Category: News

New program puts military liaisons at mental health centers

CONCORD, N.H. (AP) — Each of New Hampshire’s 10 community mental health centers will have a staff member devoted to helping veterans, military service members and their families connect with other community resources under a first-of-its-kind initiative being launched by the state’s Department of Health and Human Services.

Commissioner Nick Toumpas was joined by state military officials, the directors of VA health centers in New Hampshire and Vermont, and numerous civilian sector partners on Wednesday to describe several initiatives aimed at improving health care and other services for veterans, active military and their families. He said the federal Substance Abuse and Mental Health Services Administration recently confirmed that no other state has created military liaison positions within its entire community mental health system.

“We’re improving access to care and creating new access points, and we’re doing this together with all of you,” Toumpas said. “It’s an exciting time for the state, and it’s really an opportunity for all of us.”

In addition to serving as a point person to direct patients to available resources, each liaison will also take the lead in educating others in the health centers about military culture, said Suellen Griffin, chairwoman of the New Hampshire Community Behavioral Health System.

“We don’t want this to be sort of a sleeping dog, where only one person in the agency knows about it, but rather they keep it alive and well and talk about it, and make sure our folks are confident in being able to treat our veterans that may present themselves to us,” she said.

The mental health centers also are part of a second initiative being formally launched Wednesday called “Ask the Question.” The program, being run by Easter Seals NH, is a statewide campaign to encourage health care providers, social service organizations and others to ask patients and clients if they had served in the military.

“We don’t know who we serve. We’ve never been able to get our hands on it, it’s like sand through your fingers,” Griffin said.

The state is contracting with a Portsmouth-based group called Dare Mighty Things for a third new program to will train health care providers and others in military culture to ensure that providers understand veterans and know where to refer them. Navy veteran Nick Tolentino said having health care providers who asked him about his service before a recent surgery made a big difference in helping him avoid a bad experience in the recovery room. Instead of a violent wake up like he had experienced after a military surgery, he worked with a fellow veteran and staffer at Exeter Hospital to ensure a calm experience, he said.

But Tolentino said he hasn’t always disclosed his military service to health care providers for main reason: the stigma. He said he feels shame about what he has seen and done, and guilt over surviving when friends were killed.

“You’re always fighting the stigma,” he said. “You were fighting it over there. You’re fighting it when you come home.”

New Hampshire has the fifth-highest ratio of veterans in the United States, with 115,000 veterans making up nearly 11 percent of the state’s population. But the state does not have an active duty military installation where veterans can easily find support and services, and it is one of a few states without a full-service VA hospital. The VA medical center in Manchester, however, collaborates with its counterpart in White River Junction, Vermont, and the directors of both on Wednesday praised the new programs as further examples of how government, military and civilian groups have worked well together.


Source: Holly Ramer, Associated Press

Marine on life after severe injury: ‘Beauty is who you are’

A few years ago, Christina Geist was thumbing through a People magazine in a nail salon when she came across a story about an organization helping wounded veterans.

Moved to tears, she rushed home to tell her husband, Willie, about what she had read.

It was the TODAY anchor’s first exposure to Operation Mend at UCLA Medical Center, which provides returning military personnel with severe facial and other medical injuries access to top plastic and reconstructive surgeons. The Geists became active in their support of the organization, beginning an inspiring friendship with U.S. Marine corporal Aaron Mankin, whose life has been transformed by the program.

In 2005, Mankin’s face was badly damaged when his amphibious assault vehicle drove over an improvised explosive device in Iraq. His nose, ears and part of his mouth were badly burned in the blast, which killed four marines and wounded 11 others. In 2007, Mankin became the first patient at Operation Mend, whose surgeons have helped remarkably restore his face. Geist shared Mankin’s story on Monday as part of TODAY’s “Inspired By’’ series where the anchors reveal their own inspirations — and invite viewers to share theirs, via #InspiredBy.

U.S. Marine corporal Aaron Mankin's face has undergone a remarkable transformation thanks to more than 60 surgeries by the surgeons in Operation Mend at UCLA Medical Center.

U.S. Marine corporal Aaron Mankin’s face has undergone a remarkable transformation in the last eight years thanks to more than 60 surgeries by the surgeons in Operation Mend at UCLA Medical Center.

 

“A lot of what I have to tell other veterans, and that’s that there’s so much in life you can’t control,’’ Mankin told TODAY. “Life happens to you. But your power resides in the fact that you can choose how you respond to that.”

“He looks fantastic today,’’ Geist said on TODAY Monday. “If you look at the pictures from five years ago or from the very first day when he checked into this program at Operation Mend, you wouldn’t recognize him.”

Mankin has come a long way since seeing the damage to his face for the first time.

Aaron Mankin, before his accident, couldn't look in the mirror after his first surgery.

Aaron Mankin, before his accident, couldn’t look in the mirror after his first surgery.

 

“I woke up in the ICU, and there was a mirror in my room that I willingly ignored for weeks,’’ Mankin said. “When I finally got the courage, I cried for the longest time. It’s such a disconnect looking at yourself and you expect to see someone that resembles you, and it was a stranger staring back at me, and it was a lot to deal with.”

“The first time I ever saw Aaron Mankin was in a photograph projected up on a screen, and your heart sank and there was a feeling of horror, almost,’’ Geist said.

Mankin has undergone more than 60 surgeries in nearly nine years of recovery.

