1. Caring for America’s Veterans Department of Veterans Affairs Arthur C. Russo, Ph.D. Clinical and Neuropsychologist Chaplain Andrew Sioleti, LCSW; D. Min Chief of Chaplains & ACPE CPE Supervisor VANY Harbor Healthcare System Veteran Mental Health: Why Ministry Matters

2. Caring for America’s Veterans Department of Veterans Affairs Understanding the Department of Veterans Affairs 2 Veteran’s Health Administration Veteran’s Health Administration Central Office (Washington) Central Office (Washington) National Cemetery Administration National Cemetery Administration Veteran’s Benefit Administration Veteran’s Benefit Administration

3. Caring for America’s Veterans Department of Veterans Affairs VA Mental Health 22.7 million veterans (Sept. 2010) 81 million patient visits (2010) 30% of VA patients come for mental health issues. PTSD, depression and problem drinking are the three most common mental health conditions. 3

4. Caring for America’s Veterans Department of Veterans Affairs Old Model of Ministry For decades mental health professionals thought of community clergy primarily as sources of referral. Clergy working within the VHA had a limited role, mostly doing pastoral visits. 4

5. Caring for America’s Veterans Department of Veterans Affairs New Model of Ministry In recent years religion, spirituality and religious communities have been increasingly recognized as of inestimable value for the veteran’s/family’s support, treatment and recovery. 5

6. Caring for America’s Veterans Department of Veterans Affairs Today’s chaplains are a multi-faith group of professionally and clinically trained, ordained ministers who are here to serve veterans and their families with their spiritual, religious and existential needs, and work alongside their community faith groups. 6 New Model of Ministry

7. Caring for America’s Veterans Department of Veterans Affairs Mental Health, Chaplaincy and Faith Based Community Groups Several recent VA and DOD initiatives recognized the importance of integrating mental health with spiritual care. 7

8. Caring for America’s Veterans Department of Veterans Affairs VA’s Center for Faith Based and Neighborhood Partnership "To develop partnerships and provide relevant information to faith-based and non-governmental organizations and expand their participation in VA programs to better serve the needs of Veterans, their families, and survivors." 8

9. Caring for America’s Veterans Department of Veterans Affairs Mental Health and Chaplaincy Initiative “The initiative is born out of understanding mental health and spirituality as interrelated aspects of overall health that are optimally attended to within a coordinated system of care." 9

10. Caring for America’s Veterans Department of Veterans Affairs CURRENT MILITARY AND DEPLOYMENT STRESS 10

11. Caring for America’s Veterans Department of Veterans Affairs Current US Military 2.2 million service members –50% married –93% military spouse population is female –150,000 single parents serving in the military –Two thirds live in the community 2 million children have a parent serving in the military 11

12. Caring for America’s Veterans Department of Veterans Affairs Since 9/11 Over 2 million troops deployed to Iraq and Afghanistan. Prolonged exposure to combat over multiple rotations results in –Exposure to combat stress, –Depression, –Post traumatic stress disorder (PTSD) –Traumatic brain injury 12

13. Caring for America’s Veterans Department of Veterans Affairs 13  Events that provoke terror, horror, or helplessness  Accumulation of stress from all sources over time  Death or injury of others who are loved and with whom one identifies  Events that contradict deeply held moral values and beliefs Four Causes of Stress Injury Life threat INTENSE OR PROLONGED STRESS Loss Wear & tear Inner conflict

14. Caring for America’s Veterans Department of Veterans Affairs Moral Injury PTSD is a fear-victim concept; here the person is thought to suffer from exposure to threat. Moral Injury is an agentic concept where the person suffers from something he/she did or failed to do. It’s related to sins of omission and commission. 14

15. Caring for America’s Veterans Department of Veterans Affairs DEPLOYMENT AND FAMILIES 15

16. Caring for America’s Veterans Department of Veterans Affairs Spouses and Children 35 million spouses and dependent children of living and deceased veterans, making up 19 percent of the US population. This does not include the large number of adult children responsible for the care of their aging parents. 16

