Army OneSource Behavioral Health Campaign: Issues of Women Returning from Combat Paula McBride Community Support Coordinator Oklahoma & Arkansas

Provide background on the Army OneSource Behavioral Health Campaign, the war and its impact Provide background on the Army OneSource Behavioral Health Campaign, the war and its impact Explain the history of women in combat and the scope of the problem Explain the history of women in combat and the scope of the problem Describe the importance of military culture Describe the importance of military culture Identify psychological issues unique to women returning from combat Identify psychological issues unique to women returning from combat Discuss gender-specific treatment Discuss gender-specific treatment Provide information on mental health care resources including TRICARE insurance Provide information on mental health care resources including TRICARE insurance

Raise awareness of the challenges of Military life before, during and after deployment Raise awareness of the challenges of Military life before, during and after deployment Engage health professionals and others in providing specialized services to Service Members and their Families Engage health professionals and others in providing specialized services to Service Members and their Families Fill gaps in health services available to Service Members, especially those who live far from Military installations Fill gaps in health services available to Service Members, especially those who live far from Military installations

Already lasted longer than WWII Already lasted longer than WWII Improvised Explosive Devices (IEDs) / no front line Improvised Explosive Devices (IEDs) / no front line No down time / constant vigilance No down time / constant vigilance All volunteer force All volunteer force Multiple and longer deployments Multiple and longer deployments 90% of wounded surviving their injuries 90% of wounded surviving their injuries

Over 1 ½ million have served in Iraq and Afghanistan 75% experienced situations where they could be seriously injured or killed 75% experienced situations where they could be seriously injured or killed 62% know someone who was seriously injured or killed 62% know someone who was seriously injured or killed 33% described an event that caused intense fear, helplessness or horror 33% described an event that caused intense fear, helplessness or horror Greater percentage coming home with Traumatic Brain Injury (TBI), post traumatic stress, and depression Greater percentage coming home with Traumatic Brain Injury (TBI), post traumatic stress, and depression

Demands for services outpace the capacity of the Military Demands for services outpace the capacity of the Military Over 1 million veterans eligible for VA services Over 1 million veterans eligible for VA services 45% actually seek services from the VA 45% actually seek services from the VA Half of all Service Members experience multiple deployments Half of all Service Members experience multiple deployments Family Members are more likely to experience stress, anxiety and depression Family Members are more likely to experience stress, anxiety and depression

Analyzed data on 54,000 and 398,000 male OEF/OIF veterans-who accessed care- for PTSD risk Analyzed data on 54,000 and 398,000 male OEF/OIF veterans-who accessed care- for PTSD risk Considered: Gender, age, rank, brand, component, marital status, race Considered: Gender, age, rank, brand, component, marital status, race

45,152 female OEF/OIF VA users 45,152 female OEF/OIF VA users 12% total OEF/OIF VA users are women 12% total OEF/OIF VA users are women Mirrors the 11% of OEF/OIF women veterans eligible to use the VA Mirrors the 11% of OEF/OIF women veterans eligible to use the VA

More African-American, 28.8% vs. 15% More African-American, 28.8% vs. 15% Ratio for Hispanic is comparable, 11% Ratio for Hispanic is comparable, 11% Both enlisted rank higher Both enlisted rank higher Younger, 29 years or less Younger, 29 years or less Higher ratio on Air Force, 17% vs. 11% Higher ratio on Air Force, 17% vs. 11% Lower in marines, 3% vs. 14% Lower in marines, 3% vs. 14%

PTSD: 19% vs. 23% PTSD: 19% vs. 23% Non-Dependent Sub. Abuse: 13% vs.19% Non-Dependent Sub. Abuse: 13% vs.19% Depressive Disorder: 20% vs. 15% Depressive Disorder: 20% vs. 15% Affective Psychosis: 12% vs. 8% Affective Psychosis: 12% vs. 8% Neurotic Disorder: 15% vs. 12% Neurotic Disorder: 15% vs. 12% Alcohol Dependence 2% vs. 4% Alcohol Dependence 2% vs. 4% Drug Dependence: 1% vs. 2% Drug Dependence: 1% vs. 2% Personality Disorder: 2% vs. 1% Personality Disorder: 2% vs. 1%

Reserves at greater risk than Active Duty Reserves at greater risk than Active Duty Enlisted at greater risk than Officers Enlisted at greater risk than Officers Army at greater risk than other branches Army at greater risk than other branches Women older than 30 at a greater risk Women older than 30 at a greater risk

No clear relationship to level of education No clear relationship to level of education Divorced or legally separated veterans at greater risk than married or single Divorced or legally separated veterans at greater risk than married or single No significant difference by race No significant difference by race

Women may have less exposure to combat or may be exposed to a different range of situations Women may have less exposure to combat or may be exposed to a different range of situations Race, ethnicity, age or rank difference and/or differences in early life trauma may account for differing rates of diagnosis Race, ethnicity, age or rank difference and/or differences in early life trauma may account for differing rates of diagnosis Women may be more likely to receive diagnosis of personality disorder rather than PTSD Women may be more likely to receive diagnosis of personality disorder rather than PTSD

Disrupted menstrual cycles Disrupted menstrual cycles Exposure to prisoners and animals Exposure to prisoners and animals Sexual harassment/assault Sexual harassment/assault Combat-related fear of death Combat-related fear of death

Fertility issues/miscarriages Fertility issues/miscarriages Lack of sexual interest Lack of sexual interest Overprotective of their children Overprotective of their children