“Aaron had a lot of unique challenges because of the nature of his injuries, (and) how badly he was burned,’’ Dr. Chris Crisera, Mankin’s surgeon, told TODAY.

Geist recalled the emotional day when they first met face-to-face.

“When we saw each other, it wasn’t a handshake,’’ Geist said. “It was a hug right away. And that’s the kind of guy he is.”

Mankin is also a dedicated father who looks to impress upon his children that what you are inside is what counts the most.

“Beauty is who you are,’’ Mankin said. “It’s not the way you look. That’s important for my kids to learn. Just the way they look at me makes me feel special.

“My children don’t know me any differently,’’ Mankin told Matt Lauer. “I’ve always been this way and they see me getting better through the years. I feel like they had a misunderstanding what doctors do because every time I go see them I come back looking a lot worse than I did. Just seeing that healing process and people reaching out to me, they’re a part of that.”

Mankin has since become a compelling public speaker for Operation Mend, sharing his inspiring journey with others.

“The fact that that’s part of my life now, that I just get to be myself and people want to say thank you, and however that manifests itself, shaking my hand or hugging my neck or buying me a beer or fixing my face, they just want to serve or volunteer like I did,’’ he told Lauer. “It’s a feeling that you can’t…it’s hard to express.”

“We are so honored just to know these guys and to help in some small way because of the sacrifice they’ve given to this country,’’ Geist said. “This is literally the very least we can do, and there is more help needed.’’

Mankin regularly works to help other injured veterans.

“It’s a great responsibility,’’ he said. “I try and fill their day with some type of positive experience.”


This story written by Scott Thump originally published on Today.com.

Tetris video game may ease PTSD, study suggests

Tetris

(Photo: Mark Lennihan/AP)

A new study out of Oxford University suggests that playing Tetris — the venerable puzzle game featuring interlocking shapes — can keep bad memories or flashbacks at bay, easing their frequency and impact on those who have experienced trauma.

The research, from the same scientists who wrote in 2009 that Tetris reduced flashback frequency when played within four hours of a trauma exposure, could lead to development of drug-free treatments for preventing or easing post-traumatic stress and other combat-related mental health conditions.

The most recent research involved showing 52 subjects graphic videos of car accidents and drownings and reminding them a day later of the carnage by showing them still images of the films.

Half the group then was asked to play Tetris after a brief break while the other half simply sat quietly.

A week later, the Tetris players reported far fewer flashbacks over that previous week than their counterparts, and they scored much lower on PTSD questionnaires, according to the report, published July 1 in Psychological Science.

“We showed that intrusive memories were virtually abolished by playing the computer game Tetris following memory reactivation,” wrote the research team from the Medical Research Council Cognition and Brain Sciences Unit, Oxford and Cambridge universities, and the Karolinska Institutet.

While the results are similar to the group’s previous work, the findings are thought to be more applicable for developing PTSD therapies because they indicate that visual-spatial games like Tetris may be useful in disrupting intrusive memories long after the causative event.

The earlier research had subjects playing Tetris within four hours of a trauma — an impractical scenario for most of life’s traumatic events.

Both studies contribute to the understanding of memory imprinting and recall, with the latest research finding that a combination of memory recall and Tetris can help disrupt involuntary recall of intrusive memories.

But researchers cautioned that the combination is key to the improved scores and reduced flashbacks among the game players, adding that their research found that “playing Tetris alone … or memory reactivation alone was [in]sufficient to reduce intrusion.”

They say more work is needed to confirm the findings and develop possible PTSD preventive therapies. But they added that the study raises some interesting questions about modern living and computer engagement.

“A critical next step is to investigate whether findings extend to reducing the psychological impact of real-world emotional events and media,” they wrote. “Conversely, could computer gaming be affecting intrusions of everyday events?”


This story written by Patricia Kime originally published on MilitaryTimes.com.

Clinician’s Corner: Military psychological health experts answer providers’ treatment questions

To support Mental Health Awareness Month in May, experts from Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) invited questions from health care providers who treat members of the military. The questions and answers appear below.


Q: “Is there anything in the DoA/DoD regulations or elsewhere indicating that a service member must be chapter separated if the member demonstrated suicidal behavior (parasuicide) only once and was subsequently diagnosed with a personality disorder (borderline personality disorder)? A driving factor in this specific case is that the service member is a military police officer.”

Sheila B. Albers, LCSW, CAP, ASAP Counselor

A: There are many policies in place across the Defense Department, services, and specific military occupational communities that spell out requirements for military readiness and specifically state service members must be medically qualified. Often, these policies mention specific disorders (such as personality disorders) and risk factors (such as suicidal behaviors) that warrant special attention, require additional assessment, or compel additional considerations. For some military occupational specialties that have high risk-management requirements, such as air traffic control, nuclear reactor operation and air combat, the need for optimal medical readiness and high occupational functioning is obvious. In other cases, policies can be overly restrictive and may seem prejudicial to those who have a psychological condition or mental health treatment documented in their health records.

Diagnosed personality disorders are not automatically disqualifying. They usually require corroborating evidence that a service member’s condition causes poor adaptation to the military, interferes with the performance of duties, or represents a continuing, unmanageable risk of harm to self or others.

