Returning Veterans:Our Help and Our Hope

When the War Comes Home: Advocacy and Treatment for Returning Veterans

10/31/08 Conference at the National World War One Museum

By Ilona Meagher, author of Moving a Nation to Care and editor of PTSD Combat: Winning the War Within

Intro to OEF/OIF PTSD Statistics

• http://www.youtube.com/watch?v=z0DMNpYa3dg

OEF/OIF Troops Deployed

Troops who have served in Afghanistan and/or Iraq: ~1.6 million

• U.S. population that fought in WWII: 12%• …in Vietnam War: 2%• …in OEF/OIF: 0.5%

OIF WIA and KIA

Reality of Combat PTSD is Messy

“The causal chain that gives researchers clues about how to deal with other ailments is not as clear in the case of trauma…Unlike other disabilities for which there is a site of injury, or a visible pattern, which results in pain, immobility, or impairment, the site of injury for PTSD is experience itself.”

-- Jeffrey Kirkwood, Haunted by Combat

Understanding Combat PTSD

• Complex intersection of individual and familial beliefs, experiences, and traits – Social– Philosophical– Spiritual– Existential– Psychological– Physiological

NEJM WRAMC 2004 Study

JAMA WRAMC 2006 Study

AJP WRAMC 2006 Study

JAMA 2006 Ft Hood/Ft Lewis Study

Military Obligations to Its Soldiers

• Jonathan Shay’s thémis or “what’s right” supports necessary for troop protection– To prevent some (not all) post-combat symptoms,

soldiers need:1. In-depth/realistic training in what they will face in

battle, and the proper equipment to do their job2. Unit community and stability (cohesion)3. Capable, moral, and reinforced leadership

Le Moyne College/Zogby 2006 Poll

• OIF troops wishing for a 2006 exit of Iraq: 72%• OIF troops wishing to "stay as long as needed"

to finish job: 1-in-5• While 58% say mission is clear, 42% say U.S.

role is hazy• OIF troops indicating "felt in great danger of

being killed" on DoD demob form: over 50%

AJP WRAMC 2007 Study

JAMA WRAMC 2007 Study

National Guard/Reserve Forces

• Portion of total overall military force: >1/3• OEF/OIF vets activated from Guard/Reserve:

403,089 (vs. 384,107 active duty)• Portion of forces serving in OIF, 2004: 40%• Portion of overall DoD budget: 8%• Approved reservist permanent retirement

disability claims, 2001: 16%• Approved reservist permanent retirement

disability claims, 2005: 5%

Unique Guard/Reserve Stressors

• Northwestern University Professor Emeritus of Sociology Charles Moskos’ triggers for increased PTSD risk in OIF vets:

– Routinely serving longer in combat than active-duty troops, often not knowing when they could come home

– Being used as “fillers” and serving alongside strangers they did not train with or know very well

– Worry over lack of support services for loved ones left behind– Dissatisfaction with inferior training and equipment compared

to active forces, making them feel as second-class soldiers– Fear (or actuality) of losing their civilian jobs or small

businesses while in combat.

Deployments

• Typical tour of duty, Vietnam: 1 year• Typical tour of duty, OEF/OIF:

extended up to 2 years, multiple deployments• Troops under acute stress, 1st Iraq tour: 12%• Troops under acute stress, 2nd+ Iraq tour: 18%• Increased risk of acute combat stress in those

serving multiple tours: 50%

JTS Army/Tarleton SU 2007 Study

RAND Corporation 2008 Study

• Most returning service members readjust successfully

– Survey respondents affected by:• PTSD: 14 % (est. 300,000)• Major Depression: 14% (est. 300,000)• TBI: 19% (est. 320,000)

– At least 1/3 have at least one of the above conditions– 5% coping with all three: PTSD, major depression and TBI

Experience of the Military Family• http://www.youtube.com/watch?v=Oy-vqaJJKeQ

Military Spouses

“If the Army wanted you to have a family, they would have issued you one.”

• Today:– ~55% OEF/OIF troops married– 10-15% spouses also in uniform– 24% are parents– 6% are single parents

Military Kids

• Active duty military children: 1.8 million

• Reserve/Guard forces dependant children: 700,000

• At any given time, kids with a parent deployed to OEF/OIF: >500,000

Military Family Demographic Trends

RAND Corporation 2008 Study

• Only 23-40% with a mental health problems seek out care. Of those who do reach out for help:

– Only 50% receive minimally adequate treatment

– Even fewer receive quality care, defined as treatment demonstrated to be effective.

RAND Corporation 2008 Study

Strengths of Community Healthcare

• Services already in place and ready to help– >2,000 community-based mental

health and addictions organizations serving 6 million/year

– Less travel time for veterans and their families because they can receive hometown care

– Privacy and confidentiality eases fears

On Counseling Veterans

• Read/learn about the experiences of combat veterans and their families.

“Because veterans have experienced so much pain in their lives, they grow accustomed to it and often think that life itself is inevitably painful. They do not relate to people and lifestyles of self-fulfillment and self-actualization because their personal mythology sees the world as one of total danger.”

-- Haunted by Combat

On Counseling Veterans

• Forces that cause veterans to break down:– Overwhelming grief

• For fallen battle buddies

– Exhaustion– Guilt

• “Aren’t we all murders?”

– Fear• That they may have let comrades down at some crucial

point, that they could not do what they needed to do

- Larry Dewey, War and Redemption

Veterans: Our Help

• http://www.youtube.com/watch?v=1gKkfNQ0lg0

Veterans: Our Hope

“Veterans are the light at the tip of the candle, illuminating the way for the whole nation. If veterans can achieve awareness, transformation, understanding, and peace, they can share with the rest of society the realities of war. And they can teach us how to make peace with ourselves and each other...”

-- Thich Nhat Hahn, Vietnamese Buddhist monk who worked tirelessly for reconciliation between North and South Vietnam during the Vietnam

war