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Caring for America’s Veterans
Department of Veterans Affairs
Arthur C. Russo, Ph.D.Clinical and Neuropsychologist
Chaplain Andrew Sioleti, LCSW; D. MinChief of Chaplains & ACPE CPE Supervisor
VANY Harbor Healthcare System
Veteran Mental Health:Why Ministry Matters
Caring for America’s Veterans
Department of Veterans Affairs
Understanding theDepartment of Veterans Affairs
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Veteran’sHealth
Administration
Veteran’sHealth
Administration
Central Office(Washington)Central Office(Washington)
NationalCemetery
Administration
NationalCemetery
Administration
Veteran’sBenefit
Administration
Veteran’sBenefit
Administration
Caring for America’s Veterans
Department of Veterans Affairs
VA Mental Health
• 22.7 million veterans (Sept. 2010)
• 81 million patient visits (2010)• 30% of VA patients come for mental
health issues.• PTSD, depression and problem
drinking are the three most common mental health conditions.
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Caring for America’s Veterans
Department of Veterans Affairs
Old Model of Ministry
For decades mental health
professionals thought of community
clergy primarily as sources of referral.
Clergy working within the VHA had a
limited role, mostly doing pastoral
visits.4
Caring for America’s Veterans
Department of Veterans Affairs
New Model of Ministry
In recent years religion, spirituality and
religious communities have been
increasingly recognized as of
inestimable value for the
veteran’s/family’s support, treatment
and recovery.5
Caring for America’s Veterans
Department of Veterans Affairs
Today’s chaplains are a multi-faith group of professionally and clinically trained, ordained ministers who are
here to serve veterans and their families with their spiritual, religious
and existential needs, and work alongside their community faith
groups.
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New Model of Ministry
Caring for America’s Veterans
Department of Veterans Affairs
Mental Health, Chaplaincy and Faith Based Community
Groups
Several recent VA and DOD initiatives recognized the importance of
integrating mental health with spiritual care.
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Caring for America’s Veterans
Department of Veterans Affairs
VA’s Center for Faith Based and Neighborhood Partnership
"To develop partnerships and provide relevant information to faith-based and non-governmental organizations and
expand their participation in VA programs to better serve the needs of
Veterans, their families, and survivors."
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Caring for America’s Veterans
Department of Veterans Affairs
Mental Health and Chaplaincy Initiative
“The initiative is born out of understanding mental health and
spirituality as interrelated aspects of overall health that are optimally attended to within a coordinated
system of care."
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Caring for America’s Veterans
Department of Veterans Affairs
CURRENT MILITARY AND DEPLOYMENT STRESS
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Caring for America’s Veterans
Department of Veterans Affairs
Current US Military
• 2.2 million service members– 50% married– 93% military spouse population is
female– 150,000 single parents serving in the
military– Two thirds live in the community
• 2 million children have a parent serving in the military
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Caring for America’s Veterans
Department of Veterans Affairs
Since 9/11
• Over 2 million troops deployed to Iraq and Afghanistan.
• Prolonged exposure to combat over multiple rotations results in– Exposure to combat stress,– Depression,– Post traumatic stress disorder (PTSD)– Traumatic brain injury
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Caring for America’s Veterans
Department of Veterans Affairs
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Events that provoke terror, horror, or helplessness
Events that provoke terror, horror, or helplessness
Accumulation of stress from all sources over time
Accumulation of stress from all sources over time
Death or injury of others who are loved and with whom one identifies
Death or injury of others who are loved and with whom one identifies
Events that contradict deeply held moral values and beliefs
Events that contradict deeply held moral values and beliefs
Four Causes of Stress Injury
Life threatLife
threat
INTENSE OR PROLONGED STRESSINTENSE OR PROLONGED STRESS
LossLoss Wear & Wear & teartear
Inner Inner conflictconflict
Caring for America’s Veterans
Department of Veterans Affairs
Moral Injury
• PTSD is a fear-victim concept; here the person is thought to suffer from exposure to threat.
• Moral Injury is an agentic concept where the person suffers from something he/she did or failed to do. It’s related to sins of omission and commission.
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Caring for America’s Veterans
Department of Veterans Affairs
Spouses and Children
• 35 million spouses and dependent children of living and deceased veterans, making up 19 percent of the US population.
