Home from the War:Where can I get the help I need?

Home from the War:Where can I get the help I need?

Beth Wick, Manager of 2-1-1 Texas I&R Network

Mary Cooksey, Director of 2-1-1 West Central Texas

GoalGoal

• To provide scope of the problem for the individual, families, and societal impacts of OIF/OEF.

• To provide information on how one I&R decided to be part of the solution.

OIF/OEFOIF/OEF

Operation Iraq Freedom

Operation Enduring Freedom

“No one comes home from war unchanged.”

“No one comes home from war unchanged.”

Iraq and Afghanistan Veterans

Scope of IssueScope of Issue

• ~1.5 Million Soldiers have served• 449,000 deployed > 1 tour• 20% Female Soldiers• As of January 23, 2006, DoD reports

505,366 OIF/OEF Veterans eligible for VA services

»43% separated Active Duty troops»57% Reserve/National Guard

members

What We Know About OIF/ OEF Veterans

What We Know About OIF/ OEF Veterans

•19% OIF, and 11% OEF have mental health problems

•17% of OIF Soldiers and Marines screened positive for PTSD, generalized anxiety, or depression

•35% OIF veterans accessed MH services in first year

Hoge, Journal of American Medical Association, 2006

What we know…What we know…• Survey of 894 Army soldiers from Operation Iraqi

Freedom:

* 95% observed dead bodies or human remains* 93% were shot at or received small-arms fire* 89% were attacked or ambushed* 65% observed injured or dead Americans* 48% were responsible for the death of an enemy

combatant

Charles Hoge et al., 2004

What we know about the familiesWhat we know about the families• Over half of service members are married

– At least 1.8 million children have one or both parents in the military

» 1.2 million with Active Duty parents and 650,000 with parents in reserves

• Ages of children affected by deployment:0-5: 40%6-11: 33%12-18: 25%

Military Families cont…Military Families cont…

–Dual military families (6.9%)

–Single active duty parents (5.4%)

–Families with special health care needs (7.3%)

Military Families con’t…Military Families con’t…

• Over ½ said their child had trouble sleeping

• 1/3 of the children were categorized as “high risk” for psychosocial problems (which is 2.5x the national norm)

• Parenting stress levels were double that of normative data

• Parental stress was most significant predictor of child’s mental health

(Flake et al., 2008)

Military Families con’tMilitary Families con’t• Nationally, rate of child maltreatment in families

of enlisted soldiers was 42 percent higher when military spouses were off at war than when they were at home

• Female civilian parents were twice as likely to abuse a child physically and almost four times more likely to neglect a child when male soldiers were deployed than at other times.

Gibbs (2007): Studied U.S. Army families worldwide 2001 - 2004 using Army human-resource data and Army Central Registry

Military Youth Unique ChallengesMilitary Youth Unique Challenges

• Frequent moves• Changing schools, friends, activities, etc.• Parent working long hours and away for

long periods of time• Unprecedented combat deployments• Many parents returning home with

physical and/or emotional wounds

Military Youth con’t…Military Youth con’t…• 53% “worry about my military parent while

he/she is deployed”• 38% “worry about the person who takes care

of me while my parent is deployed”• 57% of interviewed youth said that getting to

know their parent again (upon homecoming) was difficult.

Chandra et al 2008

Military Youth con’t…Military Youth con’t…• ACADEMIC PROBLEMS: Parental

deployments may be related to modest decreases in test scores across most subjects – effects may be long-term (Engel et al., 2006)

• PHYSIOLOGICAL DIFFERENCES: Teens whose parents had been deployed to Iraq had significantly higher levels of systolic blood pressure, heart rate, and perceived stress than a civilian comparison group (Barnes et al., 2007).

