When Angels Sleep

When Angels Sleep

By Gene Hicks

It's 2 am or maybe later. 

The shadow cast from the single light bulb over the stove told me lies.

I poured a whisky, straight up, no ice and certainly no water. 

Just me and the delicate tastes washing over my tongue.

I closed my eyes and immediately I was taken to a memory of her.

God Damn, she was beautiful but.....

Her soul was as black as this starless night over a beautiful city. 

I pounded my fists against the counter, the Evil was done.

I took my whisky laid down on the couch my mother had bought me.

Being single was hard enough without your mother deciding to become Martha Stewart.

It was soft, I sunk deeper into it.

Like loving arms it embraced me.

Alass, sleep would not come to me this night.

Demons spoke to me.

offering words of praise.

No angels came to me that night.

I think they were ashamed.

Healing our Hero's and Family

As I move close to graduation from USC I began to think about what it was I truly wanted and how could I use my experience and education to help my fellow service members and Vet's. That is when I began to toy with opening a nonprofit that would focus on helping not only those Vet's that qualify for VA services and family members but, also those Vet's who do not. So as of May 2014 I have begun to see this dream become a reality. and I have now started Healing our Hero's & Family Our Mission: Healing Our Hero’s and Families mission is to “Provide military veterans, current service members and their families with therapeutic care and to help enrich their personal and family lives.” The road to recovery following a traumatic experience can be difficult to navigate alone. Healing our Hero’s and Families is an organization that was created to provide service members, veterans and family members with tools and resources to fully engage in life. Yadira and Gene have combined forces to help families develop practical solutions to problems associated with Post Traumatic Stress Disorder, Anxiety, and Depression. Special emphasis is also placed on the family members and children of veterans who may be experiencing secondary trauma or even caregiver burnout. Healing our Hero’s and Families also provide services for veterans who do not qualify for Veterans Affairs services. We serve: All current service members Veterans of all eras of combat Victims of Military Sexual Trauma Those veterans and family members that do not qualify for VA or Vet Center services. Children, Spouses and Family members of veterans and current service members. Programs Offered: Individual, group, couples and family counseling Military Culture Training Caregiver support and groups Sand Tray Therapy Art Therapy Crisis Management Please visit my website www.HEALINGHEROS.ORG We are also able to accept donations through this site, please help me by passing this on to organizations that could help us on a successful launch.

Veterans diagnosed with PTSD are more likely to die from suicide than those without PTSD

Hello everyone I apologize for not being as pro-active in keeping up my blog. Well a lot has happened since my last post. I am now in my final two semesters of graduate school (graduate Aug 2014) I also have run into a few bumps in the road that have helped re-evaluate some actions and think about how poor choices can adversely effect the goals you place for yourself. But more about that later! As for now I want to post a few things I have written concerning suicide and the impact that Post Traumatic Stress Disorders plays in increasing the propensity for completed suicide as well as increased attempts. Although this is a dark subject it is something that needs to be addressed.

 

Suicide is unquestionably the most challenging mental health issue after Post Traumatic Stress Disorder (PTSD) that is being faced by the military today. Suicide has been the second leading cause of death in the United States military, exceeding the number of combat-related losses in both Iraq and Afghanistan (Rudd, 2012).

Veterans diagnosed with PTSD are more likely to die from suicide than those without PTSD, and this risk is substantially greater among veterans with PTSD and comorbid mental disorders such as substance abuse (Jakupcak, 2011).

Can addressing PTSD decrease the number of suicides by service members diagnosed with PTSD? Yes, and steps are currently being taken to further research and present empirical and best treatment practices that will lessen the symptoms of PTSD and thus reduce the number of suicide attempts and completions. While there are a number of treatment options available to practitioners the three that have been successful are: Cognitive Behavioral Therapy more specific Cognitive Therapy, Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) Therapy (see figure 1). For the purpose of this paper I will discuss Cognitive Behavioral Therapy in which the treatment focus relies on relearning thoughts and beliefs generated from the traumatic event, which may impede current coping skills.

