Strong Committed Relationships Can Buffer Military Suicides

Can being in a strong committed relationship reduce the risk of suicide? Researchers at Michigan State University believe so, especially among members of the National Guard.

Suicide rates for members of the military are disproportionally higher than for civilians, and around the holidays the number of reported suicides often increases, for service members and civilians alike. What’s more alarming is the risk of suicide among National Guard and reserve members is even greater than the risk among active duty members.

When returning from a deployment, National Guard members in particular are expected to immediately jump back into their civilian lives, which many find difficult to do, especially after combat missions. Some suffer from post-traumatic stress disorder, depression or high anxiety in the months following their return. These mental health conditions are considered at-risk symptoms for higher rates of suicide.

The researchers wanted to know what factors can buffer suicide risk, specifically the role that a strong intimate relationship plays. They discovered that when the severity of mental health symptoms increase, better relationship satisfaction reduces the risk of suicide.

“A strong relationship provides a critical sense of belonging and motivation for living – the stronger a relationship, the more of a buffer it affords to prevent suicides,” said Adrian Blow, family studies professor, and lead author. “If the relationship is satisfying and going well, the lower the risk. National Guard members don’t typically have the same type of support system full-time soldiers receive upon returning home, so it’s important that the family and relationships they return to are as satisfying and strong as possible.”

The researchers surveyed 712 National Guard members who lived in Michigan, had been deployed to Iraq or Afghanistan between 2010-2013 and reported being in a committed relationship. The study measured three main variables – mental health symptoms, suicide risk and relationship satisfaction – each on a separate ranking scale. The soldiers were asked questions such as how enjoyable the relationship is, if they ever thought about or attempted suicide, how often they have been bothered by symptoms of depressive disorder, etc.

Results showed significant associations between each of the mental health variables (PTSD, depression and anxiety) and suicide risk, indicating that higher symptoms were predictive of greater risk.

However, once couple satisfaction and its interaction with mental health was factored in, the association between mental health symptoms and suicide risk was changed. Specifically, for those with higher couple satisfaction, the increased symptoms of PTSD, depression and anxiety were no longer a risk for suicide.

“Our findings show that more needs to be done to enhance the quality of relationships to improve the satisfaction level and through this decrease the suicide risk,” Blow said. “Having a partner who understands your symptoms may help the service member feel understood and valued. There are family support programs available, but we need to do more to enhance relationships post deployment. Relationships do not get enough consideration in the role they play in preventing military suicides, and I would love to see more attention devoted to this issue.”

Other co-authors included Adam Farero from MSU; Heather Walters and Marcia Valenstein from University of Michigan; and Dara Ganoczy from the Veterans Health Administration. The study was funded by the Veterans Administration. The study was published in the official journal of the American Association of Suicidology.

Operation Surf Uses Surfing to Help Veterans

Photo Credit: ESPN

Every day roughly twenty veterans commit suicide. It is estimated that 22% of all suicide deaths in the US are veterans. Former professional surfer Van Curaza wants to change that.

Curaza originally founded the nonprofit Amazing Surf Adventures (ASA) as a way to help at-risk youth by getting them into the ocean and off the streets. He expanded ASA to help veterans overcome the challenges caused by war with surfing – a program dubbed Operation Surf.

Operation Surf is a free program “that offers week-long adaptive surfing trips for wounded-veteran and active-duty military men and women.” They pair veterans “with their own individual surf instructor and develop a goal-based curriculum around their unique abilities. Operation Surf offers an environment of camaraderie and healing to its participants by giving them a shared experience in the water each day.”

Curaza and Operation Surf are featured in the award-winning Netflix documentary “Resurface.” The film is about Marine Corps veteran Bobby Lane. Bobby was planning on committing suicide, but he wanted to check surfing off his bucket list first. He ended up participating in Operation Surf and it changed his life. Not only did Bobby decide he wanted to keep living, but he decided he wanted to work with Operation Surf to help other veterans.

The first time I volunteered for Operation Surf I briefly met a young man named Tommy Counihan. He was learning how to kiteboard. With his long blonde hair and slender build, he looked more like a surf hippie than a veteran.

In 2011, while on deployment in Afghanistan the armored vehicle Tommy was in drove over an IED. It exploded directly under Tommy’s feet. His right foot ended up needing to be amputated. But it was more than a physical injury, “I felt like when I made that decision that day to amputate my foot that I lost more than just a physical part of myself,” he said. “It plays tricks on your head. It brings you to a really dark place that’s almost impossible to get out of on your own. I remember the times when I would sit there by myself and contemplate whether or not I should commit suicide.”

On the advice of his therapist, Tommy participated in Operation Surf. Even though Tommy had surfed when he was a teenager, he was skeptical that it would help him now. Then he caught his first wave, “I was just so ecstatic that I was able to stand up on that board because in that one instant I knew that everything that I thought I had lost was just something I was creating in my head. That I was going to be able to do it all. I just had to push myself to overcome these barriers that I placed in front of myself.” Tommy won the wounded warriors division at the Hawaii Adaptive Surfing Championship last year.

Surfing can have a profound impact on veterans’ mental health. Dr. Russell Crawford, Air Force veteran and licensed therapist, conducted a research study on Operation Surf participants and found that surfing decreased PTSD symptoms by 36%, decreased depression by 47%, and increased self-efficacy by 68%.

Surfing can help veterans overcome the challenges caused by war. It has given Bobby, Tommy, and hundreds of other veterans a new lease on life. You can show your support by volunteering or donating to Amazing Surf Adventures and Operation Surf by visiting their website.

Mental Fitness: We Can Actually Train to Become Resilient Leaders!

What if I told you that mental fitness is something you can develop in the same way you build your physical fitness?

We hear a lot these days about stress and when we do, the conversation often focuses on avoiding it or managing it. What if that isn’t actually useful?

The best illustration I’ve read highlighting the direct link between mental toughness and performance comes out of a research lab. A team of researchers wanted to look at what made subjects mentally fit or resilient and took some baby chicks into the lab to study their theory. Painting the chicks and grouping them in separate pens, the first group was left alone to interact happily and normally.

The second group was periodically picked up and stressed in a confined space. After the stress, the chick was given time back in their group pen to recuperate. The third group was continually stressed in the confined space, with no recovery time or play opportunity with other chickens. The researchers created three distinct populations with different experiences.

After raising them for a time in this manner, all the painted chicks were placed in buckets of water, with researchers timing their struggle until drowning. I know, this sounds just awful.

The chicks that had been continually stressed drowned almost immediately; they just had no hope in the face of hardship that they could swim. The second group to succumb was comprised of those “happy innocents” in group one who had never been confined and stressed. They didn’t know how to withstand this watery hardship and folded in the face of it. The last swimmers fighting to make it were the chicks from the stress adaptation group.

Somehow, the confinement stressors followed by time to recover had rendered them stronger and able to swim and survive much longer than their peers. This group was resilient; they had experienced hardship before and believed they had a chance to make it and recover. They had those past mastery experiences to rely on, and they just fought to keep swimming.

Stress has a purpose. Stress is opportunity. It’s meant to teach us to swim!

Responding well to stress requires high functional capacity of your brain’s frontal cortex. This area of our brain houses something called our working memory capacity, which helps us with both emotional regulation (being able to think and not just react) and upper-level cognition (focus). We can improve that capacity with the use of some well-studied, relatively simple exercises.

Think about the last time you experienced stress. I always think back to those really awkward years – for me it was 13 – and last week. Think about that age, standing in the middle of the school lunchroom with your meal tray. As you gaze over top of your sandwich, anemic vegetables, and cookie snack pack, you anxiously wonder who will make room for you at their table.

What happened in your body at that moment? Maybe your heart sped up, you started breathing fast, your face flushed – your body fires off a full-on stress response. As the stress is registered by your brain, wherever that stress comes from – a chain reaction fires.

Your body releases cortisol, adrenaline, and a host of other chemicals to help you cope. It also releases a hormone called DHEA into your bloodstream. DHEA’s entire role is to help your brain grow from the stressor you just survived. But there’s a catch – DHEA only does its job when you give yourself a post-stressor break.

You need that time to de-escalate your revved up nervous system in order for DHEA to do its brain-building work for you! The hormone increases synaptic firing and neural connectivity (you’ll think faster) and increases working memory capacity (emotional regulation and focus). DHEA is what makes stressful experiences worth your time, but you have to create the space for it to do its work.

Creating this space is the heavy lifting of mental fitness training, and it isn’t as easy as it sounds. If I say rest, self-care, nervous system regulation and you think taking a nap, you’re on the wrong track.

When we are asleep our brain waves are long and slow. We call these delta waves, and our brain is in delta state. When you’re awake and ambulatory, walking and talking in the world you’re in Bets state. What’s interesting for a lot of us in a hyper-stimulated environment is that we find ourselves often entirely on or entirely off, and the place in the middle where DHEA does its building work is theta state.

In this space, you’re at rest, but still aware. Also, your nervous system has space to rebuild and strengthen. So what does a drop in stress hormones and downshifting of the nervous system feel like? Think about the last time you enjoyed an activity or training – when you took a deep breath in and you just felt that “Ahhh!” feeling – even if you were working hard and running up and down trails.

You may find it while running, skiing, doing yoga, getting a deep tissue massage, taking a bubble bath, or even lifting weights. Some people call it a “click,” or a “shift.” Here is where you have to experiment a bit. That moment will look different for everyone, but when you find it, take note.