In the example you present, a comprehensive clinical evaluation and a careful assessment of current and ongoing risk, usually by a psychiatrist or clinical psychologist, would need to be performed. Based on this assessment, a recommendation for administrative separation might be made. The Army requires an additional review and endorsement by the Army Surgeon General’s office. For additional information on administrative separations for personality disorders, please see Army Regulation 635-200 for qualification/disqualification for military police, see Army Regulation 190-56.

Navy Capt. (Dr.) Anthony Arita
Deployment Health Clinical Center director


Q: “What role do you think post traumatic growth and factors of resilience can or will play in the care of veterans?”

Thad S. Rydberg, MA, LCPC

A: Posttraumatic growth refers to the experience of positive change that occurs as a result of struggling with highly challenging life crises. These positive changes can take many forms, including increased appreciation for life, more meaningful interpersonal relationships, a greater sense of personal strength, changed priorities, and more spiritual life.

The Defense Department definition of resilience is the ability to withstand, recover and grow in the face of stressors and changing demands. Resilience factors include viewing situations in ways that provide positive meaning and expectations, using active and problem-focused coping strategies, being able to act and respond effectively despite feeling fear, attending to one’s physical well-being, and reaching out for support from leaders, families and communities. These resilience factors can hasten the recovery process for those who have had traumatic exposures, and in fact, most people show natural resilience in their responses to trauma.

Resilience factors and posttraumatic growth can play an important role in the care of veterans. Many of the evidence-based psychotherapy options include a focus on elements of resilience and posttraumatic growth, and it is common for providers to integrate these factors into care.

Dr. Mark Bates
Deployment Health Clinical Center associate director psychological health promotion


Q: “Are there recommended treatment modalities for use with sub-threshold PTSD symptoms in a nonmedical setting?”

Stacie Coduto, MSW, LCSW

A: It’s important to note that “sub-threshold PTSD symptoms” can mean several things:

  • Symptoms aren’t so intense that they’re significantly disruptive or distressing
  • Symptoms do not include at least one avoidance symptom
  • Symptoms have not persisted the length of time required to meet the diagnostic threshold for PTSD

Although the diagnosis and treatment of PTSD is conducted in medical settings by medical providers, there are a variety of non-medical support services that may be able to assist with specific issues related to sub-threshold post-traumatic stress (PTS) symptoms. These resources include the Military and Family Life Counselor program, chaplains, nonclinical social workers, wellness centers and self-help technology resources.

Nonclinical providers can help address a range of potential PTS-related issues in a way that complements the natural PTS symptom recovery process. These issues include anger, grief and loss, stress management and coping challenges, sleep issues and relationship problems. Nonclinical providers can also help enhance problem-solving skills, which help people reach their goals, decrease stress and restore a sense of control. They also help people build and maintain a personal support network, including communicating effectively and identifying ways to be creative, relax and enjoy spending time with others.

Chaplains are often the first line of defense for service members wrestling with moral and spiritual concerns. The chaplains’ pastoral approach can help people process memories, find more effective ways to understand their experiences, and increase a sense of meaning and purpose.

Finally, Defense Department self-help technology resources like the AfterDeployment website and the PTSD Coach mobile app offer self-guided assessments and self-care strategies. The Breathe2Relax mobile app provides excellent coaching for diaphragmatic breathing, which is a powerful stress management tool often used as part of treatment for PTS symptoms.

Dr. Mark Bates
Deployment Health Clinical Center associate director psychological health promotion


Q: “I would like information on treatment for veterans with PTSD that includes a significant focus on moral injury.”

Lia Pendergrass, LCSW

A: As you’re likely aware, moral injury is not clinically defined and is not captured by a formal diagnosis, so clinical practice guidelines have not been developed specifically for it. However, Defense Department mental health providers often addressmoral injury when treating a mental disorder.

A patient being treated for PTSD, depression or other mental health diagnoses may disclose information that indicates a moral injury (for example, guilt over accidentally killing a civilian during a combat operation or another dilemma). When this occurs, mental health providers often help the patient explore the event they experienced or actions they took or failed to take that conflict with their values or deeply held beliefs. There is a lot of meaning to explore, and the exploration must be done without judgment, haste or expectation of a linear path to resolution.

To the degree that a moral injury relates to spiritual matters, a collaborative care or support approach involving a chaplain might be helpful. This process, of course, depends on the nature and extent of the patient’s symptoms, the presence of co-occurring conditions (such as alcohol or substance misuse), current life circumstance (demands and overall stressors), available support resources, and the character and value system of the individual. As a clinician, you can help the patient appreciate the impact of his struggle on his personal, occupational, and interpersonal functioning, while also helping to scope and prioritize areas of clinical attention and targets for intervention.

Navy Capt. (Dr.) Anthony Arita
Deployment Health Clinical Center director


Source: DCoE Public Affairs

 

 

A veteran suicide prevention network built by veterans

SALT LAKE CITY — Six weeks ago Special Forces veteran Johnny Primo logged on to his Instagram account and says he was horrified to see a suicide note from a veteran who lived just a few miles away.

The note read: “Very few people know the truth … I want this in everyone’s memory.” Desperate to help, Primo tracked down his address.

“I was 45 minutes too late from him taking his own life,” said Primo. “Immediately it was a gut wrenching feeling, knowing that there was a chance that if he had my phone number he wouldn’t have killed himself.”

Primo called friend and fellow veteran Casey Gray and that night they launched anInstagram suicide prevention page by posting a message pleading with veterans who are having suicidal thoughts to call them, day or night.