Studies have linked the relationship between suicidal ideation and self-reported psychiatric symptoms among 407 Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) combat veterans in a post deployment study at a specialty Veterans Affairs clinic. Accounting for symptoms of major depressive disorder, alcohol abuse, and illegal drug abuse, veterans who screened positive for PTSD were found to be more than four times more likely to report suicidal ideation relative to non-PTSD veterans (Jakupcak, 2011).

 Cognitive Behavioral Therapy is an individualized type of psychotherapy used to treat PTSD that is based on the principles of learning theory and cognitive psychology. From a cognitive psychological perspective, trauma exposure is thought to evoke erroneous automatic thoughts about the environment (as dangerous and threatening) and about oneself (as hopeless and incompetent). CBT directly confronts such PTSD-related distortion thinking.

 Cognitive therapy addresses the thoughts and beliefs that are often associated and generated by the traumatic event rather than the conditioned emotional responses addressed by exposure therapy. This approach focuses on how individuals with PTSD have interpreted the traumatic event with respect to their appraisals about the world and themselves (Friedman, 2003).

 Cognitive therapy has a number of elements that are distinctive in its treatment plan compared to others types of therapy. Some of the elements that make it appealing to service members and their families include being relatively short-term (for the most part), active, directive, structured, and collaborative, with a core theme being the development of individual understanding, coping, and mastery of skills essential for day-to-day living (Rudd, 2012).

There have been several studies that have shown that the effectiveness of CBT in reducing suicidal behaviors. There are several effective treatments used to reduce suicidal behaviors and they all share several of the same common elements, including theory-driven, structured strategies that are designed to target suicidal risk factors, increase motivation and treatment compliance, and introduce skills training to promote self-reliance, responsibility, and the ability to manage distress and crisis. A 2005 study by Brown, G.K titled Cognitive therapy for the prevention of suicide attempts: A randomized controlled trial found that, compared to participants receiving usual care from community providers, participants in CBT therapy for suicidality reported significantly less depression and hopelessness six months after initiating therapy and were significantly less likely to reattempt suicide in the 18 months following their initial suicide attempt (Jakupcak, 2011).

One proposed approach to treating PTSD with OEF/OIF veterans at high risk for suicide is based on a treatment plan with core features of psychosocial interventions designed for the treatment of suicidal behaviors and the treatment guidelines proposed by the International Society for Traumatic Stress. This successful (validated and reliable) approach consists of three phases: (a) comprehensive assessment, treatment engagement, and initial safety planning; (b) suicide risk reduction and CBT skills specific to suicidality; and (c) CBT for PTSD and comorbid mental disorders. The implementations of the three phases are only the beginning of a whole treatment concept which involves maintaining regular supportive contact, fostering motivation for treatment, and continually assessing changes in risk factors and symptoms must remain a priority through the treatment process.

Phase I: Assessment, Treatment Engagement, and Initial Safety Planning

  This phase allows the clinician and initial assessment opportunity to fully assess warning signs and risk factors involved in suicidal behaviors. This time can be critical in establishing rapport necessary to engage the veteran in care. Not only is this a time to discuss things such as unanticipated assignments outside of the veterans primary Military Occupational Specialty (MOS) but also the possibility of being personally re-deployed or the possibility of friends or family members being redeployed it is also a time to assess other factors of risk behaviors such as recent aggression, smoking status, family history of suicide, childhood or adult sexual or physical victimization, and current access to firearms. This will assist the provider in estimating the level of current risk and will help to guide safety and treatment planning (Jakupcak, 2011).

