Invisible Wounds: Psychological and Neurological Injuries Confront a New Generation of Veterans

As early as 1919, doctors began to track a psychological condition among combat veterans of World War I known as "shell shock." Veterans were suffering from symptoms such as fatigue and anxiety, but science could offer little in the way of effective treatment. Although there remains much more to learn, our understanding of war's invisible wounds has dramatically improved. Thanks to modern screening and treatment, we have an unprecedented opportunity to respond immediately and effectively to the veterans' mental health crisis. Among Iraq and Afghanistan veterans, rates of psychological and neurological injuries are high and rising. According to a landmark 2008 RAND study, nearly 20 percent of Iraq and Afghanistan veterans screen positive for Post Traumatic Stress Disorder or depression. Troops in Iraq and Afghanistan are also facing neurological damage,. Traumatic Brain Injury, or TBI, has become the signature wound of the Iraq War. The Department of Defense is tracking about 5,500 troops with TBIs, but many veterans are not being diagnosed. No one comes home from war unchanged, but with early screening and adequate access to counseling, the psychological and neurological effects of combat are treatable. In the military and in the veterans' community, however, those suffering from the invisible wounds of war are still falling through the cracks. We must take action now to protect this generation of combat veterans from the struggles faced by those returning from the Vietnam War

Relationship Stability After Traumatic Brain Injury Among Veterans and Service Members: A VA TBI Model Systems Study

Objective: To explore stability of relationships and predictors of change in relationship status 2 years following TBI/polytrauma. Setting: Five Department of Veterans Affairs Polytrauma Rehabilitation Centers (VA PRCs). Participants: A total of 357 active duty service members and Veterans enrolled in the Veterans Affairs Polytrauma Rehabilitation Centers Traumatic Brain Injury Model Systems database with complete marital status information at 2 years postinjury. Design: Prospective, longitudinal, multisite. Main Measures: Relationship status change was defined as change in marital status (single/never married; married; divorced/separated) at 2-year follow-up, compared with status at enrollment. Results: At the time of enrollment, 134 participants (38%) were single/never married; 151 (42%) were married, and 72 (20%) were divorced/separated. Of those married at enrollment, 78% remained married at year 2 while 22% underwent negative change. Multivariable analyses revealed that age and education at the time of injury and mental health utilization prior to injury were significant predictors of relationship change. Among those who were single/divorced/separated at the time of enrollment, 87% remained so at year 2 while 13% underwent positive change. Injury during deployment significantly predicted positive relationship change. Conclusions: The unmalleable, preinjury characteristics identified may be used as potential triggers for education, prevention, surveillance, and couples therapy, if needed

An Assessment of Mental Health Services for Veterans in the State of Texas

This report describes the complex challenges faced by veterans and their families in seeking, navigating, and attaining adequate mental health care in Texas. There are 1.7 million veterans in Texas, comprising 8.6 percent of the adult population. According to the U.S. Department of Veteran Affairs (VA), the number of veterans requiring mental health services has grown dramatically and will continue to increase, making veterans’ mental health care an urgent issue in Texas. The federal agencies responsible for military and veterans mental health care, the U.S. Department of Defense (DoD) and the VA, have created new programs and invested significant financial and staff resources. Despite barriers to addressing veterans mental health needs. Texas state agencies have increased funding and instituted new mental health programs supporting returning veterans. Nonprofit agencies focused on veteran’s mental health have multiplied across Texas and the U.S. over the past decade to fill gaps in care. While these organizations provide a growing and increasingly diverse set of resources for veterans to extend the scope of support, volunteer efforts can suffer from fragmentation and overlap. The report identifies current practices, challenges, and opportunities within and across each group of service providers. The report draws on government reports, scholarly literature, and agency websites, as well as interviews with counselors, Veteran Service Officers, nonprofit providers, state officials, and veterans themselves. This report offers five recommendations toward the goal that veterans’ mental health care in Texas become comprehensive, inclusive, effective, and efficient. First, there is a need for greater inter-agency communication across organizations, improved outreach efforts, and increased services for hard-to-reach populations, such as homeless veterans. Second, federal agencies ought to address staff shortages, improve the transition from DoD to VA care, and increase feedback. Third, at the state level, specialized services are needed to address unique veterans’ needs concentrated in cities across Texas as well as those dispersed in rural areas. Fourth, providers can improve mental health care by integrating social services and law enforcement. Fifth, both veterans and providers can benefit if they recognize opportunities for cooperation and coordination and work towards long-term goals that emphasize outcomes that improve the lives of returning veterans. This research was funded in part by the Jack S. Blanton Research Fellowship and the George A. Roberts Research Fellowship of the IC² Institute.IC2 Institut

New Veterans in Illinois: Brief 1, Background and Picture of Need of New Veterans