Do more of it – especially when you’re feeling stressed and overwhelmed. I find it often on a yoga mat. I have a friend who tells me she finds it swimming laps. Now for me, I’m trying not to drown while swimming laps, there is nothing theta state happening for me there! Dedicate the time to finding your practice. What down-shifts your nervous system? Then do it. Ritualize it. Make downshifted moments part of your training routine.

All of us face periods of adversity, and no one is going to ask us if we can swim before the crisis. We have to train for the hard times, and we can. Make a little time for your brain and watch yourself get sharper, smarter, more focused, kinder. You’ll also be ready for the bucket of water.

You need to know how to become mentally fit to be the best student, professional, parent, and friend that you can be. Be the chick that lived well! Train yourself to swim.

A wrote a book on this subject that’s brand new from Praeger – check it out here.

Veterans: Take This Survey!

Learning about military-to-civilian reintegration requires asking the right questions of the right people. A novel, new study is seeking military veteran respondents to learn more about the way service impacts health, civic engagement, and socio-economic outcomes for military-connected men and women. The data collected through this survey are expected to help us answer questions such as:

• Do veterans feel welcome and interested in institutional service groups like the VA and informal groups like VSOs? Do those organizations serve their needs? How are prospective members welcomed and served?
• How does military service impact community involvement and political engagement?
• How does military service impact experiences on the job market (and is this effect conditioned by demographic factors?
• Does military service break the glass ceiling for service women?

The project was developed by an interdisciplinary research team with experience, training, and connections to the military community. Dr. Kyleanne Hunter is a Marine Corps Cobra pilot and political science researcher. Dr. Rebecca Best is an experienced security studies researcher with a focus on service women. Dr. Kate Hendricks Thomas is a public health researcher and Marine Corps veteran. Each has specific training in community-based, participatory research and is invested in filling current gaps in what we think we know about the transition from service member to civilian.

Access the survey online here: https://udenver.qualtrics.com/jfe/form/SV_572AiK5P3P75KQt

Will Veteran Suicide and Mental Illness Rate Improve?

Even in Afghanistan, I will seek pet therapy! – Rick Rogers (pictured above)

It was about 9 years ago.  I decided to put down the rifle and pick up the DSM. You see, I was an infantryman since I was age 17.  That means, since I was a child, I was literally trained to kill people.  Looking back at it, that sounds like a profound concept.

I am proud of my time in the military.  I am proud of my brothers and sisters who have ever answered the call.  But…  I am also worried.

As I said, 9 years ago, I decided to change my path.  I didn’t realize where that path would lead.  I seen multiple traumas and death happen to my fellow comrades.  I went through some trauma myself, but I still worried about others more than myself.  So, I decided to become a Mental Health Specialist in the military.

It’s been a long road going from Infantryman to Social Worker. There are a lot of learned attitudes and behaviors I had to change. Can you believe it? I literally had to learn empathy.  And that took a long time.

Just about anyone in the military knows that drinking alcohol is a part of the lifestyle. Everyone I looked up to drank and considered me a p**sy if I didn’t.  So… when I was sent to Germany back in the early 2000’s as a 19 year old kid, you better believe I drank. It was legal!

Looking back at my adventures between then and now, I don’t regret a thing. Yes, there were many embarrassing moments, and I have lost many friends along the way.  I also met some great people.  My alcohol use made my path rockier than anything else.

Many others have had this experience as well.  Between 1998 and 2008, binge drinking went from 35% to 47% of veterans, and 27% of that 47% experienced combat. 

Between 2002 and 2008, misuse of opiate prescriptions went from 2 percent to 11 percent in the military.  These prescriptions were mostly due to injuries sustained in combat, as well as the strain of carrying heavy equipment.

This concerns me. When I was young, I had a good time. Looking back, maybe it wasn’t.This might not be every veteran’s experience, but the culture encouraged substance use and discouraged getting help. There are others that would agree with me.

This could explain why 20 veterans a day on average commit suicide. This is actually down from 22 a day before the 2014 study from the VA.  However, it is a 32% increase since 2001. In 2014, veteran suicides accounted for 8.5% of U.S.’s adult suicides, and the rates were especially high among 19-29 year old compared to the older generation.

Let’s not forget about the infamy of PTSD. Up to twenty percent of veterans have suffered from this. Of course, those who suffer are more likely to admit their distress to a computer program than a battle buddy or their superior.  This, again, goes with the constant culture that causes our military to fear judgment.

These wars have been a constant the last two decades, and have cost all U.S. citizens a pretty penny. According to one report, the VA spends $59 billion a year on health care.  This number is 3 times as much as it was since before 2002.

And let’s not forget the cost this country has incurred for being in war for this long.  Well, we don’t really know an exact number.  The cost is estimated by many to be in the billions or even trillions.  This isn’t including the interest from borrowed money.

So, after looking at all these figures, I am overwhelmed.  How can I even make a dent in helping our nation’s veterans? The current administration is planning on increasing our presence in war zones.  I am expecting the rate of PTSD and suicide to increase once again.  Also, our country will continue to spend.  It seems to me that we are all participating in a death and mental illness factory.   The thing is, I didn’t even get to the physical injuries many of our combatants have suffered from.

I love our nation’s military.  I want every one of them to know that I am here to support them.  But most of all, we all need to be here to support each other.

UA Study to Take ‘Deep Dive’ into Risk Factors for Veterans, Suicides

University of Alabama researchers, America’s Warrior Partnership and The Bristol-Myers Squibb Foundation have partnered on a four-year, $2.9 million study to explore risk factors that contribute to suicides, early mortality and self-harm among military veterans.

“Operation Deep Dive,” funded by the Bristol-Myers Squibb Foundation, aims to create better understanding of the risk-factors, particularly at the organizational and community level.

Drs. Karl Hamner, director of the Office of Evaluation for the College of Education, and David L. Albright, Hill Crest Foundation Endowed Chair in Mental Health and associate professor in the School of Social Work, are the principal investigators for UA on the study.

Recent research has shown that neither PTSD nor combat exposure are good predictors of veterans and suicide, so researchers must cast a wider net, Hamner said.

“Previous research has focused primarily on individual-level risk factors, like prior suicide attempts, mood disorders, substance abuse and access to lethal means, but suicide is a complex phenomenon, and those factors don’t paint the whole picture,” Albright said.

The study is innovative in that it focuses on veterans across the spectrum of service, gender and lifespan, utilizing data from America’s Warrior Partnership and the U.S. Department of Veterans Affairs, new data collected during the study, and data from the Department of Defense.

For instance, female veterans, who are 2.5 times more likely to commit suicide than civilian women, will be spotlighted in the study.

Both the DOD and the VA will be vital in identifying veterans with varying medical histories, combat experiences and discharges from military services. America’s Warrior Partnership will also help fill the gaps in identifying veterans who don’t fit criteria for VA benefits, like National Guard or Reserve personnel who aren’t activated, or anyone who has a dishonorable discharge, which could be for a variety of reasons.

“The scope of this study is timely and so needed that we really believe we can move the needle,” Hamner said.

The first phase of the study is a five-year retrospective investigation of the DOD service use and pattern of VA care utilization to examine the impact of less-than-honorable discharges on suicides and suspected suicides, and the differences in suicides between those who receive and do not receive VA services.

“Helping to identify the trends or predictors of veterans’ suicide could help immensely in reducing suicide rates and provide much needed interventions for this community,” says John Damonti, president of the Bristol-Myers Squibb Foundation. “This project will take a deep dive to better understand what was happening at the community level to design better, more targeted intervention programs.”

The second phase will incorporate these findings into a three-year study that will include input from medical examiners, mental health experts, veterans and family members, and the community to conduct a “sociocultural autopsy” of all new or suspected suicides in America’s Warrior Partnership’s seven partnership communities, as well as in comparison communities.

The results will explore how community context and engagement affect prevention of suicides in veterans and “why some former service members commit suicide, while others do not.

“The overarching goal of the study is to understand triggers of suicide in order to prevent potential suicides before they occur,” said Jim Lorraine, president and CEO of America’s Warrior Partnership. “With each organization bringing its own areas of expertise and data, we can make a difference in the lives of our nation’s warriors, particularly the most vulnerable veterans.”

Both Hamner and Albright are committee chairs for the Alabama Veterans Network, or AlaVetNet, which connects Alabama veterans to resources and services. Alabama Gov. Kay Ivey recently signed Executive Order 712, which tasks the group in helping reduce and eliminate the opioid crisis as well as reducing the high veteran suicide rate.

Military Service Boosts Resilience, Well-Being Among Transgender Veterans

Transgender people make up a small percentage of active-duty U.S. military personnel, but their experience in the service may yield long-term, positive effects on their mental health and quality of life.

A study from the University of Washington finds that among transgender older adults, those who had served in the military reported fewer symptoms of depression and greater mental health-related quality of life. The findings were published in a February special supplement of The Gerontologist.

The paper is part of a national, groundbreaking longitudinal study of LGBT older adults, known as “Aging with Pride: National Health, Aging, Sexuality/Gender Study,” which focuses on how a range of demographic factors, life events and medical conditions are associated with health and quality of life.

Estimated numbers of U.S. military personnel who are transgender vary widely, but range between one-tenth and three-quarters of 1 percent of the roughly 2 million active-duty and reserve forces. A study from UCLA estimates about 134,000 transgender veterans in the United States.

