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Mental Health Services

June 19, 2008

Making an Attempt to "Strip the Fuse" - Initiating Dialogue between Local Police and Veterans

IStock_000000618862XSmall NPR has another great story today, on a few OIF/OEF (Iraq and Afghanistan) combat veterans telling their stories in a public setting, in an attempt to defuse potential conflict with the communities where they live, especially with the police.  The story is called, "Dialogue Bridges Divide between Vets and Police," reported by Libby Lewis, and you can read the story or listen to it, here. It highlights the work being done by Jay White of the Hartford, Connecticut Vet Center, a facility funded by the Department of Veterans Affairs. According to Lewis, "before becoming a counselor, White served two tours in Iraq. The dialogues he moderates are meant to connect veterans with people who have no experience with war, namely people who deal with trouble — like police and emergency rescue personnel. These are the people whom soldiers returning home often find themselves dealing with."  It's great to see necessary, proactive stuff like this.

A surprising statistic, quoted in the story, by Brian Killany, a police crisis negotiator:

"The chances of [veterans] becoming a target group for us to have to deal with as a [police] negotiator is probably better than 50-50.”

Y-I-K-E-S.  Forewarned is forearmed -- no pun intended.  So much better to prepare for this in the way this program is doing, than be surprised by it -- when it's clearly a strong possibililty.

The NPR story also highlights the work of a Connecticut-based group, "Brothers in Arms," which the program says is "run by Iraq veterans with a mission of helping other returning soldiers. They also organize public speaking events to create awareness among civilians about the struggles of war veterans."  Their information is linked here.

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In addition, although not mentioned in the story, there's a great, 10 minute long video available on YouTube, which we blogged about here, by William R. Keating and the Norfolk County (Massachusetts) District Attorney's Office.  It's called "PTSD and Veterans: Beyond the Yellow Ribbon," and part of what it addresses is the re-integration of a combat veteran into his or her community, including the possibility of conflict with the police, and how both sides can manage that.  Well worth watching and bookmarking. The blog post we did about it a year or so ago is linked here, and it includes the video.

(Other counties in Massachusetts and in other states should consider contact William Keating's office and seeing if they can use the video with their constituents.  Information useful for contacting the Norfolk County (Massachusetts) District Attorney's office is linked, here.)

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Recently, we blogged about the similarities that cops and troops share in their exposure to cumulative increments of trauma, which often result -- for either of them -- in PTSD.  Ultimately, cops and trops may find out that they may find out they have more in common than they thought -- in terms of what they've been exposed to in their lines of work -- not just wearing uniforms, working out and carrying guns to work. 

Editor's note: The Hartford, Connecticut Vet Center information is linked here.  The directory lists Jay White but provides no additional contact information for him; undoubtedly, he can be reached the Center.

NPR Local Affiliate KQED's Story about VA Being Sued over Veterans' Healthcare

NPR Logo According to a story aired today on KQED -- a San Francisco public radio and television station, and NPR affiliate -- Berkeley, California's Disability Rights Advocates recently filed a lawsuit "that could affect thousands of veterans returning from Iraq and Afghanistan. They allege that the Department of Veterans Affairs is unable to provide timely mental health treatment for returning veterans. It describes a backlog of 600,000 claims for vets seeking care — some dating all the way back to the Vietnam War." To listen to the approximately five minute story, click here.  (And yes, this is the lawsuit that's produced the incendiary emails that have lately been in the news, including the infamous "shhh..." one about veterans suicides, which we blogged about earlier, here.)

Editor's Note: For more information about the veterans access to healthcare lawsuit in Federal court, as provided by the Disability Rights Advocates website, click here.

June 14, 2008

Floyd "Shad" Meshad, MSW

Shad Meshad After earning his Masters degree in Psychiatric Social Work from Florida State University in 1968, Shad went on active duty in 1969 as a Captain in the U.S. Army. In 1970, he served one tour as a Social Work/Psychology Officer for I and II Corps in the Republic of South Vietnam.

