Returning Vets: Ptsd, Multicultural And Ethical Issues

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RETURNING VETS TO YOUR COMMUNITY: PTSD,MULTICULTURAL AND ETHICAL ISSUESRETURNING VETS: PTSD, MULTICULTURAND ETHICAL ISSUES

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESHI, EVERYONE! WELCOME!!! A few things to cover Introduction/Objectives Classroom Etiquette Community Basket Breaks and restrooms Overview Multicultural Exercise PTSD and Vets Facts/figures Slide presentation D & A, PTSD andRecovery Exercises (Assess) Breakout/Brainstorm Questions

OBJECTIVES: RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESDevelop multicultural and ethical conscious awarenessthrough learning experiencesDiscuss Community resources and identify needsIntroduce multicultural skills that enable participants topractice effective listening and supportRecognize issues associated with PTSD, includingsocial problems and AOD abuseIncrease understanding in practical application, e.g.,work, social settings, church and business

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESMULTICULTURAL EXERCISE THE HOUSING SEARCH: DECISION GAMEGOALS––––MORE FULLY UNDERSTAND A RETURNINGVET’S OPTIONSIDENTIFY RESOURCES AVAILABLECREATIVELY PROBLEM SOLVE (ESPECIALLYWITH MENTAL HEALTH, SUCH ASAOD/PTSD’s)INCREASE MULTICULTURAL AND ETHICALAWARENESS

RETURNING VETS: PTSD, MULTICULTURAL AND ETHICALISSUESDISCUSSIONFACTS & FIGURES

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESFacts and Figures Currently, there are approximately 162,000troops in Iraq and with several thousandmore stationed in Afghanistan There are countless more soldiers stationedaround the world in areas that are potentiallyvolatile

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESFacts and Figures Since March of 2003, more than 3,700 troopshave been killed in IraqIn that same time period, more than 27,000troops have been wounded86% of the troops who have served in Iraqknow someone who was killed or woundedMost of us know several people who werekilled or wounded

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESFacts and Figures When Vets were asked by the Mental HealthAdvisory Team IV to describe a situation that causedintense fear, helplessness or horror, some of theresponses included:–––––“My sergeant’s leg getting blown off.”“Friends burned to death; one killed in a blast.”“Fear that I might not see my wife again, like my fallencomrades.”“Finding out two of my buddies died and knowing I could donothing about it.”“I had to pick up my friends off the ground because they gotblown up.”

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESFacts and Figures According to the Department of Defense, 1 in6 troops from Iraq met the criteria for majordepression, generalized anxiety disorder, orpost-traumatic stress disorder.Approximately 20,000 returning troops statedthey had nightmares and/or flashbacksMore than 3,700 feared they may hurt or losecontrol with someoneAlcohol/drug abuse self-medication

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESFacts and Figures In addition to the mental health issuesfaced by combat soldiers, many veteransface numerous social/psychological issuesas well, including:––––––Failed relationshipsEmployment challengesFinancial IssuesHousing issuesPhysical ChallengesSubstance Abuse Disorders

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESFacts and Figures Since 2001, the divorce rate among activeduty troops has steadily increased.–– In 2001, the Army reported 5,600 divorces.In 2004, the Army reported 10,477 divorces.The returning Reservist and National Guardmay face difficulties with employment.Some who left higher paying jobs may havefinancial struggles to overcome

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESFacts and Figures Some face housing issues.– 25% of the homeless people in theUnited States are veterans.– 25-30% of the homeless veterans arefrom the Iraq and Afghanistanconflict.– AODrampant: self-medicating

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESFacts and Figures Post-deployment mental healthassessments of troops who served in Iraqor Afghanistan indicated:––––38% of Soldiers31% of MarinesExperienced mental health issues ranging frommild depression to post-traumatic stress disorder.Experienced substance abuse related problems

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESFacts and Figures For those who served in the NationalGuard:– 48% will experience some type of mentalhealth issues following their deployment.What state has deployed the largestnumber of National Guard to Iraq andAfghanistan?––Pennsylvania6000 National Guard members were deployed a shorttime ago. They left family and friends

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESFacts and Figures Some of the mental health issues combatveterans may face ce AbuseRelational ProblemsAcute Stress DisorderPost-Traumatic Stress Disorder

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESFacts and Figures Atleast 152 active troops inIraq or Afghanistan havecommitted suicide Research conducted by CBSfound in 2005 there was anaverage of 120 suicides perweek among all veterans.

