1. Post Traumatic Stress Disorder: Implications for Law Enforcement/First Responders Presented by: Terry Yeager, MA, CACD, LPC With permission from: Marinell Miller, PhD Marinell Miller, PhD Hampton VA PTSD Clinic

2. Session Goals Overview of Who Is At Risk Overview of Who Is At Risk “Battle Mind”/PTSD: Questions To Ask About Military Trauma To Make Your Job Easier “Battle Mind”/PTSD: Questions To Ask About Military Trauma To Make Your Job Easier “War” Stories – Add Your Own, I’ll Tell Mine “War” Stories – Add Your Own, I’ll Tell Mine Terms: Terms: GWOTOEFOIFGWOTOEFOIF

3. What Is A Trauma? Event That Involves Death or Threatened Death or Serious Injury Event That Involves Death or Threatened Death or Serious Injury Feelings of Fear, Horror, Helplessness Feelings of Fear, Horror, Helplessness Resilience Is Most Common Outcome Resilience Is Most Common Outcome How Many Traumas Have You Seen?How Many Traumas Have You Seen?

4. How People Cope With PTSD— Clues For You Drinking Drinking Drugging Drugging Driving Fast Driving Fast Sleep Problems – Night Work – Peeping/Perimeter Watch Sleep Problems – Night Work – Peeping/Perimeter Watch Startle Easily--Stimulants Startle Easily--Stimulants Flashbacks/Hallucinations Flashbacks/Hallucinations Depression/Crying Depression/Crying

5. Legal Problems & PTSD Veterans Alcohol/Drug Related Driving Offenses Alcohol/Drug Related Driving Offenses Larceny Larceny Speeding/Reckless Driving Speeding/Reckless Driving Assault Murder Assault Murder Weapons Issues Weapons Issues “We Don’t Visit Jails, We Will Send The Police” “We Don’t Visit Jails, We Will Send The Police” “PTSD Is Not A Legal Defense—It Didn’t Make You Do It” “PTSD Is Not A Legal Defense—It Didn’t Make You Do It”

6. Psychiatric Casualty Rates And War WWI, WWII, and Korea Psychiatric Casualties Greater Number Than Those Killed (504,000 Psych Casualty) WWI, WWII, and Korea Psychiatric Casualties Greater Number Than Those Killed (504,000 Psych Casualty) Vietnam and Since Rates Reduced Vietnam and Since Rates Reduced VN 50% chance of dying vs. psych casualtyVN 50% chance of dying vs. psych casualty Continuous combat For 60-90 days show 98% psychiatric casualty rateContinuous combat For 60-90 days show 98% psychiatric casualty rate Expected PTSD rates are 13-30%Expected PTSD rates are 13-30% Higher numbers have adjustment issuesHigher numbers have adjustment issues

7. Post Deployment Stress Reactions Combat Operational Stress Reactions Adjustment Disorders Post Traumatic Stress Disorder Acute Stress Disorder Less Severe Most Severe

8. Typical OEF/OIF Stressors Ambushes (58-89%) Ambushes (58-89%) Incoming Rockets/Artillery (84-86%) Incoming Rockets/Artillery (84-86%) Small Arms (66-93%) Small Arms (66-93%) Shooting at Enemy (27-77%) Shooting at Enemy (27-77%) Killing Enemy (12-48%) Killing Enemy (12-48%) Killing Non-Combatants (1-14%) Killing Non-Combatants (1-14%) Seeing Dead/Remains (39-93%) Seeing Dead/Remains (39-93%) Seeing Dead/Injured Americans (30-65%) Seeing Dead/Injured Americans (30-65%)

9. NO ONE IS IMMUNE TO OPERATIONAL STRESS – “BATTLE MIND” Improves Quickly With Improves Quickly With RestRest FoodFood ReassuranceReassurance Reintegration With The UnitReintegration With The Unit Most COSR Resolve QuicklyMost COSR Resolve Quickly 50% of Those With PTSD Get Better In 3 Months (DoD Statistics) 50% of Those With PTSD Get Better In 3 Months (DoD Statistics) What To Expect In A Returning War Fighter… Battle Mind What To Expect In A Returning War Fighter… Battle Mind

10. Buddies VS Withdrawal Battle Mindset Battle Mindset Look out for each otherLook out for each other Only people to understand youOnly people to understand you Cohesive in battleCohesive in battle Questions Questions “Are you a Veteran?”

