Mental health problems and self-destructive behavior have always been difficult subjects to discuss, let alone diagnose and cure. Since the 2008 Rand Corporation study on Post Traumatic Stress Disorder (“PTSD”) entitled Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery, there has been growing preoccupation with the high incidence of psychological disorders affecting military men and women serving in Iraq and Afghanistan. According to the Rand study, it is estimated that one in five veterans suffers from some form of mental disorder.
In February of this year, Mental Health America (“MHA”) hosted a proof-of-concept conference consisting of 35 experts to help achieve the following goal:
By September 11, 2011, all active duty, retired, or separated National Guard, and Reserve Operation Enduring Freedom (OEF; Afghanistan) and Operation Iraqi Freedom (OIF; Iraq) veterans, and their dependents, will have access to unlimited, free mental health counseling which meets an established nationwide standard for military-specific, trauma-informed care.
While this goal is still far from being realized, the MHA conference had what we consider to be the finest assessment of the current difficulties we have in dealing with this growing epidemic. Because of it relevance to providing our brave warriors with access to the best treatment for PTSD, we are quoting MHA’s Key Discussion Points in their entirety.
MHA’s Key Discussion Points
- Little has changed in the three years since the 2008 RAND study. Approximately 18.5% of deployed personnel will experience PTSD or depression.
- The group concurred that there are currently several significant barriers to care for military family members facing mental health challenges:
- Lack of awareness of existing programs
- Personal shame or embarrassment (internal stigma)
- Organizational discrimination (external stigma)
- Bureaucratic, burdensome process
- Availability of trained expertise
- Quality of care
- Accessibility (phone, online, face-to-face)
- Friendliness of initial contact
- Passive programs whereby the military member is required to find the program and take a series of steps to receive benefits from the program are probably not adequate to fully meet the need. Several group members felt strongly that programs needed to assertively reach out to military families to offer help.
- One participant cited recent studies that indicate that, contrary to common belief, suicides appear to have no statistically significant correlation to deployments but occur evenly throughout the current worldwide,U.S. military population.
- The most effective current programs empower the client to define precisely what help s/he needs and place the client in contact with “culturally competent” advisers/counselors. There are many programs offering services that are inappropriate for the unique mental health needs of military service members and their families.
- To have significant impact and to reach the target population effectively, programs must ensure that their representatives are “culturally competent”, that is, sufficiently familiar with the military culture to quickly establish a bond of shared life experience with the individual asking for help.
- National efforts should focus not on developing new programs but on creating systems which lead those in need to effective existing programs. This will require a nationwide, single-message marketing effort and a “navigator” function whereby a trained expert partners with a client to connect them with the best and most appropriate programs available within their community.
- The availability of confidential care—within the legal constraints that mandate reporting potentially harmful behavior—is essential. Our society in general and the military culture in particular, will not eliminate the stigma associated with mental health issues in the foreseeable future. Thatsaid, the American public is now probably more receptive to the need for integrated care than ever before as a result of the wars in Iraq/Afghanistan.
- Counseling must be evidence-based. There was general consensus at the conference that the scientific community knows how to treat posttraumatic stress and its co-morbid conditions such as depression, substance abuse, etc.
- Several in the group highlighted the need for a “navigator” to lead a military service member or family member through the maze of available resources in their communities and link that client with those programs.
- Counselors should, whenever possible, be trauma-informed.
- Any solution must serve military service members and their families not located within a military community or near a Department of Defense (DoD) or Department of Veterans Affairs (VA) treatment facility.
- Community programs and services that are currently offering help must be consumer ratable in order to begin to establish a “gold standard” of care and to identify those programs that are working and those that are not.
- There was unanimous consensus within the group that peer counseling works to establish a bond with the service person and enhance engagement, and that it should be a part of any comprehensive solution. Specific features of an effective peer counseling network include:
- Process to properly screen peer counselor applicants
- Peers should be paid for their services
- Peer specialists who are culturally competent
- Peer specialists who are trauma-informed
- Continuity; a sustained, trusting relationship with the client
- Direct, clinical peer supervision and support
- Systemic indicators to identify “compassion fatigue” among the peer counseling network
- Near permanent client/peer assignment
- Casual, relaxed atmosphere
- Formal peer training and certification
- Precise job descriptions
- Ideally, phone or face-to-face counseling only, with an emphasis on face-to-face counseling
SFTT will be devoting an increasing percentage of its attention and resources on helping our brave warriors and their families to deal with the crippling effects of PTSD. It is important to note that the consensus among the MHA experts that attended this conference is that “National efforts should focus not on developing new programs but on creating systems which lead those in need to effective existing programs.” This panel of experts argues that we have the necessary resources to deal with the problem and help these brave warriors, but that we need “to establish a ‘gold standard’ of care and to identify those programs that are working and those that are not.”
SFTT is committed to that effort and over the next several months will begin unrolling a national resource center to our brave warriors find the support they need and, most importantly, deserve!
If you would like to help, consider becoming a member of SFTT.