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESFacts and Figures 24% of soldiers in Iraq reported having stressto the point that it impacted on performance18% had evidence of mental health problemsWITH CONTINUED PSYCHOLOGICAL HELP: 55% reported medium or better personalmorale 53% reported medium or better unit morale

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESFacts and Figures Only 42% of those who desired help got it Primary reasons for not getting help:– Stigma (50% or more report concerns about this)– Difficulty getting time off to get help (40%)– Lack of access (40%)– Leaders Discourage Use of MH/D&A Services(21%) Possible link between stress and misconductSource: Department of Defense

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESSource: Department of Defense

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESSLIDEPRESENTATION

RETURNING VETS: PTSD, MULTICULTURAL AND ETHICALISSUESDiscussionALCOHOL & DRUGSPTSD’sRECOVERY

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESALCOHOL & DRUGSAlcoholismDefinition:Alcoholism is a chronic relapsing andprogessive disease with symptoms thatinclude alcohol craving, impaired control,physical dependence and tolerance.Drinking continues despite repeatedalcohol related problems. It has agenerally predictable course, hasrecognized symptoms and is influenced byboth genetic and environmental factorsNIAAA

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESALCHOL & DRUGSDrug addictionDrug addiction, or dependency is the compulsive use of drugs, to thepoint where the user has no effective choice but to continue use. Thisphenomenon has occurred to some degree throughout recorded history(such as opium), though modern agricultural practices, improvements inaccess to drugs, and advancements in biochemistry have exacerbatedthe problem significantly in the 20th century with the introduction ofpurified forms of active biological agents, and with the synthesis ofhitherto unknown substances, such as methamphetamine and gammahydroxybutyrate (GHB). While addiction has been replaced bydependency as a clinical term, the terms are used interchangeably.

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESALCOHOL & DRUGS In the United States: 18 million Americans suffer from alcohol abuse or dependence –high percentages of returning vets 100,000 alcohol-related deaths annually One in four children under age 18 is exposed to family alcoholproblems Between 20%- 40% of hospital admissions are alcohol-related Alcohol problems cost U.S. society an estimated 185 billionannually

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESALCOHOL & DRUGSDisease Burden by Illness - US, Canada and Western Europe, 2000,15 - 44 year oldsUnipolardepressive disordersAlcohol use disordersRoad traffic accidentsDrug use disordersSelf inflicted injuriesBipolar disorderSchizophreniaHIV/AIDS024681012Percent of TotalSource: WHO – Burden of Disease Statistics, 2001141618

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESALCOHOL & DRUGS

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESALCOHOL & DRUGS FASDrunk DrivingAddictionEasy to obtainDomestic Violence &sexual assaultOthers?

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESALCOHOL & DRUGS Depressants:slow down bodyfunctions. Stimulants: arouse bodyfunctions. Hallucinogens: distortperceptions or evoke sensationwithout sensory input.

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESALCHOL & DRUGSCOMBAT OPERATIONAL/STRESS (Triggers) No real safe area Unpredictable threat Level Periodic unpredictable Re-exposure to high stress moments Mental health response, e.g., AOD Discussion

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESALCHOL & DRUGSSITUATIONAL STRESS (Triggers) Financial problems Guard and Reserve Employment and business problems Physical/environmental conditions General case of helplessness and/or hopelessness Disconnect from established support systems, faithcommunities Discussion

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESALCHOL & DRUGSRELATIONAL STRESS (Triggers) Long and/or multiple deployments Rushed marriages/pregnancies Irritability & numbing New communication styles Pre-existing strains Helpless to assist with crises People do crazy stuff (wrong things/time/person)

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESPTSDs AND AOD TRIGGERSAssessment1. Criterion A: Traumatic Stressor––Actual/threatened death/serious injuryThreat to physical integrity of self/others

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESPTSDs AND AOD TRIGGERSAssessment2. Criterion B: Persistent Re-experiencing Intrusive thoughts, images, perceptions Nightmares/distressing dreams Event recur/flashbacks Intense psychological distress with cueexposure Physiological reactivity upon cue exposure Substance abuse

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESPTSDs AND AOD TRIGGERSAssessment3. Criterion C: Persistent Avoidance, Numbing of Responsiveness (3) Avoid thoughts, feelings, conversations Avoid activities, places, people Inability to recall important aspect of trauma Diminished interest/participation in activities Feeling detached/estranged from others Restricted range of affect Foreshortened future

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESPTSDs AND AOD TRIGGERSAssessment3. Criterion D: Persistent Increased Arousal(Hyperarousal) Difficulty falling/staying asleep Irritability/anger outbursts Difficulty concentrating Hypervigilance Exaggerated startle

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESPTSDs AND AOD TRIGGERSAssessmentCriterion E: Duration of symptoms 1 month Important to note: why? (Discuss)

