Healing Combat Trauma

Mind Body Medicine: Healing the Troops

We've talked about James S. Gordon, M.D.'s Center for Mind-Body Medicine and their successes in "Healing the Wounds of War" recently on this blog, and the wait to see if they would revamp this program to address the needs of PTSD and the troops.  Finally, at long last...The Center for Mind-Body Medicine's program for Healing the Troops, informational material linked here.

From their website:

The Center has created a program of training in mind-body medicine and on-going support for physicians and mental health professionals working with veterans returning from Iraq and Afghanistan as a first step to providing veterans with a powerful and healthy approach to dealing with the stress of war and to enhancing their resiliency.

This program will be a significant focus at our Fall 2008 Mind-Body Medicine training, for which we have received funding to bring 20 military healthcare professionals on scholarship. We are seeking additional funding for this important effort.

Also from their website:

The Center for Mind-Body Medicine has developed a trauma relief program utilizing mind-body skills including biofeedback, relaxation, guided imagery, meditation, drawing, and breathing exercises that has been used successfully around the world.

This program, which is presented in small educational groups, has the advantage of enhancing veterans’ capacity to help themselves while mobilizing social support crucial to full recovery. The Center has used this program to assist in population-wide healing efforts in war-torn and traumatized regions around the world, including Bosnia, Kosovo, Macedonia, Israel and Gaza , and in the United States with NYC firefighters post-9/11 and in post-Katrina Louisiana.

Further information about the 2008 conference is linked here. Dr. Gordon's bio is linked here.

"Give an Hour" Helps Fill Veterans Counseling Gap

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 jeopardize their career or standing. Others are reluctant to expose their vulnerabilities to providers who are often military personnel themselves, given the military culture’s emphasis on strength, confidence, and bravery. Servicemen and servicewomen might be more inclined to seek help if they know that the services provided are completely independent of the military. By providing services that are separate from the military establishment, we offer an essential option for men and women who might otherwise fail to seek or receive appropriate services.

We are also offering services to parents, siblings, and unmarried partners who are not entitled to receive mental health benefits through the military. Although these individuals may have access to mental health services through other means, they are less likely to seek the help they need and deserve if that help is difficult to find or costly. Our goal is to provide easy access to skilled professionals for all of the people affected by the current war. The participating mental health professionals offer a wide range of services including individual, marital, and family therapy; substance abuse counseling; treatment for post-traumatic stress disorder; and counseling for individuals with traumatic brain injuries. Whether it is a young military wife who is anxious because her four-year-old has had nightmares since her husband’s deployment or a father who is struggling to cope with his son's loss of a leg as a result of an explosion in Iraq, both will receive the assistance they need to move through their experience. The healthier the support system for the returning troops, the lower the risk of severe or prolonged dysfunction within these military families.

Our Plan
Give an Hour is reaching out to the military community in several ways. As a member of America Supports You, a Department of Defense program that provides opportunities for citizens to show their support for the U.S. Armed Forces, we are identifying individuals involved in post-deployment processing of returning troops. We are developing collaborative relationships with the commanding officers of returning troops so that these officers are aware of and comfortable with the services we provide. We are also working closely with a number of veterans service organizations to promote our services directly to the family members of troops. Furthermore, we are working with individuals affiliated with Walter Reed Army Medical Center in Bethesda, Md. We are also collaborating with the Veterans Administration to distribute information about our services through Vet Centers across the country.

Finally, we are promoting our services to the military community and the public through a media campaign that includes print, television, and radio coverage. In fact, our founder and president, Dr. Barbara Romberg, has been interviewed in national media outlets from the Washington Post to NPR's Diane Rehm Show, Ladies' Home Journal, and HD Net's World Report.

Give an Hour recruits mental health professionals in several ways. We have been endorsed by the American Psychiatric Association and the National Association of Social Workers and are seeking endorsements from other major mental health organizations. Only licensed mental health professionals are included in the network. Licenses are verified. Non-licensed pastoral providers may be included in the network as long as they meet other criteria, including membership in professional organizations. In addition to coordinating with national organizations, we also recruit mental health professionals through professional publications and Web sites.

