Performance Measures Required of every RVOEC proposal Number & type of outreach/ inreach activities Number of veterans enrolled for services Functional/ symptom measures of improvement

10. RVOEC Future Assess needs in States without formal RVOEC Assess VISNs with high returnee numbers

11. Treatment of PTSD in VA Medical Centers In FY 2004, VAMCs treated a total of 274,285 veterans with a diagnosis of PTSD. This table shows the breakdown of these veterans by period of service in comparison to the entire population of mental health patients treated in VAMCs in fiscal year 2004. FY 2004+PTSD Any Mental Health Diagnosis% PTSD WWI61863.2% WWII20,63419992210.3% Pre Korea30970554.4% Korea11,5371421808.1% Post-Korea3,389876603.9% VN190,80061364531.1% Post VN21,21117676412.0% Other4,3043393612.7% Des Storm Act257171315.0% Des Storm (Vet)21,8389557922.8% Total274,2851,358,64020.2%

12. Treatment of PTSD in VA Medical Centers VA offers a comprehensive array of specialized programs for the treatment of PTSD including inpatient and residential care, outpatients PTSD Clinical Teams, and PTSD specialists. At the end of FY 05, there were over 160 specialized PTSD programs across the country and available in every state. In FY 05, VAMC programs served over 316,000 veterans with PTSD in specialized outpatient programs and general mental health clinics.

13. Treatment of PTSD in VA Medical Centers In FY 06, 67 new or expanded PTSD programs were funded, which includes 40 new PCTs, as well as new Day Hospitals, new women’s programs and several new Military Sexual Trauma programs. $10,865,874 Several programs for veterans with both PTSD and substance use disorders are being established. Innovative use of telemental health in CBOCs and other rural support PTSD programs have also been funded. 3 Congressionally mandated Centers of Excellence: Canandaigua, Waco, San Diego

14. Program Types: Outpatient PTSD Clinical Teams 152 PTSD Day Hosp. 11 Womens/ MST 17 Substance Use Trt. 10

15. Program Types: Inpatient/ Residential Evaluation/ Brief Trt. PTSD Units 4 Specialized Inpat. PTSD Un. 5 PTSD Resid. Rehab. Prog. 14 PTSD Domiciliary 8 Womens Therapeutic Resid. Prog. 2

16. PTSD Future Assess residential care needs Comprehensive care (e.g. SUD) Primary Care (CBOC) care Evidence Based Practice dissemination Disaster Preparedness ( Facility Disast. POCs)

17. PTSD Research National Center for PTSD Mental Illness Research, Education & Clinical Centers (MIRECCs) VISN 6: Deployment Issues V19 Suicide V 20, 21 (PTSD)

18. Research 52 identified PTSD studies funded by VA Office of Research & Development Topics: Resilience/ coping with stress (DoD collaborations) Cooperative studies (VA): cognitive behavioral therapies

19. Research Topics: Disaster response Telehealth (diabetes in veterans with PTSD) Medication trials: Prazosin; guanfacine PTSD and aging Functional MRI; genetic studies, neuroendocrine aspects of stress response