1. Challenges Facing Today’s Female Warriors and Veterans Joan Collins MSN, CNS, NP April 21, 2016

2. Some Relevant Facts  Women comprise more than 15% of the military; 20% of Nat’l Guard and Reserves on active duty.  One fifth of new military recruits are women.  There are 1.8 million (8%) women veterans. This number is projected to rise to 10% of total number of veterans by 2020.  11.6% of soldiers in Iraq and Afghanistan are female.

3. Some Relevant Facts  As of Oct 2009,more than 212,000 women have been deployed to combat areas in the current wars—compared with 7500 in Vietnam and 41,000 in the first Gulf War.  In Iraq, the distinction between combat and combat support has been virtually eliminated, since most of the injuries come from IEDs and there are no front lines.

4. Some Relevant Facts  January 17, 2013 the decision was made to officially allow women to serve in combat roles.  August 21, 2015, first two women graduated from Army Ranger Course.  March 18, 2016 President Obama named Lori Robinson to become the first woman to lead a combatant command.

5. Some Relevant Facts  More than 1/3 of OIF/OEF vets (both men and women) have mental or behavioral diagnoses. Of the 34,000 diagnosed with PTSD, 3800 are women (2005 data).  Having a history of childhood abuse—which is higher in the military for both men and women, and higher for women than men overall—makes women more vulnerable to mental and behavioral problems. (2008 Article found lifetime prevalence for women of 38% and for men 6%--Zinzow, et. al.

6. Some Relevant Facts  Women veterans are four times more likely to be homeless than the female civilian population- seems to be highly correlated with the incidence of MST. Homelessness is higher in veteran male population as well as compared to the civilian population.  38% of women experience depressive symptoms post deployment compared to 32% for men. (Jrnl of General Internal Medicine).

7. Some Relevant Facts  The rate of suicide for female veterans is 6 times the rate for civilian females, almost to the rate of male veterans. For women ages 18-29 the rates is 12 times the rate of non veterans. ( LA Times 3/3/2016)  The suicide rate for female soldiers tripled during deployment, to 14/100,000 from 4/100,000 back home, unlike for men which rises only slightly.  Factors such as helplessness, hopelessness, alienation and isolation are all known to contribute to depression and suicide.

8. Stressors Unique to Women Who Serve  Woman may be placed in positions for which they have not been highly trained.  For example, they could find themselves in combat yet not have extensive training in that. – Could be trained to be a driver and find themselves in lead vehicle in a convey and under attack.

9. Stressors Unique to Women Who Serve  Women often report feeling increased pressure to prove themselves capable in their military roles. Because of this women will often push themselves too hard and injuries, heat stroke can result.  Men tend to accept each other as good soldiers- women more likely to have to prove themselves capable.

10. Stressors Unique to Women Who Serve  Women are often not recognized as readily as men are for their military service. With less than 1% of American citizens serving in the military, the reality of the role of the female warrior is generally not known.  Many are not aware that women are serving in combat roles and their contributions are often minimized.  Women can struggle to find other women in the community they can feel a connection to after their return from deployment.

11. Stressors Unique to Women Who Serve  Women are more frequently the primary caregivers for their children, and being away from their children can be quite challenging.  Increased communication between the female soldier and her family during deployment can also create increased stress, especially when there are problems and the soldier feels powerless to be helpful.

12. Stressors Unique to Women Who Serve  Women often return home from deployment to find families that are functioning quite well without them and do not welcome their involvement or input.  At times, it can be difficult for women upon their return to demonstrate love for their children, perhaps experiencing a numbing of their emotions and possibly even being triggered by them. This can result in guilt.

13. Stressors Unique to Women Who Serve Research demonstrates higher divorce rates for women in the military than for men.  In the Army, divorce rate is 2.9 % for men and 8.5% for women,  In the Marines, the divorce rate is 3.3% for men and 9.2% for women. The difficulties faced by these fractured families can further increase the stress on a deployed soldier. The incidence of domestic abuse climbs in the presence of PTSD and depression.

14. Stressors Unique to Women Who Serve  There is often little opportunity for bonding with other women in the military because of the relative rarity of women in some units and it can be difficult to bond with the men due to the and fear of being labeled “the dyke, the bitch or the whore”.  Women don’t want to be categorized the same as other women who have been negatively labeled. This can increase social isolation.

15. Stressors Unique to Women Who Serve  If a female is not able to find a way to be fully accepted she can lose the benefits of unit cohesion and of having a sense of belonging and support by others.  They find themselves on the margin of a culture during an exceedingly stressful time and can feel tremendous alienation, isolation and lack of support.

16. Military Sexual Trauma  Military sexual trauma, or MST, is the term used by VA to refer to experiences of sexual assault or repeated, threatening sexual harassment that a Veteran experienced during his or her military service. The definition used by the VA comes from Federal law (Title 38 U.S. Code 1720D) and is “psychological trauma, which in the judgment of a VA mental health professional, resulted from a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment which occurred while the Veteran was serving on active duty, active duty for training, or inactive duty training.” Sexual harassment is further defined as "repeated, unsolicited verbal or physical contact of a sexual nature which is threatening in character.”

