Lieutenant J. L. Gandy Crisis Intervention Team

 Approximately 1.64 million troops have been deployed in support of operations in Afghanistan and Iraq. Just over half of those have been national guard and reservists.  500,000+ have separated from the military & 138,000+ have come into the VA system.  From , 72,000 veterans have been diagnosed with PTSD.

About one-third of returning service-members report symptoms of a mental health or cognitive condition. Roughly half of those who need treatment for these conditions actually seek it.

 May be prescribed medication that has too many side effects  Could harm career  Could be denied security clearances  May appear weak to co-workers if they found out  Fellow veterans, friends, and family would be more helpful  Does this sound familiar (like police officers)? Rand Corporation 2008

 Depression  Post Traumatic Stress Disorder (PTSD)  Traumatic Brain Injuries (TBI)  Drug and/or alcohol abuse

Thought to be the most common diagnosis in returning veterans  Results in sleep problems: Insomnia and Hypersomnia  Decreased interest in pleasurable activities  Sometimes accompanied by “survivors guilt”  Loss of energy or fatigue  Diminished ability to concentrate or think, indecisiveness  Loss of appetite or increased appetite resulting in weight loss or gain  Having thoughts, plans, or previous attempts of suicide - may be aggravated by availability of firearms.

 This occurs when a person is exposed to a traumatic event.  The person had experienced, witnessed, or was confronted by an event that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.  It is a natural response to intense fear, helplessness, or horror.

 Re-experience of the event: intrusive recollections, distressing dreams, flashbacks, intense distress at exposure to similar events and physical reactions to exposure.  Increased arousal symptoms such as sleep problems, irritability, concentration problems, hyper-vigilance, exaggerated startle response.  Avoidance symptoms such as avoiding thoughts, feelings, activities, places, or people that bring back memories, includes decreased interest in activities - often keeping to themselves.

 This injury is caused when something strikes a persons’ head very hard or an object actually penetrates the skull and enters the brain.  Blast/shockwaves, alone, from Improvised Explosive devices (IED) or other explosive devices can cause TBI.

 Constant Headaches  Confusion, apathy, anxiety  Light headedness or dizziness  Changes in mood and/or behavior  Sleep disorders  Trouble with memory or concentration  Repeated nausea or vomiting  Problems with vision and hearing  Seizures

 Extreme anger or violent behavior  Serious thoughts of hurting oneself or others  Decreased interest in pleasurable activities  Frequent nightmares and intrusive thoughts

After being exposed to combat stress, it is difficult for some veterans to:  Relax  Cope with Emotions  Get Restful Sleep  Be a good listener  Feel emotionally connected to family and friends  Stay focused due to intrusive thoughts

 Intrusive thoughts are unwelcome, involuntary thoughts, images or unpleasant ideas that may become obsessions, are upsetting or distressing, and can be difficult to be free of and manage.  Intrusive thoughts may include improper urges or images that fall into three categories: Inappropriate aggressive thoughts, inappropriate sexual thoughts, or blasphemous religious thoughts  Sometimes it is difficult to separate reality from perception.

The overwhelming majority of veterans, to include those experiencing some lasting condition from their war experiences will never have a serious contact with police. However, the most frequent acts that may bring some veterans in contact with police may include the following:

 Domestic Disputes or complaints of family abuse – due to stress within the household/failure to adjust to being home.  Disputes with others  Traffic stops as a result of aggressive/reckless driving: Some veterans who drove in convoys may find themselves inadvertently speeding, down the middle of the road, and failing to stop at stop signs and traffic signals.  Suicidal or other types of mental health crisis: i. e: barricaded subject

 War veterans are familiar with common police tactics: Control techniques, hand to hand combat, weapons retention, closing the gap and moving and shooting  They have an increased perception of threats – hyper-vigilance (the same as police officers)  They are constantly looking for something wrong or out of place that may be a threat to them or those around them

 Respond supportively if the person appears upset during a police procedure  Speak in a calm, matter of fact voice  Reassure the person that everything is okay and that they are safe  Explain any police procedures you may have to make, prior to making them and make sure the person understands what you are about to do.  Remind the person of his or her current location and situation.

 Always show respect and explain what you are doing.  Thank the veteran for his or her service  Offer assistance to veterans through organizations set up to do so

 Veterans Administration hospitals  Portsmouth Naval Hospital Psychiatric Center Web Resources  Military Onesource: http://militaryonesource.com  Operation Healthy Reunions:  Vet Centers: Confidential readjustment counseling for combat veterans and their families – :  Rand Corporation: :

 Nothing in this lesson plan is meant to demean or to stigmatize returning war veterans.  Our veterans deserve our gratitude, respect, understanding, and patience.  In order to assist those veterans, officers must be aware of the symptoms of depression, PTSD, and TBI and be able to communicate in a respectful and understanding way in order to provide assistance to those in need.  Officers should be aware of resources available to assist and support those returning veterans having difficulty with re-adjusting to post- deployment home life.

 RAND Corporation publication: Post Deployment Stress: What you Should Know, What you Can Do  RAND Corporation Study: Invisible Wounds Brief (Rand Center for Military Health Policy Research)  Mixing CIT & The Military, a presentation by Sgt. Corey Nooner, Oklahoma City Police Department