Phase II: Suicide Risk Reduction and CBT Strategies Targeting Suicidality
 After the initial assessment takes place suicide risk reduction and safety plan refinement is an ongoing process. The clinician is encouraged to take the lead in facilitating a coordinated treatment plan, with each provider identifying their role in a collaborative process to reduce suicide risk. There are many ways other treatment providers can provide critical support in the reduction of suicidal risk. During this phase the veteran is encouraged to identify specific emotional states that frequently cue suicidal thoughts (Jakupcak, 2011). Those veterans that devalue or fear discussing vulnerable emotions may benefit from an emotional examination of personal and cultural schemas regarding traditional norms as part of the emotional skills training. Reviewing both general and idiosyncratic functions of specific emotional states can normalize the experience of vulnerable emotions and help to address skills deficits (Jakupcak, 2011).

Phase III: Treating PTSD and Comorbid Psychiatric Symptoms

After the introduction of the safety plan and basic CBT skills to help reduce suicidal thoughts , impulses, or self-harm behaviors, it is important to address more specific psychiatric disorders. During this phase it is important that the provider remain flexible approach in treating specific disorders and other psychiatric symptoms, carefully monitoring safety, continued ambivalence, and resistance to treatment. It is not uncommon that for the veteran to become resistant to the treatment process. These resistance actions can be seen through active resistance (e.g. cancelling appointments or no-showing multiple appointments, using alcohol, or other substances immediately prior to or following a session) or may be expressed less directly through such behaviors as forgetting to do “homework for sessions, or bringing up topics that distract from trauma-related session (Jakupcak, 2011). See figure 2 for some common barriers to mental health care in general population and among former deployed military personnel.

 The most common resistant that most veteran’s exhibit is substance abuse, substance use can increase impulsivity and suicidality, but OEF/OIF veterans abusing alcohol may not be aware of the problematic nature that their drinking may be playing in their recovery process. Many veterans will reference their behaviors to peer-based norms and may even perceive benefits from alcohol consumption in terms of sleep and anxiety reduction (Jakupcak, 2011).

  In conclusion the necessity to understand local and national resources that are available to practitioners who work with OEF/OIF veterans are important to help with complex psychiatric profiles and physical disorders. IT is also important to acknowledge that treating patients who are at risk for suicide is often both challenging and stressful to providers. A substantial portion of mental health providers report having experiencing a patient suicide (rates that vary 11% to 50% across types of professions and clinical settings) and providers may experience significant emotional distress in response to a patient’s suicide attempt or completed suicide. It is just as important for providers to seek out appropriate supervision, consultation, and peer support.

  
Figure 1:

Cognitive Behavioral Techniques Used in PTSD Treatment
CBT Technique	Treatment Focus
Prolonged Exposure Therapy (PE)	Disconnecting the overwhelming sense of fear from trauma
Cognitive Therapy	Relearning thoughts and beliefs generated from the traumatic event, which impede current coping skills.
Cognitive Processing Therapy (CPT)	Understanding both emotional and cognitive consequences of trauma exposure
Stress Inoculation Training (SIT)	Anxiety Management to increase coping skills for current situations.
Interapy	Exposure and cognitive restructuring through a protocol-driven CBT treatment accessed via the internet.
Imagery Rehearsal Therapy	Changing disturbing traumatic nightmares by rehearsing "new dreams"
Biofeedback and Relaxation Training	Anxiety management to help patients master overwhelming anxiety feelings and physiological reactions elicited by a trauma reminder.
Dialectical Behavior Therapy (DBT)	Treating borderline personality disorder, a syndrome of associated with PTSD and complex PTSD.

 Figure 2:

Barriers To Mental Health Care in General Population and Among Former Deployed Military Personnel
In General Population  (Kessler, Berglund, et al., 2001)	Among Formerly Deployed Military Personnel (Schell and Marshall, 2008)
Lack of perceived need	Negative career repercussions
Unsure about where to go for help	Inability to receive a security clearance
Cost (too expensive)	Concerns about confidentiality
Perceived lack of effectiveness	Concerns about side effects of medications
Reliance on self (desire to solve problems on one's own or thoughts that the problem will get better)	Preferred reliance on family and friends
	Perceived lack of effectiveness

 Written by Gene Hicks 2013

Copyright: The entire content included in this website, including but not limited to text, graphics or code is copyrighted as a collective work under the United States and other copyright laws, and is the property of Eugene J. Hicks. The collective work includes works that are licensed to Eugene J. Hicks. You may display and, subject to any expressly stated restrictions or limitations relating to specific material, download or print portions of the material from the different areas of the website solely for your own non-commercial use. Any other use, including but not limited to the reproduction, distribution, display or transmission of the content of this website is strictly prohibited, unless authorized by Eugene J. Hicks in writing. You further agree not to change or delete any proprietary notice from materials downloaded or printed from the website.