The new paper, by researchers from the UW School of Social Work, explores how military service affects transgender people because previous data indicated that, among LGBT people over age 50, those who identified as transgender were more likely to be veterans than lesbians, gay men or bisexuals.

Reports have indicated that transgender individuals serve in the military at higher rates than people in the general population. In the 2015 U.S. Transgender Survey of 28,000 individuals, 15 percent said they had served, compared to about 9 percent of the U.S. population overall. And yet, little is known about how military service influences the well-being of transgender veterans later in life.

Other studies have shown that transgender veterans suffer higher rates of depression than other veterans. UW researchers were somewhat surprised, then, to learn that the transgender veterans they surveyed tended to have better mental health than transgender people who hadn’t served, said lead author Charles Hoy-Ellis, a former UW doctoral student who is now an assistant professor at the University of Utah College of Social Work.

The traditionally masculine culture of the U.S. military would seem to be a potentially difficult environment for someone who doesn’t identify with the gender they were assigned at birth, he said.

But military service creates its own kind of identity, the authors said, because it presents often dangerous and traumatic challenges; overcoming those challenges builds resilience. And that’s where the identity as a transgender person enters the picture.

“Many people develop an identity as a military person — that it’s not just something they did but something that they are,” said Hoy-Ellis. “If transgender people, who are among the most marginalized, can successfully navigate a military career, with so many of the dynamics around gender in the general population and in the military, then that experience can contribute to a type of identity cohesiveness.”

The internalizing of negative stereotypes, such as those around sexual orientation, is considered a risk factor for poor mental health, added co-author Hyun-Jun Kim, a UW research scientist in the School of Social Work. Military service could be the opposite — a protective factor.

“Often when people think of the transgender population, they focus on the risk factors, but it’s equally important to focus on the protective factors and nourish those resources. In this case, what aspects of military service contribute to being a protective factor?” Kim said.

Researchers said they were somewhat limited by the size of their study sample: Out of the 2,450 people ages 50 to 100 who were surveyed for Aging with Pride, 183 identified as transgender. Of those nearly one-fourth, or 43, had served in the military. Of those who had served, 57 percent identified as female. People of color made up 29 percent of the transgender veterans in the study.

But as awareness grows about gender-identity issues, there is an opportunity to address support services for transgender veterans at the federal level and in the community, Hoy-Ellis said.

“This is a population that has served the country very proudly, and it’s important that we recognize that service,” he said. “Learning what we can about transgender older adults with military service may help us develop and implement policies and programs for people who are serving today.”

Other co-authors were Chengshi Shiu, Kathleen Sullivan, Allison Sturges and Karen Fredriksen-Goldsen, all in the UW School of Social Work. Funding was provided by the National Institutes of Health’s National Institute on Aging.

More Veterans Have Enrolled in College with Post-9/11 G.I. Bill

veteran colleg
Capt. Irvin Drummond, U.S. Army, studies at a computer 18 May 2007. (Photo by Chris Sanders, U.S. Army)

The Post-9/11 G.I. Bill, which covers educational costs for veterans beyond tuition, has boosted college enrollment rates among veterans by 3 percentage points compared with the earlier G.I. Bill, finds a new study by NYU’s Steinhardt School of Culture, Education, and Human Development. However, the increase in enrollment was much larger immediately after the bill’s adoption and has waned in recent years.

The study, published online in the journal Educational Evaluation and Policy Analysis, a journal of the American Educational Research Association, comes days after Congress passed a major expansion to the G.I. Bill, which – if signed into law – will provide additional educational benefits to veterans.

The Servicemen’s Readjustment Act of 1944, commonly known as the G.I. Bill, helped pay for college and other training for millions of World War II veterans. Since its inception, the G.I. Bill has been updated to continue providing educational benefits, with the most recent expansion being the Post-9/11 Veterans Educational Assistance Act of 2008, or Post-9/11 G.I. Bill.

“The original G.I. Bill not only significantly improved the human capital in the United States after World War II, but also democratized American higher education and created a robust middle class. Education benefits provided by the bill allowed veterans to go back to college and obtain necessary knowledge and skills, while also serving as an important entry point back to civilian life,” said Liang Zhang, the study’s author and a professor of higher education at NYU Steinhardt.

The Post-9/11 G.I. Bill, which took effect in August 2009, offers more generous educational benefits than the previous version of the bill. It covers full tuition and fees at in-state public schools (or up to a set amount for tuition and fees at private institutions), a monthly housing allowance, and up to $1,000 a year for books and supplies. All veterans who have served since September 2001 are eligible for the Post-9/11 G.I. Bill, meaning that those who did not take advantage of benefits under the previous bill were retroactively eligible.

In this study, Zhang examined the impact of the Post-9/11 G.I. Bill – including its monthly housing allowance and stipend to cover miscellaneous educational costs – on veterans’ college participation.

Zhang used 11 years of data (2005 to 2015) from the American Community Survey, which resulted in a sample of approximately 200,000 veterans who have served in the post-9/11 era. This sample enabled a comparison between data from before and after the 2009 adoption of the Post-9/11 G.I. Bill in order to determine how veterans might have reacted differently to the bill over time.

Zhang found that the Post-9/11 G.I. Bill increased overall college enrollment by about 3 percentage points when compared with enrollment prior to the bill’s adoption. However, the effect was much larger immediately after the bill’s adoption (approximately 4 percentage points) and has waned in recent years (to about 2 percentage points), suggesting that part of the initial enrollment burst was due to the retroactive nature of the bill.

Despite the increase in enrollment, Zhang noted that the effect of the Post-9/11 G.I. Bill is much smaller than the effects of typical financial aid programs, which have been shown to improve enrollment by about 3 to 6 percentage points for every $1,000 reduction in college costs.

In addition, Zhang examined how the bill affected college enrollment among veterans ranging from 20 to 60 years old, given that veterans typically follow a different educational trajectory than that of nonveterans. He found that the Post-9/11 G.I. Bill has had a consistent and positive impact on college enrollment among veterans of all ages, even among older veterans who are usually considered less likely to enroll in college.

“This suggests that older veterans may be more responsive to financial incentives, echoing previous research findings that older students are more responsive to financial aid than younger students,” Zhang said.

Finally, Zhang looked at the levels of existing educational attainment among veterans, since the Post-9/11 G.I. Bill can be used for a variety of educational and training programs, including both undergraduate and graduate education. He found consistent and positive enrollment effects across veterans with all levels of education, with those already holding master’s degrees taking the most advantage of the bill’s educational benefits.

Zhang concluded that it is both important to evaluate the effect of veterans’ programs on college enrollment, as well as to consider the social impact of the bill – which is broader and more profound than any college-related outcomes could possibly measure.

“While providing generous education benefits to veterans could ease the financial burden of going to college, research shows that veterans can face additional challenges associated with service-related injuries and disabilities, as well as being older students. Higher education institutions must continue to better understand and support this growing, yet potentially vulnerable student population, to best serve those who served the country,” said Zhang.

What Do Service Women Need: Invisible Veterans but Resilient Leaders

As a military health researcher, I hear veteran women tell me all the time that they sometimes feel invisible. The Service Women’s Action Network is calling for active duty, reserve, Guard, and veteran women to help change that.

Take our 2017 needs assessment and help government, community, and advocacy groups develop THE RIGHT programs to meet the needs of military women past, present, and future. The survey is short and easy, and it will help us make our community’s diverse voices heard.

Our assessment last year helped us understand and share information about belonging and support – it shed interesting light on the need for service organizations to open their doors to women in new, inclusive ways.

You see, women veterans share many of the exact same concerns as our male colleagues; yet we also face unique issues, especially when it comes to accessing services after we leave active duty.

Some of the most important places veterans connect, network, and socialize while transitioning our Military and Veteran Service Organizations (MSOs/VSOs). However, our team’s latest research in the Journal of Veterans Studies indicates that women veterans participate less and even report feeling unwelcome in those very spaces.

Be part of the solution this year by taking the survey! Military women are some of the most resilient leaders you’ll meet, and you can change our reintegration experiences if you help make that visible.

Loneliness Kills: Lessons From a Combat Hospital

Kate Hendricks (center)

I used to think I understood health. I worked in fitness and told people about it for a living. I WAS WRONG. Focusing only on movement and nutrition, I was missing the bedrock concept upon which real health is built. We are wired to connect and social health is the foundation of human well-being. (Check out the science behind this in my just-released TEDx talk).

This is what I study today, but in a life quite different than my current as a suburban mom and public health professor, I was a Marine Corps Military Police Officer. I have a little brother who also joined the Marines and we’ve always been very close, probably because we had to be! When we were young we moved over 20 times – there was many a summer where my siblings were my only friends because we were the new kids.

I was already deployed to Iraq when he e-mailed me to share his grand romantic plans to propose to his girlfriend before he headed over. She was a civilian schoolteacher that I had yet to meet. I was in my cynical deployment mode and I was surrounded by Marines receiving what we call “Dear John” letters. They often read the same, “the grind of deployment is too much, our relationship is over, I already have a new significant other, the end.” I didn’t think his proposal would wind up any differently because he was headed to Iraq right behind me, but I wanted to be supportive so I told him I didn’t have a problem with the proposal but admonished him to buy her a ring made out of cubic zirconia. No sense in buying a diamond he might never get back.

As younger brothers often do, he ignored my advice and bought her a beautiful ring.

