Post-traumatic Stress Disorder @ MindSay

By Samantha L. Quigley

American Forces Press Service

 

July 25, 2008 - Veterans transitioning from war to peace may need a place to call home, whether it's for the long or short term, the executive director of a North Carolina-based program that offers them that and a good bit more said. "The needs we are addressing all, in some way, revolve around temporary and long-term living arrangements that are appropriate for the various challenges that our active duty and military veterans face," Lance Orndorff said about "American Heroes Return."

 

"Camp Hero" is an integral part of American Heroes Return, which, in turn, is part of the Virginia-based "Place of Solace, Inc."

 

The camp offers a phased living environment at no cost to active-duty servicemembers or veterans, he said. Veterans suffering from post-traumatic stress disorder or permanent disability and in need of long-term care have access to the home-style camp that offers a mixed-use residential environment with shopping and social and recreational opportunities.

 

Active-duty servicemembers simply looking for someplace to hang out while they're home for rest and recuperation can stay in simple cabins and take in all that Camp Hero has to offer.

 

"Active-duty military on terminal leave and veterans post-active duty have a difficult time finding a 'landing zone' when returning to the states or leaving the base," Orndorff said. "They usually need just one to three months of living accommodations, as well as job location and training assistance, to get them reestablished in the civilian sector.

 

"This is where they can choose from either the rural farm or in-town contemporary housing experience, where they work with others like themselves who are transitioning back into civilian life," he added.

 

American Heroes Return is a new supporter of America Supports You, a Defense Department program connecting citizens and companies with servicemembers and their families serving at home and abroad.

 

The organization's America Supports You affiliation is helping bridge the gap between its efforts to support both active-duty servicemembers and veterans, Orndorff said.

 

"I'm finding that my own review of other [America Supports You-affiliated] organizations ... is leading me to begin thinking about ways to network and partner," he added. "There may be portions of programs that we had intended to establish on our own that we can better accomplish by partnering with a group already accomplishing that task."

By Jamie Findlater

Special to American Forces Press Service

 

June 17, 2008 - Mental Health practitioners nationwide are donating their time and services to provide free, confidential counseling to military people and their families. "Combat affects everyone in one way or another," explained Dr. Barbara Romberg in an "ASY Live" interview on BlogTalkRadio. "Most people react when exposed to a situation where there are extreme or horrific events; it is a human reaction to abnormal situations."

 

ASY Live is part of the Defense Department's America Supports You program, which connects citizens and companies with servicemembers and their families serving at home and abroad.

 

Romberg, founder and president of "Give an Hour," said she started her nonprofit organization to educate servicemembers and their families about the seriousness of post-traumatic stress disorder and the importance of taking steps to combat it.

 

"When we set up the organization a few years ago, the concept was very simple, she said. "We asked mental health professionals across the country to give an hour of their time."

 

When one of the program's providers was asked why she joined, Romberg said, her answer was equally simple. "How could I not? It's so little that they are asking of me to give," the practitioner said.

 

Romberg said a broad spectrum of mental health practitioners participated in Give an Hour. "We have mental health professionals of all kinds -- psychologists, psychiatrists, social workers, licensed marriage and family counselors, substance abuse counselors and pastors," she explained. "One size doesn't fit all; people need different things."

 

Raising awareness about PTSD is as important to the group as providing help to people who need it, she said.

 

"We are really launching a public education campaign to make sure our entire country understands post-traumatic stress -- what it is and why it's so important to address," she said. "Post-traumatic stress is a condition that will affect most people."

 

Romberg said there are important signs that a family member can identify that may be an indication that professional help may be a necessary part of the recovery process.

 

"Anyone might be withdrawn or irritable for awhile, but if those symptoms persist past six or eight weeks, then you need to take action," she said. "If the family member seems to be uninterested in activities that they used to be interested in before, uninterested in relationships with spouses or children, or engaging in persistent drinking or substance abuse as a way of escaping, that's a warning sign," she explained.

 

Nightmares, anxiety attacks and rage can lead to very serious symptoms if left untreated, she added, "but it doesn't have to become a chronic mental illness at all."

 

For that reason, Romberg explained, it is important that family members work to recognize symptoms and seek counseling as quickly as possible. Most people want to feel as if they can handle these issues, she said. And in fact, they can, but sometimes they need assistance, she added. That's where Give an Hour comes in.

 

Give an Hour provides counseling not only for servicemembers, but also for affected family members, whom Romberg defines as "anyone who loves someone who is serving."

 

"When someone we love is deeply affected, the consequences are usually fairly far-reaching," she explained. "Spouses and children are, of course, an immediate concern, ... but grandparents, aunts and uncles are just as affected by this situation.

