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Mental Health Issues of Veterans Returning from Iraq & Afghanistan (Part II)

Mental Health Issues of Veterans Returning from Iraq & Afghanistan (Part II). Heather Brown, PhD Louis A Johnson VA Medical Ctr Clarksburg, WV Heather.Brown4@va.gov. Following this presentation, the learner will:.

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Mental Health Issues of Veterans Returning from Iraq & Afghanistan (Part II)

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  1. Mental Health Issues of Veterans Returning from Iraq & Afghanistan (Part II) Heather Brown, PhD Louis A Johnson VA Medical Ctr Clarksburg, WV Heather.Brown4@va.gov

  2. Following this presentation, the learner will: • Review information on the mental health issues affecting Veterans returning from Iraq & Afghanistan • Receive education about innovative programs within VA to address the needs of this population • Understand the eligibility and enrollment process within VA

  3. Mental Health problems of returning service members seeking VA care: • 1) Adjustment Reactions (includes PTSD) • 2) Drug abuse (includes nicotine) • 3) Depression

  4. Hidden Wounds: • Traumatic Brain Injuries (TBI) • Post-Traumatic Stress Disorder (PTSD)

  5. Substance Abuse • 11 percent of OEF and OIF Veterans have been diagnosed with a substance use disorder (SUD)—an alcohol use disorder, a drug use disorder, or both • Almost 22 percent of OEF and OIF Veterans with post-traumatic stress disorder (PTSD) also have a SUD • SUD may co-occur with a mental health issue for “self-medication”

  6. Veteran-specific suicide risks (JAMA Psychiatry, 4/1/15) • Deployment was not associated with the rate of suicide • An increased rate of suicide was associated with separation from military service, regardless of deployments • Elevated suicide rates for those with less than 4 years of service or discharge that was not honorable

  7. Traditional MH Treatment Options • Acute (inpatient psychiatry) • Residential treatment • Day Treatment • Intensive Outpatient • Outpatient treatment (i.e., medication and supportive psychotherapy) • Self-Help groups

  8. Newer Treatment Options • Evidence-based psychotherapy (EBPs) • Proven through research to be effective when utilized as structured/designed • Available in individual and/or group formats • Some available by Telepsych (seeing the provider by computer screen)

  9. EBPs available thru VA • Prolonged Exposure Therapy and Cognitive Processing Therapy (PTSD) • Cognitive-Behavioral Therapy for Depression, Insomnia and Chronic Pain • Motivational Interviewing (SUD, etc) • Social Skills Training (for SMI) • Seeking Safety (PTSD + SUD)

  10. Newer Treatment Options (cont’d) • In-home services: • Mental Health Intensive Case Management (MHICM) and Rural Access Network for Growth Enhancement (RANGE) • Home Based Primary Care (HBPC)

  11. MHICM/MHICM RANGE • Offers in-home MH case management by nurses and/or social workers • Goal is to reduce the number of acute psychiatry admissions for individuals with serious mental illnesses (SMI) such as schizophrenia • Focus on utilizing community and natural supports for stability

  12. HBPC • Help Veterans learn to live independently with new or chronic illnesses (e.g., neurological disorders, spinal cord injury, cancer) • Help Veterans adjust to living safely in their homes after returning home from a hospital or a nursing facility admission • Multidisciplinary team

  13. Supportive Programs/Services • CHOICE program • Caregiver Support Program • Telehealth • Compensated Work Therapy • Veterans Justice Outreach • Therapeutic Recreational Programs • Peer Support

  14. CHOICE Program • Allows eligible Veterans to receive health care in their communities rather than waiting for a VA appointment or traveling to a VA facility • Improves access to care • Not all community providers are participants in the program

  15. CHOICE eligibility • Your local VA medical facility says you will need to wait more than 30 days for an appointment from the date determined by your physician, or • Your residence is more than 40 miles driving distance from the closest VA medical facility (includes clinics). • Call 866-606-8198 to verify eligibility

  16. Caregiver Support Program • General Caregiver Program (for caregivers of Veterans of all eras) • Family Caregiver Program (for caregivers of eligible Veterans seriously injured on or after 9/11/01)

  17. Caregiver Program Services • Skilled Nursing • Home health aide • Home Based Primary Care • Medical equipment • Home modification/Vehicle modification • Aid & Attendance • Support groups • Education and training on Caregiving • Up to 30 days of respite care per year

  18. General Caregiver Program eligibility • The Veteran is unable to perform an activity of daily living, or • The Veteran needs supervision or protection based on impairment or injury

  19. Family Caregiver Program • All services previously mentioned • Monthly Caregiver stipend • CHAMPVA healthcare coverage • Mental health services • At least 30 days of respite care per year including during required training • Travel, lodging, and per diem during Veteran medical appointments.