They call it “22 Too Many” — highlighting an estimate of the number of veterans who commit suicide every day. Veterans responded immediately.

“Within the first three hours we saved one person,” said Primo. “Within the first 24 hours we saved five people, people who were on the verge of suicide.”

Casey Gray served in Iraq, lost friends in combat and was severely injured in a helicopter crash. He says his experiences help him connect and built trust with other veterans.

reid-22-too-many-copy-08frame1214.jpg

A view of the “22 Too Many” Instagram page where veterans’ contact information is posted so that veterans in need can have someone to contact. (CBS NEWS)

“Guys get to the point where they feel secluded and they isolate and they need to know that there’s somebody still there for them,” said Gray.

There are now about 180 veterans offering a lifeline on the “22 Too Many” Instagram page and they’ve already helped more 400 veterans who were contemplating suicide.

b-roll-johnny-and-caseyframe44850.jpg

Casey Gray, left, Dr. Carrie Elk, middle, and Johnny Primo, right. (CBS NEWS)

When professional help is needed, they contact a network of psychologists — which includes Dr. Carrie Elk.

“Veterans take care of veterans in the community and then they call me if they need mental health help,” explained Dr. Elk. “It’s a team effort and both are needed.”

Primo and Gray are currently developing a website and a smartphone app which will give vets more resources when they find themselves in a dark place. They intend on doing this for the long haul with the goal of saving lives.

Primo’s ultimate message to veterans: “You’re courageous enough to do what you did in the military, just pick up a phone and call. That’s all you have to do.”

This story written by Chip Reid was originally published by CBS News.

Suicide rate of female military veterans is called ‘staggering’

Their suicide rate is so high that it approaches that of male veterans, a finding that surprised researchers because men generally are far more likely than women to commit suicide.

“It’s staggering,” said Dr. Matthew Miller, an epidemiologist and suicide expert at Northeastern University who was not involved in the research. “We have to come to grips with why the rates are so obscenely high.”

Though suicide has become a major issue for the military over the last decade, most research by the Pentagon and the Veterans Affairs Department has focused on men, who account for more than 90% of the nation’s 22 million former troops. Little has been known about female veteran suicide.

The rates are highest among young veterans, the VA found in new research compiling 11 years of data. For women ages 18 to 29, veterans kill themselves at nearly 12 times the rate of nonveterans.

In every other age group, including women who served as far back as the 1950s, the veteran rates are between four and eight times higher, indicating that the causes extend far beyond the psychological effects of the recent wars.

The data include all 173,969 adult suicides — men and women, veterans and nonveterans — in 23 states between 2000 and 2010.

It is not clear what is driving the rates. VA researchers and experts who reviewed the data for The Times said there were myriad possibilities, including whether the military had disproportionately drawn women at higher suicide risk and whether sexual assault and other traumatic experiences while serving played a role.

Whatever the causes, the consistency across age groups suggests a long-standing pattern.

“We’ve been missing something that now we can see,” said Michael Schoenbaum, an epidemiologist and military suicide researcher at the National Institute of Mental Health who was not part of the work.

The 2011 death of 24-year-old Katie Lynn Cesena is one of a dozen cases The Times identified in Los Angeles and San Diego counties. Cesena’s death highlights two likely factors in the rates.

First, she had reported being raped by a fellow service member. The Pentagon has estimated that 10% of women in the military have been raped while serving and another 13% subject to unwanted sexual contact, a deep-rooted problem that has gained attention in recent years as more victims come forward.

The distress forced Cesena out of the Navy, said her mother, Laurie Reaves.

She said her daughter was being treated for post-traumatic stress disorder and depression at the VA Medical Center in San Diego and lived in fear of her purported rapist — who was never prosecuted — and his friends.

Cesena had started writing a memoir and shared the beginning on Facebook. “I would like to dedicate this book to the United States Navy and all the men and women who have bravely served our country with humility and have been raped and were brave enough to tell someone, whether anything came of it or not,” she wrote.

The second factor was Cesena’s use of a gun, a method typically preferred by men.

In the general population, women attempt suicide more often than men but succeed less because women usually use pills or other methods that are less lethal than firearms. Female veterans, however, are more likely than other women to have guns, government surveys have shown.

In the new data, VA researchers found that 40% of the female veterans who committed suicide used guns, compared with 34% of other women — enough of a difference to have a small effect on the rates.

Another area of interest to researchers is the backgrounds of women who join the military.

Female service members have always been volunteers, and their elevated suicide rates across all generations may be part of a larger pattern. Male veterans 50 and older — the vast majority of whom served during the draft era, which ended in 1973 — had roughly the same suicide rates as nonveteran men their age. Only younger male veterans, who served in the all-volunteer force, had rates that exceeded those of other men.

The differences suggest that the suicide rates may have more to do with who chooses to join the military than what happens during their service, said Claire Hoffmire, the VA epidemiologist who led the research. A more definitive explanation would require information not included in the data, such as when each veteran served and for how long.

In the general population, women attempt suicide more often than men but succeed less because women usually use pills or other methods that are less lethal than firearms. Female veterans, however, are more likely than other women to have guns, government surveys have shown.

In the new data, VA researchers found that 40% of the female veterans who committed suicide used guns, compared with 34% of other women — enough of a difference to have a small effect on the rates.

Another area of interest to researchers is the backgrounds of women who join the military.

