Indiana University Bloomington

Indiana Prevention Resource Center (IPRC)

Caring for the Mental Health of Our Active Military Service Members, Veterans and Their Families

This article is the second in a series of three articles on the military leading up to Memorial Day of 2012.

Mental health is a national concern, particularly salient for those who put their lives on the line to protect America's freedom. Mental health disorders are the 10th leading cause of death and disability and result in approximately 37,000 deaths in the United States (SAMHSA, 2012; CDC, 2012). In 2010, among noninstitutionalized adults, 3.3% reported a serious psychological distress in the past month. (CDC, 2012)  In contrast, the percent of veterans of the wars in Iraq and Afghanistan with serious mental health disorders is far higher. Up to 20% of active duty military and 42% of reserve component military are in need mental health treatment. (NIDA, 2011) This article describes mental health challenges facing our military, veterans and their families, and describes programs and resources addressing their needs.

The Indiana Prevention Resource Center (IPRC) seeks to support active duty and reserve military, veterans, and their families, and also to support their service providers. To this end the IPRC created a searchable database of online resources with descriptions and links, available both at www.vetresources.org and from the IPRC homepage. All of the resources described and cited in this article, and many more, can be found in this database.

Source: http://newsantaana.com/2011/03/27/veterans-mental-health-conference-in-garden-grove-on-march-28-29/

Consequences. Untreated mental health problems are associated with depression, anxiety, marital problems, sleeplessness, substance abuse, homelessness, inability to obtain or maintain employment, child and/or spousal abuse, physical illness, school failure, and/or involvement with the criminal justice system. Military and veterans returning from the trauma of war may also suffer from posttraumatic stress disorder (PTSD). Often unrecognized in returning veterans, depression manifests itself in incidents of domestic violence and/or other family problems. Research among military veterans found that about 75% of married or cohabitating veterans reported experiencing a family problem within the past week, such as uncertainty about their role in the family, feeling their children were afraid or acting distant towards them, or feeling like a stranger or guest in their home. Of those veterans separated from a past partner, over half reported incidents of shouting or shoving or that their partner was afraid of them. (Sayers, Farrow, Ross, and Oslin, 2009)

Stigma and military culture. A long-standing stigma associated with having mental health problems is particularly strong in the military and makes addressing mental health issues more difficult for people in the military culture. Especially powerful restraints face those wishing to pursue a military career.  In addition to the stigma of perceived weakness attached to having or seeking help for a potential mental health problem, there is real potential that being identified as having a mental health problem could impede career progress and there is also fear of lack of confidentiality. These concerns were explored in the PBS Frontline program, The Soldier's Heart: Obstacles to Getting Help. (PBS, 2005)

The Departments of Defense and Veterans Affairs have been working aggressively to provide needed care and to change the military culture to reduce and eliminate the stigma traditionally associated with mental health concerns. Examples of efforts include the website www.afterdeployment.com, created by Telehealth and Technology in cooperation with the Defense Centers of Excellence. This site offers assessment videos and tutorials on a myriad of important topics, including PTSD, depression, families and friendships, physical injury, life stress, spirituality, anxiety, alcohol and drugs, anger, health and wellness, resilience, mid traumatic brain injury, tobacco, stigma, and sleep. It has sections for military, veterans, families and service providers, and community resources.

Female Vets. Women vets face different challenges than their male counterparts. A majority of female vets have been exposed to trauma, and as many as one in three report having been raped or sexually assaulted while in the service (DOL, 2011) About 40% of women serving in Iraq and Afghanistan have children, and about 30,000 are single moms. (Ibid.) They suffer all the same difficulties upon homecoming as men. In 2010 an estimated 6,500 female veterans were homeless on any given night, nearly double the number in 2000. At the same time, only five percent of VA facilities for homeless veterans offer separate quarters for females. (CBS New.com, 2010)

To help address women veterans' problem, the Department of Labor recently published Trauma-informed Care for Women Veterans Experiencing Homelessness: A Guide for Service Providers (2011). This guide aims to change the culture through a collaboration of private and government service providers, to make sure both men and women are receive the care they need and that even the most vulnerable female veterans are successfully reintegrated into their communities. The Department of Labor (DOL) Women's bureau also initiated Female to Female Stand Downs to offer comprehensive services in a one-stop event that connects female veterans to available services, described in the video Giving Voice to Hope (DOL, 2011). Another examples of these efforts are described in the Department of Defense, Annual Report on Sexual Harassment and Assault (http://www.sapr.mil/), where prevention efforts are to “institutionalize prevention strategies in the military community” and “increase climate of victim confidence associated with reporting.” (DoD, 2012)

