Suicide—Data, Theories and Actions

Contributed by Stephen E. Dannenbaum, Ph.D., Vice President, Behavioral Health, United Healthcare Military & Veterans

In September, PMCN helped to plan and sponsor the VA Mental Health Conference here in Colorado Springs.  The following report is based on a presentation by Stephen Dannenbaum, PhD, Vice President Behavioral Health, UnitedHealthcare Military & Veterans. The report provides data and clinical insight into suicide rates, causes, and prevention steps in active service member and veteran populations.

The Data

Today we see over 46,000 suicides per year in the general population; a  number  that  increases  by  around  10  percent year over year, dwarfing the homicide rate of just over 20,000. This  translates  into  one  suicide  every  15  minutes  or  95  per day. Suicide is much more likely in the Western half of the United States with these states occupying eight of the top 10 states (Alaska being number one). While men are four times more likely than women to die from suicide, women   are three times more likely to make a suicide attempt. And while suicide generally increases with age, in the typical high school classroom one male and two females have probably attempted suicide in the past year. “Attempts” are a key factor in understanding suicide risk.

With respect to current service members and veterans, rates have steadily increased over the past decade with rates per 100,000 as high as 17-20, whereas the national average is 11.5 for young adult males. Post-Traumatic Stress Disorder (PTSD) can increase this rate six-fold.  While the Military Health System has implemented a variety of prevention initiatives, in many cases the results have not kept pace with the increasing rates. Moreover, it appears that veterans are particularly susceptible to an increased risk due to the use of alcohol and prescription drugs.

Finally, suicide risk is high for 30 days after an acute psychiatric hospital discharge and while for post-discharge from an inpatient acute psychiatric facility suicide is most frequent in the first two weeks, most suicides occur on the first day after discharge. These facts speak to the critical importance of post-discharge planning as a central part of inpatient treatment. Inpatient suicide risk factors include, but are not limited to: high lengths of stay and multiple prior admissions, prior suicide attempts, depression, family history of suicide, recent bereavement, being single and living alone.

Approaches and Theories of Suicide

For many years,  most  behavioral  health  care  professionals have been trained in what we might call the “Classical” approach to suicide. This includes key predictive markers of Intent (how clear and imminent are suicidal thoughts?), Means (how lethal and available are the methods for suicide?), and the Plan (how specific and well thought are the plans?). This is a very reactive approach, not that dissimilar from calling the Fire Department after flames are seen.

A more recent theory has been researched and put forth by Dr. Thomas Joiner (2005) and featured in his book, “Why People Die by Suicide.” Dr. Joiner’s work has strong research support and puts forth the Interpersonal Theory of Suicide which is more akin to detecting smoke signals rather than reacting to flames. The theory posits that there are two key factors to consider; the acquired ability to inflict self-harm, and the desire for suicide. Within the desire component are the components of Perceived Burdensomeness and Thwarted Belongingness. Where these components or factors overlap exists the greatest risk for suicide. The graphic below best illustrates this model:

Suicide chart

The first component, Acquired Ability (for self-harm) is learned by direct and vicarious exposure to pain, danger,   and training such as might be received in the military. This explains which veterans, first responders, physicians, victims of physical abuse and other harm-related individuals are at higher risk. It also explains why those with previous, unsuccessful suicide attempts are at greater risk.

Unfortunately, we cannot unlearn capability. Once acquired it cannot be un-acquired.

However, the Desire for Suicide and its component parts, Perceived Burdensomeness and Thwarted Belongingness are perceptual or cognitive in nature and can be addressed through therapy such as Cognitive Behavioral Therapy which confronts irrational and erroneous beliefs. It is easy to understand by a service member returning from a deployment might feel like a burden on their family or support system, or why they might feel they just don’t belong.  The good news is the perception of being a burden is just that—“a perception” and is more often than not, wrong. Similarly, the perception of belongingness is a cluster of thoughts that can be challenged and modified through Cognitive Therapy, as well as behavioral interventions such as expanding the individual’s support system.

In sum, the Interpersonal Theory offers many more opportunities to prevent suicide by looking at these early predictive factors, rather than waiting for the situation to “erupt into flames.”

Actions

Finally, when working with an individual suffering from suicidal ideation and desire there are some very specific and concrete steps that can be taken. While there have been mixed perspectives on the effectiveness of suicide contracts, there is greater consensus that detailed alternative-to-suicide plans can be very effective. A Coping Card simply involves the development of a straightforward crisis plan that can be written down on the back of a business card, a 3×5-inch index card, or a sheet of paper. An example would be, “When I’m upset and thinking of suicide, I’ll take the following steps:   1) Call a  Friend,  2) Exercise,  3)  Listen to music,” and additional very specific interventions. Contact numbers for suicide hotlines, close friends, and mental health professionals must be included as well. It is very important to have the individual sign the Coping Card as there is research to indicate that people are almost twice as likely to follow through on a commitment if they sign their name to it.

