1. Behavioral Health is Essential To Health, Prevention Works, Treatment is Effective, People Recover

2. Alternatives 2013 Building Inclusive Communities: Valuing Every Voice December 4–7, 2013 Austin, TX 22

3. Unique Approaches to Military Veterans’ Wellness and Reintegration 33

4. 4 Speakers Stephen Robinson Prudential Financial, Inc. David Berceli, Ph.D. Trauma Prevention (Trauma Releasing Exercises) 4

5. 5 The Eight Dimensions of Wellness Adapted from Swarbrick, 2006. 5

6. 6 SAMHSA’s Wellness Initiative Goals: – Raise awareness of early mortality rates; – Promote ways to improve health behaviors; – Incorporate the Eight Dimensions of Wellness into our recovery; and – Enhance quality of life and increase longevity through wellness. 6

7. 7 Overview Social Context: – Public and media discussion of mental health; – Recent tragic incidents (e.g., Newtown, CT); – Government shutdown, program closures, sequestration, unemployment, and other factors; and – Longest wars in our Nation’s history. 7

8. 8 Overview For discussion: – Facts, misunderstandings, and discrimination relating to mental and substance use disorders and other veterans’ issues; – Focusing on overall health and the Eight Dimensions of Wellness to reduce veterans’ fear of seeking care for mental and substance use disorders; – Essential elements of healthy, productive work and home environments; – Education about the brain and body’s reactions to war; – Reframing discussion regarding proven resilience techniques; and – Examples of resilience techniques. 8

9. 9 Veterans and Health Care The wellness of all peers is critically important, but some groups are particularly at risk for developing mental health challenges—especially those we send into harm’s way, such as police officers, firefighters, and service members. – There are approximately 2.6 million post-9/11 veterans of Iraq, Afghanistan, and other places related to the war on terror (U.S. Department of Defense, 2013). – Even if they do not have a diagnosable condition, all veterans face a complex period of readjustment to society upon their return from active duty. – Many face mild traumatic brain injury (mTBI) caused by improvised explosive devices. 9

10. 10 Veterans and Health Care The U.S. Department of Veterans Affairs (VA): – The VA provided care for roughly 6 million of the Nation’s 22 million veterans in 2012, including 83.6 million outpatient visits and 703,500 admissions for inpatient services (U.S. Department of Veterans Affairs, n.d.). – Mental health services, including treatment for post- traumatic stress disorder (PTSD) and traumatic brain injury (TBI), represent a significant portion of this care. – Already, nearly 900,000 veterans of Iraq and Afghanistan have received VA care. Fifty-four percent of these have been diagnosed with a mental health disorder (U.S. Department of Veterans Affairs, 2013). 10

11. 11 Veterans and Wellness Many returning veterans have high rates of: – PTSD and TBI (roughly 15 to 20 percent will have symptoms) (Tanielian & Jaycox, 2008) ; – Substance use disorders; and – Homelessness. Suicide rates, especially among female veterans, demonstrate the critical need for mental health care. Research estimates that 22 veterans complete suicide each day (Kemp & Bossarte, 2013). 11

12. 12 Supporting Our Veteran Community Many veterans return home and successfully readjust, but many others need assistance. – They often rely on their own knowledge or that of spouses, parents, friends, coworkers, teachers, and managers. What can be done for those who need help? How can we assist the veteran population? – Mental health needs are well understood, and many programs and therapies are effective. Treatment can involve a wide range of approaches suiting most people’s needs and belief systems. 12

13. 13 Education and Information Teach people how to promote a healthy environment that values honesty, engagement, creativity, and productivity. For veterans, reframe the discussion toward performance rather than the mental illness. Seek to understand common behavioral health issues, to help ourselves and our loved ones. 13

14. 14 Important Components of Veteran Wellness Cultural Competence – Learn how to speak to veterans and assist them in finding peer support programs. Family – Educate yourselves about the wartime experiences of your returning veteran. – Learn about existing assistance programs, both inside and outside the system of care. – Learn and reinforce everything that your service member is learning about health and wellness. – Seek formal education and information about what to expect and how to survive the deployment cycle. 14

15. 15 Important Components of Veteran Wellness Reintegration Training — social, physical, and emotional. – Seek help from qualified veteran service organizations or student veteran associations. – Consider the following: What is the plan for the kids? Do you know age-appropriate ways to help them cope? The war also impacts the family support network—moms, dads, brothers, and sisters. Do all family members know how to be helpful and to recognize signs that they (or the veteran) may need support? – Create a family mentor network: National Military Family Association Blue Star Families Student Veterans of America 15

16. 16 Take Action and Share the Knowledge! The Resources slides contain information for every veteran, family member, or staff person in need. These links do not replace the help available from a trained caseworker or physician, but they can help educate the family and veteran about what to discuss with their health care provider. 16

