The Hidden Casualties of War: Promoting Healing and Resiliency for U.S. Military Service Members and Their Families A Two-Day Symposium A Partnership Project Of The Deployment Health Clinic – Naval Hospital Pensacola & The Center For Applied Psychology – Department Of Psychology University of West Florida

Two-Day Symposium Partnership: UWF Center for Applied Psychology and Department of Psychology, Department of Deployment Health and Wellness, Naval Hospital Pensacola Purpose: To provide education and outreach to military and civilian behavioral health professionals who deliver deployment-related behavioral health services to military personnel and their families. Audience: Mental Health Providers Psychologists Mental health counselors Social workers Marriage and family therapists Physicians Nurses 14 Hours of CME/CEU’s Available

Background 1.5 million American troops have been deployed One-third served at least two tours in a combat zone 70,000 have been deployed three times 20,000 have been deployed at least 5 times Approximately 1.2 million children in America have at least one parent deployed Over 23,000+ Americans have returned from a combat zone with physical wounds and a range of permanent disabilities (traumatic brain injury) Over one-fourth are struggling with less visible psychological injuries *Note: these data are about 7 months old.

Background “Given the risks associated with the stress of deployment and exposure to combat, it is not surprising that military service members and their families may be suffering significant mental health problems…” (American Psychological Association, 2007)

Background “Mental Health is a state of subjective well-being and successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity. Mental health is indispensable to personal well-being, family and interpersonal relationships, and contribution to community or society.” (Department of Defense, 2007)

Impact of Military Deployment on Families Throughout the Deployment Cycle Pre-Deployment Anger and protest; Emotional detachment Family stress; Martial disagreements Deployment Emotional destabilization and disorganization Sadness, depression, disorientation, anxiety Sleep disturbances, health complaints, great stress Reunion Apprehension over redefined roles and power dynamics Resentment over loss of independence Post-Deployment Insecurity Difficulty disengaging from combat mission orientation *Note: Citations for this research are available upon request.

Background Not all of the vets from Vietnam, Desert Storm, and the current Global War on Terror (GWOT) suffer from psychological problems, and most go on to hold jobs, stay out of prison, contribute to society, and so forth. However, we don’t want to repeat mistakes made with veterans of these previous conflicts, i.e., treating combat stress problems as disciplinary problems, not providing adequate healthcare, not coming clean on Agent Orange for nearly a decade, etc.

Background What is different about the GWOT compared to previous conflicts? Multiple deployments Fighting insurgencies Urban environments Assignments outside the domain of training National guardsmen and reservists Navy on ground carrying weapons

Why offer a Two-Day Symposium? American Psychological Association February 2007, Presidential Task Report The Psychological Needs of U.S. Military Service Members and Their Families: A Preliminary Report Department of Defense June 2007, Task Force on Mental Health An Achievable Vision: Report of the Department of Defense Task Force on Mental Health

Primary Issues “…an adequate supply of well-trained psychologists and other mental health specialists to provide services..” (APA, 2007) “…a shortage of professionals specifically trained in the nuances of military life, and those who are qualified often experience “burnout” due to the demands placed on them.” (APA, 2007) “Against the backdrop of the Global War on Terror, the psychological health needs of America’s military service members, their families, and their survivors post a daunting and growing challenge to the DoD.” (DoD, 2007)

APA Recommendations 3.3: Mental health services should be available through the deployment cycle and include a focus on prevalent diagnoses/conditions…Further, mental health services through the deployment cycle should incorporate prevention and intervention strategies designed to help families. 3.5: Outreach programs should be developed and fostered by both the military and non-military communities in order to ensure that—whenever possible—mental health problems among service members and their families are prevented rather than treated. 5.3: Training and education regarding the unique needs of service members and their families who are faced with deployment must be on-going for all mental health service providers (military and civilian) who treat these populations…

DoD Recommendations 1. Culture of support for psychological health Easily accessible mental health professionals 2. Full continuum of excellent care (deployment cycle) Accessible high-quality care for family members 3. Sufficient resources Adequate resources for mental health services Adequate supply of military providers

Symposium Topics and Presenters Caring for the Psychologically Wounded: From Washington to Beyond CAPT Robert L. Koffman, M.D., Combat and Operational Stress Consultant, Bureau of Medicine and Surgery, U.S. Navy The Deployment Cycle Bithiah R. Reed, Ph.D., ABPP, Center for Deployment Psychology Military Traumatic Brain Injury Louis M. French, Psy.D., Defense and Veterans Brain Injury Center, Walter Reed Army Medical Center, Department of Neurology Col. Bereavement Counseling for Families of OIF/OEF Casualties Lynne Peralme, Ph.D., Clinical Coordinator at the Birmingham Veterans Center, Birmingham, AL

Symposium Topics and Presenters Post Traumatic Stress Disorder (PTSD) Charles C. Engel, MD, MPH, Department of Defense Deployment Health Clinical Center, Walter Reed Army Medical Center; Department of Psychiatry, Uniformed Services University  Teaching Children Resilience Skills Ronald S. Palomares, Ph.D., American Psychological Association Military Sexual Trauma Sue Ann Garrison, Ph.D., Gulf Coast Veterans Health Care System and Mental Health Clinic The Impact of OEF/OIF on Reserve and National Guard Troops Kenneth I. Reich, Ed.D. and Jaine L. Darwin, Psy.D., Harvard Medical School

Conclusion “There is no such thing as a soldier, there is a soldier and someone.” (Darwin, 2007) More than 57.6 million people are impacted by soldiers deployed to Afghanistan and Iraq. A national public health crisis for years to come. We can help…

For Further Information call 14 Hours CME/CEU’s For Physicians, Nurses, Psychologists, Social Workers, Marriage & Family Therapists Registration Fee - $245 (Includes 2 lunches) To Register Go To http://continuinged.uwf.edu/deployment%5Fpsych/ For Further Information call David Dean, Ed.D. Deployment Health Clinic – Naval Hospital Pensacola(850) 505-6174 or email to <david.dean@med.navy.mil