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FACTS AND STATISTICS REGARDING THE NEEDS OF LONG ISLAND VETERANS

FACTS AND STATISTICS REGARDING THE NEEDS OF LONG ISLAND VETERANS. VETERANS HEALTH ALLIANCE OF LONG ISLAND John A. Javis Director of Special Projects (MHA Nassau County) PHONE: (516) 489-1120 ext. 1101 E-MAIL: jjavis@mhanc.org.

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FACTS AND STATISTICS REGARDING THE NEEDS OF LONG ISLAND VETERANS

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  1. FACTS AND STATISTICS REGARDING THE NEEDS OF LONG ISLAND VETERANS Exploratory Committee

  2. VETERANS HEALTH ALLIANCE OF LONG ISLAND John A. Javis Director of Special Projects (MHA Nassau County) PHONE: (516) 489-1120 ext. 1101 E-MAIL: jjavis@mhanc.org Exploratory Committee

  3. Special thanks to the Long Island Unitarian Universalist Fund in the Long Island Community Foundation for their support of this project.

  4. WHAT IS YOUR PERSONAL LEVEL OF INVOLVEMENT? • You are a veteran yourself? • You know someone currently serving / recently served in the military? • You have family ties to the military? • You are a concerned practitioner who sees this an emerging issue? Exploratory Committee

  5. WE ARE ALL INVOLVED IN THE WAR ON TERROR • SOME MILITARY SERVE IN COMBAT ZONE • OTHER MILITARY SERVE ON BASES IN THE U.S. AND OTHER OVERSEAS BASES • ON 9/11 – REALIZATION THAT CIVILIANS HAVE BECOME POTENTIAL TARGETS TOO • > NEW YORKERS WITNESSED 2 ATTACKS ON THE WTC (1993 / 2001) • WITH PROJECT LIBERTY, PRACTITIONERS HELPED FELLOW CITIZENS RECOVER FROM THE ATTACKS • PRACTITIONERS NOW SERVING OEF / OIF VETERANS

  6. National Military Perspective • Nearly 24 million veterans in the U.S. • 40% are 65+ years of age • 7.8 million are enrolled in the VA • 5.2 million receive services from the VA (22%) Exploratory Committee

  7. OEF / OIF VETERANS • 1.7 million have served in OEF / OIF • 39% of those veterans sought services at the VA * 38% of those seeking services at the VA were diagnosed with a mental health condition * 17% of those seeking services at the VA had substance abuse issues * 11% had a Traumatic Brain Injury Exploratory Committee

  8. NEW YORK STATE MILITARY PERSPECTIVE • 1,065,749 veterans in NYS • NYS has the 4th largest population of veterans in the U.S. • Over 784,000 are “war time veterans” (But not necessarily combat veterans) • 155,000 WW II • 151,000 Korean War • 320,000 Vietnam War • 149,000 War on Terror • 66,000 are Women Veterans • NYS has the 4th highest number of Reserves in US Exploratory Committee

  9. NYS VETERANS CONT’D. • 60% of NYS veterans are 55+ years of age • 16% of Gulf War veterans are women • 75% of NYS veterans separated from the service in 2006 are under 30 years of age • About 10,000 veterans return to NYS per year in the past few years Exploratory Committee

  10. VA SYSTEM IN NYS • 12 VA Hospitals (On LI, VA in Northport) • 52 Outpatient Clinics (In Nassau to be moved to NUMC) • 13 VET Centers (Babylon, Nassau Site TBD) Exploratory Committee

  11. UPSTATE NY • 10th Mountain Division (Fort Drum) has been deployed 5X. • Buffalo has started a “Veterans Court” / Similar concept to the “Mental Health Court” Exploratory Committee

  12. LI VETERANS OVERVIEW • 174,248 Veterans on Long Island • Nassau: 79,146 Suffolk: 95,102 • Long Island is 2nd only to San Diego in the % of veterans it has in its population. • Loss of 40,000 Veterans over 5 year period World War II Veterans passing away / Others moved off LI) • About 7,000 LI residents have served since 9/11/01 Exploratory Committee

  13. LONG ISLAND MILITARY PERSPECTIVE • No Active Duty Military bases on Long Island (Therefore no access to “on base” services / No strong military “culture”) • High level of Guard / Reserve members • High enlistment following 9/11/01 • Guard / Reserve Units have played a major role in OEF / OIF. (at certain points in time, Reserves total 40% of forces) • Many experiencing multiple deployments Exploratory Committee