In summary, suicide is still an ever-growing, very serious problem, particularly for service members and veterans. Fortunately, there are new and promising models of suicide prevention that offer both mental health professionals, family members and others new ways to address individuals who are suffering from thoughts of self-harm, at an earlier stage in the process, well before a crisis emerges.

This article originated from the United Healthcare “TRICARE West Region Military & Veterans Monthly”

UHC_ID_MilitaryAndVet_CMYK

Advertisements

Rocky Mountain Human Services’ Homes for All Veterans Program: Efforts to End Veteran Homelessness

 

Contributed by RMHS Communications

“There is no place in the [U.S.] where someone working full time at the federal minimum wage can afford a modest one bedroom apartment, and the majority of renting families who live below the poverty line spend at least half of their income on housing costs. As a result, millions of families experience housing insecurity, and teeter on the brink of homelessness, one financial challenge or a lost job away from living on the street or shelter.” – Heartland Alliance 2017 Report

Rocky Mountain Human Services’ Homes for All Veterans (HAV) program is funded by the Supportive Services for Veteran Families (SSVF) grant from the U.S. Department of Veteran Affairs (VA) that was founded on the principle that every veteran has a right to safe, permanent housing. Dedicated to ending veteran homelessness, the HAV program provides outreach, case management, and support accessing community and mainstream resources to more than 1,000 veteran households each year who are experiencing literal homelessness or in danger of homelessness throughout the state of Colorado.

RMHS_Logo_(Homes_for_All_Veterans_2017)HAV Program Manager for southern Colorado, Alison Gerbig, shares that “the SSVF program is designed to help our veterans and their families quickly access and obtain safe, stable housing in order to better support them in developing connections and resources in the community to maintain housing.”

In the past, HAV’s priority was to encourage the veterans to focus their time first on solely obtaining housing then focusing on employment and other needed supports. However, the current high rental market in Colorado has caused rental rates to increase and rental requirements to change drastically, shifting the priority to securing employment in conjunction with securing housing. Per monthly data reports by RMHS/HAV, the average time to house a veteran in the program is about 45 days. Heartland Alliance (Schnur, Warland, Young & Maguire, 2017) reports that it “takes the average jobseeker 25 – 27 weeks to obtain employment.” However, veterans who experience homelessness often face additional barriers that can cause them to face even longer periods of unemployment and homelessness. Criminal records, lack of basic skills, and poor job history or gaps of employment can quickly disqualify them from getting a job and/or housing, and often the typical employment setting can be too rigid and overwhelming for someone who spent last night on the streets or in a shelter, or for a veteran dealing with trauma.

Through experience and a person-centered groundwork for support, the dedicated staff of HAV have worked to develop a better understanding of veteran-specific barriers and needs and improve their processes to best support the specific needs of their clients. Today, the team embraces tools from trauma-informed care and utilizes motivational interviewing practices to provide services and support that are sensitive and avoid overwhelming situations or actions.

Part of these efforts include the Veteran Employment and Housing Orientation classes held at HAV’s Veteran Housing Resource Center in Colorado Springs every Monday morning. This class provides access to information and resources designed to address the realities of obtaining housing in Colorado Springs coupled with the increased importance of employment designed to support veterans who are experiencing homelessness.

HAV is grounded in the philosophy of not duplicating resources, therefore cultivates community partnerships to promote success for veterans in the program. They invite partners to speak at orientation classes and utilize services as a way to provide further resources. Pikes Peak Workforce’s Financial Coach speaks about housing income and expense information supporting veterans to start planning their goals and next steps toward housing. The Department of Human Services’ Income Maintenance Tech connects veterans to benefits while they are searching for employment. The Disabled Veteran Outreach Program Specialists at Pikes Peak Workforce Center (PPWFC) act as a resource, offering intensive services for veteran employment. In addition, the team invites employers and landlords to connect veterans with opportunities to meet their individual employment and housing goals.

When a veteran does obtain housing and exits the program, although they may still be considered rent-burdened (paying more than 30-40% of their income toward housing costs), the goal is to support them into a home, teach them about the tools and resources to be able to maintain their home and employment, and to assist them in creating a plan in case their income decreases or they risk returning to homelessness. Supporting the veteran to break down barriers and achieve individual goals, the HAV team and community partners collectively work to end veteran homelessness one home and one job opportunity at a time.

You can find more information about our Homes for All Veterans program on our website, or by participating in monthly Community Advisory Council on Veteran Homelessness meetings. The meetings are open to those who are interested in learning about the community of Colorado Spring’s efforts, successes, and opportunities to end veteran homelessness. Landlords, employers, community partners, and interested citizens are always welcome to come to join us in our efforts to end veteran homelessness:

Community Advisory Council on Veteran Homelessness (CACVH)
Third Friday of each month
9:30 a.m. – 10:30 a.m.
Veteran Housing Resource Center
17 S. Weber Street
Colorado Springs, CO 80903

References:

Schnur, C., Warland, C., Young, M., & Maguire, T. (2017). Integrating rapid re-housing & employment: Program & policy recommendations for enhancing rapid re-housing. Chicago, IL: Heartland Alliance’s National Initiatives on Poverty & Economic Opportunity.