 

"If you, as a family member, feel like you have resources," she continued, "you can put together a plan and you have ... someone else to help you think through it, and eventually encourage [your] loved one to come with [you]."

 

It is also important, she noted, to keep a close eye on children.

 

"Spouses that are focused on their husband or wife, it might be really difficult to also be concerned with their children," she said. "We see things such as regression -- a young child that's maybe 3 was potty-trained and all of a sudden starts wetting the bed or isn't eating or sleeping well."

 

The services offered by Give an Hour are free and ongoing, and providers stay in the network a minimum of a year, Romberg said.

 

"If their provider has to leave, we provide a replacement," she noted. "They are never told, 'You've used up your services here.' By building such a hard network, it's not a hardship to give an hour. And [the practitioners] are happy and eager to give."

 

To receive support or to register to become part of this support network, people can visit the organization's Web site, www.giveanhour.org. People seeking help can search for the nearest participating provider by entering their ZIP code.

 

"It can be an educational conversation or it can be setting up an appointment to meet face to face," Romberg said. "If they don't know what type of assistance they need, they can also click on the 'Contact Us' button, ... and we will help locate a provider.

 

"It's all about partnering, networking, reaching out, connecting -- helping them to get what they need," she said.

 

(Jamie Findlater, host of "ASY Live" on BlogTalkRadio, works in the New Media directorate of the Defense Media Activity.)

By Navy Lt. Jennifer Cragg

Special to American Forces Press Service

 

May 23, 2008 - Reducing the stigma related to servicemembers seeking mental health assistance is a total team effort that involves educating peers to look out for each other and encouraging those who might be reluctant to receive care, a senior military medical official said yesterday.  "Commanders and noncommissioned officers really play a critical role in eliminating stigma, especially the junior-level noncommissioned officers who are with the troops on a day-to-basis. They play a key role in this goal of decreasing stigma," Col. (Dr.) C.J. Diebold, chief of the psychiatry department at Tripler Army Medical Center in Hawaii, said in an interview on the "Dot Mil Docs" program on BlogTalkRadio.com.

 

He added that improving one's overall behavioral health by eating sensibly, getting exercise, and practicing good hygiene are key factors when facing stressful situations. "Behavioral health is important to everyone, as it directly affects how a person feels and acts," Diebold said.

 

He added that keeping up overall mental health is especially crucial when deployed to a combat zone.

 

"When one is deployed in a place like a combat zone, one must really maintain a really healthy lifestyle and a positive attitude to be able maintain good behavioral health," Diebold said.

 

Encouraging servicemembers to learn more about maintaining overall mental health for not only themselves, but also for their families, is just one of the elements highlighted in May, which is Mental Health Month.

 

"It jogs people's consciousness to recognize the importance of mental health, and hopefully that will continue throughout the entire year," Diebold said.

 

Many lessons have been learned by looking at mental health issues year-round, he added.

 

"One of the lessons learned over the past few decades is the importance of a servicemember's psychological well-being in terms of being able to perform their mission, but also the psychological well-being of their families," Diebold said. He added that servicemembers who may need assistance either during or after their deployment have a lot of different options to choose from.

 

"A servicemember could go to their unit chaplain, and I have talked with servicemembers over the years, and this is really the first place that a lot of people will go to," he said. "The chaplains are a very good way to go and be able to talk through some of the issues that are going on."

 

Diebold said still other outlets include talking with primary care providers, behavioral health professionals, psychologists, psychiatrists, social workers, family therapists, and alcohol- and substance-abuse counselors.

 

"The important thing to remember is that if a person is concerned that they may have experienced a traumatic event in theater and some other environment, and it is really affecting them, to go in and talk to a counselor [or] their primary care manager and get evaluated and get treated if it is indicated," Diebold said. "The sooner it's recognized and the sooner it is evaluated and treatment, the better a person is going to feel, and [it decreases] the chance that they may have long-term effects."

 

Servicemembers may encounter post-traumatic stress disorder or combat and operational stress during or after deployments, Diebold said.

 

"I think that it is now the longest continuous combat operations of any war besides the Revolutionary War, and we have had servicemembers deploying multiple times now," he said. "The stress that servicemembers and the families [are experiencing] have been well recognized, and that is why these special programs and bolstering of helping services have been implemented to help out."

 

Some of the symptoms associated with PTSD are nightmares, nervousness, anxiety or flashbacks. In contrast to PTSD, combat and operational stress reactions are short reactions to stress from being in the combat zone. Usually, combat and operational stress symptoms will resolve with rest, short-term counseling or sometimes simply on their own, he explained, whereas symptoms of PTSD can last a few days, months or even years.