17. Caring for America’s Veterans Department of Veterans Affairs Deployment and Families Feel Concern, worry or panic, loneliness, sadness Have added family duties & responsibilities Learn new skills, make new friends Fear for their service member's safety 17 Feel overwhelmed Experience financial difficulties Deal with problems on their own Do not always understand what their loved ones have been through Are concerned about being needed and loved

18. Caring for America’s Veterans Department of Veterans Affairs 18 PhysicalPhysical Negative Coping FinancialFinancial Family Stressors RelationshipsRelationships Spiritual and Emotional Stressors Secondary Trauma Loss Moral

19. Caring for America’s Veterans Department of Veterans Affairs Home is Different for Veterans Homecoming is disorienting and can represent a significant change for a family. They have learned to live without their military member. Neither the returning service member nor their family and friends are the same as they were before deployment to war. Families and friends must re-adjust and “re- set” upon re-integration. 19

20. Caring for America’s Veterans Department of Veterans Affairs Secondary Trauma Trauma also affects those who experience it indirectly. Secondary, or vicarious trauma, refers to those people who care for, or are involved with, those who have been directly traumatized. Symptomatology very similar to that of PTSD. 20

21. Caring for America’s Veterans Department of Veterans Affairs Spouse and Child Abuse The number of Soldiers who committed spouse abuse and child abuse or neglect in the last six years has increased by 177% (913 cases in FY 2004 vs. 1,625 in FY 2009). Army: Health Promotion, Risk Reduction, Suicide Prevention Report 2010, (80) 21

22. Caring for America’s Veterans Department of Veterans Affairs The Child Victim Prolonged deployment and trauma related stress impacts the whole family Over 700,000 children have experienced the absence of a parent due to deployment Approximately 220,000 children are currently living through the absence of a deployed parent 22

23. Caring for America’s Veterans Department of Veterans Affairs Deployment & Children Jessica Ramirez (Newsweek reporter) found that a number of children who are experiencing the repeated absence of their parents are displaying “clinically significant” mental and behavioral health problems. Colonel Kris Peterson, a child and adolescent psychiatry consultant to The Surgeon General of the Army, stated that he is “seeing a range of problems requiring intervention; from attention issues and heightened aggression, to anxiety and depression.” Dr. Shelley MacDermid Wadsworth, the director of the Military Family Research Institute, says “the signs of trouble among the troops’ children appear to be growing.” Army: Health Promotion, Risk Reduction, Suicide Prevention Report 2010, (98) 23

24. Caring for America’s Veterans Department of Veterans Affairs THE OLDER VETERAN 24

25. Caring for America’s Veterans Department of Veterans Affairs The Aging Veteran Population In 2010 the median age of all veterans was 62 years Veterans 85 years of age and older increased from 164,000 in 1990 to 1,393,000 in 2010 25

26. Caring for America’s Veterans Department of Veterans Affairs US Census In 2000, Americans 65 years of age or older made up 12 percent of the population. –By 2020 this will increase by 16 percent. –By 2040 this will increase by another 20 percent. The fastest growing segment of older adults will be those 85 years of age or older, increasing 223 percent from 2000 to 2040. 26

27. Caring for America’s Veterans Department of Veterans Affairs Older Adult 85 percent have at least one chronic health condition with 75 year olds averaging 3 chronic conditions. 37 percent of those 65 and older have a hearing impairment with 30 percent having impaired vision. Degenerative dementia, rare among the young, finds an increasing rate of incidence among the elderly. 27

28. Caring for America’s Veterans Department of Veterans Affairs Loss and the Elderly “Not only are older adults more likely to have experienced loss, but they may find themselves the only surviving member of their family or peer group.” (Russo, 2012). 28

29. Caring for America’s Veterans Department of Veterans Affairs Depression and Despair Faced with a potential loss of functioning, autonomy or personhood, it is not unusually for the older adult to react with depression or despair, interpreting the results as evidence of personal dishonor or disgrace. (Nuffield Council on Bioethics (2009). 29

30. Caring for America’s Veterans Department of Veterans Affairs QUESTIONS? 30