Upon his return to the states, Meshad continued his dedication to American veterans by starting the Vietnam Veterans Re-Socialization Unit at the Brentwood, CA VA Hospital in 1971. He spent eight years working with Vietnam veterans and their severe readjustment problems in the Los Angeles area. Shad was one of the pioneers in the study of the disorder known as Post-Traumatic Stress Disorder, or PTSD.

In the past 27 years, Shad has received many service awards and recognitions for his work. He authored a book about his year in Vietnam, Captain for Dark Mornings, which, highly acclaimed, is in its second printing. Meshad has made appearances on many major television networks and cable news talk shows, including 60 Minutes, 20/20, Dateline, Nightline, and CNN News. Shad continues to consult, train, and counsel nationally and internationally.

In 1986, Shad started a stress management and consulting service. In the early 90's he began focusing on treating compassion fatigue. This condition is identical to secondary traumatic stress disorder (STSD) and is the equivalent of PTSD. It is the stress resulting from helping or wanting to help a traumatized person. Through his associations, Shad introduced Charles Figley, Ph.D., a long-time friend and colleague to Dr. Roger Callahan who developed Thought Field Therapy. Dr. Callahan approached Meshad with the opportunity to study the effect of TFT therapy on veterans who suffered from PTSD. Impressed by the amazing results of this study, Shad has become a certified TFT diagnostician and practitioner, offering seminars on Levels I and II TFT nationwide.

In 2000 Shad founded Quantum Performance Institute with the goal of utilizing the amazing power of energy psychology techniques in the area of negative emotional states and attaining one's optimum performance level.

One Great Book: "Home to War - A History of the Vietnam Veterans Movement," by Gerald Nicosia

Home to War "The Past Does Not Equal the Future" -- queue Tony Robbins -- well, unless we refuse to learn the copious lessons of the past, in which case it very well might -- or it might make the past look positively enlightened, by comparison.  Another take on the same thing, by the perennial, inveterate quotemeister himself, Ben Franklin: "Experience keeps a dear [expensive] school, but fools will learn in no other."  I'm reading the greatest book right now, recommended by another journalist who's interested in veterans issues -- "Home to War: A History of the Vietnam Veterans Movement," by Gerald Nicosia, linked here.  It's 2 lbs., 10 oz., 689 pages, and roughly 136 cubic inches of nowhere-else-to-be-found material on the actual history of what created the Vietnam veterans' movement, which informs the veterans' rights movement of today, including the efforts to destigmatize PTSD, figure out what it was, re-include it in the DSM manual for psychiatrists (where it had been removed), etc.  Just fascinating.  All the players are there -- dozens of politically important types, including John Kerry, Ron Kovic (if you've seen "Born on the Fourth of July," you know who he is) as well as therapeutically important ones -- Shad Meshad, Ray Scurfield, Arthur Blank, M.D., Sarah Haley, etc. 

As a late-model Child of the Sixties, I had completely forgotten how much sheer effort -- blood, sweat and tears -- it took to get certain things passed that we now take for granted: better care at the VA, better provisions in the GI Bill, etc.  I had totally forgotten about the armed protests, the hunger strikes and sit-ins at the VA, etc.  It made me wonder whether leaders of the current veteran rights movements actually KNOW this history, and know how far their predecessors had to go, to secure the rights veterans rely on today -- which still need to keep pace with the times, and haven't.  The book is just plain fascinating, and b/c it's relatively neutrally written (as opposed to written with partisanship), with a steadfast focus on the facts and the key participants -- and because it's based on 600 or so interviews with the actual players, it's both extremely well done (a PBS series in book form, but with more depth!) and should keep my interest for quite a while.  So fascinating to know, or begin to hazily recall, the all-important "backstory" of where we are today.  And the insights on the genesis of understanding PTSD are well worth revisiting, all on their own.  Great book - wish I'd known about it before. As more and more veterans send me (unsolicited, I might add) their life stories, or their experiences with PTSD, I have to say -- this book really puts an awful lot together, behind the scenes, as to why they suffered in silence for so long.  Wonderful effort, and a pleasure to read.

Too bad tomorrow is already "Father's Day," but if you're lacking a gift for a veteran dad, Vietnam era or later, and can find this in stock at a local bookstore, it's a superlative collection of everything that went before, and helps us to understand the issues of the present, through the highly informing prism of the past.