Well, that is some cash he will never see again! Should have listened to me!

When he was coming in I had convoyed south and I was able to be there at the hangar in the middle of the night when he flew in. Even armed and incredibly well-trained my brother will always look like a little kid to me. He was walking towards me with a huge pack on his back, a Kevlar on his head, and a rifle in his hands. All I could see were his big, blue eyes peeking out like a turtle under all that gear and I thought, “who let a ten year old on the plane with a rifle???”

As I stood watching his C-130 unload on the tarmac I forgot to feel invincible for a moment and my heart sunk – I knew where he was heading and I knew what was happening there. I had some big sister notions of telling him what he needed to know to stay safe during his deployment and for the first time it occurred to me that may not be enough.

Soon after I was headed home to the states and I didn’t know it at the time, but he was as well. Except that an improvised explosive device made sure that his trip home was wounded and on a stretcher.

When a service member is medically evacuated and they make it to the stateside hospital, there are no guarantees and a lot of unknowns.

When my brother arrived at Bethesda, we didn’t know what he might be facing. Our family came together to be there for him, but even with our support system gathered, Bethesda was a dark place some days.

Into this world walked my brother’s civilian schoolteacher.

Frankly, I didn’t yet know if she was part of our close-knit family. I had stereotyped her on sight—mostly because she was a pretty girl who often wore makeup and always had on matching accessories. I was waiting for her to fall apart.

She never did.

When her leave ran out at work she went back to teaching all day long in nearby Virginia, but made the drive every night to sleep in a chair at my brother’s bedside. I was terrible in that hospital room always dropping things – just graceless. She kept him smiling and focusing on their future together. She kept him connected to their community of friends when he left the hospital and had to spend his days in a reclining chair. She kept him looking forward to new plans to build a family, even when they had to install bars over his bed at home and he needed help with the most basic tasks.

That makeup had fooled me; she was more than serious. She showed up, and she was a foundation for my little brother when he really needed one.

They got married and she gained three sisters that would help her hide a body today if she asked.

She has a really good memory though. Every now and again, I hear about that cubic zirconia comment.

The Science of Social Cohesion

Here’s the truth about human health – nothing will kill you faster than loneliness.

We know all of this because scientists have studied social cohesion from a variety of angles and proven that disconnection is dangerous! We’ve studied partner relationships, friendships, and civic involvement – it is all important and comprises our social health. In one study, medical students without many friends had depressed immune systems. A 30 year study out of Roseto, PA found that support protected against heart disease even when the diet wasn’t ideal. My own research has demonstrated convincingly that people without partnerships are at greater risk for depression.

We talk in public health about behaviors that offer something called protective effect and upping your social support has more protective effect than quitting smoking. Don’t hear me wrong – smoking is still bad!

The reason for that can be found in our physiology. Stress hormones surge when you’re feeling lonely or rejected, and if this happens too often or for too long, you start seeing problems.

Cortisol and adrenaline are useful when facing a real threat – they fire us up to respond, but they also shut down everything non-essential. Our heart rate and our breathing rate jump up and blood flows to our biggest muscles. Energy to the logical brain, digestive system, and even blood flow to our extremities is diverted.

If hormone levels stay up, you can imagine the problems your body starts to face. At first, diminished blood flow to the extremities is just cold fingers and toes. Over time it might become neuropathy. Then, you stop feeling and have trouble picking things up or even balancing – in this way our body is trying to signal us – loudly, in the only way that it can – social numbing becomes physical numbing.

Our brain activity being interrupted may mean initially only that it becomes tough to find our car keys. Soon enough, we begin to have difficulty communicating, displaying empathy, or engaging in high-level thinking. This makes connecting with others even more challenging, and our isolation can easily become self-perpetuating.

I work in military public health today, and for a long time, all we talked about was the correlation between post-traumatic stress and combat deployments. That’s not the whole story, though – it’s far too simple. The riskiest time for veterans is the first six months of coming out into the civilian world. We face that complex mix of losing identity, our purposeful, all-consuming work, and the biggest loss – our tightly-bound community.

Conclusion: So-What Factor

When social support is happening the way we want it to, you get a veteran reintegration story like my brother’s.  In our family, he is still everyone’s favorite. He’s now a dad and a slightly-intense High School English teacher.  His wife is hilarious and keeps us all on our toes.

When it’s not, you get one like mine, and like too many of our service members leaving active duty today.

I struggled with pulling the right people around me after deployment and that time at the hospital. I was angry, guilty, then angry some more. I drew inward and sought to surround myself with people who had similar experiences to my own.

The results for me weren’t pretty. I worked too hard, drank too much, and communicated not at all. I found a relationship that was as volatile and crazy as I was feeling on the inside. I didn’t know the meaning of the word “introspection” or the phrase – ‘I need help.’” There was a time I could’ve wound up an isolated, angry statistic.

The social health issues I’m talking about aren’t strictly veteran problems. The angry veteran, the elderly shut-in, and the person in an emotionally abusive relationship all deal with the same physical effects.

All of us have to prioritize it.

I was never lonely exactly, I certainly had people around me, but I had too many of the wrong people, and I had no one who ever challenged the way I was doing things.

We all need the strength that an uplifting group of different – and thus complementary – personalities brings us. So I had to ask myself, as I encourage you to ask yourself – how are my people?

Do they support you? We need affirming, yes.

Do they challenge you? We also need different.

Connect. Be willing to get a little uncomfortable – It can completely change your health.

Danielle King: A Champion for the Disabled and LBGTQA Youth

Danielle King: Master’s Degree Student at Rutgers School of Public Health

Danielle King’s deep concern for the well-being of others was nurtured back in elementary school as she cared for a blind and deaf classmate and was more clearly defined later when she came out as gay in middle school.

“It wasn’t cool to be gay,” she says. “My peers called me names and made me feel uncomfortable. I didn’t understand why someone would want to hurt me.”

The challenges she faced in her youth made King stronger and motivated her to become an advocate for others.

Today, King, a former U.S. Marine, is nearing completion of a master’s degree at Rutgers School of Public Health and also making plans to help homeless LGBTQA teens and young adults.

She volunteers as assistant chair of community outreach for Disability Allies, an East Brunswick nonprofit that pairs young adults with disabilities with mentors. King’s advocacy for challenged individuals traces back to an elementary school program that paired handicapped students with non-disabled classmates during lunch.

It became a life-changing moment when she discovered that the girl next door was both blind and deaf and could use a friend. “I started taking her to the park after school and realized that disabled people needed involvement and interaction,” she says. She sought opportunities to work with the disabled community, such as teaching children with disabilities to swim.

At 18, she enlisted in the U.S. Marine Corps for three years, including a one-year deployment to Afghanistan as an intelligence analyst. “Serving as a Marine made me more confident,” she says. “I realized I could overcome any obstacle.”

When she entered the military, she formed a group of LGBTQ women and men near her base in North Carolina. “This was during the time of ‘Don’t ask, don’t tell,’ which really put me in the closet,” she says. “I found many people had similar stories about coming out to their families at a young age. That’s when it hit me that we needed a voice.”

Her service completed, she enrolled in Middlesex Community College, where she learned about careers in public health. “I started taking classes and thought, ‘Oh, this is exactly what I want to do: Get into the grassroots of the issues that plague our community,” she recalls.

In 2014, she transferred to Rutgers to finish her degree in public health and became a health activist. Volunteering with the Health Outreach, Promotion and Education (H.O.P.E.) peer education program, she taught fellow students about substance abuse and encouraged them to pledge to be designated drivers. She continues her work in improving community health by working as a HIV counselor and tester at Hyacinth AIDS Foundation.

A 2016 internship at the Monmouth County Regional Health Commission assisting the registered environmental health specialist solidified King’s interest in another form of helping others – environmental advocacy. She thrived on helping to inspect landfills and ensuring residences were up to code. “I was hooked,” she says. “I realized the importance of regulation in taking care of the earth and personal health.”

She accompanied her supervisor to the New Jersey State House and testified on behalf of a proposed bill to raise the legal smoking age to 21. “I had worked with the health specialist on progressing the bill,” she says. “One of the legislators in opposition kept asserting that young people in the military should be able to smoke if they wanted to, so I offered to testify as a veteran who supported the bill. Even though it was vetoed, I still feel passionately that the smoking age should be raised.”

Her sights are now set on joining the CDC in Atlanta, where she hopes to establish a nonprofit joint venture with her wife, Jahari Shears, fulfilling a dream to support the LGBTQA community. Shears shares King’s excitement for improving communities; she will graduate with her bachelor’s of science degree in public health from Rutgers in May.

“We want to be the adults teenagers can look up to if they don’t have that support at home. We want to provide a place for them to go and assist them with enrolling in college or finding employment,” she says. “I want to share with them what I learned as a Marine: When you feel like you’re hitting a block, say ‘I’ve got this.’ It’ll give them the energy to keep pushing.”

Simple Intervention Proves Effective in Reducing Suicide Among Active-Duty Soldiers

Suicidal behavior among active-duty service members can be reduced for up to six months with a relatively simple intervention that gives them concrete steps to follow during an emotional crisis, according to a new study from the University of Utah’s National Center for Veterans Studies.

The study’s findings show there was a 75 percent reduction in suicide attempts among participants who engaged in crisis response planning versus a contract for safety. Crisis response planning also was associated with a significantly faster decline in suicidal thoughts and fewer inpatient hospitalization days.