 

Diebold added that the Department of Veterans Affairs has been working to find treatments for PTSD. Usually, with treatment, a servicemember affected by PTSD can return to active duty. Mental health professionals are deployed in theater to aid servicemembers who may be dealing with PTSD or know someone who is, he noted.

 

"Our mental health professionals are out there among the troops, educating the troops that this is an expected reaction and here are some of the things that you can do to help decrease some of your stress.

 

"Commanders and soldiers are being educated and being encouraged to go in and seek mental health treatment," he continued, "and leaders are encouraged to allow their soldiers time away from work ... to get evaluated and treated."

 

(Navy Lt. Jennifer Cragg works in the New Media branch of the Defense Media Activity.)

By Elaine Wilson

Special to American Forces Press Service

 

May 22, 2008 - The U.S. Army Institute of Surgical Research here has launched a program aimed at caring for a segment of the military population much more accustomed to administering care than receiving it. The program, called Care for the Caregivers, is designed to identify and treat a syndrome called "compassion fatigue" in military health care providers.

 

Compassion fatigue, also known as secondary traumatic stress disorder, is the emotional residue or strain of exposure of working with patients recovering from traumatic events.

 

The relatively new term, coined by Dr. Charles Figley in the 1990s, is becoming increasingly popular as caregivers are faced with the long-term care of trauma patients surviving the battlefield in greater numbers than ever before.

 

"We're starting to notice signs of compassion fatigue in caregivers of wounded warriors," said Army Col. Kathryn Gaylord, director of the Army Institute of Surgical Research's Care for the Caregivers program. "Caregivers are giving everything of themselves to care for patients, but there's a price sometimes associated with that."

 

Taxed by deployments of their own and the complicated care of severely wounded servicemembers, caregivers are beginning to exhibit signs of trauma normally reserved for patients. With symptoms such as heightened irritability, anxiety, depression and sleep disturbances, the syndrome bears a marked resemblance to post-traumatic stress disorder.

 

"Compassion fatigue is when caregivers have such deep empathy they develop symptoms of trauma similar to the patient," Gaylord explained.

 

While similar in nature, Gaylord pointed out the difference between compassion fatigue and "burnout," an emotional exhaustion many people experience due to increased workload and institutional stress. Unlike compassion fatigue, burnout does not contain a trauma element.

 

Over time, compassion fatigue can lead a caregiver to grow distant from patients or, on the flip side, too close. Both can be detrimental to the patients and families.

 

Caregivers at the burn center, for instance, treat the same patients for months or even years, which can lead to a strong connection, and a strong sense of failure, guilt and loss if a patient does not survive.

 

"We treat patients for many weeks to months, during which time they undergo many operations and procedures," Gaylord said. "A strong relationship develops with the patient's family; we get to know them very well."

 

Army Spc. Antonio Cevallos, a physical therapy technician at the institute, is familiar with the ongoing intensity of day-to-day care. He went from transferring patients wounded in Iraq via ground ambulance in Kuwait to treating wounded warriors in the burn center.

 

"I see a lot more here [at the institute]," he said. "Compared to minutes or hours of one-on-one contact, it's days and weeks. It has its ups and downs."

 

Cevallos said he grew close to several patients and was pained to see two patients deteriorate, then pass away.

 

"It's difficult at times," he said. "But what keeps me going is the fact that I'm helping other people. As long as I keep my purpose, it keeps me above water."

 

Caregivers are trained to be compassionate, but there is little training in the military on how to handle the stress of compassion, said Gaylord, who hopes to remedy the problem through the Care for the Caregivers program.

 

The doctor described the program as a combination of prevention training and treatment through the use of seminars and stress-management techniques.

 

"We have a series of world-renowned experts coming here to speak on topics such as grief, relaxation, nutrition and exercise," said Gaylord, who said the key to prevention is to find ways to manage and alleviate stress.

 

The seminars include education on the latest relaxation techniques, including "Alpha Stim," which is cranial electrical stimulation and vibration sounds that trigger the brain to relax.

 

In addition, Gaylord and her staff are building a respite room at the institute, which will serve as a peaceful haven caregivers can retreat to and regenerate. Wanting a state-of-the-art area, Gaylord contracted an architect who designed relaxation rooms for Nike and Hilton.

 

"The room will be very relaxing with a waterfall, music, massage chair, special motion chair and a video with headsets," she said.

 

Gaylord also plans to integrate group sessions and questionnaires that will help identify issues and track the impact of the program.

 

Cevallos said having a support system at work is beneficial.

 

"Sometimes you need to talk to someone or relax with a group," he said. "I've sat down in a session, and it was soothing. There's a sense of comfort from being with other people who are going through similar experiences."