The newest cohort of veterans of the United States Armed Forces is a unique population with particular needs. They face a challenging context upon return: an economy with few job openings, systems of care that have grown accustomed to serving older and predominantly male veterans, and personal reluctance to seekhelp. The newest veterans-military service members who have been deployed in 2001 or later-may also suffer from mental and physical injuries that act as barriers to reintegration into civilian life. These veterans require sufficient supports in order to prevent the long-term negative impacts that many previous veteran cohorts have suffered. **This is the first in a series of four briefs that provide a snapshot of new and future veterans, their needs, and their service utilization in Illinois and the Chicago region

Suicide Risk in Homeless Veterans with Traumatic Brain Injury

ABSTRACT SUICIDE RISK IN HOMELESS VETERANS WITH TRAUMATIC BRAIN INJURY Dr. Briana Lafferty Dr. Marilynn Sommers Every sixty-five minutes a veteran takes his or her own life. Suicide is now the second leading cause of death among United States (US) military service members, with rates almost three times that of the general population. An association may exist between suicide and traumatic brain injury (TBI). One in six military service members involved in the wars in Iraq and Afghanistan are said to have been subjected to at least one TBI. With the growing number of service members exposed to blast injuries, the consequences of TBI, such as changes in mood, personality, cognition, and behavior, expose them to the risk of suicide. Veterans are also 50% more likely than other Americans to become homeless, and homelessness is another problem contributing to a greater risk for suicide in this population. Rates of suicide among individuals experiencing homelessness are reported to be approximately ten times higher than the annual percentage of suicides within the housed population. Currently, there is no existing literature that examines suicide risk in veterans affected by both TBI and homelessness. The aim of my study was to examine the associations among suicide risk and specific physical, psychological, social, and military factors, as well as to describe the association of suicide risk and utilization of Veterans Affairs (VA) healthcare services, in a sample of homeless US Veterans who have experienced at least one TBI. I conducted a cross-sectional study using secondary data from the National Center for Homelessness Among Veterans, in addition to performing retrospective chart reviews. My findings demonstrated strong associations between high risk for suicide and marital status, PTSD, issues with memory/problem solving, seizures, and inpatient admissions for mental health treatment. My findings have implications for health care and policy change related to decreasing stigmatization of mental health issues, overcoming barriers and increasing eligibility to VA healthcare benefits, and mandating more aggressive screening and prevention efforts. These changes are needed particularly during the transition to civilian life

Policy Implications of Demographic Changes in the VHA Veteran Population Following OEF/OIF

Includes article and tables.The US Department of Defense (DoD) and the US Department of Veteran’s Affairs (VA) are the two institutions responsible for the medical care of military personnel and Veterans. DOD major policy and operational personnel changes impact the VA by modifying the characteristics of Veterans presenting at the VA for medical health care. The challenges to VA resulting from DOD changes over the past four decades include managing the large influx to the VA of aging Veterans; accommodating the Veterans from OEF/OIF; responding to the expanded role of female service members in DoD; accepting increased numbers of National Guard and Reserve Components resulting from extended deployment and expanded operational role

Understanding the public health problem among current and former military personnel

The Report to Congress on Traumatic Brain Injury in the United States: Understanding the Public Health Problem among Current and Former Military Personnel is a publication of the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) in collaboration with the Department of Defense (DOD) and the Department of Veterans Affairs (VA).Since the beginning of Operation Enduring Freedom (OEF) (Afghanistan) and Operation Iraqi Freedom (OIF), public health and health care-communities have become aware of the increased rates of traumatic brain injury (TBI) among active duty U.S. military personnel. Epidemiologic and clinical studies suggest that many of these military service-related injuries have serious long-term health and socioeconomic consequences.In response to these public health and medical concerns, Congress passed the Traumatic Brain Injury Act of 2008 (TBI Act of 2008), which requires the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH), in consultation with the Department of Defense (DoD) and Department of Veterans Affairs (VA), to determine how best to improve the collection and dissemination of information on the incidence and prevalence of TBI among persons who were formerly in the military; and to make recommendations on the manner in which CDC, NIH, DoD, and VA can collaborate further on the development and improvement of TBI diagnostic tools and treatments. To that end, the CDC, NIH, DoD, and VA formed a Leadership Panel of experts with extensive experience in epidemiologic and clinical research, and in treating and managing TBI and its consequences.This report presents the major findings and recommendations of the Leadership Panel and a review of relevant scientific literature and a thorough examination of current TBI-related activities and programs conducted by the four agencies/departments. It describes the public health importance of military service- related TBI, recommends how to measure the magnitude of the health and socioeconomic impact of TBI and suggests ways in which the four agencies/departments can collaborate further on the development and improvement of TBI diagnostic tools and treatments.Suggested Citation: The CDC, NIH, DoD, and VA Leadership Panel. Report to Congress on Traumatic Brain Injury in the United States: Understanding the Public Health Problem among Current and Former Military Personnel. Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), the Department of Defense (DoD), and the Department of Veterans Affairs (VA). 2013.Preface -- Goals of the Report -- Members of the Leadership Panel -- Executive Summary -- I. Introduction -- II. Pathophysiology and Mechanisms -- III. Diagnosis -- IV. Treatment -- V. Prognosis and Recovery -- VI. Surveillance -- VII. Epidemiology -- VIII. Prevention -- IX. Recommendation