Craig J. Bryan, an associate professor of psychology and director of the U’s National Center for Veterans Studies, led the research team. The study titled “Effect of crisis response planning vs. contracts for safety on suicide risk in U.S. Army Soldiers” was published online on Jan. 24 in The Journal of Affective Disorders.

Co-authors include researchers at the University of Texas Health Science Center at San Antonio, the University of Utah, the University of Memphis, and the U.S. Army.

The Pentagon said last April that 265 active-duty service members killed themselves in 2015, continuing a steady increase in suicides noted since 2001. In response to this tragic trend, the Department of Defense and Veterans Health Administration has made suicide prevention a priority, supporting interventions and studies of how to help the nation’s warriors.

“Our results mark a critical next step in preventing military suicides,” said Bryan.

The study compared the effectiveness of two risk management strategies:

• Contract for safety, which entails getting a commitment from a suicidal patient to avoid self harm — what not to do.

• Crisis response planning, which involves writing on an index card the steps for identifying one’s personal warning signs along with coping strategies, social support, and professional services to use in a crisis — what to do.

The researchers also conducted an analysis to see if an enhanced crisis response plan that added an explicit discussion of the participant’s reasons for living would provide even better results, but this enhancement did no better or worse than a standard crisis response plan without this enhancement.

Each participant had active suicide ideation and/or a lifetime history of attempted suicide and had actively sought help at a military medical clinic in Fort Carson, Colorado, in 2013 and between January 2015 and February 2016. The soldiers were offered one of the three interventions, which varied in the combination of supportive counseling, strategies to manage emotional distress, education about crisis services and referrals to treatment services. The researchers followed the 97 participants over a six-month follow-up period.

The crisis response plan was a central ingredient of another successful treatment developed by many of the same researchers at the National Center for Veterans Studies — brief cognitive behavioral therapy — which contributed to a 60 percent reduction in suicide attempts among active duty soldiers. The results of that study were published in 2015.

“Our previous results showing a significant reduction in suicide attempts were based on a treatment that heavily emphasized crisis response planning,” Bryan said. “This time around, we tested crisis response planning by itself and found that it reduced suicide attempts as well. This bolsters our confidence in the technique’s effectiveness.”

Overall, the findings show that giving active-duty service members who are at risk of suicide a crisis response plan may be a more effective way to keep them safe than a contract for safety. And because of its brevity and simplicity, the crisis response plan strategy could feasibly be implemented in a wide range of medical settings by diverse health care professionals.

“Suicidal individuals don’t always visit mental health clinics when in crisis,” Bryan said. “They also visit emergency departments and primary care clinics or talk to friends and family members. Crisis response planning could be a practical and effective way to connect those in greatest need of potentially life-saving treatment.”

The National Center for Veterans Studies at the University of Utah leads the nation in suicide prevention and PTSD research and treatment. The center has developed and tested the only scientifically supported methods to prevent suicidal behavior among military personnel. Many veterans die by suicide, often as a result of untreated PTSD, at a rate of 20 deaths each day on average.

Military Women: The Surprising Health Benefits of Combat Integration

Better, Not Worse, Together

Military veterans have a good understanding of what unit cohesion means, but if you’re not a veteran or want a refresher, a recent RAND study outlines various ways unit cohesion is established. Task cohesion means everyone is working toward the same goal. Vertical cohesion means troops and their leaders bond, while horizontal cohesion means bonding between peer members is strong.

Our bodies view lack of unit cohesion – or the absence of social support – as a physical threat. In fact, feeling disconnected from others is more dangerous to your health than smoking. Stress hormones surge, and when they’re elevated too long, men and women both begin to have difficulty communicating, displaying empathy, and engaging in high-level thinking. Physical performance also suffers.

Women in the military self-report low levels of unit cohesion. They don’t feel they belong in their respective groups. The reasons are many and the solutions – which inevitably lead to better physical performance and mental health outcomes – are simple.

However, while task cohesion can be easily established among the differently abled, vertical and horizontal cohesion are incredibly difficult to build without trust. Trust built around physical toughness is at the core of vertical and horizontal cohesion in the military; blending varying physical requirements creates a low-trust environment.

Even if a female service member is capable of the same performance as her male counterparts, she will not be inherently trusted if that capability is not validated through identical performance standards. Lack of trust influences unit cohesion and the performance of that less-cohesive team.

Currently, one in seven women Marines seeking to enter combat arms specialties pass the rigorous, gender-neutral performance tests. In an age where 85% of America’s youth are ineligible for military service because of weight problems, medical issues, education, or criminal past, a slender subset of men are capable of becoming U.S. Marines. Fewer women – only one in every 12,889 – will choose to serve as a Marine. Those who opt into combat arms specialties are an even more slender subset and represent a powerful class indeed.

From the moment women recruits enter boot camp, they are trained to a lower standard. Different performance and training standards establish women as marginal, ensuring that they will always be suspect in terms of capability. This marginalization damages military women in ways that matter even after they leave the service. Women are more than twice as likely to suffer from stress injury and depression and the suicide rates of military women are six times higher than civilian women!

Of course, expectations aren’t the only thing that drive performance. Physical capability matters too. Marine Corporal Angelique Preston, the first artillery woman in the Marine Corps, remarked that respect is driven by a combination of will and capability.

“Coming into these types of jobs, you have to be both emotionally and physically strong,” Preston said. “You can’t just be one or the other.

Amazons Only

Security challenges facing America in the 21st Century are many. They include enemies united by ideology rather than statehood – male and female extremists alike. Women Marines will continue to be operationally needed, especially in the Middle East, during the coming years.

As gender integration continues in the military, expect several things to happen.

  • First, equal standards will weed out the majority of women in the Marine Corps. We need to accept that – at least initially – increased standards will result in a drop in the number of women in the Corps. Women currently comprise 7% of the Corps. That number is likely to drop to 1-3% as new standards come into play.
  • For integration to work, it needs to be performance driven and not quota-driven. However, to position women for success, they must not be hamstrung by the substandard training they continue to receive. Good training will ensure that when the enemy meets a woman Marine at a Syrian outpost, she’ll be the right Marine for the job.
  • Second, as combat roles open to women Marines, and as formal and informal expectations of performance increase, so will the performance of women Marines. Expectations are closely correlated with performance.
  • Third, as gender integration into combat arms occupational specialties begins, and as the integration happens with peers who can trust their physical capabilities, expect to see better horizontal and vertical cohesion.
  • Fourth, improved cohesion will result in better individual and group performance.
  • Finally, better mental health outcomes for women service members are likely. Women Marines will no longer mentally join the vocal chorus of men who ask, “Are you really capable?” Instead, they, and their male peers, will be certain.

The military’s insistence on performance-based integration, while perhaps driven by widespread misogynistic culture, will ultimately result in stronger and better performing units and better mental health outcomes for women service members.

We are integrating the combat arms because we have needed women operationally the last fifteen years in theater. Training women to do what the Marine Corps is already asking of them and creating the same mastery experience opportunities from entry-level changes the environment in ways deep and meaningful.

As 21st Century challenges evolve, we need diverse teams with diverse thoughts. However, this diversity of thought must be bound together by unity of capability and high trust. The former breeds the latter.

Battling for Balance

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When I left the Marine Corps, I had a hard time carving a new identity for myself. I was terribly invested in what others thought of me. My public story was of crisp uniforms, physical fitness metrics, and successes. I always looked good on paper. My private story involved destructive choices, broken doors and holes in the walls, hiding weapons in the house, and getting dragged across the living room floor by my hair.[/caption]

I had no words to explain the disaster that had become my personal life and felt crippling shame about being one of “those people” with disordered drinking behavior going through a violent divorce.

I would have fit right in on the Jerry Springer show.

Right now we are losing more veterans to suicide than to combat. I’m a pretty decisive person with limited ability to ask for help and zero trouble taking risks; there was a time I could have become one of those statistics.

I stumbled quite by accident into three things that helped me regain my footing and become more resilient. I’m grateful for that stumble and always will be. Later, I learned that the research supports mental fitness training in the pre-incident space. Unfortunately, I didn’t learn until I was decidedly in the “post” camp.

First, I started treating myself in a healthy way again. I ate a little cleaner and made time for physical movement.

Not my typical physical movement, the kind where I used throwing up or a stress fracture as evidence that I was working hard enough – REAL, wellness-building movement that strengthened my body rather than punished it. I found myself on a yoga mat and never wanted to leave. In truth, I came to yoga as an athlete looking for something challenging, a fitness fad to master, and something to help me bend my unyielding muscles a bit more easily. What I found on the mat changed my life entirely. I found a practice that was about more than my body.

Be still and know that I am God –Psalm 46:10

For me, a huge part of self-care involved slowing down enough to listen. I spent a little less time talking and a lot more observing. That made space for faith and for a focus on other people. All of a sudden, my energy was redirected. I could be generous with myself and with the people I cared about. I found a new tribe of healthy people who shared those service ethic values.

And that was my beginning.

We can weather storms much better than I did – we don’t have to wind up tearful and alone with only a six-pack of beer to help us mourn. Resilience can be taught. Self-care modalities, social support cultivation, and spiritual practices are the components upon which we must rely to build our foundation in advance of the storm.

So if you’re left asking what it means to practice wellness?

Spoiler alert – it ain’t about your biceps’ size.