Female service members have always been volunteers, and their elevated suicide rates across all generations may be part of a larger pattern. Male veterans 50 and older — the vast majority of whom served during the draft era, which ended in 1973 — had roughly the same suicide rates as nonveteran men their age. Only younger male veterans, who served in the all-volunteer force, had rates that exceeded those of other men.

The differences suggest that the suicide rates may have more to do with who chooses to join the military than what happens during their service, said Claire Hoffmire, the VA epidemiologist who led the research. A more definitive explanation would require information not included in the data, such as when each veteran served and for how long.

The numbers were much further apart for women: 28.7 for veterans and 5.2 for everybody else.

A stratification of the data by age group — which was provided to The Times — shows that young veterans face the greatest risk.
Among men 18 to 29 years old, the annual number of suicides per 100,000 people were 83.3 for veterans and 17.6 for nonveterans.

The numbers for women in that age group: 39.6 and 3.4.

The differences between female veterans and other women are less extreme in older age groups but still considered alarmingly high by researchers.

The states in the study represent about half the nation’s veterans but did not include California.

In the local cases identified by The Times, one pattern stood out: Several women had been discharged early for psychiatric or medical problems.

A back injury forced out Sara Leatherman in 2009 and continued to cause her pain. She was also suffering from traumatic memories of maiming and death she witnessed as a medic in Iraq, said her grandmother, Virginia Umbaugh.

Leatherman was 24, attending community college in La Mesa in San Diego County and receiving treatment for PTSD when she hanged herself in her grandmother’s shower in 2010, Umbaugh said.

The war, however, was not the only factor. Leatherman had tried to kill herself with pills while stationed in Texas, before going to Iraq, said Umbaugh, who raised her. “I don’t think there’s any one answer,” she said.

In other cases, veteran status seemed almost incidental, with decades passing since military service and no clear link to the broken relationships, financial problems, mental health troubles and other disappointments that can accumulate in the course of a life.

Linda Raney was 65 years old in 2011 and dealing with problems that mounted for several years: the death of her sister in a car accident, money and health difficulties.

She was living with an aunt in Acton and was disappointed that she didn’t meet the financial requirements for the VA to help her get her own place.

“She didn’t want to be a burden on her aunt,” said her nephew, Kevin Pearcy. One afternoon, she called him to say goodbye, then committed suicide with prescription pills.

She had never talked much about her time in the Air Force.

“I don’t know her specialty,” Pearcy said. “She was very young.”

This story written by Alan Zarembo was originally published in the LA Times.

Face of defense: service dog helps soldier move on

Army Master Sgt. Lyle Babcock, a management analyst for the Kansas National Guard, lives and works through his post-traumatic stress disorder with the help of Gunther, his service dog. Kansas National Guard photo by Army Sgt. Zach Sheely

Army Master Sgt. Lyle Babcock, a management analyst for the Kansas National Guard, lives and works through his post-traumatic stress disorder with the help of Gunther, his service dog. Kansas National Guard photo by Army Sgt. Zach Sheely

Master Sgt. Lyle Babcock is a combat veteran who’s served more than 30 years in the Army. He is an avid fisherman. He loves to kayak.

He also suffers from post-traumatic stress disorder. Fortunately, he has help from a four-legged friend.

Gunther, a 2-and-a-half year old, 100-pound yellow Labrador retriever, is Babcock’s service dog. His duty is to be at Babcock’s side at all times, allowing Babcock to live and work through his PTSD.

“He’s been a godsend to me,” Babcock said of Gunther. “He’s allowed me freedom from my own prison.”

An Internal Battle

Babcock was deployed nearly 15 months to Afghanistan as the noncommissioned officer in charge of the 102nd Military History Detachment, Kansas National Guard. He returned home to Topeka, Kansas, to his wife Traci and went back to work at Joint Forces Headquarters as the management analyst of the Human Resources Office, Kansas Adjutant General’s Department.

On the surface it was business as usual, but internally, the battle was still raging.

He struggled to reintegrate with society. He suffered from anxiety, problems sleeping and concentrating. He had panic attacks. His immediate instinct, however, was not to seek help out of fear of a stigma he thought people may place on him. Not until he started volunteering in the PTSD clinic at the Colmery-O’Neil Veterans Affairs Medical Center in Topeka did Babcock realize he wasn’t alone, others were struggling with the same inner turmoil.

“It was good to just sit down and talk with other vets and realize we’re all dealing with the same stuff,” Babcock said.

Another way Babcock relieved stress was through his love of being on the water. While researching kayaks to purchase, he discovered a group called Heroes on the Water, a nonprofit organization that helps service members and veterans relax, rehabilitate and reintegrate through kayaking and fishing.

Discovering Service Dogs

A few months later, Babcock, along with a group of volunteers, started the Kansas chapter of Heroes on the Water. Through HOW, Babcock learned of a group that provides service dogs to veterans and service members struggling with PTSD and/or a traumatic brain injury.

Joe Jeffers founded Warrior’s Best Friend based in Kansas City, Missouri, with the goal of pairing wounded warriors with trained service dogs rescued from animal shelters throughout the United States. Jeffers contacted Babcock about the possibility of pairing an interested veteran from Heroes on the Water with a trained yellow Labrador.

As Babcock learned more about Warrior’s Best Friend and the service dog available, he realized that he might be interested in being paired with the dog himself. After discussing it with family, friends and a Veterans Affairs counselor, Babcock decided to take a leap of faith and filled out the application to be paired with Gunther.