17. 17 Trauma’s Effects on the Brain Trauma imprints itself in the reptilian brain (stem), not in the cortex. During stressful experiences, the brain stem and limbic system disengage the frontal lobes of the cortex. Over time, this neurological adjustment can lead to impulsive, short-sighted, or even violent behavior; increased anxiety; depression; substance abuse; learning disorders; and increased risk of stress-related diseases. Source: Berceli, 2008. 17

18. 18 Trauma’s Effects on the Brain Tremors are the body’s natural release of trauma. – Neurogenic tremors are a reflexogenic pattern held in procedural memory. – They are a generic discharge of the human organism. – Neurogenic tremors complete the trauma reaction that the brain was not able to have at the time of the traumatic event. Source: Berceli, 2008. 18

19. 19 Resources The Business Case for Hiring a Veteran (Syracuse University) – http://vets.syr.edu/wp-content/uploads/2012/08/The-Business-Case-for- Hiring-a-Veteran-3-6-124.pdf http://vets.syr.edu/wp-content/uploads/2012/08/The-Business-Case-for- Hiring-a-Veteran-3-6-124.pdf Careers After Combat: Employment and Education Challenges for Iraq and Afghanistan Veterans (IAVA) – http://iava.org/files/iava_careers_after_combat_2009.pdf http://iava.org/files/iava_careers_after_combat_2009.pdf Employing America’s Veterans: Perspectives From Businesses (CNAS) – https://www.cnas.org/publications/reports/employing-america-s-veterans- perspectives-from-businesses https://www.cnas.org/publications/reports/employing-america-s-veterans- perspectives-from-businesses Engaging Veterans in America’s Civilian Workforce (Syracuse University) – http://toolkit.vets.syr.edu http://toolkit.vets.syr.edu Everyone Serves: A Handbook for Family & Friends of Service Members During Pre-Deployment, Deployment and Reintegration (Vulcan Productions and Blue Star Families) – http://www.everyoneservesbook.com http://www.everyoneservesbook.com 19

20. 20 Resources Investing in the Best: How to Support the Nonprofits That Serve Veterans, Service Members, and Their Families (CNAS) – http://www.cnas.org/publications/reports/investing-in-the-best http://www.cnas.org/publications/reports/investing-in-the-best Helping Military Families. [Television series episode]. This Emotional Life. (PBS) – http://www.pbs.org/thisemotionallife/campaign/helping-military-families http://www.pbs.org/thisemotionallife/campaign/helping-military-families SAMHSA’s Wellness Initiative – http://www.samhsa.gov/wellness http://www.samhsa.gov/wellness Well After Service: Veteran Reintegration and American Communities – http://www.cnas.org/publications/reports/well-after-service-veteran- reintegration-and-american-communities http://www.cnas.org/publications/reports/well-after-service-veteran- reintegration-and-american-communities 20

21. 21 References Berceli, D. (2008). The revolutionary trauma release process: Transcend your toughest times. Vancouver, Canada: Namaste. Kemp, J., & Bossarte, R. (2013). Suicide data report, 2012. Washington, DC: U.S. Department of Veterans Affairs. Swarbrick, M. (2006). A wellness approach. Psychiatric Rehabilitation Journal, 29(4), 311–314. Tanielian, T. L., & Jaycox, L. H. (Eds.). (2008). Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica, CA: RAND Corporation. U.S. Department of Defense, Contingency Tracking System. (2013, July 31). Profile of service members ever deployed. Washington, DC: Author. 21

22. 22 References U.S. Department of Veterans Affairs. (2013). Analysis of VA Health Care utilization among Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) veterans: October 1, 2001–December 31, 2012. Washington, DC: Author. Retrieved from http://www.publichealth.va.gov/docs/epidemiology/healthcare-utilization-report- fy2013-qtr1.pdf http://www.publichealth.va.gov/docs/epidemiology/healthcare-utilization-report- fy2013-qtr1.pdf U.S. Department of Veterans Affairs, Veterans Health Administration, Office of the Assistant Deputy Under Secretary for Health for Policy and Planning. (n.d.). Selected veterans health administration characteristics, FY2002 to FY2012 [Excel table]. Washington, DC: Author. Retrieved from http://www.va.gov/vetdata/Utilization.asphttp://www.va.gov/vetdata/Utilization.asp 22

23. 23 Contact Stephen Robinson Vice President, External Veteran Affairs Prudential Financial, Inc. Stephen1.Robinson@Prudential.com 23

24. 24 Contact David Berceli, Ph.D. Trauma Prevention (Trauma Releasing Exercises) traumaprevention.com www.bercelifoundation.org trecalifornia.com/neurogenic-yoga 24