Military Culture, Mental Health and Law Enforcement

Military Culture, Mental Health and Law Enforcement

Crisis Intervention Team International Conference1 June 2010

Deloria R. Wilson, Ph.D.Warrior Resiliency ProgramSan Antonio Texas210-424-8946

Disclaimer

Many slides were derived from staff at theCenter for Deployment Psychology (CDP) and other Experts.

The views and opinions expressed in this presentation are solely those of the author

and do not reflect an endorsement by the U.S. Government, DoD, Department of the Army orthe Warrior Resiliency Program.

Military CultureSome similarities with Law Enforcement

Military and Law Enforcement

Indoctrination Sense of Belonging

Structure and Hierarchy

Diversity and Opportunity

Challenge and Responsibility

Culture-Similarities

Service often before self

Seeking challenge

Emotional regulation

Multiple exposure to high stress situations

Military Culture-Uniqueness

Variation across services

Variation with AFSC, MOS, etc. (jobs)

Variation in combat exposure

Subcultures

Combat Stress and PTSD

A Continuum of Combat Reactions

Combat Stress Acute Stress PTSD

AdjustmentAdjustment

Stressors

Coping Ability

Leadership

Control

Support

Stressors

Coping Ability

Leadership

Control

Support

CombatReady

Mission Event

A Continuum of Combat Reactions

Combat Stress Acute Stress PTSD

AdjustmentAdjustment

Stressors

Coping Ability

Leadership

Control

Support

Stressors

Coping Ability

Leadership

Control

Support

CombatReady

Mission Event

Typical Post Deployment Adjustment Issues

Problems sleeping Irritability/Anger More (assertive) driving? Disturbing dreams/images Feeling out of place Physical/Emotional/Cognitive Fatigue Range of emotions including

numbness

Yellow Flags

Increased drinking More withdrawn Some family difficulties Reduced work performance Occasionally late to

work/appointments Hyper-vigilance / arousal Discipline Problems

Red Flags

Alcohol Abuse/Dependence Behavior requiring paperwork Signs for Depression/Anxiety Psychotic Behavior Signs of suicidal ideation Consistently unable to control anger Increasing withdrawal and isolation

PTSD Symptoms Impact onSocial Support

PTSD and associated problems can reduce available social support Emotional numbing Detachment Hostility and aggression Distrust of others Social problem solving deficits

As symptoms persist, individuals may tire of providing support or exhaust resources CDP

Relation between PTSD and Social Support

One of the strongest predictors of recovery following trauma is social support

Deterioration of perceived social support over time may contribute to increased symptoms

In general, families provide a primary source of social support, with intimate partners typically the chief source

Other Types of Deployment Stress

Operational Stress

Separation Stress

Reunion Stress

Adjustment Stress

Traumatic Stress

Deployment Cycle and Family Considerations

Why is the family important?

Veteran’sWell Being

Spouse Well Being

Child(re

n) Well

Being

Each gear impacts the ability of the service member to complete theMission.

Stressors in the Deployment Cycle

Pre-deployment

NotificationPreparationTraining

Deployment

DepartureSustainment

Combat and conflict

Return from Deployment

ReunionReintegration

Pre-Deployment Stressors

Preparedness

Shifting expectations

Changes in family dynamics

Anticipation of threats

Perception of Mission

Lack of information/RumorsBriefing by David Riggs, June 2007

Pre-Deployment Stressors - Spouses

Confusion

Denial

Resentment

Arguing

Worrying

Planning

Briefing by Doug Lehman, May 2008

Pre-Deployment Stressors - Kids

Confusion Regression Anger Outbursts Sadness Surprise Guilt Behavioral problems

Briefing by Doug Lehman, May 2008

Pre-Deployment Stressors - Adolescents

“I don’t care”

Fear of rejection

Denial of feelings

Anger

Higher value on friends

Briefing by Doug Lehman, May 2008

Stressors in the Deployment Cycle

Pre-deployment

NotificationPreparationTraining

Deployment

DepartureSustainment

Combat and conflict

Return from Deployment

ReunionReintegration

Stressors in the Deployment Cycle

Pre-deployment

NotificationPreparationTraining

Deployment

DepartureSustainment

Combat and conflict

Return from Deployment

ReunionReintegration

Common Stressors SMStressor Deployment Postdeployment

Operational/Physical

heat, dehydration, lack of comforts, desert, noises, fumes

traffic, crowds, unarmed, access to alcohol

Cognitive boredom, monotony, unclear role or mission, experiences that defy beliefs, information overload

loyalty issues to family vs unit, secrecy vs disclosure, boredom, regrets, thoughts of losses

Emotional fear of failure, guilt, horror, fear, anxiety, feeling devalued

grief, anger, feeling unsafe, guilt, withdrawal from war “rush,” numbness

Social separation from loved ones, lack of privacy, public opinion and media

separated from buddies, overwhelmed or misunderstood by family, feelings of alienation

Spiritual change in faith, inability to forgive, loss of trust

asking why buddies died, lack of purpose, changed faith, conflicting values

Editors Charles Figley and William Nash, Combat Stress Injury (2007)

CDP

Change in Mindset: SMMindset in deployed setting Mindset once home

Stay focused on mission /nothing else matters

Life is now unfocused and complex

Truly life or death / always on the edge

No longer on the verge of life or death

Constant adrenaline “rush” What can replace the “high” of war?

Black or white / all or nothing Things aren’t clear cut

Sense of purpose, invincibility No sense of purpose, nothing matters

Only trust battle buddies /others are threat

Can’t trust anybody

Need to control environment Can’t be in control of surroundings

Real problems and needs exist in Iraq

Problems at home pale in comparison to those in Iraq

CDP

Family Re-Adjustmentcan be like driving in San Antonio

It can be hard to figure out how to merge safely

Many times families will confuse normal adjustment issues for serious problems or vice versa.

Most service members and families expect that the service member or the family will remain unchanged.

Knowing thedifference

between expected

adjustment issues and mental health problems

often depends on time.

“IF YOU WENT TO WAR AND WEREN’T CHANGED, YOU WERE CRAZY BEFORE YOU LEFT.”

Ch. Morris, Minnesotata

Changes for Family

• New routines• New responsibilities • More independence and confidence• Made many sacrifices• Worried, felt lonely• Gone through milestones that were missed

• Interrupt routine• Disrupt space• Throw off decision making• Cause family to walk on tip toes• Not make everything perfect • Not replace the sacrifices and missed milestones

Family has…

Service Member’s Return can…

CDP

Community Partnering to Maximize Positive Outcome

Common Issues during Crises

Not necessarily dissimilar than general civilian population Domestic issues/ Relationship issues Financial problems Legal Issues

Circumstances may be different May not have family nearby Possible exposure to violence in theater Injured/Wounded Service Member

Get to know

Military Leadership

Military Police

Military Mental Health/Medical

VA and other veteran’s resources

On Line and Community Resources

They May Be Able to Help With Information about service member and or family

Information about what member’s unit has gone through

Links to family and other resources

Possibly medical and personal history

Resources to collaborate with training

Follow-through after an event

Discussion and Questions