A Hard but Necessary Step

“Our pairing was quite unique,” Babcock said. “He’d never been around water, so the first time I took him to the lake, of course it was like glass. He stepped right off the dock, headfirst into the water. His eyes were huge. I was right down there encouraging him and pulled him out of the water. That was the instant we connected.”

The two go everywhere together — restaurants, the grocery store, the lake, and even to work.

However, gaining clearance to bring him to the office was a lengthy process for Babcock. The most difficult part was disclosing to his leadership that he needed help.

“You want me to admit to you that I’m broken and that I want to start bringing a service dog in,” Babcock said. “That was a road block. That took me a long time to write that request and actually send it in. Looking back, it was a hard, but a necessary step.”

Babcock said that there are other service members in the Kansas National Guard who are living with PTSD, trying to fight it on their own, afraid, as he was, to admit they need help.

Extended Family

“The first thing is coming to grips with recognition that you do need some help and there’s no shame or embarrassment in that,” said Army Maj. Gen. Lee Tafanelli, Kansas adjutant general. “We all find ourselves at points in our lives where we do need somebody to lean on and do need the ability to reach out.”

Tafanelli said the Kansas National Guard is an “extended family” and that the first step to getting better is recognizing there’s a problem.

“We owe it to all of our soldiers and airmen to look out for their wellbeing,” he said. “It really isn’t a weakness. In many cases, these traumatic events have had a lasting impact,” an impact that Babcock and Gunther outwardly embody.

Gunther wears a service vest akin to a uniform while he’s on duty. A patch on it reads “PTSD service dog — ask to pet.” Babcock does allow people to pet Gunther if they ask — which, according to Jeffers, is not the case with most service dogs. Jeffers compared service dogs to other medical tools, like a wheelchair or crutches — their purpose is to help their user to live as normal a life as possible.

Gunther ‘is Right There’

“This is something I spoke to the trainer with during the pairing process,” Babcock said. “I decided that as long as Gunther would maintain focus on me, I would allow others to pet him with my permission. He has always got an eye on me. When I say something, he’s up and moving and he’s focused strictly on me. If I start getting nervous, or anxious, or loud, he’s right there.”

At work, Gunther soon became one of the “employees.”

“I know my co-workers had some apprehensions about me bringing a service dog into the work area,” Babcock said. “Most of them had never been around a service dog before. I think some of them thought that Gunther would be like their pets at home — constantly seeking attention or being a distraction at work. I think they were shocked at how well trained Gunther is and most of the time they don’t even realize he’s there with me.

“When Gunther walks into the office with me, my co-workers greet him and tell him good morning. They look after him — the way they look after me. I understood that by taking this step there was a chance it would have a negative impact on others around me, which is the last thing I wanted. But the opposite has been true. They have been very accepting of Gunther and of the fact that I am receiving counseling for PTSD.”

Gunther didn’t only have to integrate at work, but also at home with Traci, the family’s Pomeranian, Pookie, and their three cats.

Ground Rules

“We laid a few ground rules,” Traci said. “I don’t need the added work. It’s his dog, but Gunther is definitely part of the family. He’s really grown on me. He’s a real likable dog. He’s well-mannered and well trained.”

“I learned, during the pairing process, that having a service dog is a lot of work and responsibility,” Babcock said. “They are 100 percent dependent on you, from feeding to cleaning up. They become dependent on you as much as you become dependent on them. A service dog is not for every service member or veteran dealing with PTSD, but he’s changed my life for the better.”

Gunther’s training was provided by Warrior’s Best Friend. Jeffers said the organization looks at 200-300 dogs to every one dog that they deem a service dog candidate. The dog has to demonstrate a certain level of focus and eagerness to learn in order to be considered for service. The dog’s training alone can take up to 14 months.

“It’s important that we get the dogs as early as possible,” Jeffers said. “The dog must be able to work in a minimum of three-hour segments and respond to roughly 25 commands, including block, wait and release.”

Once trained, an eligible veteran applicant is selected and is put through a familiarization process with the dog, which can take three to six months.

One of Many Treatment Options

“When you think about PTSD in terms of the symptom clusters (avoidance, intrusive, negative thoughts/emotions and hyper arousal) the ways in which a dog can help are many,” said Dr. Chalisa Gadt-Johnson, a licensed psychologist who works at the Topeka VA Medical Center. “The companionship is great for those who feel a sense of isolation, along with helping with those who may be avoiding people and/or places.”

While Gunther has helped him, Babcock acknowledged that a service dog may not be the best treatment option for all. Gadt-Johnson said there are other treatment options including peer-to-peer, group and peer-to-counselor counseling, which can teach better coping strategies. The VA Hospital in Topeka offers many education groups and treatment programs for substance abuse, addiction and psychiatric disorders, including a seven-week inpatient stress disorder treatment program, open to affected service members and veterans from around the country.

PTSD is not a new affliction, nor is it new to the Kansas National Guard, but for those suffering in silence, Babcock shared this advice.

“The first step in reclaiming your quality of life is to seek out help,” he said. “There are a lot of veterans and service members struggling with PTSD every day. We think the only solution is avoidance, isolation, drinking, drugs or even suicide. Sometimes the biggest step is admitting to ourselves that we can’t do it on our own, putting our pride aside and asking others for help.”