 

Army Chaplain (Maj.) Philip Kochenburger, Brooke Army Medical Center chaplain, attended a compassion fatigue seminar on loss, grief and trauma May 9 and used an air travel safety briefing analogy to describe the importance of caring for caregivers.

 

"The flight attendants always tell you to put on your own oxygen mask first before you help others," he said. "The same is true of caregivers. They have to make sure they take care of themselves along with the patients."

 

Gaylord said the focus will remain on resiliency and mental well-being.

 

"We'd like to eventually delve into the research aspects of this so we can determine what makes some people more innately resilient than others."

 

(Elaine Wilson works in the Fort Sam Houston Public Information Office.)

By Donna Miles

American Forces Press Service

 

May 1, 2008 - The Defense Department is working to reduce stress on the force and improve quality of life for the troops, Defense Secretary Robert M. Gates told soldiers at the Army Sergeants Major Academy here today. As part of that effort, Gates asked the senior leaders' help in getting troops who need it to seek combat-related mental health care.

 

"Our country, in recent years, has asked a tremendous amount of you and those who serve with and under you, and everyone has risen to the occasion," Gates told the senior noncommissioned officers, all attending the Army's top NCO school and bound for sergeant major and command sergeant major jobs in the force.

 

He conceded that "no one expected major combat operations in Iraq to go on this long" and cited the challenges: "multiple and sometimes extended deployments, the stresses of battle, the wounds of war, both seen and unseen."

 

"All of this has taken its toll on our troops and their families," Gates said. Yet, he noted, morale remains high, "testimony to the extraordinary honor, courage and resilience of those who serve, as well as the leadership and mentoring provided by the senior NCO corps."

 

But that high morale can't be taken for granted, Gates said. "I know I am preaching to the choir when I tell you that, as senior leaders, we must all be ever cognizant of stress on the force -- stress that has been greatly increased in recent years," he said.

 

Gates outlined measures being taken to reduce that stress and improve soldiers' quality of life.

 

Combat deployments are being reduced from 15 to 12 months in light of changes on the ground and gains made. Gates expressed hope that conditions on the ground will enable force levels in Iraq to reduce further by the year's end. A more sustainable deployment rotation will be adopted within the next year or so, with the active force serving two years at home after every one year overseas.

 

"From my perspective, we are trying to strike a balance: to reduce the tempo of deployment without compromising our strategic objectives or national security," Gates said.

 

The United States is growing its ground forces and will add 7,000 troops to the Army as part of a five-year, 65,000-troop expansion. The Marine Corps is getting larger too and will complete its 27,000-member expansion next year, two years ahead of schedule.

 

"With a larger pool of soldiers and forces available, individual soldiers and their units should be deployed less frequently, with more dwell time at home," Gates said.

 

The secretary cited vast improvements in emergency care on the front lines and in the Army medical system. Since last year's revelations of what he called "deplorable outpatient conditions" at Walter Reed Army Medical Center, Gates said, he has focused a lot of time and energy on the system of care for wounded warriors.

 

"We have made great strides, even though more remains to be done," he said.

 

New warriors-in-transition campuses are revolutionizing the way wounded warriors are getting medical treatment and rehabilitation, he said. With an NCO with them throughout the process, wounded troops get help navigating the full range of support available for their families.

 

Gone are the days, Gates said, when wounded warriors are considered "permanently broken."

 

"The reality is that these extraordinary young men and women are far from broken," he said.

 

The Defense Department also is emphasizing care for troops with post-traumatic stress disorder, Gates told the NCOs, but he admitted that not all are getting the treatment they need.

 

In addition to new screening procedures that will help ensure no one "slips through the cracks" of the care system, the department is actively working to eliminate the stigma associated with PTSD, he said.

 

As part of that effort, Gates announced earlier today that the Defense Department will no longer require people who have received treatment for combat-related stress to report it on Standard Form 86, the government security-clearance form.

 

"Mental health treatment in and of itself will not be a reason to revoke or deny a clearance," Gates told the soldiers. "We hope this will encourage more men and women in uniform to seek help."

 

Gates called on the NCOs, the "backbone of the military," for help in getting soldiers who may have hesitated in the past to step forward to now get the care they need.

 

"All of you have a special role in encouraging troops to seek help for the unseen scars of war -- to let them know that doing so is a sign of strength and maturity," Gates told the group. "I urge you all to talk with those below you to find out where we can continue to improve.

 

"Those who have sacrificed for our nation deserve the best care they can get," he continued. "As I have said before, there is no higher priority for the Department of Defense, after the war itself, than caring for our wounded warriors."