Surrounded by men Surrounded by men Guilt Guilt Denial Denial

Distinct culture with its own order, norms, chain of command, ethical codes and language Distinct culture with its own order, norms, chain of command, ethical codes and language Rules counterbalance the chaos of war ensuring missions are completed no matter how hard or uncertain Rules counterbalance the chaos of war ensuring missions are completed no matter how hard or uncertain Group bonding Group bonding

Women participated in large numbers in WWII Women participated in large numbers in WWII 1993 Congress opened combat ships to women 1993 Congress opened combat ships to women first female pilots placed in all branches first female pilots placed in all branches 2005 first female awarded Silver Star in combat 2005 first female awarded Silver Star in combat 2008 first female promoted to 4-Star General 2008 first female promoted to 4-Star General Some specialties are still restricted to women Some specialties are still restricted to women

Some people: Believe in the Boy’s Club or Rite of Passage Believe in the Boy’s Club or Rite of Passage Consider women’s physical and psychological characteristics incompatibility leads to lessening of standards Consider women’s physical and psychological characteristics incompatibility leads to lessening of standards Believe women are a distraction to the male warrior who wants to protect Believe women are a distraction to the male warrior who wants to protect Believe in stereotyping female roles and jobs Believe in stereotyping female roles and jobs Frustrated by accommodating female presence in barracks Frustrated by accommodating female presence in barracks

Aggressive vs. emotional Aggressive vs. emotional Isolation and lack of camaraderie Isolation and lack of camaraderie Socialization with men Socialization with men Competition for recognition Competition for recognition “Becoming one of the guys” “Becoming one of the guys” Garnering too much attention Garnering too much attention

Sexual assault Sexual assault Risk working environment, reputation and promotions Risk working environment, reputation and promotions Pregnancy Pregnancy No-sex policy No-sex policy Risk being sent home Risk being sent home Jeopardizing a unit Jeopardizing a unit

Single mothers Single mothers Pre-deployment Pre-deployment Deployment Deployment Reintegration Reintegration Wanting to go back Wanting to go back Buying weapons Buying weapons Getting into trouble Getting into trouble Adrenaline rush Adrenaline rush Isolation Isolation Anger Anger

System set up for men System set up for men Woman seeking care for sexual trauma or PTSD in waiting room with men Woman seeking care for sexual trauma or PTSD in waiting room with men Primary and specialty care were not available until recently Primary and specialty care were not available until recently Fragmentation of Care Fragmentation of Care Stigmatization of PTSD leading to abuse Stigmatization of PTSD leading to abuse Denial Denial Pride Pride

Women typically decide who receives care in the family, putting herself last Women typically decide who receives care in the family, putting herself last If it is paired with something they think is valuable for the family they are more likely to get the treatment If it is paired with something they think is valuable for the family they are more likely to get the treatment Support groups can be helpful for developing social support, detrimental if a woman cannot stand being in a closed room or in groups Support groups can be helpful for developing social support, detrimental if a woman cannot stand being in a closed room or in groups Integrate short interventions with primary care such as cutting back on drinking Integrate short interventions with primary care such as cutting back on drinking

Smoking problems are much higher in veteran women than civilian women Smoking problems are much higher in veteran women than civilian women Proportion of women prescribed NRT is lower for women Proportion of women prescribed NRT is lower for women Encourage phone counseling or cessation treatment if they are concerned about weight management or mood changes Encourage phone counseling or cessation treatment if they are concerned about weight management or mood changes Veterans want more education but not all at once or right after they come home Veterans want more education but not all at once or right after they come home Incorporate subsequent contact and Web-based information Incorporate subsequent contact and Web-based information

DoD integrated health care delivery system DoD integrated health care delivery system Provides health care benefits/services to active duty, retired, families, survivors and their eligible beneficiaries Provides health care benefits/services to active duty, retired, families, survivors and their eligible beneficiaries Combines access to military hospitals and clinics with a network of civilian health care providers Combines access to military hospitals and clinics with a network of civilian health care providers Supports readiness, ensures health of forces and cares for them when ill or injured Supports readiness, ensures health of forces and cares for them when ill or injured

Regions: North, South and West Regions: North, South and West Options: Prime, Standard, Extra and Reserve Select Options: Prime, Standard, Extra and Reserve Select Services: Pharmacy, Inpatient and Outpatient Services: Pharmacy, Inpatient and Outpatient Becoming a provider Becoming a provider

Includes the Veterans Health Administration and Veterans Benefits Administration Includes the Veterans Health Administration and Veterans Benefits Administration 23.4 million veterans currently alive 23.4 million veterans currently alive 25% of US population is eligible for benefits 25% of US population is eligible for benefits Each veteran is eligible for 5 years upon returning from each deployment Each veteran is eligible for 5 years upon returning from each deployment

Located at each VA medical Center Located at each VA medical Center Ensures OEF/OIF veterans quickly find their way to the right VA services and benefits Ensures OEF/OIF veterans quickly find their way to the right VA services and benefits Begins with contacts at Post Deployment Health Assessments, walks veterans through the VA system Begins with contacts at Post Deployment Health Assessments, walks veterans through the VA system Direct any veteran or family member seeking assistance in connecting with VA services Direct any veteran or family member seeking assistance in connecting with VA services

Awareness Campaign Folder Awareness Campaign Folder Awareness Campaign Online Course Awareness Campaign Online Course Awareness Campaign Handouts Awareness Campaign Handouts