Babcock added, “I was afraid to take that first step. But now that I have, I wish I’d done it sooner. I’m starting to feel more in control of my life. My battle buddy, Gunther, is by my side, helping me get through the rough spots in my day. I don’t know what I’d do without him, but it took admitting that I needed help in order to get where I am today.”


This post was written by Army Sgt. Zach Sheely of the Kansas Adjutant General Department was originally published the by U.S. Department of Defense.

Don’t Give Up on Mental Health Treatment

Capt. Anthony A. Arita, Deployment Health Clinical Center director

Capt. Anthony A. Arita, Deployment Health Clinical Center director

It’s not a sprint, it’s a marathon. If you’ve had a coach, personal trainer, inspirational teacher, or a really motivational friend, there is a good chance you heard them say something similar. Most likely, they said this to you because they wanted to encourage you to keep working toward your goal – whatever it was.

A senior military leader, and psychologist, has a similar hope – he wants service members to stick with mental health treatment and give it a chance to work even if they don’t see immediate progress.

According to Capt. Anthony A. Arita, Deployment Health Clinical Center director and experienced clinical neuropsychologist, people who give up on treatment too soon rob themselves of the benefits of care. Many forms of psychotherapy require 10 to 12 sessions to achieve noticeable symptom reduction. If medications are prescribed, it can take several weeks to find the right medications and therapeutic dosages.

If it’s not working, talk to your provider

If you don’t think your treatment is working, or if you are unclear about your treatment options, share your concerns with your provider. You should feel comfortable asking your provider to explain your diagnosis, and treatment plan, in a way you understand.

“For treatment to have the most impact, it’s important patients actively participate in the recovery process, follow their treatment plan – including taking medications as prescribed and completing therapy homework – and meet with their providers regularly with limited breaks in care,” Arita said.

Don’t expect a quick fix; recovery takes time, especially when patients have co-occurring conditions, such as alcohol or substance abuse, traumatic brain injury or chronic pain.

“Most people who persevere with treatment can expect very positive results,” Arita said.

It sounds like a lot of work; maybe I don’t really need it

If you think ignoring your medical conditions will make them go away, think again. Not taking your health seriously or choosing to do nothing may make things worse.

“Some people assume that forgoing medical treatment for severe psychological conditions, like posttraumatic stress disorder (PTSD), won’t matter – this is simply not true,” Arita said. “Without proper care any medical condition can get worse and negatively affect many aspects of a person’s life.”

It may affect my career

Some service members don’t seek treatment because they fear it will hurt their careers. Although it is true that a severe medical condition — physical or psychological — may affect a person’s fitness for duty, according to Arita, participating in treatment or receiving a mental health diagnosis doesn’t automatically impact one’s status.

“The important thing to know is that treatment does work, so keep at it,” Arita said. “In most cases, people recover from symptoms and return to optimal readiness – and that’s what we really want for our service members.”


Posted by Myron J. Goodman, DCoE Public Affairs on May 14, 2015

Breaking the chain: PTSD, substance abuse and domestic violence

Last week, the Military Compensation and Retirement Modernization Commission (MCRMC) outlined its plans for a 21st century military system. And so they should because we now have an eye-popping 23,816,000 veterans alongside current personnel and all of their families. Few families are left untouched by our military in one way or the other.

According to the Department of Veteran Affairs, two in ten veterans have turned to substance abuse of some kind or another. One in three of these veterans suffer from PTSD and the department estimates that 31% of all veterans are suffering from Post-Traumatic Stress Disorder. This means 7-8 million veterans require treatment. According to veteran mental health specialist Monica Mathieu back in 2008, this care is not integrated properly.

Dov Zakheim, writing in Foreign Policy Magazine, outlined the bipartisan agreement on the Capitol, which given the divided state of government at the moment was quite a surprise, which covers current and former members of the military. Four decades on from the creation of the All-Volunteer Force, the modern military now encompasses families as a fixed part of the landscape but also takes into account that women make up a far larger proportion than any time in our history.

The benefits offered, including great government contributions to retired personnel, are welcome, but with such a large number of veterans with problems, something more integrated is required that goes beyond personal finances. With large numbers of veterans turning to substance abuse – 6 in 10 PTSD sufferers are smokers, many have alcohol and drug addiction problems, a total care package is required.

It is important to look at PTSD and substance abuse because people with a Substance Use Disorder (SUD) are more likely to commit domestic violence. For example, 25-50% of men who committed battery against a spouse had a substance abuse problem. It goes beyond the veterans too because it forms part of a vicious circle. Various studies seem to suggest that 31% to 84% of women who suffer domestic violence show symptoms of PTSD. Many of them then turn to substance abuse themselves.

Back in 2008, Matthieu said that “the increasing number of veterans with post-traumatic stress disorder (PTSD) raises the risk of domestic violence.” In talks with Peter Hovmand, a domestic violence expert at Washington University in St. Louis, Matthieu outlined a solution: “Veterans need to have multiple providers coordinating the care that is available to them, with each provider working on one treatment goal. Coordinated community response efforts such as this bring together law enforcement, the courts, social service agencies, community activists and advocates for women to address the problem of domestic violence. These efforts increase victim safety and offender accountability by encouraging interorganizational exchanges and communication.”

Given the agreed updates to retired veterans in the modern world and the taking into account their spouses and families, it’s time to make sure there is a truly inter-organizational and integrated approach to veteran mental health to help prevent them from turning to substance abuse and domestic violence.