Trauma-Informed Care for Veterans

By Kate Hendricks Thompson and Sarah Plummer Taylor

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An increase in trauma-informed care leads to more efficient and effective response at every level of patient care, and thus, a reduction of wait times at VA Hospitals.

Rebecca served nine years as a Marine Officer, and had relied upon the Veterans Administration Medical Center (VAMC) for her health care since departing active duty.  She was a devoted runner trying to get back in shape, but a few months into this well-intentioned effort she found herself calling the VAMC appointment line.  Her Achilles tendon was swollen and painful, and she found herself limping through busy days. The first call to the appointment line resulted in a referral, a message taken, and the promise of a call back. The nurse who called back wasn’t authorized to book anything beyond 24-hours out, and the promise of a return call was again offered. A week later, the phone had not rung, and Rebecca was still limping along without an appointment.

Military veterans consistently report access problems with Veterans Affairs (VA) hospitals and outpatient clinics.  Patients in Phoenix reportedly died while waiting for slow cancer care.  The issue is an administrative and ethical conundrum; veteran satisfaction rates and overall patient wait times must be improved.

The solution is not entirely structural, though more infrastructure and staff would directly reduce wait times because more providers are available.  The answer to date has been the bandage of increased oversight – stipulating tighter regulation and monitoring of recorded wait times. The intention of such accountability measures is consistently undermined by employees incentivized to modify the numbers, and it is a rare whistle-blower willing to call attention to the statistical maneuvering.

If adding more directives to reduce wait times has been met with maintenance of the defunct status quo, how can we improve accountability while working within the current system reality?

The answer involves expanding the standard of care and embracing holistic wellness. First and foremost, we need to make the process of receiving care easier, more effective, and more efficient, and one of the best and most empirically validated ways to do so is to offer trauma-informed care. Trauma-informed means knowing the history of past and current abuse or trauma in the life of the consumer with whom one is working and to understand the role that violence and victimization play in the lives of most consumers of mental health and substance abuse services, thereby utilizing that understanding to design service systems that accommodate the vulnerabilities of trauma survivors and allow services to be delivered in a way that will facilitate consumer participation in treatment. With trauma at the center of understanding, all parties – clients, providers, clinicians, and programs – will benefit.

We must begin providing trauma-informed care at all levels of care, from point A to point Z in the care cycle for our veterans, working with existing VA employees, staff, and providers. Our veterans are coming from a place of trauma, be that trauma combat or simple transition.

VA hospitals are not public hospitals. Therefore, trauma-informed care must be a requirement for any person in the VA.

 Research has convincingly shown that it is not just mental health care providers who need a trauma-informed approach, and sadly even many of those providers do not have this background. For instance, psychiatrists are not taught to account for cultural, environmental, economic, gender, or trauma history differences among clients. Social workers, for example, are exclusively trained and educated from this perspective of the prevalence of trauma and the impact of environmental factors.

How does this impact wait times?  Education of the entire staff is required, not just the person the veteran encounters after the 5th stage of waiting (multiple phone calls, an employee they encounter in the parking lot, the volunteer at the front desk, employees inside the building, the receptionist at the clinic office) because all of those stages of interaction impact how care is sought, followed up with or not, or perceived by the patient.  Part of wait time computation involves the actual time but some of it is the perception of time – sometimes a 2 hour wait can feel worse than a week long wait; it depends on how the person who is addressing you talks to you. Veteran perceptions are important and impact how they feel about care received.

  • Improving the staff’s trauma-informed perspective improves wait times by improving and tailoring the environment. Frankly, this trauma-informed paradigm can be used as an incentive to the care provider because the whole process becomes more humane to them. As they are trauma-informed they address people differently.
  • Trauma-informed personnel are more likely to address issues more effectively and efficiently. As empathy and understanding increase, so does efficiency because veterans come in to be treated, feel safe doing so, are being treated one time, versus becoming overwhelmed and leaving, necessitating another visit. For instance, if a veteran enters the hospital and is yelled at by the person behind the desk, or harassed by a janitor, he or she very well may turn around and leave. The veteran will then have to call in again, make another appointment, likely be perceived as disrupting the system and be chastised for not showing up for their appointment. The whole process not only may be re-traumatizing, but will add to the backlog of appointments.
  • Trauma-informed care creates safer environments. Feelings of safety are fundamental to effective health care, especially effective mental health care. Thus, veterans are more likely to feel comfortable coming in for proactive and preventative care versus waiting until they find themselves in a most extreme case which then often requires more resources for a longer amount of time, resulting in more pressure on the system again.
  • Trauma-informed care creates better-informed clients. Veteran patient clients, when treated with the respect a trauma-informed model demands, are well-informed at every stage of care, from administrative matters to the care itself. Lack of information leads to confusion and threatens the basic need for feelings of safety. Waiting for return phone calls that never come, or waiting in a waiting room for hours on end well after their scheduled appointment time, are re-traumatizing (and common) occurrences for veterans seeking care at VA hospitals. Trauma-informed care standards would mandate that appointment times be honored, that waiting room facilities are safe and comfortable, and that a patient is communicated to regularly and with respect about the process required to receive care.

Every single employee at a VA hospital needs some trauma-informed education and training, not just psychiatrists. Through a trauma-informed lens, any staff member can see issues more clearly and solve problems where they occur. This would mean, for instance, having a person at the entrance of the VA Hospital who is calm, clear and helpful; not an untrained, random volunteer. Having staff members who are trained in harm reduction and de-escalation techniques is also critical to trauma-informed training, education, and care provision. To shift culture, you cannot just train the leaders. All employees at the VA should receive at least a basic level of training of trauma-informed care. This absolutely also includes care providers.

We do not need more regulations and stipulations on time-frames, which are already in place and already not being followed. Veterans and the families who support them are calling for a true cultural shift in care, one that can be achieved with training and standard of care expansion.

Editor’s note: This article was jointly authored. Sarah Plummer Taylor, MSW is an established leader in the field of resilience building, holistic wellness, and leadership training. Learn more at SEMPER Sarah®. Kate Hendricks Thomas, PhD is an Assistant Professor of Public Health at Charleston Southern University. 

It’s Grief To Me – Death, Divorce, Incarceration, Deployment and Foster Care

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Every year, educators in the public education system spend roughly 180 days and approximately around 1,000 hours with our children.  For many children, the time spent with their classroom teacher accumulates to more time then the time they spend with their own parents.  For many grieving children and teens in our communities today, their schools and their teachers remain the one constant in their lives.

Who are our grieving students in our schools today?  They are our students impacted by experiences of not only death, but situations like divorce, parental deployment, parental incarceration and foster care placement.  Many students impacted by grief and loss are not only unaware of their own grief, they find themselves struggling academically.

Grieving children have more academic barriers than their peers who are not experiencing grief.

Like the students themselves who may be unaware of their own grieving, many teachers are left in the dark about who their grieving students are.  Many may not know grief and loss experiences can connect to other life experiences such as parental divorce, incarceration of a loved one, parental deployment and foster care placement. Unfortunately, due to shame and stigma that can surround the specific grief situation of a child or teen, they may not tell their teachers out of fear or embarrassment.  Even when the teacher does know the situation, they might not quite know what to do to support their student.

In my research, I continue to find a scarcity of information on how to serve grieving youth impacted by grief and loss outside of death.  In my opinion, death is only one aspect of a much larger issue.  I realized this 13 years after my own graduation from high school when I found myself walking the halls of someone else’s high school thinking of that period of my own life that was so fraught with darkness.  This time however my role was different.  I was different.

As a mental health practitioner one of my roles was to prepare curriculum for an after school grief group within the high school mental health program where I worked.  When one student was referred to the grief group because of her father’s military deployment, I remember initially not understanding what deployment had to do with grief and loss. That quickly changed as facilitating the after school grief group provided a whole new awareness of how different grief and loss can look for a teen.

After finishing up my role as co-facilitator of the high school grief group and as my years working in the mental health program began to accumulate, I began to realize many of the youth I was surrounded by daily were grieving. Not only were they grieving, they were hungry for acknowledgement of their loss.  They wanted validation of their pain.

In my search for information,  I came to the realization that all key players need to be on the same page when it comes to the many emotions youth experience in connection to grief and loss.  Who are these pivotal players?  Not only are they the parents and caretakers of the grieving children and teens, but also educators and other key adults in the lives of youth.

I’ve come across a series of videos on Military Kids Connect, a great resource geared toward military children, teens, parents, and educators.  Although these videos are geared towards parents and caregivers of youth grieving the loss of a loved one, in my opinion, these videos also express very clearly the grief reactions of children and teens due to the effects of divorce, incarceration, and foster care placement.

In the videos Dr. Mogil, a licensed clinical psychologist and Director of Training and Intervention Development at The Nathanson Family Resilience Center, highlights grief reactions in both children and tween/teens.  Also, the Dougy Center, another great resource nationally known for their work with children and grieving families offers coping strategies for children and teens.

What initially began as one grief group experience has now turned into a lifetime mission for me.  My work is a result of my students, who allowed me into their space.  It is through their gifts I’ve learned to be curious, to ask questions instead of pass judgments.  It is through their actions and from their words I’ve learned to set the bar high, to never take “no” or “I don’t know” for an answer, and to never give up on them.