The VA and Colorado Springs Community Discuss Suicide Prevention

Contributed by Amanda Nurmi, Community Outreach Coordinator, PMCN

Community organizations came together last week for the VA Mental Health Summit and one of the main topics of conversation was suicide prevention. There were five panelists with strong and important messages, the main one being that people need support systems and cannot/should not have to go through these tough times alone.

Tammy Hopman, Suicide Prevention Coordinator for ECHCS VA, talked about how the feeling of loneliness kills more people than a heart attack. Hopman also spoke about Thomas Joiner’s three key motivational aspects, which contribute to suicide: 1) a sense of being a burden to others, 2) a profound sense of loneliness, alienation and isolation, and 3) a sense of fearlessness.

IMG_4009
VA Mental Health Summit Pannelists (left to right: Tammy Hopman, Joshua Kreimeyer, Waymon Stallcup, Katie Civiletto, and the moderator, Adam Hoffberg)

Joshua Kreimeyer, Regis University, discussed the effective preventive measures the Division of Counseling and Family Therapy at the University utilize to help military families come together and build strong, positive relationships. They host a Welcome Home Warrior Retreat where military families can go away for a couple of days together and bond. Building relationships with each other and the other families.

The Vet Center pointed out  that there are many resources for the veteran, but not for the spouses, “you need to be in the safety plan because you are a big part of it, and a good part of it”, stated Waymon Stallcup, Readjustment Counseling Therapist at the Vet Center. The Vet Center has veterans and their families create safety plans that work for them and their lifestyles to ensure they are creating positive situations. Stallcup reiterated that the three rules they have for their veterans is “self-care, self-care and self-care.”

Give an Hour discussed the Campaign to Change Direction, changing the culture of mental health and encouraging people to pay attention to their emotional well-being. Katie Civiletto, Project Specialist at Give an Hour, stated the population needs to change the conversation around mental health and start to pay attention to the warning signs of someone needing help.

Overall, the community gathered at this daylong event to discuss productive and realistic ways we should, and are, rallying together to ensure our military and veterans are receiving the assistance they need. Suicide takes the lives of approximately 20 veterans a day, and the community will not stop until that number is down to zero.

Honor and Empower with the Wounded Warrior Program

Wounded Warrior Project® (WWP) serves veterans and service members who incurred a physical or mental injury, illness, or wound, co-incident to their military service on or after September 11, 2001 and their families.

With advancements in battlefield medicine and body armor, an unprecedented percentage of service members are surviving severe wounds or injuries. For every US soldier killed in World Wars I and II, there were 1.7 soldiers wounded. In Operation Iraqi Freedom and Operation Enduring Freedom, for every US soldier killed, seven are wounded. Combined, over 48,000 servicemen and women have been physically injured in the recent military conflicts.

In addition to the physical wounds, it is estimated as many as 400,000 service members live with the invisible wounds of war including combat-related stress, major depression, and post-traumatic stress disorder. Another 320,000 are believed to have experienced a traumatic brain injury while on deployment.

With the mission to honor and empower Wounded Warriors, WWP is the hand extended to encourage warriors as they adjust to their new normal and achieve new triumphs. Offering a variety of programs and services, WWP is equipped to serve warriors with every type of injury – from the physical to the invisible wounds of war.

The WWP Alumni program is your point of entry to the many free Wounded Warrior Project® (WWP) programs, services, and events available to you and your family. During military service, warriors form bonds with one another that are as strong as family ties. The Alumni program helps veterans to reform relationships by providing opportunities to connect with one another, programs, and their communities. From recreational activities and sporting events to professional development opportunities and community service projects, there’s something for everyone. Because we understand the value a thriving family life can have, we also host numerous family- and spouse-focused events.

WWP1Physical Health and Wellness (PH&W) programs for veterans are designed to reduce stress, combat depression, and promote an overall healthy and active lifestyle by encouraging participation in fun, educational activities. When wounded warriors commit to making a positive change in their physical recovery, WWP is ready to help. Goal-setting, coaching, skill-building, physical training, and other opportunities provide the resources warriors need to make long-term changes toward a healthy life.

WWP3Soldier Ride is a unique four-day cycling opportunity for wounded service members and veterans to use cycling and camaraderie to overcome physical, mental, or emotional wounds. The rides are exhilarating and a great way to help warriors gain confidence and realize you can do this!

Wounded Warrior Project® (WWP) provides free programs and services to address the needs of wounded warriors and fill gaps in government care. The demand for our programs and services has grown from serving a handful of injured veterans to now serving tens of thousands, and we continue to receive hundreds of new registrations from injured veterans, heir families, and caregivers each month.

