Mental Health Issues of Veterans Returning from Iraq & Afghanistan (Part II) Heather Brown, PhD Louis A Johnson VA Medical Ctr Clarksburg, WV

Following this presentation, the learner will:  Review information on the mental health issues affecting Veterans returning from Iraq & Afghanistan  Receive education about innovative programs within VA to address the needs of this population  Understand the eligibility and enrollment process within VA

Mental Health problems of returning service members seeking VA care:  1) Adjustment Reactions (includes PTSD)  2) Drug abuse (includes nicotine)  3) Depression

Hidden Wounds:  Traumatic Brain Injuries (TBI)  Post-Traumatic Stress Disorder (PTSD)

Substance Abuse  11 percent of OEF and OIF Veterans have been diagnosed with a substance use disorder (SUD)— an alcohol use disorder, a drug use disorder, or both  Almost 22 percent of OEF and OIF Veterans with post-traumatic stress disorder (PTSD) also have a SUD  SUD may co-occur with a mental health issue for “self-medication”

Veteran-specific suicide risks (JAMA Psychiatry, 4/1/15)  Deployment was not associated with the rate of suicide  An increased rate of suicide was associated with separation from military service, regardless of deployments  Elevated suicide rates for those with less than 4 years of service or discharge that was not honorable

Traditional MH Treatment Options  Acute (inpatient psychiatry)  Residential treatment  Day Treatment  Intensive Outpatient  Outpatient treatment (i.e., medication and supportive psychotherapy)  Self-Help groups

Newer Treatment Options  Evidence-based psychotherapy (EBPs)  Proven through research to be effective when utilized as structured/designed  Available in individual and/or group formats  Some available by Telepsych (seeing the provider by computer screen)

EBPs available thru VA  Prolonged Exposure Therapy and Cognitive Processing Therapy (PTSD)  Cognitive-Behavioral Therapy for Depression, Insomnia and Chronic Pain  Motivational Interviewing (SUD, etc)  Social Skills Training (for SMI)  Seeking Safety (PTSD + SUD)

Newer Treatment Options (cont’d)  In-home services:  Mental Health Intensive Case Management (MHICM) and Rural Access Network for Growth Enhancement (RANGE)  Home Based Primary Care (HBPC)

MHICM/MHICM RANGE  Offers in-home MH case management by nurses and/or social workers  Goal is to reduce the number of acute psychiatry admissions for individuals with serious mental illnesses (SMI) such as schizophrenia  Focus on utilizing community and natural supports for stability

HBPC  Help Veterans learn to live independently with new or chronic illnesses (e.g., neurological disorders, spinal cord injury, cancer)  Help Veterans adjust to living safely in their homes after returning home from a hospital or a nursing facility admission  Multidisciplinary team

Supportive Programs/Services  CHOICE program  Caregiver Support Program  Telehealth  Compensated Work Therapy  Veterans Justice Outreach  Therapeutic Recreational Programs  Peer Support

CHOICE Program  Allows eligible Veterans to receive health care in their communities rather than waiting for a VA appointment or traveling to a VA facility  Improves access to care  Not all community providers are participants in the program

CHOICE eligibility  Your local VA medical facility says you will need to wait more than 30 days for an appointment from the date determined by your physician, or  Your residence is more than 40 miles driving distance from the closest VA medical facility (includes clinics).  Call to verify eligibility

Caregiver Support Program  General Caregiver Program (for caregivers of Veterans of all eras)  Family Caregiver Program (for caregivers of eligible Veterans seriously injured on or after 9/11/01)

Caregiver Program Services Skilled Nursing Home health aide Home Based Primary Care Medical equipment Home modification/Vehicle modification Aid & Attendance Support groups Education and training on Caregiving Up to 30 days of respite care per year

General Caregiver Program eligibility The Veteran is unable to perform an activity of daily living, or The Veteran needs supervision or protection based on impairment or injury

Family Caregiver Program All services previously mentioned Monthly Caregiver stipend CHAMPVA healthcare coverage Mental health services At least 30 days of respite care per year including during required training Travel, lodging, and per diem during Veteran medical appointments.

