By Mark H. Pollack, M.D.
Guest Columnist
Chicago, IL,
USA
In
the aftermath of the terrorist attacks on September 11th, 2001 that
destroyed the World Trade Center in New York and severely damaged the Pentagon
in Washington, the United States has been engaged in armed conflict in Iraq and
Afghanistan, the longest war in our country’s history. Over 2.5 million
servicemen and women have served in the war zones of Iraq and Afghanistan, more
than half with multiple deployments. Over 6,800 service members have died in
these conflicts and about a third of troops return with a so-called “invisible
wound of war”, post-traumatic stress disorder (PTSD) and/or traumatic brain
injury (TBI). These invisible wounds of war are complex and highly
individualized in their presentation, and can impede the ability of the
returning veteran to reintegrate at home or work. Those with PTSD may exhibit
irritability, isolation, or a lack of interest in their usual activities; along
with the
behavioral changes and impediments associated with TBI such as
impulsivity and
memory and concentration difficulties, these conditions can put
enormous strain on the families of affected individuals. Rates of marital
discord and divorce are elevated among couples in which one or both partners
have served, and repeated deployments are associated with higher levels of depression
and anxiety in their children,
persisting even after the deployed parent returns. Reservists called to deploy may
return to communities where few or none of their neighbors share their
experiences, and where their sons and daughters are the only military children
among their peers, increasing their sense of isolation. Every day, over twenty
veterans kill themselves, a rate of suicide that is orders of magnitude higher
than in the general population – this grim finding dramatically underscoring our
failure to address the profound unaddressed aversive experience of many of our
servicemen and women.
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| Mark H. Pollack, M.D. |
Socioeconomic
factors can compound the problem for the veteran who may return from their time
in service years behind their peers in degree of educational attainment and
civilian job experience. They may return home to a stagnant job market and
encounter employers that do not understand how military experience translates
into civilian skills.
Though
a “sea of goodwill” for returning veterans has proliferated, resources are
fragmented, and veterans and their families often find the process of
identifying and navigating the systems of care and support to which they are
entitled confusing and overwhelming. Only about half of returning veterans
needing care receive it and for many of those, the care is inadequate. The VA
system and other military facilities, despite some well-publicized
difficulties, have worked hard to take care of the returning veterans but the
need is great, and it has been increasingly clear that these institutions can’t
do it alone. It is apparent that a void exists in providing veterans and their
families with help in accessing and navigating the care, support, and services that
they have earned and need and that the non-military health care system has to
take on a role in providing veteran-sensitive care to our returning servicemen
and women. While many veterans benefit from their care at the VA, a significant
number may be uncomfortable accessing VA programs because of its association
with their military, or have had previous frustrating or negative experiences;
others may be ineligible for VA services. Further, the Veterans
Administration (VA) is specifically not commissioned to provide care for
spouses and children who thus may have difficulty accessing the treatment that
they need.
In the spring of 2014 with the
help of anchor funding from the McCormick Foundation and the Major League
Baseball’s Welcome Back Veterans Initiative, as well as other private and
foundation philanthropic support and in-kind resources from Rush University Medical
Center, we opened the doors of the Road Home Program – The Center for Veterans
and their Families at Rush. This program, representing a collaboration of
departments and services across the institution, provides care not only for the
veterans who are dealing with the invisible wounds of war, but also support and
treatment for their families, spouses, parents, children and other loved ones,
who are often not able to get care in traditional military settings. In 2015,
with substantial support from the Wounded Warrior Project, we and colleagues at
three other leading academic medical centers across the country, Harvard’s
Massachusetts General Hospital in the Northeast, Emory University in the South
and UCLA in the West, established the Warrior Care Network. As part of this
initiative, we have expanded our outpatient services for veterans and their
families and developed an innovative intensive outpatient program in which we
bring veterans in from all over the country to receive focused care over a
three week period for their PTSD and related mental health conditions as well
as TBI. To date, our network has treated over a thousand individuals and the requests
for services from veterans and their families continue to escalate.
In addition to evidence-based
and innovative treatments for the invisible wounds of war, our program’s
veteran outreach workers, help veterans and their families navigate the breadth
of available social service resources available to them including those related
to education and job training. With the recognition that as many as 20 to 25%
of service women as well as a significant number of service men have experienced military sexual
trauma we have also developed specific treatment programs to meet the needs of
this population. We collaborate
with colleagues at the VA and other military medical facilities – connecting
patients to resources in these settings for which they are eligible and that
are likely to be helpful – and receiving referrals from these institutions for
veterans and family members who may benefit from our services.
In addition to directly
providing services at our own program, we are committed to expanding the pool
of providers able to effectively treat veterans throughout the general medical
system. We therefore provide
educational programs for medical and mental health personnel to enhance their
understanding of veteran culture and challenges, as well as to develop their
expertise in evidence based treatments to improve outcomes for veterans with a
range of mental health issues consequent to their service.
The growth and success of our
program and network to date, as well as the nascent development of other
veteran related initiatives in the general medical health care system,
demonstrates the potential for the private sector to be an important
contributor to the health care of the veteran population. Going forward,
private-public partnerships with the VA and other military medical institutions
and supported through a range of government and private sources may become an
increasingly important factor in meeting the mental health and other medical
needs of our servicemen and women and their families.
Links:
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Mark
H. Pollack, M.D. is the Grainger Professor and Chairman – Department of
Psychiatry, Rush University Medical Center; Director – Road Home Program: The Center for Veterans and their Families at Rush.