Arts, Health and Well-Being across the Military Continuum

Is there an active, meaningful role for the arts and creative arts therapies in addressing this vast array of critical human readiness issues across the military continuum? In general, "readiness" is the #1 issue for the military at all times. The connection of the arts to the human dimension of readiness is key. Military leaders say we need every weapon in our arsenal to meet the many challenges we face today. However, one of the most powerful tools we have in our arsenal -- the arts -- is often under-utilized and not well understood within the military and the healthcare system. The arts and creative arts therapists are -- and have been -- a part of military tradition and missions across all branches, supporting military health services, wellness, and mission readiness, including family support. For example, the War Department ordered the use of music in rehabilitation for the war wounded in World War II. In June 1945, the Department of War issued "Technical Bulletin 187: Music in Reconditioning in American Service Convalescent and General Hospitals." This bulletin was a catalyst for the growth and development of music therapy being used as a rehabilitative service for active duty service members and veterans alike during and after WWII. Although many gaps exist in our knowledge regarding the arts in military settings, what we do know to date holds great promise for powerful outcomes for our service members, veterans, their families, and the individuals who care for them. Today, a growing number of members of the public and private sectors are eager to collaborate with military leaders to help make these outcomes a reality.Nowhere was the momentum for greater collaboration more evident than in October 2011, when the first National Summit: Arts in Healing for Warriors was held at Walter Reed National Military Medical Center (now referred to as Walter Reed Bethesda) and the National Intrepid Center of Excellence (NICoE). Rear Admiral Alton L. Stocks, Commander of Walter Reed Bethesda, hosted the National Summit, in partnership with a national planning group of military, government, and nonprofit leaders. The 2011 Summit marked the first time various branches of the military collaborated with civilian agencies to discuss how engaging with the arts provides opportunities to meet the key health issues our military faces -- from pre-deployment to deployment to homecoming.Building upon its success, a multi-year National Initiative for Arts & Health in the Military was established in 2012, with the advice and guidance of federal agency, military, nonprofit, and private sector partners (see Figure 2). The National Initiative for Arts & Health in the Military (National Initiative) represents an unprecedented military/civilian collaborative effort whose mission is to "advance the arts in health, healing, and healthcare for military service members, veterans, their families, and caregivers."Members of the National Initiative share a commitment to optimize health and wellness, with a deep understanding and awareness that the arts offer a unique and powerful doorway into healing in ways that many conventional medical approaches do not. The Initiative's goals include working across military, government, private, and nonprofit sectors to: 1. Advance the policy, practice, and quality use of arts and creativity as tools for health in the military; 2. Raise visibility, understanding, and support of arts and health in the military; and 3. Make the arts as tools for health available to all active duty military, medical staff, family members, and veterans

An Occupational Therapy Veteran Resource Guide

Currently, there are limited resources available to occupational therapists working with the veteran population. The Department of Veterans Affairs (VA) is often confusing and complex for many health care workers to understand. An extensive literature review was conducted and the research indicated there is a need for an occupational therapy resource guide which includes a working knowledge of military culture, The Department of Veterans Affairs eligibility requirements and access, military priority conditions as well as military specific assessments. Therefore, the purpose of this project is to develop a guide that allows occupational therapists working with the veteran population to gain foundational knowledge on the military culture, information regarding VA access and eligibility, military priority medical conditions as well as military specific assessments. The product developed consists of four sections including: military culture, VA access and eligibility, military medical priority conditions and military specific assessments. The product is designed to be a guide for occupational therapists to advocate for the veteran population, educate occupational therapists as well as other health care professionals on military priority medical conditions and military specific assessments to utilize in various facilities. The guide can be used to consult with other health care professionals in regards to gaining access and receiving services through the VA

Making the Comeback from Combat: An Analysis of the Effectiveness of Occupational Therapy for Combat Veterans

Combat veterans have been found to experience difficulties with community reintegration after coming back from their deployments. Many of them experience physical and mental injuries from their deployment, such as mild traumatic brain injury, post-traumatic stress disorder, and amputations. Combat veterans not having effective treatment for these injuries can contribute to issues with community reintegration. These issues can consist of marital and financial problems, problems with alcohol or substance abuse, homelessness, and motor vehicle accidents. The Department of Veterans Affairs and the United States military have put forth efforts with improving community reintegration for combat veterans; one of those efforts is better utilizing the profession of occupational therapy. Occupational therapy provides a holistic approach to combat veterans with mild traumatic brain injuries, post-traumatic stress disorder, and amputations and has been shown to have several beneficial interventions when working with this population. The objective of this systematic review is to analyze the effectiveness of occupational therapy interventions on combat veterans experiencing difficulties with community reintegration