Military-Civilian Drift: Leaders Work to Bridge the Gap at S2C Summit

I spent last week at the University of Alabama’s second Service Member to Civilian Summit. S2C was full of amazing speakers from realms academic, government, and grassroots. It was a truly humble space where thought leaders strove to collaborate rather than “talk at” one another. A key theme kept emerging, and it is one that data support as relevant to veterans’ reintegration strongly, as do my own experiences. Social support. Tribe. Community. Military-civilian drift. We used a lot of words for the same problem and shared success exemplars to bridge gaps. We have military personnel falling into risk and illness because of issues related to alienation and we can change that together.

I came away thinking about that rallying cry – both for veterans to be resilient leaders who contribute and connect in their home communities and for civilian members of those communities to care, notice, and commit to change.

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Warrior Culture

My community is a military one, and we in the military social work and health communities know that we’ve lost too many this year. Not all veterans lose their social support systems upon returning home, though many of us do. It can be tough to stay close to people when we aren’t sure that we speak the same language any longer. Some veterans are blessed with the ability to keep communication lines open, even in hard times and with loved ones able to weather the storm alongside. These are the cases that highlight even more powerfully the importance of connection, and I will always be grateful that this was my brother’s experience.

I was already deployed to Iraq when my brother e-mailed me to share that he was probably going to propose to his girlfriend before he headed over. She was a civilian schoolteacher from Philadelphia that I had yet to meet, and I just rolled my eyes when he shared his romantic plans with me. I was surrounded by guys losing their girlfriends to the grind of deployment, and I expected that his schoolteacher would be mailing him the same “Dear John” letter after a few months. I told him I didn’t have a problem with the proposal but admonished him to buy her a ring made out of cubic zirconia. No sense in buying a diamond he might never get back.

As younger brothers often do, he ignored my advice and bought her a beautiful ring.

Well, that is some cash he will never see again! Should have listened to me!

He didn’t listen, but he did come home around the same time I did, sent back by a pressure-detonated IED that tore apart metal and bodies and all of our hearts.

When my brother arrived at Bethesda, we didn’t know what he might be facing. There was so much damage. On his third surgery, the physicians in the operating room took a vote about whether or not to amputate his leg at the hip; he had infection setting in and they were worried it could get worse. Two voted to amputate, and three voted to give him a couple of days.

Ward 5 was a dark place. We were surrounded by morphine drips, pain, injury, and struggling families who weren’t sure what to make of it all.

Into this world walked my brother’s civilian schoolteacher.

She won’t be able to handle this.

We Can All Be Warriors

When a wounded service member is medically evacuated, he or she often has a long period in a hospital ward and in lots of different outpatient treatment facilities ahead. There are no guarantees and it is painful for both the patient and those standing alongside. I watched the prospect of a long, uncertain recovery level some people. In others, I watched uncertainty and trauma bring out their diamond-hard character.

Throughout this period I watched his young fiancé with a cynical eye. I stereotyped her on sight—she was a pretty girl who often wore makeup and always had on matching accessories. I assumed she lacked gravitas and would fall apart any minute.

She never did.

When her leave ran out at work she went back to teaching all day long in nearby Virginia, but made the drive every night to sleep in a chair at my brother’s bedside. I would find her sitting by his side laughing about some silly thing or another, always keeping him smiling. She never complained and never gave up, never confessed fears about marrying a man with so many new health issues.

While I fumbled gracelessly in his hospital room, once even dropping a portable DVD player on his gaping wounds, she was all kindness and poise. She kept him looking toward their future on a daily basis. Even when he left the hospital and had to spend long days in a reclining chair. Even when he needed help with any and all of the most basic tasks.

The makeup had fooled me; she was more than serious. Only in her twenties, she helped him make it to the bathroom, shower, move, and get through hard physical therapy appointments without complaint. There were guys on the ward whose wives filed for divorce when they saw what they were going to have to struggle through together. I don’t think the thought ever crossed her mind. She helped him through medical retirement, a search for a new career and a civilian identity, and they became parents with that joyous excitement reserved for newbies who don’t yet know how much sleep they will soon go without.

She married a Marine with three sisters, all of whom would gladly hide a body for her today—no questions asked. She has a good memory though. Every now and again, I hear about that cubic zirconia comment.

Invisible Wounds

For me personally, this was the start of a very confusing time. I spent some nights in the hospital lounge, some with my parents at the Fisher House, and many others with friends in the local area. I began to struggle with leaving the hospital and interacting in the real world – it was a world I no longer recognized. Everyone was so casual and happy, oblivious to the pain and sorrow facing everyone I’d just left. I lost the ability to speak to civilians and my resentment seethed under the surface. I was simply angry with no way to articulate why.

And then, I got self-destructive.

Not all wounds are visible, and you can join us in working to navigate this space at the next S2C Summit. Look for dates next year! Until then, how can you connect? Where can you help?

Mental Fitness Training: A New Military and Veteran Mental Health Paradigm

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The idea that PTSD is an unalterable, lifetime sentence is neurologically untrue. This is good news!!! So why haven’t our conversations about military mental health moved from narratives of broken veterans and disability diagnoses? Let’s have a new conversation with military personnel about mental health –

Stress Injuries vs. PTSD

Stress injuries are very natural responses to unusual situations and exist along a spectrum. Whether you’ve experienced a single traumatic event or multiple stressors over a long period of time, your body likely responded in a totally appropriate way by adapting to the threat. Your nervous system kicked into high gear – your body and brain woke up and went into overdrive.

savasanaYour response was vital to navigating a stressful or dangerous situation well. However, now that imminent danger is past, your stress response may still activate out of context. When this happens, empathy may disappear, your focus may degrade, and you may struggle to make logical decisions.

It’s true that severe stress injury (also known as PTSD) is a complicated disorder. However, healthcare practitioners often apply the “chronic” label to mild or moderate stress injuries – which are 100% recoverable. This label can be psychologically deadly – sapping resilient people of the agency they need to learn and apply tools to quickly de-escalate the body and brain’s response to perceived threats.

The truth is that PTSD is not everyone’s stress injury. A misdiagnosis suggests irrecoverable brokenness, and can layer on a host of additional anxieties and worries.  It also keeps us talking about problems rather than focusing on solutions and prevention through mental fitness.

Road to Recovery

One of the most empowering first steps you can take toward recovery is to seek out information about stress physiology – work to understand what is happening in your body.

Self education is an incredibly empowering step. You’ll discover that your out-of-context responses are natural, and you’ll simultaneously find ways to calm your body and mind through a variety of self care practices.

When you put these tools into practice on a daily basis, your body and brain will respond in some really interesting ways. Your neurons will fire differently, you’ll shrink the amygdala (the part of your brain that activates the fight or flight response) – your brain will literally start to look different. Stress hormones will drop, too.

Not only will your body and mind change, but so will your behavior. You’ll find that you’re better able to handle a fight with your partner. You’ll be able to focus better and exist with more empathy. Of course, you’re still human. Your stress response will still fire. But by practicing effective self care, you can begin to respond to others in a more deliberate way.

But what if a vet’s stress injury is severe?

Some people experience permanent changes to their brains. If your injury co-occurs with a Traumatic Brain Injury, depression, or an anxiety disorder, that is totally normal, but incredibly challenging. When you have a major stress injury and you’re dealing with a chronic condition, the symptoms can be extremely debilitating.

The symptoms of severe stress injuries can be improved upon, but – much like a bad back injury – you may need to accept that your condition will need to be managed for many years to come.

* For severe stress injury, you will need highly individualized clinical help. Seek medical guidance and talk to your clinician about your specific stress injury and wellness techniques.

Training for Mental Fitness

What is really exciting for today’s law enforcement, military, and emergency management communities is that mental fitness and resilience can be taught, trained for, and tested.

The three pillars of a resilient life are social support, self-care, and spirituality. The individual value of these pillars is backed irrefutably by science, and – when practiced together – their benefits increase exponentially.

Ready to get started? Here are some simple tactics you can start using today to build a better life.

  1. Social Support: Surround Yourself with Good People

The first and most important step in building resilience is making the hard choice to surround yourself with great people. If you don’t have them around you, you can’t get started. You won’t start or keep growing.

Take a moment to honestly evaluate the influence of the people in your life. Is their influence negative and destructive or positive? If you don’t have great people around you right now, that’s ok. It means you have plenty of room to grow.

  1. Self-Care: Calm Your Body and Mind

Start here by choosing just one or two healthy practices you can incorporate as daily habits, then track how they benefit your life. Don’t worry about trying to change everything at once.

By practicing effective self-care to calm your body and mind, you can become less reactive to external stressors. When you’re less reactive, you’re more capable of engaging in positive social interactions. There’s a ripple effect here that’s really exciting.

Self-care can be as simple as cooking at home or going back to the gym. What you’re looking for is something that makes you feel relaxed. You might be working hard, but you’re going to feel your sympathetic nervous system (body and mind) calm down. Some people call it a click. An exhale.  A down-shifting. When you feel it, you’ll know you found your thing.

  1. Spirituality: Find Your Meaning

Finally, there’s a clear correlation between physical, mental, and emotional resilience and a sense of meaning in our lives. We all need a connection to someone higher – with God, or a sense of personal purpose. Whether you approach this aspect of resilience from a secular perspective (think Maslow’s hierarchy with transcendence at the top) or with a theological view, give yourself some time to ask questions about the source of purpose and meaning in your life.

To plug into a community that supports you as you explore this aspect of resilience, consider getting involved with a faith group, volunteering, or taking time to study some concepts of purposeful living you’re curious about.