Contributed by Greg Monck, Alumni Manager, WWP

Phoenix Multisport- COS

Phoenix Multisport is a sober active community that fosters a supportive environment for people in recovery, or those who choose to live a sober lifestyle. The only requirement to attend an event is 48 hours clean and sober. If an individual wishes to attend events on a regular basis, we also ask that they have a commitment to a sober lifestyle. After that, our events are free to anyone who meets these requirements. We also ask that people sign a team member agreement which includes being safe and supportive, and leaving a positive impact. We are not an alternative system of recovery, so we ask that whatever individuals are doing to get sober or stay sober, be continued, with Phoenix Multisport just adding to that piece.

PhoenixThe two main groups that we serve within the military in Colorado Springs are veterans, who come to us through the VA substance abuse program (SAP), and active duty personnel in the addiction medicine intensive outpatient (AMIOP) program at Fort Carson military base. These two groups are reached through regular outreach meetings with an employee of Phoenix Multisport. The outreach consists of a video or documentary telling how Phoenix Multisport came into existence, the culture and community that it supports, and what to expect when coming to an event. The employee then gives a small talk about their problems with addiction, how these were overcome, and what part Phoenix Multisport played and still plays in their recovery. Current monthly calendars with all the events are also shared with the class.

Our events currently include strength training, yoga, boxing, climbing, running, and soon mountain biking will also be included again. We try to stress our understanding with the stigmas associated with addiction, and to show that a happy and healthy lifestyle can still be possible, without alcohol or drugs. Not only that, but we welcome people of diverse backgrounds into our community, and try to be inclusive. Many of our members are former military, or still serve, and we thank them for that service.

Contributed by John Schneider, Colorado Springs Instructor, Phoenix Multisport

SIX THOUGHTS ON POSTTRAUMATIC STRESS DISORDER

Contributed by Duane France, Director of Veteran Services, Family Care Center

Posttraumatic Stress Disorder. Shell Shock. Battle Fatigue. Call it what you want, it’s that combination of psychological and behavioral reactions to exposure to traumatic events that people see in combat veterans. There is a lot of discussion, whether at the water cooler, kitchen table, social media, wherever, about what it is. Who has it. What can it mean for those who do have it, those who live with them, and those who work around them.

PTSDThere are a lot of misconceptions around PTSD, a lot of unknowns that cause people to jump to conclusions. While I’ve written about PTSD before, and often try to make a point that challenges that veterans experience in regard to their mental health goes far beyond PTSD, I thought that I would lay out some of my thoughts about the condition. Here are six quick thoughts that might help you understand what PTSD is, and how it impacts veterans.

Just Because a Veteran Has Been to Combat Doesn’t Mean They Have PTSD

One of the stereotypes that many in society have is that exposure to combat, or even just combat deployments, must mean that a veteran has PTSD. Witness the high-profile events over the last eighteen months in which military service members committed egregious criminal acts: the sniper-style shooting event in Dallas, the multiple homicides in Baton Rouge a week after that, or the Airport Shooting in Florida. In each of these cases, the veteran’s military experience, including deployment experience, was examined to determine if PTSD was the “cause” of their actions. Correlation is not causation, as any scientist will tell you, and the fact that a veteran deployed to a combat zone does not mean that they will automatically develop PTSD.

The fact is, there are a large number of individuals who deployed to a combat zone who never actually saw combat action. They were never shot at, they were threatened with rocket or mortar attacks, their lives were never really in danger from enemy activity. That does not mean that nothing bad ever happened when not in active combat; certainly accidents happen. I recall, as a young Soldier in Bosnia, walking from our living area to the motor pool. Everyone walked the same path; we had arrived in the winter, so the snow was trampled and worn. Guess what happened when the snow melted, however? All of the unexploded ordnance started to appear on the ground. I don’t want to make it sound dramatic and say that we had been walking through a minefield, but if the path had been ten feet to the right or left, someone would have gotten hurt or killed. The military is an inherently dangerous profession, so certainly mishaps and accidents can occur…but the individual who deployed to Kuwait in 2012 was not faced with the same danger as the group of men and women hanging off the side of a mountain in 2009. So, just because someone’s a “combat vet” doesn’t automatically mean they “have PTSD.”

PTSD Is Both a Natural AND Negative Reaction

PTSD is as much a neurological condition as it is a psycholgoical one. Studies have shown that repeated exposure to trauma results in physical areas of the brain, specifically the amygdala and the hippocampus, actually undergoing structural change. Activation of the amygdala and hippocampus combined with reduced activation and volume in the frontal lobe of the brain are indicative of veterans who display symptoms of PTSD. Therefore, the brain is adapting the way the brain should adapt to repeated traumatic exposure.  It is doing exactly what it should do when exposed to high levels of cortisol and adreneline and constant activation of these regions. Many who rail against the “D” in PTSD say, “why pathologize a natural reaction to combat?” That’s absolutely right…PTSD is precisely a natural reaction.