This story written by Mark Wollacott originally published on Military Medical News.

DoD: It takes only one person to stop a suicide

Security guards open a gate for motorist at the visitor entrance to Fort Lee, Va., on Aug. 25 after a female soldier with a gun turned the weapon on herself. (Steve Helber / AP)

Security guards open a gate for motorist at the visitor entrance to Fort Lee, Va., on Aug. 25 after a female soldier with a gun turned the weapon on herself. (Steve Helber / AP)

 
Just six days before the start of Suicide Prevention Month in September, Army Sgt. 1st Class Paula Walker, 33, barricaded herself inside an office at Fort Lee, Virginia, and, in what military leaders later described as “upset and rage,” killed herself with a personal firearm.

The Aug. 25 death stands out for several reasons. First, female troops like Walker die by suicide at rates much lower than male service members; they tend not to use firearms; and, unlike more than half the service members who commit suicide each year, Walker had deployed to a combat zone, spending 15 months in Iraq in 2007 and 2008.

Her death and others by military personnel this year show how difficult a challenge suicide is for the Defense Department, which is launching several initiatives in September as part of National Suicide Prevention Month.

“Suicide is complex and the trajectory toward death is as individual as the person,” Defense Suicide Prevention Office Director Jacqueline Garrick said in an interview Sept. 4.

Together with the Veterans Affairs Department, DoD is launching the “Power of 1” awareness campaign — a public service initiative based on the idea that it takes just one person asking a question, texting a friend in need or making a phone call to save a life.

In a DoD-wide message Sept. 2, Defense Secretary Chuck Hagel emphasized the impact of simple intervention.

“These brave individuals shouldn’t be avoided or stigmatized. They need to be embraced. Whether you’re a service member, a veteran, a DoD civilian, or a friend or family member of someone who is, you have the power to make a difference,” Hagel said.

Garrick said statements conveyed in a nonjudgmental manner, such as, “I’m worried you might hurt yourself,” “You don’t seem yourself,” or “You seem to be taking risks,” accompanied by, “Let’s figure something out,” can help.

“It’s knowing how to ask the right questions without being afraid of the answers, and part of not being afraid is knowing where the resources are,” Garrick said.

Last November, DoD expanded its Vets4Warriors program, an around-the-clock call center that offers peer counseling and support, to active-duty, National Guard and reserve members, retirees and their families.

Staffed by veterans representing all service branches as well as a handful of family members, the toll-free line (1-855-838-8255) receives an average of about 1,500 calls a month, according to the Pentagon.

Garrick said the program not only gives those under stress someone to talk to, but the staff can help callers navigate the complexities of the mental health system as well as provide case management.

“When someone is really stressed, it’s hard to navigate. Our peers are really good at problem solving,” Garrick said.

For service members in emergencies, the Military Crisis Line, 1-800-273-8255, is staffed by trained mental health specialists — many of whom also are veterans, according to VA.

The 24-hour phone service, online chat and text-messaging system, overseen by VA, has fielded more than 1.25 million calls since 2007 and is credited with nearly 40,000 lifesaving rescues, according to the department.

While DoD is ramping up its suicide prevention programs in September, officials say the department maintains a full-court press on the problem year-round with the goal of reducing a surge in suicides in the past 12 years.

In 2013, 259 active-duty personnel, 87 reservists and 133 Guard members died by suicide.

The suicide rate per 100,000 personnel in 2013 was 18.7 for the active component, 23.4 for the reserves and 28.9 for the Guard.

In comparison, the civilian rate, adjusted to similar demographics as those who serve, is 18.8 per 100,000.

“Getting help when you need it is not only a sign of strength, but it works,” Army Lt. Gen. Michael Linnington, military deputy to the undersecretary of defense for personnel and readiness, said in a news release. “Having the confidence to seek help when you need it is important.”

Concerned over the frequency of suicide among young veterans, Iraq and Afghanistan Veterans of America made the subject its top priority this year.

IAVA founder Paul Rieckhoff said the DoD figures underscore the scope of the problem and call attention to the broader issue, that troops and veterans — including those recently discharged — are dying by their own hands in significant numbers.

“We’re outraged, which is why we’ve asked the president to draft an executive order focused solely on military and veteran suicide,” Rieckhoff recently told Military Times.

A poll of IAVA members earlier this year found that 31 percent said they have thought about taking their own lives since joining the military and 40 percent have a friend who served in Iraq or Afghanistan and died by suicide.

First Sgt. Paula Walker’s brother Paul told the British paper MailOnline on Aug. 27 that his sister’s suicide “came out of nowhere.”

“I am devastated at the loss of my twin sister. This was totally unseen….you never know what’s going on in a person’s mind,” Paul Walker said, according to the paper.

And that, precisely, is the major challenge of preventing suicide, Garrick said.

In studying military suicide in the past several years, DoD has found the majority of those who take their own lives are young, white, enlisted men who have never deployed to a combat zone. About one-third told someone of their intent and nearly half had seen a doctor in the months before they died.

But often, those who die by suicide fit none of those descriptions.

“As much as I wish I could say there is a known portion of the population that dies by suicide, there are constant exceptions to the rules,” Garrick said. “Constant vigilance is needed.”

Related Links

This story written by Patricia Kime originally published on AirForceTimes.com.