June 13, 2008

The Double Whammy: Women Combat Veterans with PTSD and Military Sexual Trauma

CIMG0819 What's blowing up right now -- on the Web -- in terms of searches, within combat trauma and PTSD: definitely this one. People, the VA included, are looking for resources on treating women combat veterans who are victims of Military Sexual Trauma (MST) (see our index to entries discussing that, linked here). 

That means one of two things (prediction coming): either there's a scandal brewing, and about to hit the news, on this topic; or, the VA and others are fairly well bereft of resources and wondering how best to treat sufferers of this problem, who are apparently reaching the VA in greater numbers.  (One possibility: news items like this that show studies recently have shown an unsurprising but nevertheless unfair disparity in care between men and women veterans.)

Unfortunately, this is another case where civilians have a better situation going for them than the troops do.  In the civilian world, women can take their employers to court for providing a sexual harrassing or otherwise hostile work environment, and their victories in this arena put other employers on notice not to go and do likewise.  Sadly, the troops have no such protection.  It's completely a double whammy: combat trauma AND trauma from rape or other sexual crime.  Women servicemembers who've been affected by it say that in their minds, predominantly, the military sexual trauma is even worse than the PTSD, though they often occur together. 

It's clear we don't have a handle yet on treating PTSD; unfortunately, PTSD concerns even more people; and MST is probably further down the list of where resources are focused right now.  But whether through growing public awareness, better reporting, or for whatever reason, if searches are any indication, the VA is in a quandary about how best to treat MST, and even who the experts / what the resources are.  We wish them, and particularly those who have been injured and mistreated in this manner, all the best, and hope the situation resolves positively, and quickly, for our women veterans, who have been doubly injured.

June 11, 2008

Israeli Military's Proactive Plan for Identifying and Treating Soldiers Who Have PTSD

Here in the U.S., in our usual myopic way, we can get bogged down in the news about returning servicemembers with combat trauma and PTSD and forget just how many other countries in the world have struggled with this problem as well, and often found their own solutions.  Internationally, Japan, Israel, Australia, England and Canada frequently search the Internet for news about who's doing what, and what's working, for treating PTSD worldwide -- according to data from Google's analytical trends.  Today, the Jerusalem Post has an article about how Israel's Defense Ministry is about to unveil a plan for evaluating and treating soldiers systematically who have been exposed to PTSD as part of their military service.  (The article in question is linked here.)  Their expectation is that 2,500 Israelis suffer from PTSD, in a country where military service is compulsory, and conflicts in the region frequently boil over into sustained violence. 

The significance of the Israeli announcement is that the soldiers will be treated according to a "set psychological and medical format," meaning systematically and methodically.  Their understanding is that PTSD treatment succeeds better if initiated earlier, so evaluating all soldiers soon after military service will increase the chances of favorable treatment outcomes.  According to the article, three years ago the military started thinking through how to create a protocol that would involve every soldier, and optimize chances of finding and treating PTSD.  The protocol was developed by Zeev Waisman and Dr. Dan Dolfin.

Two interesting comments from the article express a vision that the U.S. might be wise to emulate:

"A soldier who comes out of battle will immediately be evaluated and we will see what type of treatment he needs," Waisman said. "Nothing is done today in a regulated fashion and we want all treatment to be according to a protocol."

The process begins by inserting the soldier's profile into the system which will then offer several courses for treatment that could include medicines, psychological therapy, family therapy, sex therapy and others. Waisman said that the Ministry of Defense hoped to convince other organizations to adopt the new format which will be evaluated in two years.

Stateside, it's not even clear that the various branches of the Armed Forces share a similar protocol for identifying and treating PTSD -- most likely, they do not.  With far more servicemembers at risk for PTSD than the Israelis have, we could do worse than to imitate what the Israeli Defense Ministry is putting into action as a plan to deal with PTSD, and return exposed servicemembers to better mental and emotional health.

June 10, 2008

Survivors Quilt: Combat Veterans Patch Meaning Together in Quilts about PTSD, War and Loss

Quilt Photos at VA in Seattle

You've heard of survivors' guilt - here we've got survivors' QUILTS.  (Bad pun, I know -- but true.)