That doesn’t mean that it’s beneficial. There are hundreds of things that are natural reactions to our environment, and they’re still not beneficial. Allergic much? Anaphalactic shock occurs after a bee sting, it’s a reaction of one organism to a substance from another. Am I comparing PTSD to allergies? Of course not, but just because a reaction is typical for a small group of people doesn’t make it beneficial. This very natural reaction can be a debilitating condition…it’s both.

A Veteran Can Experience Challenges Even If They Don’t Have PTSD

To be clincially diagnosed with PTSD means that the individual must meet a certain set of critira. I have written about these criteria before, so you can check that out here. But not all veterans meet all the diagnostic criteria at the same time. Some veterans don’t experience nightmares or intrusive thoughts, but behaviorally isolate themselves. Or are extremely hypervigilant. At one point in their lives, or in one particular location, they can experience the mood symptoms but nothing else. Not only that, PTSD may not be the issue, but guilt or shame may be the issue. Or a lack of purpose and meaning in their lives, a substance abuse problem, relational difficulties, or any other of a number of challenges that many veterans…and many non-veterans…face.

A Veteran Can Develop PTSD from a Single Event or Multiple Events

Complex trauma as a result of exposure over an extended period of time can result in PTSD that is much different than that of a single event. Any one of us can experience PTSD after a vehicle accident or a natural disaster. As a matter of fact, these are two of the most common conditions that non-veterans would experience when it comes to developing PTSD. Complex trauma, however, occurs when multiple traumatic events happen over a period of time, or even a lifetime. As I’ve mentioned before, the military is almost a refuge for many who had a traumatic childhood, when is then compounded after exposure to trauma as an adult.

PTSD can also occur after single instances of sexual assault, which is much different than that which results from accidents or natural disasters. This form of PTSD is much more personally and physically intrusive, and layers of guilt and shame. An aspect of Military Sexual Trauma (rape or assault while in the military) was made clear to me as I attended a conference in San Francisco: MST can almost be seen as incestuous. We talk about the “Band of Brothers” and the military family, how we become closer to those we serve with than we sometimes are with our own family. Often, the perpetrators of the assault in the military are those in a position of trust, either professionally or personally. So an MST survivor has not only the trauma of the assault, but also the betrayal of trust.

A Veteran can Develop PTSD Even If They’ve Never Been to Combat

I’ve worked with veterans who have developed PTSD, but have never deployed. The 82nd Airborne Division responded to Hurricane Katrina, and had to recover the remains of their countrymen. Just that level of devastation can have a traumatizing effect. I have known, of course, service members who have been raped, as discussed above. Any event that causes threat or actual death, dismemberment, or sexual violence is described as “traumatizing” when it comes to PTSD. Having a bad experience with a supervisor while you were in the miltiary? Not PTSD. It could certainly lead to helplessness, frustration, angry outbursts, depression, and a whole host of other mental health concerns, but not PTSD.

But, as I mentioned above, the military is a dangerous profession. Parachute accidents, howitzer misfires, training accidents, each of these are potentially traumatic and could cause someone who has served to develop PTSD, even if they haven’t deployed.

A Veteran can “Have” PTSD and Still be Functional and Productive

So perhaps a veteran has been exposed to multiple traumatic events and meets the clinical definition of PTSD. Does that mean that we should write them off entirely? Of course not. The condition can be managed to the point where the veteran may not feel the challenges for months, if not years. With treatment, the veteran can absolutely manage their PTSD symptoms to the point that they can be a functional and productive member of their community, their workplace, their family.

Understanding this condition is a key factor in reducing the gap in understanding between those who have served in the military, or love those who have, and those who have not served. What questions do you have about PTSD? What do you know about it, and how can we have a conversation that can help you understand more? Reach out, comment below, and join the conversation.

See original article on Head Space and Timing.

Acknowledging the Stigma of PTSD and 4 Tips for Seeking Help​

​Contributed by an anonymous Veteran and Licensed Professional Counselor, Colorado Springs.

Recently, I was asked to offer a perspective on PTSD since June is PTSD awareness month.

The first word that came to mind was “stigma.”  The name alone, Post-traumatic Stress Disorder (PTSD) holds some stigma within itself by use of the term “disorder.” As a mental health provider, I do my best to defeat the stigma of seeking mental health treatment and ​support by talking about mental health as often as possible​.

​Post-traumatic stress is actually an effect that sometimes develops after exposure to trauma. Some people have higher levels of resiliency and others may have coping skills that are not as effective in resolving exposure to trauma. It is important to realize that the effect of trauma can sometimes (not always) result in the future development of PTSD.

Trauma is exposure to imminent physical or emotional danger whether directly to a person, by witnessing trauma happen to another person, or by being told the details of a traumatic event that has happened to a loved-one.

​Another area of stigma associated with PTSD is that it is a life-long “disorder.” PTSD is treatable.

4 Tips for Seeking Help (for PTSD or other mental health needs)​

There is no shame in seeking help and in fact, it takes courage to reach out for support for PTSD or any other mental health needs. When a client seeks support, it is important to know that you have full control in how your treatment process goes.