Remember – the practices that make us a better warrior also make us better parents, partners, friends, and professionals. Make the time for mental fitness, whether you are recovering, preparing, or both!

5 Ways a PTSD Service Dog Can Help

U.S. Navy Hospital Corpsman 3rd Class Sean Stevenson takes a knee while on a security patrol in Sangin, Afghanistan, June 6, 2011. Stevenson is a corpsman with Combined Anti-Armor Team 2, Weapons Company, 1st Battalion, 5th Marines, Regimental Combat Team 8. The U.S. Marines conduct frequent patrols through the area to show a presence and interact with the community to find ways to help the populace. (U.S. Marine Corps photo by Cpl. Nathan McCord/Released)
U.S. Navy Hospital Corpsman 3rd Class Sean Stevenson takes a knee while on a security patrol in Sangin, Afghanistan, June 6, 2011. Stevenson is a corpsman with Combined Anti-Armor Team 2, Weapons Company, 1st Battalion, 5th Marines, Regimental Combat Team 8. The U.S. Marines conduct frequent patrols through the area to show a presence and interact with the community to find ways to help the populace. (U.S. Marine Corps photo by Cpl. Nathan McCord/Released)

Post-traumatic Stress Disorder (PTSD) is a mental disorder that results from a traumatic experience. Common symptoms are nightmares, flashbacks, intrusive memories, depression, and anxiety following a traumatic event. Living with PTSD can be very difficult. Public outings may result in flashbacks while depression can become overwhelming if the person stays at home.

The risk of depression is high as well as the risk of suicide. While there are very effective treatments available for people with PTSD, a service dog can be a very useful support. Here are a few reasons you might want to consider getting a PTSD service dog.

They Encourage Exercise

Any dog needs someone to play with them and take them for walks. This physical activity is a very beneficial way to help treat PTSD. The positive endorphins that are produced during exercise can help combat depression and anxiety as well as improving physical fitness. Even on bad days, it’s hard to say no to a dog begging for a walk.

They Prevent Social Isolation

0-4Dogs are a wonderful way to cushion social interactions. They attract friendly people who want to pet them while providing something for you to talk about. Walks or trips to the dog park will force you to get out and see other people rather than isolate yourself in your home.

They Can Make Public Outings More Feasible

A trained service dog will be able to recognize when you have an episode and either comfort you or lead you to safety. They can also be trained to lead you to the nearest entrance in anticipation of an episode. These specialized skills can make going out in public safer, easier, and more comfortable for their handler.

They Can Recognize and Act Upon Nightmares

For at-home assistance, service dogs may be trained to fetch medication or even interrupt nightmares. When you are having a nightmare, the dog may be able to wake you and halt the nightmare, making it easier to recover and go back to sleep. If you have woken up from a nightmare, the dog will be able to provide comfort in the form of pressure or affection, also helping to prevent insomnia.

They Make Therapy Sessions Easier

Attending therapy for PTSD can be very difficult. You will need to discuss your trauma, the symptoms you are experiencing, and other potentially painful subject matter. With a dog by your side to stroke and seek comfort from, talking about these topics can become easier. The dog can also become part of your treatment plan, whether that means taking it to a new destination each week or simply spending a few hours a day on training sessions.

Though a dog is certainly a financial responsibility and a well-trained service dog can be expensive, the benefits a service dog has to offer are worth it. Even an untrained dog can be a wonderful addition to your home if you are suffering from PTSD. The unconditional love, encouragement to exercise, and help in social situations might even be all you need to start recovering.

https://www.youtube.com/watch?v=nZOaR1vnBik

How Do We Alter the Dialogue About Resilence

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Despite the vast news coverage of the wars in Iraq and Afghanistan since 2001, one figure has remained mysterious: the number of suicides among US servicemen and women, compared to combat casualties. Here’s one statistic to contemplate: In 2012, the US military lost 295 soldiers, sailors, airmen, and Marines in combat in Afghanistan. But over this same time period, 349 took their own lives.

Right now, we are losing more veterans to suicide than to combat. I’m a pretty decisive person with limited ability to ask for help and zero trouble-taking risks; there was a time I could have become one of those statistics.

Those figures are mysterious because even as we throw money and resources at clinical mental health treatment and blame rising rates on multiple deployments, the answers are elusive. The narrative of the “broken veteran” struggling with combat stress just doesn’t ring quite true to those of us who served over the last decade, and the issue is more complicated than simple statistics can show.

I became a Marine to serve, and I loved being part of the Corps. As with anything I have ever loved intensely, the military changed and shaped me. To the casual observer looking in, the world seems brutal and intense. That casual observer isn’t entirely wrong—the military is some of those things. Shared hardship and challenge are vital parts of the refining and rebuilding process that changes a civilian into a warrior. If you ask anyone who served, they wouldn’t have it any other way. No one wants what comes easily or is handed to just anyone.

That process of obstacles, mastery experience, and shared suffering offers growth and transformation, but coming back to civilian life afterward can be incredibly hard. Standards are different. Camaraderie is different. Culture is absolutely different. I witnessed firsthand the toll that leaving the service took on many of us.

Stressful work environments, high rates of divorce and domestic violence, family separation, and repeated combat deployments all contributed, but the biggest reason for the reintegration problems many of us faced is cultural. We subscribe to unbalanced notions of what it means to be a warrior and uphold silent suffering as a virtue. Mistakes are shameful; pain is weakness. Saying that something is hard or stressful just isn’t done.

I don’t want to contribute to the silence that surrounds these issues anymore. Too many aspects of warrior culture are destructive lies we tell ourselves.

Who are we maintaining this veneer for?  What do we have to prove anymore?

Constant invulnerability is an illusion, and cultural mandates to be “together” in every way become dangerously prescriptive. We lose our authenticity in this way; we don’t know how to reach out to each other when stresses start to overwhelm us. Too many of us who are used to appearing strong would, indeed, rather consider suicide than admit to being human, fallible, or broken.

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Dr. Kate Hendricks Thomas

My own public story was of crisp uniforms, physical fitness metrics, and successes. I always looked good on paper. My private story involved destructive choices, broken doors and holes in the walls, hiding weapons in the house, and getting dragged across the living room floor by my hair. I was as far from God as a person could be but had no idea at the time.

As a Marine Officer, I was not supposed to make mistakes, feel depressed, or need help. But I did. Tough places and situations became tougher because I didn’t know that people might be okay with an imperfect version of me. For too long I chose silence over reaching out to loved ones. I opted for deeply felt, visceral shame over openness and vulnerability.

When serving in the military we are trained to lead with confidence. Presenting a certain and effective façade requires some incredibly useful skills. We make decisions quickly and responsively, but these very same skills become incredibly destructive when we never learn how to turn them off. This description fits most service members. We tend to be a driven, almost comically dysfunctional, lot.

What if I told you that I am not perfect?

What is so useful about sharing our experiences with one another is that we offer each other the opportunity to say that kindest of phrases: “Me too.”

We are not alone.

The determined avoidance of care-seeking I lived through is disturbingly normal in the military community that I call home. For me, learning to do better involved stumbling by accident into the three key components required to build human resilience. My later academic study brought a wry smile to my face as I realized that the answer had always been there; I just hadn’t known it when I needed to.

What if I had training in resilience before hitting rocky shoals?

To get to a healthier space, I had to make some hard choices, choices that involved leaving destructive patterns and people in the rearview mirror. It felt like dying to do so, but it allowed me space to breathe and to focus on becoming a new version of myself. Once I deliberately and consciously began stepping outside old patterns and belief systems to connect with and serve my community, embrace a healthy lifestyle, and seek and find an authentic relationship with God, the world stopped spinning in quite such an unforgiving fashion.

It wasn’t a chaplain or a counselor who pointed me in the direction of wholeness, though I certainly tried those routes. I keenly remember sitting in my first counseling session with a well-intentioned professional, answering her with short sentences and half-truths. While I have great respect for clinical mental health practice, many of us are not interested in embracing the identity of a patient. I never was. I sneered at things that would have been really useful!

You can keep your couch.

I’m a true nerd at my core, and when the dust cleared in my personal life I became motivated to learn all I could about how we as veterans are talking about mental health. I went back to school for an interminably long period of time and threw myself into community-based programming and health promotion. When I really drilled down in my issue analyses, I didn’t much like what I found. We are killing ourselves alone in apartments and no one is seeing any symptoms—we are that good at hiding out. It really isn’t that services aren’t available to veterans and military personnel when things become difficult, we just won’t use them.

No matter what magic we do in the clinical realm, focusing on treatment requires a disempowerment narrative that is perceived as being incompatible with the cultural values of military veterans. We cannot overcome such norms by asking warriors to become patients and pop pills, no matter how dedicated, innovative, and gifted the clinician is. While treatment is certainly part of the solution, it is not culturally acceptable for it to be the entire answer.

I know this to be true on both an academic and a personal level and believe we need to alter the dialogue about resilience. We must flip the current paradigm and turn words that currently connote weakness (like authenticity, self-care practices, and social cohesion) into training mandates and metrics of performance.

There is tremendous work to be done.

Trying to do that work is a translational team coming together at the 2016 Service member to Civilian Summit. S2C brings together researchers, practitioners, government employees, veterans, and military-connected family members to talk about best practices and processes to improve veteran health and reintegration. Speakers include field leaders like:

There is still time to join us. Register today.

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