As of May 2008 we have a redesigned Web site, expanded to include materials to guide visitors seeking services as well as reference materials to inform mental health professionals. Only mental health professionals trained and experienced to work with trauma victims will identify themselves as available to work with soldiers who have experienced combat. We are working with experts in the trauma field to prepare materials for our Web site and to find appropriate mental health professionals for recruitment.

The Eli Lilly and Company Foundation recently awarded Give an Hour, in partnership with the American Psychiatric Foundation, a major grant that will allow us to spread our message to the leaders of the mental health community in every state. 

We are recruiting volunteers from a number of organizations and institutions as well as through our Web site to assist us in the implementation of our program. Volunteers from retired military personnel to members of military families to concerned civilians throughout thte country are helping Give an Hour. Volunteers are checking licenses, distributing brochures, and coordinating community partnership opportunities for those troops and family members interested in giving back an hour to their own community.

Our Vision
Our primary focus will always be to attend to those in need by linking them to individuals in our society best equipped to respond effectively. In addition, we will develop research and educational programs to further promote the value and importance of a new kind of volunteerism. We hope to encourage an increase in shared responsibility for those citizens who are suffering. We need only look at the outpouring of aid and support following both the terrorist attacks of September 11, 2001, and Hurricane Katrina in August 2005 to see the potential we have to become a truly compassionate and united nation. And we need only look at the significant costs of the war in Iraq and the relief efforts for Katrina’s victims to see that federal and state governments are already strained beyond their means. We have not only the potential but the duty to help one another in times of need.

For more information, contact Barbara V. Romberg, Ph.D., Founder and President, Give an Hour.  Her email address is linked here.

NYC's Urban Justice Center Offers Returning Veterans Legal Aid and Advocacy

The Veterans and Servicemembers Project of New York City's Urban Justice Center, linked here, offers, in their own words, "legal services and advocacy to a population often abandoned by the very system of government they defend in battle. Drawn increasingly from the poorest and most vulnerable communities in the country, past and present military personnel contend with poorly regulated recruiting tactics, unsafe working conditions, and an antiquated and overloaded disability benefits process. Often unaware of their rights and wary of challenging authority, they face especially daunting barriers to necessary assistance."

Furthermore, "At an individual level, the Veterans and Servicemembers Project provides legal training and representation on matters ranging from veterans disability claims to service discharge applications. The project also pursues systemic reform through litigation and advocacy in such areas as recruiting irregularities, workplace harassment, and inefficiency and abuse in the benefits application process. With the active collaboration of existing service organizations, it aims to provide comprehensive education and support for a population that, in a time of mounting war, promises only increase in size and collective need." 

Editor's Note: To learn more about this program, read the excellent article by Thomas Adcock, called, "Returning from War," originally published in the New York Law Journal, on February 22, and linked here.  If you're a lawyer who'd like to participate pro bono in helping veterans, click this link. 

James S. Gordon, M.D., Founder and Director of The Center for Mind-Body Medicine

James S. Gordon, MD, a Harvard-educated psychiatrist,is a world-renowned expert in using mind-body medicine to heal depression,anxiety,and psychological trauma. He is the Founder and Director of The Center for Mind-Body Medicine, a Clinical Professor in the Departments of Psychiatry and Family Medicine at Georgetown Medical School, and recently served as Chairman of the White House Commission on Complementary and Alternative Medicine Policy. He also served as the first Chair of the Program Advisory Council of the National Institutes of Health’s Office of Alternative Medicine and is a former member of the Cancer Advisory Panel on Complementary and Alternative Medicine of the NIH.

 

Dr. Gordon has devoted over 35 years to the exploration and practice of mind-body medicine. After gradating Harvard Medical School, he was for 10 years a research psychiatrist at the National Institute of Mental Health. There he developed the first national program for runaway and homeless youth, edited the first comprehensive studies of alternative and holistic medicine, directed the Special Study on Alternative Services for President Carter’s Commission on Mental Health, and created a nationwide preceptorship program for medical students.

 

Dr. Gordon has created ground-breaking programs of comprehensive mind-body healing for physicians, medical students, and other health professionals; for people with cancer, depression and other chronic illnesses; and for traumatized children and families in Bosnia, Kosovo, Israel and Gaza as well as in post-9/11 New York and post-Katrina southern Louisiana. Nearly 3,000 health and mental health professionals throughout these regions have been trained by Dr. Gordon to more effectively address the psychological trauma within their communities, including supervision and training of a local leadership group within each region which enables the CMBM model to be fully integrated into and sustainable within the local healthcare community.