We've been talking a bit lately about art therapy, and how combat veterans with PTSD use it successfully to tap into, and work through, some of the pain they feel inside. The photos here, by Mike Kane, at the Seattle Post-Intelligencer, are from a story published on March 19 about how the inpatient PTSD program at the VA hospital in Seattle has a "wall" of quilt squares, made by combat veterans, and encouraged by a nurse, Betsy Shapiro (she's at right, above), now retired, who gave deeply hurting veterans 6x6" cotton squares, on which to draw something or paint something that related to their experience: something they could leave behind, to let others know about them and what they had gone through. 

Initially, there was moaning and groaning, and reluctance to comply.  But shortly thereafter, everyone produced something, and the results were really pretty impressive.  The veterans also gave input into how they wanted the resultant squares displayed -- not set in pretty frames, like squares in a regular patchwork quilt might be, but together, side-by-side, touching.  The article, by Mike Barber, is called "Veterans tell stories in patchwork of memories," and it's linked here.

In an earlier article, from the Honolulu Advertiser from October 2, 2007, linked here, Glenn Reys, an Air Force vet in Honolulu worked through his recovery from drugs and alcohol by immersing himself in making a Hawaiian quilt, symbolic of his homeland, but also incorporating patriotric U.S. symbols.  He found himself devoted to the practice, and able to quilt for hours at a time.  "This kept me busy," Reys said. "When I do sewing like this, I can sew for like six or eight hours, and it's no problem. That's what I do in my continuing recovery."

In one of the best articles I've read about a Vietnam vet, Cecil Ison, struggling with PTSD, the author, Kathy Dobie, talks about visiting his home in Kentucky and watching his wife, Bet, a quilter, work on a quilt with Vietnam themes. Cecil and his two brothers all served in combat in Vietnam, and each responded in a different way.  Cecil's wife, Bet, attempted to capture her view of what they suffered in the quilt, turning an abstract -- feelings about the war, and the isolation it produced -- into something very concrete -- the quilt. She says that the quilt is too painful for Cecil to address directly, but through it, she is able to give vent to some of her feelings, about what she has watched her husband and his brothers go through.  Kathy Dobie writes:

[Cecil's wife, Bet, and I are spending time one afternoon.] We’re talking upstairs in the sewing room while she works on her Vietnam quilt. The room is stuffed with fabric: tweeds, cottons, velvets, hundreds of men’s ties. Bet sews at a small table by the window. She listens to oral histories of Vietnam 2428049925_b10a518f99 veterans as she works. On the left side of the quilt is an army-green map of Vietnam, showing the three cities where James, Cecil, and Arnold served. The rest of the quilt is blue, and three male figures float there, separated from one another and bearing labels: anger, despair, and guilt. The quilt reads: "my husband and his brothers came home from vietnam…three islands in an ocean of silence."  James is the Angry one, Cecil the figure of Despair, and Arnold is Guilt.

(This is the quilt in question, pictured to the right.  From top to bottom, you can see "Anger," "Despair," and "Guilt," and "Vietnam" is written lengthwise, on the left.)  Quilt copyright Bet Ison.

Below is another quilt with Vietnam imagery by Bet Ison.  Both quilts are copyright Bet Ison, and property of the author.  Photos are shared with Bet Ison's permission.

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(The article by Kathy Dobie article in GQ, is called "The Long Shadow of War," and we blogged about it earlier, here.  Dobie is also the author of the excellent article in the Nation, recently, called "Denial in the Corps" -- about Marines and the stigma of mental health issues, including PTSD, which we've also blogged about, here.)