11. Discipline & Ordering VS Conflict In Combat In Combat Survival depends on discipline and obeying ordersSurvival depends on discipline and obeying orders HomeHome Inflexible ordering leads to conflict with family, friends and co-workers Inflexible ordering leads to conflict with family, friends and co-workers You are a trigger: use it to your advantage You are a trigger: use it to your advantage Be a good authority figure Be a good authority figure Be in control but not an ***hole Be in control but not an ***hole

12. Mission OPSEC VS Secretiveness Battle Mindset Battle Mindset Only talk to those who need to know, i.e., unit membersOnly talk to those who need to know, i.e., unit members HomeHome Avoid sharing ANY information about your deployment Avoid sharing ANY information about your deployment Questions Questions Who did you serve with? Marines/AB/SF When were you in? What was your MOS? What did you do? Were you wounded?

13. Targeted VS Inappropriate Aggression Battle Mindset Battle Mindset Lethal Split Second Decisions Keep You and Your Buddies AliveLethal Split Second Decisions Keep You and Your Buddies Alive Anger Keeps You Alert, Awake and AliveAnger Keeps You Alert, Awake and Alive HomeHome Snap at wife/kids/co- workers Snap at wife/kids/co- workers Overreact to minor insults Overreact to minor insults Questions --DON’T ASK TOO MANY!! Questions --DON’T ASK TOO MANY!! “At Ease” “At Ease” “Suck it Up Man” “Suck it Up Man”

14. Tactical Awareness VS Hypervigilance Battle Mindset Battle Mindset Survival = awareness of surroundings at all times and reacting immediatelySurvival = awareness of surroundings at all times and reacting immediately HomeHome Anxious in large groups Anxious in large groups Anxious indoors Anxious indoors Easily startled Easily startled Questions… DON’T Questions… DON’T ASK A LOT ANALOGY: FEAR and Caged Animals Get Space

15. Lethally Armed VS “Locked and Loaded” at Home Battle Mindset Battle Mindset Weapon at all times is mandatory and necessaryWeapon at all times is mandatory and necessary HomeHome Feel “naked” Feel “naked” Weapons in car Weapons in car At front door At front door At back door At back door Under pillow Under pillow CCP CCP Questions Questions Where Is Your Weapon?

16. Emotional Control VS Detachment Battle Mindset Battle Mindset Controlling your emotions is critical to mission successControlling your emotions is critical to mission success HomeHome You are detached You are detached You are uncaring You are uncaring You only show anger You only show anger Questions – Questions – What Were You Thinking? Where Was Your Head?

17. Non-Defensive Driving VS Aggressive Driving Battle Mindset Battle Mindset Unpredictable driving helps avoid IED’s and VBIED’sUnpredictable driving helps avoid IED’s and VBIED’s HomeHome Aggressive driving leads to tickets and accidents Aggressive driving leads to tickets and accidents Questions Questions Did You Serve In Iraq/Afganistan? Were You Aware That…?

18. Treatment Interventions Class A Significant Benefit Class A Significant Benefit MedicationsMedications Substance Abuse TreatmentSubstance Abuse Treatment Cognitive Therapy (Group and Individual)Cognitive Therapy (Group and Individual) Stress Inoculation TrainingStress Inoculation Training Exposure Therapy (PE/CPT)Exposure Therapy (PE/CPT) Food Not Mentioned, Experience Shows OtherwiseFood Not Mentioned, Experience Shows Otherwise

19. Questions/Comments Send Us Referrals!!