  1. Finding a Therapist

Check with your insurance provider or the VA to find a list of therapists in your network. There are also lists of therapists who provide support for veterans in the community which can be found through Peak Military Care Network. Alternatively, if you’re willing/able to pay out of pocket this is also an option. Once you’ve got your list of therapists you wish to try, call and ask the therapists on your list if you can meet them or talk on the phone with them  for a consultation to see if you might be a good fit for working together on your treatment goals. Many therapist offer initial consultations at no-cost. This can be a helpful way to get to know the person a bit before you decide to proceed with treatment.

  1. View Therapy as a Collaboration

You and your therapist work together to select a suitable course of treatment. Identify treatment goals. Ask as many questions as you would like to ask to ensure you have a clear understanding about the therapy process with your chosen (or assigned) therapist. The other reason to ask questions is to make sure you feel comfortable with the person working along side you.

  1. Be Open and Honest for Best Results

​If you feel in your gut that there is something you want to discuss–share it. Your therapist is trained to hear you out without judging you or your thoughts/feelings.

  1. ​Evaluate your Progress

Throughout your therapy process you and your therapist may check-in to evaluate what is improving, what works, what didn’t work, etc. This is helpful because it gives you a more clearly defined idea of which areas of your life are being impacted by all your hard work in therapy. This is also a good time to adjust course if needed.

As a veteran–I hope for success for other veterans. Wishing veterans success in overcoming the stigma of PTSD and mental health needs in general so that veterans can get their needs met without shame. Wishing veterans success in finding a therapist who is a good fit for you so that you may reap the benefits of a positive therapeutic relationship. And finally, wishing veterans success in healing from PTSD and any other treatable mental health needs.

Post Trauma Growth

Contributed by Geoffrey P. Smith, Psy. D., Administrative Director of Inpatient Mental Health, Section Chief of Specialty Mental Health, Denver Veterans Affairs Medical Center, Eastern Colorado Health Care System

The Department of Veterans Affairs is devoted not just to effective treatment of Post-traumatic Stress Disorder (PTSD) but to developing a greater societal understanding of the impact of trauma and promoting Post Trauma Growth.

Effective treatment is developed through rigorous scientific investigation and the National Center for PTSD (https://www.ptsd.va.gov/) is dedicated to research and education on trauma and PTSD. This body assists the VA in offering a number of so-called “Evidence-Based Practices” to Veterans including: Cognitive Processing Therapy (CPT), Eye Movement Desensitization and Reprocessing (EMDR), Prolonged Exposure (PE), and Stress Inoculation Training (SIT), and antidepressant medications.

Such a list of jargon and acronyms begs the question: What aspects of the human trauma response do these treatments target and how do they work? Understanding the impact of trauma and sending a message of hope that recovery can happen are key early starting points for Veterans beginning treatment. The effects of traumatic events have consistent reactions in people that occur in various constellations but the themes are quite constant:

Normal human responses to trauma:

  1. Vigilance and Arousal:  When people have been hurt threatened or have seen the un-seeable they naturally stay on watch for the next threat. This can look like difficulty sleeping, pervasive worry and anxiety, mistrust of others, difficulty sitting with their back to a door, and/or always watching the perimeter.
  2. Re-experiencing Symptoms:  Nightmares, flashbacks, and/or feeling like it is happening all over again especially when triggered by some reminder of the event
  3. Numbing and Avoidance:  People naturally avoid triggers, isolate from others, use substances, deny the problem, and a host of other strategies to try not to feel the intense consequences of trauma. The urge to avoid intense discomfort and deep frustration with living life this way can even lead some to contemplate suicide.
  4. Negative thinking:  When life feels so lousy and people have been struggling with lost jobs, lost relationships, inability to sleep or escape from nightmares and flashbacks, their minds naturally make negative conclusions about the future, themselves and others.

 

Although these themes are constant, every individual has a unique experience and constellation of which elements of the list above are most interfering with living a valued life. Sending the message of hope that recovery is possible and asking people to flesh out their own particular version of their trauma response can lead to making informed choices about which kind of treatment is best suited for them.

Trauma-informed care understands that all forms of trauma whether from combat, domestic violence, childhood abuse, car accidents, or natural disasters have in common that the impacted person had a loss of power and control. So, the best programs offer choices, hear voices, and provide information about what to expect. In this manner, the VA seeks to describe and offer options of types of trauma treatment and build upon their preferences, strengths, values, and existing resources/successes.