  14. LI GUARD / RESERVE UNITS • AIR NATIONAL GUARD • 106th Air Rescue Wing (Westhampton) • ARMY NATIONAL GUARD • 1st Battalion - 69th Infantry Regiment (Bayshore, Freeport, Huntington Station, Farmingdale) • 3rd Battalion – 142nd Aviation (Ronkonkoma) • ARMY RESERVES • 800th Military Police Brigade (Uniondale) • 448th Adjutant General (Shoreham) • 4220 Hospital / Dental / Veterinary (Shoreham) • 338th Military Police – Interrogation (Shoreham) • 455 Engineer Detachment (Amityville)

  15. MARINE RESERVES: • HHC Marine Corps Recruiting Command (Garden City) • 2nd Battalion, 25th Marine Regiment (Garden City) • NAVAL RESERVES • Naval Reserve Center (Amityville) **** Other Long Island residents are serving in Active Duty Units, or in other Guard / Reserve Units not based on Long Island. **** This initially causes some difficulties for families in accessing / finding commonality in Family Readiness Groups. (*NOTE: Family Readiness Groups on LI are willing to offer support to these families)

  16. Guard / Reserves have sustained 50% of casualties in OIF. • The Defense Medical Surveillance System indicated that 50% of Army National Guardsmen and 45% of Marine Reservists from OIF had mental health concerns. • Multiple deployments result in multiple transitions from the combat zone to civilian / family life. • According to the Mental Health Advisory Team (MHAT) survey soldiers and Marines deployed to Iraq more than once were 50% more likely to be diagnosed with a mental health issue than those on their first deployment. Exploratory Committee

  17. RELUCTANCE TO SEEK HELP • Many Long Island Guard / Reservists serve as Police Officers / Firefighters in civilian life – they may be reluctant to seek mental health help from the VA due to concerns about stigma. • Veterans openly admit to not being honest on post-deployment mental health surveys. (Give false answers so they “get home”.) • VA Committee on Post-Traumatic Stress Disorder admitted, “No one seems to expect them to answer truthfully”. • Rand Study indicated that 20% of OEF / OIF Veterans have PTSD or Depression but only 50% get treatment. (The 50% treatment rate, however, is consistent with the general population) Exploratory Committee

  18. RELUCTANCE TO SEEK HELP (Capella Study) • (1) Concern about negative impact on military career. • (2) No help was offered me. • (3) No one with combat experience available to help me. • (4) Concern loved ones would “lose respect for me”. • (5) Not enough access to community mental health resources. Exploratory Committee

  19. Long Island is a “high cost” area. Some Guard / Reservists earn substantially less in the military than they do in their civilian jobs. This causes emotional and financial distress, particularly for the families • (NOTE: In some upstate communities Guard / Reservists “lose” income when they return home as their military salary is higher than their civilian salary.) • This is compounded by the fact that their income (in theory) is too high for them to qualify for social services. • For earlier veterans, their income level may preclude them from accessing VA services. Exploratory Committee

  20. Comments by LTC. Scott Rutter to Association of Fundraising Professionals (Long Island Chapter) (9/21/07) • “THREATS” • Complacency • “Veterans already get benefits” • “The VA takes care of them” Exploratory Committee

  21. ARGUMENT: Isn’t this a federal problem? Why can’t they just deal with it? • The VA is well funded, and does offer an impressive array of services. • Veterans should always be encouraged to register with the VA. • Not every veteran is eligible for VA services. • (Ex.) COL. Jim McDonough, the Director of the NYS Division of Veterans Affairs, an Iraq veteran with 26 years of service in the Army is not eligible for services from the VA. • Income Limits: • On LI around $43,000 for single / $49,000 for married. • On a federal level last year 290,000 veterans were denied enrollment. Exploratory Committee

  22. Federal Problem Question (continued) • Of the 174,000+ veterans on LI – Northport VA saw about 33,000 veterans last year. • VA cannot serve the children of veterans • Limited services for the mental health needs of the spouses, families of veterans – (VET Center can) • Services for parents / family of those KIA • Transportation to Northport can be a barrier for some. • Availability of evening hours for those who work? • Stigma concerns Exploratory Committee