  20. Telehealth • Veterans seen by computer at locations closer to their homes (e.g., CBOC) • Services include mental and physical health (e.g., psychiatry, diabetes management, maternity counseling) • Newest services include home telehealth (Veterans seen on their home computers)

  21. Compensated Work Therapy (CWT) • Transitional Work (TW) • Therapeutic, short term, work activity, at contracted work sites, to relearn work skills, habits & behaviors necessary for employment • Supported Employment (SE) • Community employment, with on-going support, specifically geared toward Veterans with Serious Mental Illnesses

  22. Veterans Justice Outreach (VJO) • VJO staff partners with local law enforcement and courts to link eligible Veterans to needed treatment (e.g., substance abuse, PTSD) • With Veteran’s consent, communicates treatment recommendations and treatment compliance to justice officials

  23. Therapeutic Recreational Programs • Project Healing Waters Fly Fishing, Inc. - dedicated to the physical and emotional rehabilitation of disabled active military service personnel and Veterans through fly fishing, fly tying education and outings. • Guitars for Vets • Same purpose as above; focus is on learning & continuing to play the guitar (10 week beginner class earns guitar @ graduation)

  24. Peer Support • Peer Support Specialists within VA are Veterans who have “lived experience” with MH and/or SUD issues • Have a minimum of one year in “recovery” • Work in a variety of VA programs/locations (e.g., inpatient, residential, outpatient, VJO, MHICM)

  25. Specialty Contact Persons • Transition & Care Management (post 9/11 Veterans) • Suicide Prevention Coordinators • Military Sexual Trauma Coordinators • Women Veteran’s Program Manager • Homeless Program Managers

  26. VA Hospitals in West Virginia • Beckley • Clarksburg • Huntington • Martinsburg

  27. Who is eligible for VA Care? • Priority groups (disabled Veterans, former POW’s, Purple Heart recipients, low income, etc.) • Minimum duty requirements • Cannot have a dishonorable discharge • When in doubt, let the VA figure it out!

  28. How do Veterans enroll? • Complete application in person, by mail, by phone or online at www.va.gov/HEALTHBENEFITS/apply/index.asp • Must have DD214 (discharge paper), which shows when served, length of service, medals earned, etc. • Financial information (income, medical expenses, etc).

  29. Community Based Outpatient Clinics linked to Huntington VA Hospital • Charleston • Gallipolis (OH) • Lenore • Prestonsburg (KY)

  30. Vet Centers in West Virginia • Beckley • Charleston • Huntington • Martinsburg • Morgantown • Princeton • Wheeling

  31. What’s the difference between VA Hospitals and Vet Centers? • Services • Presenting problems • Costs • Record keeping • Transportation

  32. Resources • 1. Defense Centers of Excellence (DCOE): 24/7 MH and TBI resources for service members, family, and Veterans by phone, online chat, or e-mail. (866) 966-1020. • 2. Military OneSource: 24/7 Assistance and resources by phone and online for service members and their families on many different issues. (800) 342-9647. • 3. Vet Center Combat Call Center 877-WAR-VETS: 24/7 call center staffed by combat Veterans for combat Veterans and family members to discuss their military experience and adjustment issues. Individual & family counseling, bereavement counseling for family members, military sexual trauma counseling. 877-WarVets or (877) 927-8387. • 4. National Care Giver Support Line: M-F 8am-8pm. VA support for anyone providing care for Veterans coping with the effects of war, disability, chronic illness, or aging. (855) 260-3274. • 5. Coaching Into Care: 8am-8pm Mon-Fri. Call center works with family/friends concerned about Veteran post-deployment difficulties. (888) 823-7458.

  33. Additional 24/7 Hotlines Veterans Crisis Line/Chat/Text 800-273-8255, Press 1 http://www.veteranscrisisline.net/ Text to 838255 National Call Center for Homeless Vets 877-424-3838

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