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESPTSDs AND AOD TRIGGERSAssessmentCriterion F: Clinically significant distress or impairment Specify if: Acute: Duration of symptoms 3 months Chronic: Duration of symptoms is 3 months Specify if: With Delayed Onset: Symptom onset is atleast 6 months after trauma

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESPTSDs AND AOD TRIGGERSRisk Factors Pre-trauma: Previous trauma,T Psychiatric history, high hostility, low selfefficacy, Family history / genetics Both peri-trauma and post trauma: traumaseverity, social support, life stress Severity of injury, acute symptoms

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESPTSDs AND AOD TRIGGERSKey Assessment Scores by Level of RuralityMean Score (Higher ssessment Measure

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESPTSDs AND AOD TRIGGERS 56% of Rural Veterans had scores suggestingPTSD/Depression–– Scores on the PTSD Checklist and the CESDepression Scale:– This was statistically significantly more than for Urban (32%)and Out-of-State Veterans (34%)Stats reflect probability of a scarcity of Tx options/resourcesHigher for Rural Veterans than for Urban; both were higherthan for Out-of-State VeteransCombat Exposure Scale–Higher scores (more combat exposure) for Rural than forUrban Veterans

PTSD’s: Decline in FunctioningVeterans with PTSD/Depression were as likely as OtherVeterans to be employed prior to deployment. Afterreturning homeVeterans with PTSD/Depression were statisticallysignificantly more likely than Other Veterans to beunemployed (12% vs. 4%) or physically/mentallydisabled (11% vs. 1%)Veterans with PTSD/Depression were statistically morelikely to have a lower income and show statisticallysignificant declines in functioning. (Veterans in RuralCounties have a lower income and are less likely to bestudents.)

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESPTSD’s: Decline in FunctioningCurrent Income Level by GroupIncome Level 50,000 & Above 40-49,000 30-39,000PTSD/DepressionOther Veterans 20-29,000Below 20,0000102030Percent405060

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESMilitary Information, Continued PTSD/DepressionOther VeteransPercent at each Levelof Combat Exposure by GroupPercentLevel of Heavy10203040

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESPTSDs: Other FactsVeterans with PTSD/Depression were statisticallysignificantly more likely than Other Veterans to haveserved in the National Guard (42% vs. 34%) and the Army(75% vs. 55%), to have had Combat Roles (52% vs. 39%).They are also more likely to have been exposed to heavierlevels of combat, risk, gore, injury to self and others, anddeath of others.

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESPTSD’s: Other Facts ChartPercent in Active DutyReservesNational GuardAir ForceArmyMarinesNavyCoast GuardCombatCombat SpprtService Spprt10203040506070

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESPTSD’s SUICIDE AND AOD ABUSE CES-Depression Scores were categorized into fourlevels (based on Ogles et al., 1998) Non-Depressed (below “Clinical Level”) 0-15 (n 544) Mild Depression 16-27 (n 197) Moderate Depression 28-39 (n 123) Severe Depression 40-60 (n 72)

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESPTSD’s SUICIDE AND AOD ABUSEPercent of Total Sample Scoring atEach Level of DepressionPercent of Total sedMild DepressionModerate Depression Severe DepressionLevel of Depression

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESPTSD’s, Continued Five Levels of HELP–––––Informal Support: Family, friends, other VeteransFormal Support: Veteran organizations andsupport groupsEmergency/Medical: Crisis line, emergency roomMental Health: Clergy, counselors, social workers,psychologists, psychiatristsCenter-Based: Community mental health center,Vet Center, VAMC, psychiatric hospital

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESAOD Recovery Recovery is: far more than treatment of mentalhealth problems Encompasses psychological, spiritual, social, andphysical realms: BIOPSYCHOSOCIAL AND OTHERASSESSMENT EXERCISES Need to ensure the right services are available whenand where needed Transitions need to be as seamless as possible

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESAOD Recovery THE EXERCISES DISCUSSION BRAINSTORMING: MULTICULTURALAPPROACHES, ETHICALCONSIDERATIONS AND TREATMENT (Tx)

RETURNING VETS: PTSD,MULTICULTURAL AND ETHICALISSUESFURTHER CONSIDERATIONS Listen as if you had to teach the content Attend a lecture or take a foreign language Avoid asking questions of the person who istalking; make statements Ask yourself – what is important? How is theperson’s “story” material framed? Avoid assuming you know how the person isfeeling or thinking Monitor nonverbal and verbal communication

RETURNING VETS: PTSD, MULTICULTURAL AND ETHICAL ISSUES Develop multicultural and ethical conscious awareness through learning experiences Discuss Community resources and identify needs Introduce multicultural skills that enable participants to practice effective listening and support Recognize issues associated with PTSD, including social problems and AOD abuse

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