  23. IS THIS WAR DIFFERENT FROM OTHERS REGARDING PTSD? • CIVIL WAR: “Soldiers Heart” • WORLD WAR I: “Shell Shock” • WORLD WAR II: “Battle Fatigue” • VIETNAM: “Combat Stress” / PTSD becomes diagnosis in 1980 • Can’t compare Vietnam PTSD (some untreated 20+ years) with OEF / OIF PTSD (who may be treated within days.) Exploratory Committee

  24. Other Factors Related to OEF / OIF (1) Better “Combat Medicine” results in high survival rates of seriously wounded veterans – Depression due to severe injuries. (2) Changing Combat Environment: (a) WW I, WW II fought with “front lines” (b) “Cold War” : Trained to fight conventionally (East / West Germany, Berlin Wall) (c) Desert Storm, for the most part, was fought, “at a distance”. (Cruise Missiles, Stealth Bombers, Apache Gunships, M-1 Tanks etc.) Exploratory Committee

  25. (d) Initial stage of Operation Iraqi Freedom (2003) fought along conventional lines > Later became an “insurgency” * Enemy does not wear a uniform * War fought among civilians / children - possibility of killing innocent civilians * Forces Soldiers / Marines to live a “dichotomy” (i.e. Candy in one hand – rifle in the other / “Be Nice – Kill someone”) Exploratory Committee

  26. * Some groups have “changed sides” during the war * “Bad Voodoo Story” * Enemy has used persons with mental mental disabilities as “suicide bombers” * Contractor Scandal (3) Urban Warfare is highly lethal (i.e. Attack via Stealth Bomber vs. “House to House”) * Upon return home – environment is very similar. (ex. Jungles of Vietnam do not resemble Nassau, City neighborhoods – Iraq urban setting resembles urban areas in U.S.) Exploratory Committee

  27. THE BATTLE OF FALLUJAH • During the Battle of Fallujah the Marines encountered not a poorly trained group of insurgents, but an “All Star Team” of insurgents from other countries that were highly trained and organized. • The Marines found syringes of liquid adrenaline on enemy corpses – “Our troops were doing it in on Folgers crystals and Coca Cola”.

  28. (4) Constant threat of: IEDs: Improvised Explosive Devices VBIEDs: Vehicle Borne Improvised Explosive Devices IRAM: Improvised Rocket Assisted Munitions * No enemy to find or retaliate against Exploratory Committee

  29. (5) Mental Health in the Combat Zone • 13 - 17% of soldiers deployed to Iraq / Afghanistan are taking some form of medication for stress, anxiety, depression or sleeplessness. • In 2007 the Army was treating 28,365 for PTSD, Marines were treating 5,641 • This would not have been done in earlier wars. • 2004 New England Journal of Medicine reported that 11% of recruits had a psychiatric history before entering the military. • Increase in “waivers” from 5% in 2004 to 11% (leading up to the surge) for issues like marijuana possession, DUI, misdemeanors and felonies. Exploratory Committee

  30. MENTAL HEALTH IN THE COMBAT ZONE • COMBAT STRESS TEAM: Team of Psychiatrists, Psychologists, Social Workers, enlisted Mental Health Tech. • Organic Mental Health Resources on base form a mental health clinic. • Counseling, groups, stress management, coping skills • Critical Incident Stress Debriefings • Social Workers became mobile flying or driving out to sites where an incident occurred.

  31. (6) The media may add to the stress for warrior and family members • In previous conflicts, reporting on the war had a certain “lag” time. • Now, with almost instant reporting from the combat zone, media announces that a number of soldiers or Marines from a certain unit were killed or wounded – Families left wondering if it is their loved one.

  32. (7) INSTANT COMMUNICATIONS (e-mail, Cell Phones etc.) • In prior wars, this was unheard of • WW II: Handwritten letters being carried by boat (after passing through censors) • Families may pass on “distracting” information to warrior, or may withhold the information. • Families become nervous when regular communication suddenly stops.

  33. THE INTERNET AS A TOOL FOR HEALING AND SUPPORT • In some cases, e-mails / Discussion Boards / On-Line Communities have been extremely helpful in providing support to deployed servicemembers.

