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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. Min Chief of Chaplains & ACPE CPE Supervisor VANY Harbor Healthcare System Veteran Mental Health: Why Ministry Matters

Caring for America’s Veterans Department of Veterans Affairs Arthur C. Russo, Ph.D. Clinical and Neuropsychologist Chaplain Andrew Sioleti, LCSW; D. Min

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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

DEPLOYMENT AND FAMILIES

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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 OLDER VETERAN

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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

Caring for America’s Veterans

Department of Veterans Affairs

QUESTIONS?

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