PTSD. Anyone who goes through a traumatic event like war, an assault, car crash or natural disaster, can develop posttraumatic stress disorder (PTSD). Because of the nature of combat in Iraq and Afghanistan a large number of military service members suffer from PTSD and also traumatic brain injuries (TBI).  PTSD results in four main types of symptoms: re-experiencing the trauma, avoidance, numbing, and arousal. Memories of the event flash back, along with feelings of fear or horror, sometimes triggered by a sight or sound. This may occur in nightmares. Avoidance includes people, places and things that you think may trigger the reliving of the trauma. Numbness refers to difficulty expressing your feelings, even strong feelings of love, and may be expressed by a lack of interest in things you once enjoyed. Finally, arousal, also referred to as hyperarousal, causes you to be jittery, on edge, on guard, suddenly angry, unable to sleep or concentrate, fearful for your safety and easily startled. When these symptoms persist beyond the normal period after a traumatic experience, they lead to a diagnosis of PTSD. People with this disorder often have or develop other problems such as substance abuse or addiction, employment problems, relationship problems including divorce and intimate partner violence, severe depression, shame or despair, and/or physical problems. (VA, 2012)

The Department of Veterans Affairs (VA)'s National Center for PTSD  (http://www.ptsd.va.gov) offers an array of resources and information to assist military and veterans and their families. In addition to their many independently offered resources, the National Alliance on Mental Illness (NAMI, www.nami.org) has partnered with the Suicide Prevention Resource Center (SPRC, www.sprc.org) to create a series of guides for the person and for their family “After an Attempt: a Guide for Taking Care of . . . after Treatment in the Emergency Department.” (see Bibliography for links)

Suicide. When untreated, an extreme negative consequence of depression and mental illness can be suicide. So far in 2012, as of March 31st, there had been 20 confirmed suicides among active duty soldiers, with 25 potential suicide events still under investigation. In 2011 there were 164 confirmed active-duty suicides. (DoD, 2012) According to an Oct 2011 policy brief, the rate of suicide among service members from 2005-2010 was about one every 36 hours. (Policy Brief. Losing the Battle, 2011)

So far in 2012, among reserve component military not on active duty there have been 13 confirmed suicides and seven remain under investigation. In 2011 for this group there were 117 confirmed suicides (81 Army National Guard and 36 Army Reserve). (DoD, 2012) Reservists face the challenge of coming back into communities that do not always have the VA mental health support facilities that are available on military installations, nor the support that other military families find on the military bases. In the U.S., only one percent of the population are veterans, but suicides among this 1% account for 20% of all suicide deaths in the nation (VA, 2010 Factsheet) The Citizen's Support Program (www.citizensoldiersupport.org) is but one example of a congressionally authorized and federally funded project focusing on needs of Reserve and National Guard returning from Iraq and Afghanistan to provide support and benefits needed to successfully return to civilian life.

Rates of suicide among veterans number more than 6,500 per year, or one every 80 minutes. That is more in a single year than the deaths in combat in Iraq and Afghanistan since those wars began. (Veteran's Death, the Nation's Shame and check links within) The Depart of VA is working aggressively to provide needed services , initiating new programs and offering crisis hotlines and online resources, but it cannot keep pace with the problem. Admission to an inpatient treatment VA facility may be subject to a 6-month waiting list. (Vet's Death, Nation's Shame)

There is a strong relationship between substance abuse and suicide with 30% of deaths involving BAC over the legal limit and 40% involving alcohol at some level. It is also important to note that the rate of suicides among persons with major depression is eight times higher than the suicide rate for the general population. (McKeon, 2011)

National Response. The suffering of our military members, veterans and their families reverberates across the land. The teachers, co-workers, employers, schools and businesses missing out on their talents and creativity, healthcare providers, grocers, neighbors and entire communities feel the pain and want to help. In Indiana the Inter-Service Family Assistance Committee (ISFAC) represents the coming together of the military and community businesses, educators, non-profits organizations, and individuals to address the needs of our veterans and their families. ISFAC's Joining Forces Initiative will be part of a national initiative to mobilizes all sectors of society in order to bring to our service members and their families opportunities and support they deserve.

From the Department of Veterans Affairs, the “Make the Connection:  Shared Experiences and Support for Veterans"(maketheconnection.net) web site serves to connect veterans by gender, era of service, branch of service and exposure to combat.  Individuals can connect by shared life events such as transitioning from service or death of family or friends.  It features in-depth stories and testimonials of veterans from various generations and branches of the military. There are materials for veterans, National Guard & Reserve, partners, family and friends, active duty, and clinicians. For clinicians it includes links to provider resources such as the “I'm a Provider” web site (http://www.mentalhealth.va.gov/providers/index.asp), also from the Department of Veterans Affairs. This site offers substance abuse disorder, suicide prevention, campus counseling, VA Psychology Training Council, and trauma and PTSD resources. Crisis hotlines (1-800-273-TALK) have been established.

Having military experience helps a treatment provider relate to clients from the military. Military culture is close-knit. Sharing that background can make a treatment provider more relevant to the client. For example, speaking the shared language of military acronyms avoids problems in communication.  (ADAW, 2012) We can all do something to help and to honor our active military and our veterans. Let's each do our part!