Evidence-based treatments for PTSD have common guiding principles that directly address the four normal human responses to trauma. Key examples include:

  1. Exposure with Response Prevention: This is a central feature of Eye Movement Desensitization and Reprocessing (EMDR), Prolonged Exposure (PE), and Stress Inoculation Training (SIT). When people develop skills for tolerating distress, soothing themselves, and expressing uncomfortable feelings they are better able to engage in community activities, connect to family and friends, sustain gainful employment and pursue recreational and leisure activities. Engaging in a valued life in these ways helps people replace avoidance and numbing behaviors and promotes reasons for living which can be powerful new protective factors and social support preventing suicide
  2. Skills training for self-soothing and relaxation: The VA is actively promoting not just traditional methods for reducing arousal/vigilance like diaphragmatic breathing but also exploring a host of nontraditional and holistic strategies including trauma-informed yoga, meditation, and mindfulness practice. Through building community collaborations, the VA is also increasing referrals to organizations that provide nature walks, equine assisted psychotherapy, and other outdoor activities like white water rafting, skiing, and mountain biking
  3. Promoting Flexible Thinking: All of the types of psychotherapy offered through the VA assist people in noticing their thoughts and developing the skills for reframing the kinds of rigid harmful thinking that are not helpful for recovery. This portion of treatment targets those negative beliefs or “stuck points” that so often have Veterans convinced that they are no good or should have been the one who died or that the world is a terrible unsafe place.

Emerging promising practices in the treatment of trauma and stress include integration of Peer Support Specialists and Volunteers. A Peer Support staff member is a Veteran with the lived experience of recovery in mental health and or addictions problems who acts as a symbol of hope and provides disclosure of elements of their own journey of recovery to Veterans in care. Five years ago the VA rolled out a national endeavor to hire and train over 800 Peer Specialists who are now embedded in various mental health programs. The science can be potent but there is nothing quite as credible as  the testimony and encouragement from someone who has lived a similar experience.

Other recent innovations in Trauma treatment include using smart phone technology with applications such as PTSD Coach, PE Coach, CPT Coach, Breathe2Relax, Tactical Breather and Life Armor.

Reach out to your local VA medical center or community clinic and find out which kinds of trauma informed services they offer. VA healthcare system Mental Health resources vary by location but typically offer individual and group therapies by clinicians specially trained in these treatments.

Websites for more resources and information:

https://www.ptsd.va.gov/

https://maketheconnection.net/conditions/ptsd

 

Professional Fulfillment as a Military Spouse – The Challenge and Local Resources to Help

Contributed by Shannon Rauen, Membership & Capacity Builder, Center for Nonprofit Excellence and volunteer chair of the Military Spouse Career Committee.  

As a military spouse, you expect to encounter a number of recurring challenges.  Managing a household solo while your spouse deploys or goes TDY, packing and unpacking your household over and over again, or plunking yourself into a new community to rebuild a network once more.

Ask a career-minded military spouse about their last job search and I bet you’ll hear about how tough it is to find a position in a new community where you don’t know a soul, the pressure they felt to take the first job offered them for fear it would be the only offer they received, or perhaps how they are underpaid or underutilized at a job they did find.

If you are a military spouse, I’m not telling you anything new – odds are you know this well and have experienced one (or all) of these scenarios first-hand.  What is new is a growing focus and study on the issues of military spouse employment; the findings are alarming.  According to Syracuse University’s Institute for Veterans and Military Families (IVMF) Employing Military Spouses Series:

  • Military spouses experience unemployment at a rate significantly higher – estimated to be 3 times higher – than our civilian counterparts.
  • When we do find jobs, we are typically paid less for the work we do. IVMF’s study found that military spouses earn, on average, 38% less than their civilian peers.
  • Think an advanced degree is going to make up for that wage disparity? Think again – in spite of the impressive level education amongst military spouses – 25% of us have a bachelor’s degree and 10% an advanced degree – the more education you have the greater the wage gap between you and your civilian colleagues.

It would seem the odds are stacked against a milspouse seeking any sort of professional fulfillment, but have no fear.  As a three-time resident of this incredible city, I’ve found that Colorado Springs offers a multitude of programs, services, and connection points to help us find good jobs.  Here are a few of my favorites:

  • In Gear Career, Colorado Springs chapter – a national effort by the US Chamber of Commerce Foundation, In Gear Career’s local chapters are soft landing places for career-minded military spouses. The COS chapter meets monthly to share tips, grow as professionals, network, and support one another.
  • Pikes Peak Workforce Center – a gem of a local resource offering trainings, resume workshops, online job searches, job fairs, and so much more.
  • Networking groups galore – check out Colorado Springs Young Professionals, Colorado Springs Rising Professionals, Girl Crush Social Club, and Peak Startup for events that will connect you with professionals working in the community.
  • Looking to start your own business? The Colorado Springs Chapter of SCORE provides free mentorship, expertise, and advice all free of charge.  They also offer affordable, relevant trainings in partnership with Pikes Peak Community College.
  • Mt. Carmel Center of Excellence – through collaborations with community partners, this nonprofit provides transition and wellness services for Veterans, Military and their Families. Their Peer Navigators program hosts regular networking events that are open to military spouses.
  • Employment Services on Your Military Installation – regardless of your Service Member’s branch, there are programs and resources on each of our many military installations in Colorado Springs. Reach out to Ft. Carson’s ACS or Airman and Family Readiness at Peterson, Shriever, or the Air Force Academy to connect with employment specialists who can assist in your job search.

