DMHAS Veteran's Services
Stigma around help seeking for mental health concerns has been a significant barrier to care among Service Members and their families. A 2004 study reported in the New England Journal of Medicine (NEJM) found that soldiers were reluctant to seek treatment because they felt that their leaders would look down on them, their fellow soldiers would deride them, and they would see themselves as being weak. The research found that, among the soldiers determined during post-deployment health screenings as needing mental health care, few actually followed through on referrals to treatment (1).
In February 2008, the U.S. Army Office of the Surgeon General released its fifth comprehensive report on the mental health of military personnel deployed in Iraq and Afghanistan. Among the Mental Health Advisory Team (MHAT V) Report findings were that 55.6% of soldiers felt that their unit would treat them differently if they sought mental health care and 56.7% felt they’d be seen as weak (2).
These findings were reinforced by a June 2008 Survey that was conducted by Harris International for the American Psychiatric Association. The survey reported that “six in ten military members (61%) thought that seeking help for mental health concerns would have at least some negative impact on their career”. About half of military members (53%) believed that others would think less of them if they sought help for mental health concerns (3). In addition to confirming the influence of stigma among military personnel, the survey revealed an alarming lack of insight among both soldiers and military spouses concerning the prevalent emotional problems associated with war zone service, as well as the effects of stress on the families left behind. Moreover, a large majority of both soldiers and military spouses were unaware of the availability and effectiveness of clinical services in place to help them (3).
Despite the prevalence of such stigma, studies are showing that large numbers of Service Members returning from war may be in need of treatment. Analyses of routine Post Deployment Health Assessments, conducted during the first 6 months following soldiers’ return from deployment, reveal that many soldiers could benefit from mental health care. Two studies released in 2007 and 2008 found that nearly half of reserve component soldiers self-report experiencing psychological problems within the first 6 months following their return from deployment in Iraq or Afghanistan. While 20%-38% of active duty soldiers reported having problems, the percentage was 42% - 49% for reserve component soldiers (4, 5). Prevalent symptoms reported by soldiers include depression, anxiety, irritability, anger, difficulty sleeping and increased substance use.
The Rand Corporation has reported that as many as 300,000 combat personnel (18.5%) would return with psychological problems, principally depression, anxiety and post traumatic stress disorder, and that as many as 320,000 may have suffered mild traumatic brain injury (6).
Another recently published study affirmed what National Guard and Reserve unit commanders have known for quite some time - that many OEF/OIF veterans now struggle with substance use disorders. The August 2008 study found that “Reserve and National Guard personnel and younger service members who deploy with reported combat exposures are at increased risk of new-onset heavy weekly drinking (9.0%), binge drinking (53.6%), and alcohol-related problems (15.2%).” (7). One of the reasons that MSP established its transportation program is because several National Guard Soldiers had lost their licenses secondary to multiple DUI (driving under the influence) charges.
The prevalence of behavioral health problems among our deployed military personnel and the challenge of defeating the negative influence of stigma has been a prominent theme among U.S. Department of Defense leadership. Defense Secretary Robert Gates and Joint Chief of Staff Admiral Mike Mullen have been leading the effort to encourage open, honest discussion within all military branches regarding the hidden wounds of war, and the need to address such wounds no differently than physical wounds.
The Military Support Program
The Connecticut Military Support Program, a DMHAS program implemented in October 2007, is a full-partner with our State’s National Guard and Reserves in meeting the military’s call to assist wounded warriors in accessing treatment services. Unlike any other state in the nation, the Connecticut National Guard has embedded civilian licensed clinicians within Units affected by deployment. And unlike any other state, the families of our Citizen Soldiers may, at any time, access free, confidential counseling from an MSP clinician who is available to see them right in their community.
Veterans Jail Diversion Program
Connecticut is one of the first states in the nation to establish jail diversion services for veterans whose trauma-related symptoms have contributed to their involvement in the criminal justice system. Following a nearly year-long planning process that involved multiple stakeholders from several systems (judicial, law enforcement, VA healthcare, Vet Centers, Department of Defense, state agencies and community nonprofits), in 2009 DMHAS’ Southeastern Mental Health Authority began a pilot initiative to divert veterans at the earliest opportunity along the criminal justice continuum into a seamless system of trauma-integrated and trauma-informed treatment and recovery support services.
Veterans Resource Representative Training Program
DMHAS Veterans Services provides a 3-day training for DMHAS clinicians (twice per year).The training is offered through the DMHAS Education and Training Division course catalog. The purpose of the training is to ask clinicians to be mindful that veterans are among their participant matrix; to inform them of the full range of services and benefits available to eligible veterans; and to encourage them to always "go deeper" with veterans -- to explore character of service and eligibility questions and to connect them with VA Healthcare or to VA claims advocates when necessary.
1. Hoge CW et al, “Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care”. NEJM.2004. (July 1); Vol 351:13-22, No 1.
2. U.S. Army Medical Department, Office of the Surgeon General, “Mental Health Advisory Team (MHAT) V Report: Operation Iraqi Freedom 06-08: Iraq, Operation Enduring Freedom 8: Afghanistan”. 2007. (February 14).
3. Harris Interactive, “The Military Mental Health Survey”. American Psychiatric Association. 2008. (June 30).
4. Department of Defense Task Force on Mental Health, “An Achievable Vision: Final Report of the Department of Defense Task Force on Mental Health”. DoD. June 2007.
5. Milliken CS, Auchterlonie JL, Hoge CW, “Longitudinal Assessment of Mental Health Problems Among Active and Reserve Component Soldiers Returning From the Iraq War”. JAMA. 2007. (Nov 14); Vol 298, No 18.
6. Tanielian T, Jaycox LH et al, “Invisible Wounds of War: Psychological andCognitive Injuries, Their Consequences, and Services to Assist Recovery”. RAND Center for Military Health Policy Research, RAND Corporation. April 2008.
7. Jacobson IG, Ryan MAK et al, “Alcohol Use and Alcohol-Related Problems Before and After Military Combat deployment”. JAMA. 2008. (August 13); Vol 300, No 6.