 

Dr. Gordon’s most recent book is Unstuck: Your Guide to the Seven Stage Journey Out of Depression (Penguin Press). His also the author of Comprehensive Cancer Care: Integrating Alternative, Complementary and Conventional Therapies and Manifesto for a New Medicine: Your Guide to Healing Partnerships and the Wise Use of Alternative Therapies (both Perseus Books). In addition, Dr. Gordon has written or edited 9 other books, including the award-winning Health for the Whole Person, and more than 120 articles in professional journals and general magazines and newspapers, among them the American Journal of Psychiatry, Alternative Therapies in Health and Medicine, Journal of Traumatic Stress, Psychiatry, The American Family Physician, The Atlantic Monthly, The Washington Post, and The New York Times. He also helped develop and write the educational materials to supplement the public television series “Healing and the Mind with Bill Moyers”.

 

Dr. Gordon’s work has been featured on Good Morning America, The Today Show, CNN, CBS Sunday Morning, FOX News and National Public Radio, as well as in The Washington Post, USA Today, Newsweek, People, American Medical News, Clinical Psychiatry News, Town and Country, Hippocrates,  Psychology Today, Vegetarian Times, Natural Health, Health, and Prevention.

Legal Services for Veterans and Their Families

In the legal world, the term "legal services" has come to mean attorneys offering services to those who can't afford to pay the ordinary full rate, because of a specific financial hardship.  Lawyers might service "pro bono" (from the Latin, meaning "for the public good") or at a lower fee than they usually charge, in order that more deserving clients whose financial conditions would otherwise preclude them from getting legal representation might get some timely help.  Harvard Law School, among others, under the visionary leadership of Dean Elena Kagan, has put a strong emphasis on the need for law students to spend some time during their training doing public interest law, or otherwise contributing their time to those less fortunate, and has made this a requirement for graduates since 2002 (click here to learn more about that program, or here to learn about Harvard Law School's commitment to public service). 

In the lawyers and veterans world, there's a specific organization devoted to providing legal services to needy veterans.  It's called the National Veterans Legal Services Program, or NVLSP, and it's been around for more than 25 years. (To learn more about the National Veterans Legal Services Program, click here.)

According to its website, the NVLSP is an independent, non-profit, nonpartisan organization that has helped veterans and their families with legal advice and representation for the last 25 years.  It's dedicated to ensuring that the U.S. government honors its commitment to our veterans by providing them the federal benefits they have earned through their service to our country. NVLSP accomplishes its mission by:

Providing veterans organizations, service officers and attorneys with training and educational publications to enable them to help veterans and their dependents obtain all of the benefits
that they deserve; and
 

Representing veterans and their dependents who are seeking benefits before the U.S. Department of Veterans Affairs and in court.

It trains veterans advocates, both lawyers and non-lawyers - in classroom trainings and through correspondence courses.  For more information about its advocacy training, click here.  It also encourages practicing attorneys to represent veterans on a pro bono basis (i.e., for the public good.)  For more information about the pro bono need for lawyers, click here.

The National Veterans Legal Services Program (NVLSP) has published a manual, called "Veteran Benefits Manual, 2007," linked here. The authors are Barton F. Stichman, Co-Director of and lead litigator for NVLSP, who has earned over $100 million in VA benefits for his clients over the last 27 years, and Ronald B. Abrams, Co-Director of NVLSP and a 17-year VA insider. Over the past 16 years he has trained thousands of veterans’ advocates.

Editor's Note: If you're a Harvard Law School alumnus or alumna, consider contacting Dean Elena Kagan and encouraging her to institute a program offering pro bono services geared towards veterans and their families.  HLS has a number of fantastic legal services offerings and programs, but as of this writing, none directed specifically towards veterans, who clearly need and could use the help -- and alumni comments make a difference.  The Dean's Office address is Harvard Law School, Griswold 200, 1525 Massachusetts Avenue, Cambridge, MA 02138.  Tel.: (617) 495-4601.

Also, if you're an attorney who has developed a specialty representing veterans, or better yet, does the same pro bono, and would like to have your services listed, please contact us to be listed in a forthcoming directory.  Thank you.