Scope of ProblemScope of Problem

• 30-40% Iraq Veterans will face depression, anxiety, or PTSD

• Multiple tours and prolonged deployments increase combat stress by 50%

• National Guard and Reserve at increased risk for MH issues and Suicide

Scope of ProblemScope of Problem

• MH symptoms reported to a health care provider

–56% of Active Duty

–60% of Reservists

–76% of Veterans– Dole-Shalala Commission

Scope of ProblemScope of Problem

• 300,000 OIF/OEF Veterans with PTSD and/or Major Depression

• 320,000 OIF/OEF Veterans with TBI

• RAND Survey: 2008

Scope of ProblemScope of Problem

• NOT Knowledgeable about MH warning signs– 49% Soldiers– 52% Military Spouses

• Treatment options for MH: Ignorance– 59% Soldiers– 66% Military Spouses

• 10% have sought treatment; STIGMA prevents MH Care

• APA Harris Interactive Survey: 2008

PTSDPTSD

Diagnosis of PTSDDiagnosis of PTSD

The individual experienced or witnessed an event that involved actual or threatened death or serious injury, and felt very afraid or helpless.

Traumatic events can include a wide variety of different experiences: military troops involved in combat victims and rescue workers involved in natural disasters victims and rescue workers involved in man-made disasters sexual assault or other violent crimes domestic violence physical and/or sexual abuse immigrants fleeing violence in their homeland Torture MVAs

Impact of PTSDImpact of PTSD

Individuals may AVOID certain triggers or reminders of the trauma and may experience EMOTIONAL NUMBING (and/or distance themselves from others).

They may try to avoid:

• activities

• places

• thoughts

• people

Traumatic Brain InjuryTraumatic Brain Injury

What Is A Traumatic Brain Injury?What Is A Traumatic Brain Injury?

External force applied to the head

Disruption of brain function

Alteration of consciousness

» incomplete memory of the event

» “dazed” or confused

» loss of consciousnessAdapted from ACRM Special Task Force on TBI

Blast InjuryBlast Injury

• Incidence of TBI in med evac patients with blast injuries at Walter Reed ~ 60%

• 64% of all military-related TBI from blast

• OIF/OEF: 33% of all battle injuries TBI

• Past war-wounded: 14-20% TBI

Modern warfare TBI risk 2X greaterWarren Lux, MD, Presentation @ BIAT, August, 2005Deputy Director, Defense of Veterans Brain Injury Center

Impact of TBI Impact of TBI

Attention/Concentration

Speed of Mental Processing

Learning/Information Retrieval

Executive Functions (e. g., Planning, Problem Solving, Self Monitoring) May see judgment problems, apathy, inappropriate behaviors

Psychological/Psychiatric and Psychosocial Changes after TBI

Psychological/Psychiatric and Psychosocial Changes after TBI

Personality:

Increased/Decreased Activation

Episodic Dyscontrol; Irritability

Psychiatric:

Mood Disturbance

Psychosis

Psychosocial:

Work Status

Relationships with others

Public Health Impact: OIF/OEFPublic Health Impact: OIF/OEF

• Alcohol Abuse

• Narcotic addiction

• Major Depression

• Military Sexual Trauma

• Job loss• Family dissolution• Homelessness• Violence towards

others• Incarceration• Suicide

Post Deployment Mental Health: It’s not just PTSD and/or TBI

Post Deployment Mental Health: It’s not just PTSD and/or TBI

Effects on RelationshipsEffects on Relationships

1. Social anxiety

2. Angry outbursts

3. Emotional unavailability

4. Sleep disturbance

5. Difficulty managing family roles and responsibilities

Relationship ImpactRelationship Impact

• 20% of married Iraq troops are planning a divorce

• 2/3 of Married or Cohabitating Veterans report Family Adjustment Issues

Iraq and Afghanistan Veterans of America

Impact on FamiliesImpact on Families

• Domestic Violence

• Childhood Abuse

• Substance Abuse

• Parent with MH/TBI and associated socioeconomic/legal issues

What To Do, and How To Do ItWhat To Do, and How To Do It

– Community Awareness» Military Forces members, Veterans, and

their families» Employers» School» Faith Based Organizations» State & Non-Profit Agencies» Health Care Providers

– Coordination of Available Services» 2-1-1 West Central Texas Experience