Select Bibliography

Alcoholism Drug Abuse Weekly (ADAW). “CRC:  Veterans Are Best Treated by Staff with Military Experience,” Special Issue: Addiction Workforce 24/17 (April 30, 2012).  

CBS News.com.  “This is How America Treats Its Female Veterans?”  (Mar 7, 2010)  NewsPoliticsInfo Sunday cover with Russ Mitchell.  Accessed 4-24-2012 at http://www.youtube.com/watch?v=J3UFrsW4BU0

CDC. FastStats:   Mental Health, 2012.  Accessed 4-26-2012 at http://www.cdc.gov/nchs/fastats/mental.htm   [/# of suicide deaths, 36,909.  12.0/100,000  in 2009.

Center for New American Security.   Policy Brief. Losing the Battle: The Challenge of Military Suicide (M.C. Harrell and N. Berglass, Oct 2011) Accessed November 2011 at http://www.cnas.org/files/documents/publications/CNAS_LosingTheBattle_HarrellBerglass.pdf

Citizen Support Program (CSSP): Citizen Soldier Support Program: Bridging Military and Community Service Systems.  Accessed 4-25-2012 at www.citizensoldiersupport.org

Harrell, M.C., and N. Berglass.   Policy Brief. Losing the Battle: The Challenge of Military Suicide (M.C. Harrell and N. Berglass, Oct 2011) Accessed on 4-24-2012 at http://www.cnas.org/files/documents/publications/CNAS_LosingTheBattle_HarrellBerglass.pdf 

McKeon, R. (2011) “Preventing suicide and substance abuse: why collaboration is important.” National Prevention Network Prevention Research Conference, Atlanta, GA, Sept.23.

NAMI in partnership with the Suicide Prevention Resource Center. After an Attempt: a guide for taking care of yourself after treatment in the emergency department” and “After an Attempt: a guide for taking care of your family member after treatment in the emergency department”  Accessed in 2011 at http://mentalhealth.samhsa.gov/publications/allpubs/SVP-0157/ and http://mentalhealth.samhsa.gov/publications/allpubs/SVP-0159/

NAMI.  Suicide: Learn More, Learn to Help. 2012.   Accessed 4-26-2012 at http://www.nami.org/Content/ContentGroups/Helpline1/Suicide_-_Learn_more,_learn_to_help.htm

NIDA.  Substance Abuse among the Military, Veterans, and Their Families – April 2011,” Topics in Brief. (2011) Accessed 5-2-2012 at http://www.drugs.indiana.edu/repository/veterans.pdf

PBS. Frontline. The Soldier’s Heart: Obstacles in Getting Help/Stigma.   Accessed 2011 at http://www.pbs.org/wgbh/pages/frontline/shows/heart/themes/stigma.html

SAMHSA. Major Depressive Episode and Treatment for Depression among Veterans Aged 21 to 39 (NSDUH Report, Nov. 6, 2008) Accessed 2011 at  http://oas.samhsa.gov/2k8/veteransDepressed/veteransDepressed.htm

Sayers, Steven, and  Victoria Farrow, Jennifer Ross, and David Oslin.  “Family Problems Among Recently Returned Military Veterans Referred for a Mental Health Evaluation,” Journal of Clinical Psychiatry 2009;70(2):163-170  Accessed 2011 at http://www.ncbi.nlm.nih.gov/pubmed/19210950

U.S. Department of Defense (DoD).  An Achievable Vision:  Report of the Department of Defense Task Force on Mental Health.  2007.  Accessed 2011 at http://www.veteransandfamilies.org/SpecialReport.html

U.S. Department of Defense (DoD).  Army releases March suicide Data (News Release No. 287-12, April 18, 2012) Accessed 4-19-2012 at www.defense.gov/releases/release.aspx?releaseid=15199.

U.S. Department of Labor (DOL), Women’s Bureau.  Trauma-informed Care for Women Veterans Experiencing Homelessness:  A Guide for Service Providers.  Includes web-based training and a video.  Accessed 4-19-2012 at  http://www.dol.gov/wb/trauma/

U.S. Department of Labor (DOL), Women’s Bureau.     YouTube video:   Giving a Voice to Hope.  Uploaded by US Dept of Labor on Nov. 9, 2011.   Accessed on 4-16-2012 at http://www.youtube.com/watch?v=ynSJtdz8MkI.

U.S. Department of Veterans Affairs (VA). What is PTSD? 2012.   Accessed 4-27-2012 at http://www.ptsd.va.gov/public/pages/what-is-ptsd.asp

U.S. Department of Veterans Affairs (VA).   I’m a Provider Website for Mental Health Professionals.  Accessed 4-27-2012 at http://www.mentalhealth.va.gov/providers/index.asp.

U.S. Department of Veterans Affairs (VA).   Make the Connection:  Shared Experiences and Support for Veterans.  Accessed 4-27-2012 at http://maketheconnection.net/



By Barbara Seitz de Martinez, 5/14/2012