Homeless Veterans: Still Hidden in Plain Sight

The plight of homeless veterans may not be making the news right now as it did around Thanksgiving -- but one thing's for certain: they haven't stopped being homeless in the meantime.

Recently, Homeless Veteran Provider Technical Assistance Center listed our blog as an excellent resource -- thank you.  Note the wonderful illustration at left, done by veteran activist and artist John Paul Hornbeck, creator of the "Shattered Soldier" lifesize sculpture about PTSD, blogged about earlier, here.  John's revisions to the famous POW/MIA flag says quite kindly about the homeless veterans among us, "You Are Not Forgotten Either."  If only that were really the case -- perhaps over time we as a society can make it so.  (He's also cleverly changed "MIA" to mean, "Missing in America," pretty much the same as, "missing in plain sight" -- since clearly the homeless, and homeless veterans in particular, are everywhere, whether we choose to tune in and notice, or not.  (To see more about John Paul Hornbeck's "Shattered Soldier" sculpture, click here, here or here.) 

If you want to learn more about the plight of homeless veterans in America, start here, with the Homeless Veterans Fact Sheet, produced by the National Coalition for Homeless Veterans.  The fact sheet discusses statistics for both homeless veterans and incarcerated veterans.  And the statistics paint a grim and sorrowful picture.  According to statistics supplied by the U.S. Department of Veterans Affairs (VA), the nation's homeless veterans have been historically mostly males (though those figures are likely to change, with the advent of more women serving in the military). 

The vast majority are single, most come from poor, disadvantaged communities, 45% suffer from mental illness, and half have substance abuse problems. America’s homeless veterans have served in World War II, Korean War, Cold War, Vietnam War, Grenada, Panama, Lebanon, Operation Enduring Freedom (Afghanistan), Operation Iraqi Freedom, or the military’s anti-drug cultivation efforts in South America. Forty-seven percent of homeless veterans served during the Vietnam Era. More than 67% served our country for at least three years and 33% were stationed in a war zone. (Editor's Note: observe the connection between substance abuse and/or mental illness and homelessness. More work needs to be done to study other predisposing factors to homelessness, including PTSD and Military Sexual Trauma.)

The National Coalition for Homeless Veterans also has a good, web-based list of service providers -- programs that are geared towards homeless veterans.  Click here for that link.  They say they periodically update their website by adding more programs as information becomes available, but right now you'll only find organizations listed in the following handful of states: California, Indiana, Massachusetts, Maryland, Minnesota and New York.  (Click on any of those states' names to go right to the information available on their site.)

Mental Health of Veterans' Family Members Deserves Attention, Too

Just a quick note to mention that Todd Bowers, Director of Government Affairs at the highly pro-active Iraq and Afghanistan Veterans of America ("IAVA") recently testified before the House Veterans' Affairs Subcommittee of Health about an additionally important topic: the mental health of veterans' family members.  The topic?  "Mental Health Treatment for Families: Supporting Those Who Support Our Veterans" -- that would make a great slogan.  (A few days later, the Christian Science Monitor also covered this topic, in an article entitled, "A New Push to Help Families of Veterans."  That article is linked here.)

It's no secret though perhaps it should get much more attention that combat trauma affects not only veterans but also those in their immediate families.  A veteran's suffering affects his or her family members significantly, as the burden of caregiving falls most strongly on the veteran's immediate family.  There are physical, emotional, social and financial costs to caregiving, not the least of which is strained mental health.  At least with Vietnam veterans, studies have shown that children of veterans with PTSD are at increased risk for suicide themselves. (Although it's the subject of some controversy, an Australian government study of their own Vietnam veterans concluded that children of veterans were three times as likely as the general population to commit suicide.)  It's great to see that the IAVA is making the case that more resources need to be allocated for families' mental health resources as well.  For more information on this important topic, see the IAVA blog entry linked here, or the House subcomittee's site, linked here.  For a link to the audio coverage of the hearings, click here.  For earlier blog posts on caring for the caregivers, click here; or about the family, click here.

Editor's Note: It's interesting to note that just today, the Australian government published its conclusion, that counseling services would be made available to their veterans and families.  To read more about it, download this PDF.  To learn more about the Australian Vietnam veterans health studies, click this link to a subsequent blog post.