  34. (8) POOR TRANSITION: • Generally poor preparation for transition from “combat” environment to “civilian” life. • No communication from state VA to local VSA that a veteran is returning home. • Unfortunately, due to this lack of communication, veterans can wind up “in crisis” before seeking help • Aforementioned multiple deployments, particularly of Guard / Reservists causes multiple transitions Exploratory Committee

  35. TRAUMATIC BRAIN INJURY • The Iraq and Afghanistan Veterans of America estimates that between 150,000 – 300,000 OEF / OIF veterans have a Traumatic Brain Injury • “MILD”: Less than 1 hour of unconsciousness, or 24 hours of amnesia (Note – this can be problematic does 1 minute of unconsciousness = 59 minutes in severity?) • “MODERATE”: Less than 1 day of unconsciousness or 7 days of amnesia • “SEVERE”: More than 1 day of unconsciousness or more than 7 days of amnesia Exploratory Committee

  36. INCREASING AWARENESS OF TBI • FEB. 2007: Documentary of ABC News Anchor Bob Woodruff who suffered a Traumatic Brain Injury in Iraq • SPRING 2007: VA mandates TBI Screening for all OEF / OIF Veterans • By mid-2007, only 35,000 veterans had been screened for TBI – of those 11% were diagnosed with TBI • Of troops at screened positive for TBI at Ft. Carson 13% were deemed unfit to return to Iraq. • At Walter Reed Army Medical Center, 30% of wounded soldiers also have TBI Exploratory Committee

  37. CONSIDERATIONS FOR TREATMENT OF TBI • Dr. Maria Mouratadis (Naval Medical Center – Bethesda) Presentation at Brain Injury Association Conference in NYC – April, 2009 • Early in wars more 19 years olds were being treated, later in wars, with heavier use of Guard / Reserves, more 30 years olds being treated. • 3 months seems to be a critical point for recovery, symptoms getting worse, or staying the same. • High divorce rate 1 year after injury.

  38. TBI (Cont’d) • 4 issues commonly seen together: • TBI • PTSD • Chronic Pain • Alcohol Abuse • Need for Multi-disciplinary approach (i.e. OMH + OASAS) • Sometimes as brain “heals” TBI gets worse as brain begins to process the traumatic event.

  39. TBI (Cont’d) • Need to know what soldier did for treatment purposes. (i.e. Graves Registration vs. Cook) • Complicated grief and bereavement issues for leaders who sent others to their deaths. • Suicide and TBI –Common question to ask is “Do you have a plan?” People with brain injuries often cannot plan! – Also can be impulsive. • Need to alter approach – Exposure Therapy and Stress Debriefing are contraindicated for TBI. – May need to alter approach – not 1 hour session, three 20 minute sessions.

  40. TBI (Cont’d) • Resiliency: Lose one eye – other gets stronger. • Expectation of Recovery • “Of course I’m having nightmares, but they’ll get better”.

  41. US ARMY SUICIDES RISING: • 2004: 67 • 2005: 85 • 2006: 102 • 2007: 115 Exploratory Committee

  42. 2007 ARMY SUICIDES • OF THOSE 115: • 1/3 died at the battlefront. • 30% also involved drugs / alcohol • 50% involved a failed relationship • In addition to completed suicides in Iraq and Afghanistan, there were another 166 attempts in Iraq / Afghanistan and 935 in the whole Army Exploratory Committee

  43. SUICIDE RISK DOUBLE AMONG MALE U.S. VETERANS • NIMH Study (Dr. Mark Kaplan) • Followed 104,000 veterans who served between 1917 and 1994. • Study concluded that those individuals were 2.13 more likely to die of suicide over time then their non-veteran counterparts. • VA Admission / E-Mails indicate that 18 veterans a day nationally complete suicide. • VA Suicide Hotline based in upstate NY receives between 130 – 140 calls a day. Exploratory Committee

  44. ARMY “ACE” – SUICIDE INTERVENTIONASK YOUR BUDDY • Have the courage to ask the question directly, “Are you thinking about killing yourself”, but remain calm

  45. CARE FOR YOUR BUDDY • Remove means of self-injury • Calmly control situation – do not use force • Active listening to promote relief

  46. ESCORT YOUR BUDDY • Never leave your buddy alone • Escort to chain of command, Chaplain, behavioral health professional or primary care provider

  47. “Risk” (6 Pack) (BG Loree Sutton, SAMHSA August 2008) • GOT SLEEP? • GOT BUDDIES? • GOT PAIN? (Emotional, Physical, Spiritual) • GOT BUCKS? • GOT GRIEF? • GOT HOPE?

  48. HOMELESSNESS Veterans Comprise 11% of the general population, yet are 26% of the homeless population. Exploratory Committee

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