The most important thing any job-hunting milspouse can do is show up.  Be more than another sheet of paper in a tall stack of resumes – network, network, network.

A great opportunity to do just that is quickly approaching.  May 16-18 will see the ultimate local job fair come back to the Springs.  MVEE boosts two full days of professional development – with a track designed specifically for military spouses – followed by a gigantic job fair.  Those who attend panels on the 16th and 17th have first crack at the job fair.  Registration is available and I would love to see you there!

Shannon Rauen is the Membership & Capacity Builder at the Center for Nonprofit Excellence, which serves the diverse and growing nonprofit sector in the Pikes Peak Region, and serves at the volunteer chair of the Military Spouse Career Committee

 

Making Military Life Easier for Families in the Pikes Peak Region

Military families face many challenges, from frequent moves and deployments to the difficulty of putting down roots somewhere and really feeling like a part of the community. The mission of the Southeast & Armed Services YMCA is to make military lives easier, with primary focus on lower enlisted service members providing free or low-cost events and programs the reduce stresses of military life and promote resiliency.

The Colorado Springs Pikes Peak Region is one of only four cities in the country that serves four or more military bases (the others being Honolulu, San Diego and Norfolk), making the mission of Southeast & Armed Services YMCA even more vital for our community.

ASYMCA_Logo_for_pmcn
The Southeast & Armed Services YMCA provides various programs that supplement or compliment programs already in place on base installations.

One of the unique programs offered by Armed Services YMCA is Operation Kid Comfort. When military service member parents are deployed, eligible parents can request for a FREE quilt or pillow made by quilter volunteers. These quilt or pillows bring comfort to children that include pictures of their deployed parent, so they can help bring comfort close and help ease the stress of military life.

Operation Kid Comfort has created more than 1,300 pillows and blankets for the children of deployed soldiers since it was brought to the Pikes Peak Region in 2009. One of those smiling kids was Elena Mendez. She’s only 20 months old, but when she got her sunshine-yellow quilt, she picked out the pictures of her dad right away.

“This quilt is going to be dragged with us everywhere across the house,” her mom, Blair, laughed. “It will definitely help…we have pictures, and we FaceTime, but this quilt will be readily available, so now she can see her dad more.”

Blair said the quilt was especially important to her as a mom because she was afraid that Elena would forget her dad.

“All the technology, it helps, but programs like this give you ideas you’d never have, and this quilt gives us another way to have Dad around more,” she said. “We just so appreciate the people who put their time and effort into this to help us.”

Another family who recently picked up their quilts got two – one for five-year-old James and one for his year-old sister, Briella.

Their mom, Cecilia, said that she loved how the Southeast & Armed Services Y is always there to invite her family to events like the military family dinner, or breakfast with Santa, making sure her kids gets presents for Christmas.

“It’s nice to know there are helpful people out here,” she said. “I love the way they treat me at the Southeast & Armed Services Y. The moment I walked in, everyone was so welcoming, there were hugs…they were absolutely amazing.”

The quilts, she said, were extra special to her and her family. Her son James agreed.

“I love my quilt because it has all my favorite stuff I like…ninja turtles and my dad who I love,” he said.

When military parents are home, however, the Y recognizes the importance of providing events and programs that will help families grow closer and create memories that keep them strong when they have to be apart.

TFather-Daughterhe Military Father-Daughter Ball is one of those events. Military daughters are transformed into princesses (complete with their own crowns) and get their dads all to themselves for an evening. Both fathers and daughters create memories which will last a lifetime.

“The Military Father Daughter Ball was greatly appreciated by my family…a very positive event to show community support for our military children, who are the true unsung heroes of the Army story,” said one father.

The annual event includes carriage rides, caricatures, food, dancing, flowers, live princesses and more – all the ingredients needed to create a magical night for fathers and daughters.

Father-Daughter 2“They treated my princess like a real queen and they treated me with the utmost respect…it gives us a necessary break to take time to spend with our families and those who mean more to us than anything else,” said another dad.

Another parent said his daughter is still talking about the night she’ll ‘never, ever forget.’

“Time with my children is precious, and this night could not have been any more magical for both my daughter and me,” he said.

Other events the Y offers exclusively to military families include a father-son fishing trip, a Mother-Daughter Tea, weekend family camps, Breakfast with Santa, Veterans Appreciation Breakfasts and more.

Beyond this, the Southeast & Armed Services Y offers a variety of other services, from swim lessons and soccer to fitness classes and two-hour child watch for Y members. Military families and veterans receive a military discount on their memberships, so they don’t have to worry about cost – they can simply enjoy all the Y has to offer.

These programs, events and services are our way of saying thank you to the military families in our community. We are honored to serve you.

For more information, please visit: www.ppymca.org/programs/military/events www.facebook.com/SoutheastArmedServicesYMCA

POC: Drew Aquino – Military Outreach Director: daquino@ppymca.org / 719.622.9622