• This does not include the large number of adult children responsible for the care of their aging parents.
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Caring for America’s Veterans
Department of Veterans Affairs
Deployment and Families • Feel Concern, worry or
panic, loneliness, sadness
• Have added family duties & responsibilities
• Learn new skills, make new friends
• Fear for their service member's safety
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• Feel overwhelmed
• Experience financial difficulties
• Deal with problems on their own
• Do not always understand what their loved ones have been through
• Are concerned about being needed and loved
Caring for America’s Veterans
Department of Veterans Affairs
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PhysicalPhysicalPhysicalPhysicalNegative Negative Coping Coping
Negative Negative Coping Coping FinancialFinancialFinancialFinancial
Family StressorsFamily Stressors
RelationshiRelationshipsps
RelationshiRelationshipsps
Spiritual and Emotional StressorsSpiritual and Emotional Stressors
SecondarSecondary Traumay Trauma LossLoss
MoralMoral
Caring for America’s Veterans
Department of Veterans Affairs
Home is Different for Veterans
Homecoming is disorienting and can represent a significant change for a family. They have learned to live without their military member.
Neither the returning service member nor their family and friends are the same as they were before deployment to war.
Families and friends must re-adjust and “re-set” upon re-integration.
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Caring for America’s Veterans
Department of Veterans Affairs
Secondary Trauma
• Trauma also affects those who experience it indirectly.
• Secondary, or vicarious trauma, refers to those people who care for, or are involved with, those who have been directly traumatized.
• Symptomatology very similar to that of PTSD.
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Caring for America’s Veterans
Department of Veterans Affairs
Spouse and Child Abuse
The number of Soldiers who committed spouse abuse and child abuse or neglect in the last six years has increased by 177% (913 cases in FY 2004 vs. 1,625 in FY 2009).
Army: Health Promotion, Risk Reduction, Suicide Prevention Report 2010, (80)
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Caring for America’s Veterans
Department of Veterans Affairs
The Child Victim
• Prolonged deployment and trauma related stress impacts the whole family
• Over 700,000 children have experienced the absence of a parent due to deployment
• Approximately 220,000 children are currently living through the absence of a deployed parent
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Caring for America’s Veterans
Department of Veterans Affairs
Deployment & ChildrenJessica Ramirez (Newsweek reporter) found that a number of
children who are experiencing the repeated absence of their parents are displaying “clinically significant” mental and behavioral health problems.
Colonel Kris Peterson, a child and adolescent psychiatry consultant to The Surgeon General of the Army, stated that he is “seeing a range of problems requiring intervention; from attention issues and heightened aggression, to anxiety and depression.”
Dr. Shelley MacDermid Wadsworth, the director of the Military Family Research Institute, says “the signs of trouble among the troops’ children appear to be growing.”
Army: Health Promotion, Risk Reduction, Suicide Prevention Report 2010, (98)
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Caring for America’s Veterans
Department of Veterans Affairs
The Aging Veteran Population
• In 2010 the median age of all veterans was 62 years
• Veterans 85 years of age and older increased from 164,000 in 1990 to 1,393,000 in 2010
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Caring for America’s Veterans
Department of Veterans Affairs
US Census• In 2000, Americans 65 years of age
or older made up 12 percent of the population.– By 2020 this will increase by 16 percent.– By 2040 this will increase by another 20
percent.• The fastest growing segment of older
adults will be those 85 years of age or older, increasing 223 percent from 2000 to 2040.
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Caring for America’s Veterans
Department of Veterans Affairs
Older Adult
• 85 percent have at least one chronic health condition with 75 year olds averaging 3 chronic conditions.
• 37 percent of those 65 and older have a hearing impairment with 30 percent having impaired vision.
• Degenerative dementia, rare among the young, finds an increasing rate of incidence among the elderly.
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Caring for America’s Veterans
Department of Veterans Affairs
Loss and the Elderly
“Not only are older adults more likely
to have experienced loss, but they
may find themselves the only surviving
member of their family or peer group.”
(Russo, 2012).
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Caring for America’s Veterans
Department of Veterans Affairs
Depression and Despair
Faced with a potential loss of functioning,
autonomy or personhood, it is not
unusually for the older adult to react with
depression or despair, interpreting the
results as evidence of personal dishonor
or disgrace.
(Nuffield Council on Bioethics (2009). 29