Quilting is a uniquely American tradition.  Not that other countries haven't had their own versions of it, but it's uniquely tied up in the "fabric," as it were, of American history.  There are so many examples, from crazy quilts made of just scraps of silk, satin and wool garments, patched together on wagon trains as Americans headed West, to quilts made from flour sacks by pioneer women, to Civil War era "album quilts," to today's photo transfer quilts.  Quilts are often about "making do" with just the materials available, and there's something therapeutic about the needlework involved.  In 1837, American writer Nathaniel Hawthorne wrote in The Scarlet Letter, "Women derive a pleasure, incomprehensible to the other sex, from the delicate toil of the needle."  Well, by the 1970s, even he-men like football great Rosey Grier had picked up the needle, though not necessarily to quilt (he favored needlepoint instead).  Quilting is an unusual 3D art form that combines texture (the fabric, and the stitchwork) with color and design, and has a long and storied American history, besides.  It's interesting that combat veterans and their loved ones would find an outlet for some of their feelings in quilting.  Whether it's a square, a bed quilt, or a wall hanging, quilting allows for freedom of expression, and a form of "art therapy" that may just help those who are hurting to focus and transform their experience into something physical that they can share with others. 

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Editor's Note: If you want to continue this conversation about quilting and paying homage to a combat experience, your own or someone else's, email tributequilts AT gmail DOT com. 

"Give an Hour" Helps Fill Veterans Counseling Gap

Hourglass Give an Hour -- the foundation that matches member psychogists and counselors with veterans and their families in need of counseling at no charge -- to fill the currently unmet gap in mental health services, has been in the news recently.  (You can learn more about Give an Hour's founder, Barbara V. Romberg, Ph.D., in her bio, linked here). It's truly fantastic to see this public-spirited act of service on the part of Give an Hour; at the same time, it's a shame that private industry, so to speak, has to jump in to fill the unmet gap of mental health care -- the need for which care is an entirely predictable "soft cost" of going to war.  Nevertheless, good stuff, and very altruistic and forward-thinking on the part of Dr. Romberg and her organization.

From a press release:

The American Psychiatric Foundation, Lilly Foundation And Give An Hour Join Forces To Provide Mental Health Care To Iraq And Afghanistan Veterans

Heeding the call of a growing public health crisis -- the unmet mental health needs of returning soldiers and their families -- Give an Hour (GAH) and the American Psychiatric Foundation (APF) announced a major expansion of a nationwide effort to help U.S. veterans returning from Iraq and Afghanistan.

GAH and APF, the philanthropic and educational arm of the American Psychiatric Association (APA), will be using a $1 million grant from the Lilly Foundation to recruit and educate volunteer mental health professionals, who will become part of a network aiming to bridge the gap in mental health services for soldiers returning from service, as well as their families. Among troops returning from Iraq and Afghanistan, approximately 40 percent of soldiers, a third of Marines, and half of the National Guard members report psychological problems, but mental health services are in short supply.

"This all-volunteer effort provides badly needed support to help our veterans, many of whom come home with mental health needs," said U.S. Representative Steve Buyer (R-Indiana), Ranking Member, House Committee on Veterans' Affairs. "I applaud the hard work of Give an Hour, the American Psychiatric Foundation, and the Lilly Foundation, which are stepping up to help those who have selflessly served."

Efforts will be made to create a large, national, volunteer network over the next three years to address postwar mental health issues such as post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), drug abuse, anxiety and depression.

"This grant will allow us to get out the message that help is available. We want to normalize what our military personnel and their families are experiencing and support the sacrifices that they are making by providing critical mental health support at no cost," said Barbara V. Romberg, Ph.D., founder and president of GAH. "We will be educating the military community and broader public about these mental health needs in hope of helping veterans keep their lives and families intact."

GAH is recruiting mental health professionals to volunteer one hour each week for a minimum of one year to provide direct services in person, by phone or in consultation with schools and community organizations that serve the military community. Services are wide-ranging and include marital and family therapy, substance abuse counseling and treatment for PTSD. APF brings strong ties to the psychiatric community and is actively encouraging psychiatrists to join the network.

"This grant will help us reach our goal of recruiting 10 percent of the 400,000 mental health professionals in the United States by 2015 to assist in this effort," said Dr. Richard K. Harding, M.D., president of the APF. "It is an ambitious goal, but we are confident it can be achieved."