Telehealth  Veterans seen by computer at locations closer to their homes (e.g., CBOC)  Services include mental and physical health (e.g., psychiatry, diabetes management, maternity counseling)  Newest services include home telehealth (Veterans seen on their home computers)

Compensated Work Therapy (CWT)  Transitional Work (TW) –Therapeutic, short term, work activity, at contracted work sites, to relearn work skills, habits & behaviors necessary for employment  Supported Employment (SE) –Community employment, with on-going support, specifically geared toward Veterans with Serious Mental Illnesses

Veterans Justice Outreach (VJO)  VJO staff partners with local law enforcement and courts to link eligible Veterans to needed treatment (e.g., substance abuse, PTSD)  With Veteran’s consent, communicates treatment recommendations and treatment compliance to justice officials

Therapeutic Recreational Programs  Project Healing Waters Fly Fishing, Inc. - dedicated to the physical and emotional rehabilitation of disabled active military service personnel and Veterans through fly fishing, fly tying education and outings.  Guitars for Vets –Same purpose as above; focus is on learning & continuing to play the guitar (10 week beginner class earns graduation)

Peer Support  Peer Support Specialists within VA are Veterans who have “lived experience” with MH and/or SUD issues  Have a minimum of one year in “recovery”  Work in a variety of VA programs/locations (e.g., inpatient, residential, outpatient, VJO, MHICM)

Specialty Contact Persons  Transition & Care Management (post 9/11 Veterans)  Suicide Prevention Coordinators  Military Sexual Trauma Coordinators  Women Veteran’s Program Manager  Homeless Program Managers

VA Hospitals in West Virginia  Beckley  Clarksburg  Huntington  Martinsburg

Who is eligible for VA Care?  Priority groups (disabled Veterans, former POW’s, Purple Heart recipients, low income, etc.)  Minimum duty requirements  Cannot have a dishonorable discharge  When in doubt, let the VA figure it out!

How do Veterans enroll?  Complete application in person, by mail, by phone or online at  Must have DD214 (discharge paper), which shows when served, length of service, medals earned, etc.  Financial information (income, medical expenses, etc).

Community Based Outpatient Clinics linked to Huntington VA Hospital  Charleston  Gallipolis (OH)  Lenore  Prestonsburg (KY)

Vet Centers in West Virginia  Beckley  Charleston  Huntington  Martinsburg  Morgantown  Princeton  Wheeling

What’s the difference between VA Hospitals and Vet Centers?  Services  Presenting problems  Costs  Record keeping  Transportation

Resources.  1. Defense Centers of Excellence (DCOE): 24/7 MH and TBI resources for service members, family, and Veterans by phone, online chat, or . (866) Defense Centers of Excellence (DCOE) :  2. Military OneSource: 24/7 Assistance and resources by phone and online for service members and their families on many different issues. (800) Military OneSource  3.  3. Vet Center Combat Call Center 877-WAR-VETS: 24/7 call center staffed by combat Veterans for combat Veterans and family members to discuss their military experience and adjustment issues. Individual & family counseling, bereavement counseling for family members, military sexual trauma counseling. 877-WarVets or (877) Vet Center Combat Call Center 877-WAR-VETS.  4. National Care Giver Support Line: M-F 8am-8pm. VA support for anyone providing care for Veterans coping with the effects of war, disability, chronic illness, or aging. (855) National Care Giver Support Line.  5. Coaching Into Care: 8am-8pm Mon-Fri. Call center works with family/friends concerned about Veteran post-deployment difficulties. (888) Coaching Into Care

Additional 24/7 Hotlines Veterans Crisis Line/Chat/Text , Press 1 Text to National Call Center for Homeless Vets