17. Military Sexual Trauma  1/3 of women applying for VA healthcare services report rape or attempted rape while in the service.  Of these, 37% reported multiple rapes, and 14% reported gang rape.- 10% higher rates for women than men.  A change in DOD policy in 2005 allowing sexual assaults to be reported confidentially in “restricted reports” led to the number of reported assaults across the military rising to 40 percent.

18. Military Sexual Trauma  More frequently women sustain a combination of sexual harassment and/or rape and combat trauma. These sexual traumas are up to 10 X more likely in the combat setting for women then for men. Women tend to put up with more harassment.  Rates of both sexual harassment and rape rise during wartime.

19. Military Sexual Trauma  Rape or assault by a fellow soldier is most traumatic because it is a breech of military cohesion. Trust of fellow soldiers is essential in the combat setting because personal safety literally depends on your fellow soldiers.  The person who is supposed to help protect your life may be the one who is threatening you. And what if the perpetrator is your C.O?

20. Military Sexual Trauma The Army’s system for reporting and trying sexual offenses (Victims Advocates at most bases) does not appear to be working. Only 10% of reports result in conviction. Almost half of women who reported a sexually hostile environment were dissatisfied with the response they received.

21. Military Sexual Trauma  Often women say that it didn’t seem worth it to report the offense. Punishments for the perpetrator were frequently minimal or nonexistent.  Many women report seeing other women who do report these crimes retaliated against or lose their military careers.

22. Military Sexual Trauma Two days after viewing the film “The Invisible War” Defense Secretary Leon Panetta changed the requirement that a military person must report a sexual assault to his/her immediate commander- now the report must be given to a person with a rank of at least a colonel. As women gain rank with the combat restrictions lifted, there will be more opportunity for women to serve at these higher levels.

23. PTSD in Women  16% of women in the first Gulf War were diagnosed with PTSD, compared with 8% of men. Why the disparity?  Some traumatic experiences are more psychologically toxic than others: rape is one of them, followed closely by combat exposure

24. Military Sexual Trauma Although both men and women who join the service have more pre-enlistment trauma than civilians, women in this group tend to have more trauma than men in this group.  A history of childhood trauma increases the risk of developing PTSD in the face of later trauma  Women who were abused as children frequently lose their self-protective instincts resulting in increased traumatic events.

25. Military Sexual Trauma  Women with childhood sexual assault are 7 times more likely to develop PTSD than women without sexual assault.  Women with civilian adult sexual assault are 5 time more likely to develop PTSD than women without adult sexual assault.  The rate of MST in women with PTSD is 31% and only 1% for men with PTSD. ( VA stats)  Women with military sexual assault are 9 times more likely to develop PTSD than women without assault.

26. How Can We Help?  How can we best support these women as soldiers and veterans, given the isolation, shame, fear, and depression so many experience?  Creating safety, connection with healthy others, validation and treatment can make all the difference for the female soldier or veteran and their families who are also affected by their struggles.

27. How Can We Help?  Provide resources to stabilize difficult circumstance such as referral to a Safe house, assistance with long term housing, childcare, job training, supportive counseling  Assist women veterans to get connected to both medical and mental health care  Educate the community to these pressing issues  Advocate with legislators for resources to provide women veteran support and treatment

28. How Can We Help?  Other ideas?

29. Resources For additional information please visit the U.S. Department of Veterans Affairs, National Center for PTSD www.ptsd.va.govwww.ptsd.va.gov and click on the Tab- “ For Professionals”  Further reading:  Kayla Williams: “Love my Rifle More than You: : Young and Female in the U.S. Army ; W.W. Norton and Company 2006.  The invisible war movie.com. Kdick, K. 2012  WhenJaney Comes Marching Home, by Laura Browder and Sascha Pflaeging www.vqronline.org/webexclusive/2008/07/02/browder-janey/ www.vqronline.org/webexclusive/2008/07/02/browder-janey/  Traumatic stress in Women Veterans- www.ptsd.va.gov/public/pages/traumatic-stress-female-vets.asp  Corbett, Sarah. The Women’s War. NY Times March 18, 2007

30. Resources  “Service Women’s Action Network aims to reform health care and benefits for women and their families, offering legal services and domestic and sexual violence support. Free, confidential mental health counseling can also be found here.aims to reformhere  The nonprofit American Women Veterans advocates for awareness of the challenges women face when transitioning from the military offering childcare and housing resources, while Grace After Fire nationally assists with accessing education benefits and military peer networking support.American Women Veterans Grace After Fire  Volunteers of America offers supportive services and reintegration programs for homeless veterans, with local resources available.local resources available  Employment opportunities for women can also be found at Hirepurpose, which connects veterans with military-friendly” Hirepurpose  From-http://taskandpurpose.com/mistreatment-female- veterans-not-just-womens-issue/