The Department of Defense (DoD) is making an unprecedented attempt to encourage personnel to seek mental health treatment, but a significant increase in demand, in some areas, has forced the rationing of services, created long waiting lists and limited individual counseling sessions. In addition, some members of military families such as parents, siblings and unmarried partners do not qualify for care through the Veterans Administration or DoD but are affected nonetheless by the mental health of the veteran.

"We're privileged to be able to give something back to our troops, but we know there's still much more to be done," said Steven Paul, M.D., executive vice president for science and technology and president of Lilly Research Laboratories. "Lilly is fully committed to assuring that the best possible medicinal treatments are available, but unfortunately, we also know that having access to the best care -- in this case mental health services -- is essential."

About Give an Hour
Give an Hour is a nonprofit 501(c)(3), founded in September 2005 by Dr. Barbara V. Romberg, a psychologist in the Washington, D.C., area. The organization's mission is to develop national networks of volunteers capable of responding to both acute and chronic conditions that arise within our society. Currently, GAH is dedicated to meeting the mental health needs of the troops and families affected by the ongoing conflicts in Iraq and Afghanistan. Give an Hour now has approximately 1,200 providers across the nation and continues to recruit volunteer mental health professionals to its network. For more information or to volunteer to become part of the effort, please visit http://www.giveanhour.org.

About The American Psychiatric Foundation
The American Psychiatric Foundation is the charitable and educational subsidiary of the American Psychiatric Association. The mission of the foundation is to advance understanding that mental illnesses are real and can be effectively treated. For more information, please visit the foundation's web site at http://www.psychfoundation.org.

About Lilly
Lilly, a leading innovation-driven corporation, is developing a growing portfolio of first-in-class and best-in-class pharmaceutical products by applying the latest research from its own worldwide laboratories and from collaborations with eminent scientific organizations. Headquartered in Indianapolis, Ind., Lilly provides answers -- through medicines and information -- for some of the world's most urgent medical needs. Additional information about Lilly is available at http://www.lilly.com.

From Give an Hour's website:

Our Mission
Our mission is to develop national networks of volunteers capable of responding to both acute and chronic conditions that arise within our society. Our first target population is the U.S. troops and families who are being affected by the current military conflicts in Afghanistan and Iraq. Give an Hour is asking mental health professionals nationwide to literally give an hour of their time each week to provide free mental health services to military personnel and their families. Research will guide the development of additional services needed by the military community, and appropriate networks will be created to respond to those needs. Individuals who receive services will be given the opportunity to give an hour back in their own community.

Our Focus
Our organization is currently focusing on the psychological needs of military personnel and their families because of the significant human cost of the current conflicts. Over 1.6 million troops have been deployed in Afghanistan, Iraq, and the Persian Gulf since September 11, 2001. Nearly 550,000 of these troops have been deployed more than once. According to the U.S. Department of Defense, as of May 15, 2008, nearly 4,600 American troops have died in Iraq and Afghanistan. Roughly 32,875 U.S. troops have been injured during these conflicts.

In addition to the physical injuries sustained, countless servicemen and servicewomen have experienced psychological symptoms directly related to their deployment. According to a RAND report released in April 2008, over 18 percent of troops who have served in Iraq and Afghanistan--nearly 300,000 troops--have symptoms of post-traumatic stress or major depression. At the same time, about 19 percent of service members reported that they experienced a possible traumatic brain injury. And let us not forget: millions of Americans belong to the families of these servicemen and servicewomen. Spouses, children, parents, siblings, and unmarried partners of military personnel are all being adversely affected by the stress and strain of the current military campaign.

Our military leaders are well aware of the human cost of this campaign. Indeed, they are attempting to address the psychological needs of the troops through a variety of programs within the military culture. Unfortunately, the tremendous number of people affected makes it impossible for the military to respond adequately to the mental health needs in its greater community. For example, according to the RAND study, only 43 percent of troops reported ever being evaluated by a physician for their head injuries. Moreover, returning combat veterans suffering from depression, anxiety, and post-traumatic stress disorder (PTSD) are not routinely seeking the mental health treatment they need. RAND also reports that only 53 percent of service members with PTSD or depression sought help over the past year.

A major barrier preventing military personnel from seeking appropriate treatment is the perception of stigma associated with treatment. Many fear that seeking mental health services will