 

Military bonds draw veterans to mental health jobs

As a graduate student working towards my Masters Degree in Social Work degree I can honestly say that I truely want to help Veterans and their families. I also believe that it is important that a Vet help a Vet because there is a common bond between the two "SERVICE". I am reminded of a saying that "For those who fought for it, freedom has a taste the protected will never know." 

1SG Gene Hicks Helmand, Afghanistan

 By Maria LaMagna, Special to CNN

(CNN) -- Things probably should have turned out differently for Samantha Schilling.  The stories she tells have dark beginnings and could have had, under different circumstances, dark endings -- as so many stories for those in the military do. Schilling, now 31, served in the U.S. Navy from 1999 to 2003. She was never deployed but worked as an information systems technician at Naval Station Norfolk in Virginia.

Several of her friends were killed during the 2000 al Qaeda bombing of the USS Cole in Yemen, which left 17 dead and at least 37 injured. Some of the injured were transferred to her base in Norfolk. Many of the survivors suffered from mental trauma after the bombing. One of them, a man who had been aboard the ship, attacked Schilling and attempted to rape her. That assault drove home the impact that active duty had on her colleagues' mental state. "I experienced military sexual trauma, and that just inspired me," she said. "Coming back into civilian life, you're not the same person you were in the military. ... You carry with you all these burdens, all these stressors."  

Schilling was released from service with an honorable medical discharge in 2003. Since that time, she has taken on a personal mission to help others who need counseling after military service. She's nearly completed a masters in a joint military psychology and neuropsychology program at the Adler School of Professional Psychology in Chicago and plans to finish her doctorate degree in 2015.
"I'm determined to be able to be helpful to others," she said. "Helping others helps me. ... I think therapy can help people adapt to civilian life again instead of maladapt. People who have PTSD and other (issues) can maladapt and cause trouble in the civilian world."

It's no secret the U.S. military has struggled to adequately support its troops after they leave active duty.

A large number of service members suffer from post-traumatic stress disorder (PTSD). An estimated 11% to 20% of veterans returning from the Iraq and Afghanistan wars suffer from the condition, according to the U.S. Department of Veterans Affairs.

That's between 220,000 and 400,000 of the 2 million troops deployed since the September 11 terrorist attacks.

A new study shows that only about half of U.S. service members deployed to Iraq and Afghanistan diagnosed with PTSD received any treatment for it.

And statistics from the U.S. Department of Veterans Affairs show that about 18 veterans commit suicide every day.

The VA has stepped up efforts to expand care and recently announced plans to hire 1,600 more mental health professionals and 300 support staff members to help meet the increasing demand for services.
But some former active-duty service members aren't waiting for help to arrive. Veterans have turned to psychology to become mental health professionals, and they're filling in gaps in veteran care that government and civilian efforts have left open. And while they are still rare, programs to train them are slowly emerging at universities and nonprofit organizations around the United States.
                                           "It's just going to increase and increase"

Born a year ago with funding from the Department of Veteran Services in Massachusetts, a program through the Massachusetts School of Professional Psychology called Train Vets to Treat Vets has recently picked up steam. It has several goals: mentoring new veterans, providing services to at-risk and homeless veterans, and educating the public about ways they can help.

"As the stigma (of seeking professional mental health treatment) breaks down more and more, and more veterans are willing to come into treatment, (the need) is just going to increase and increase," said Robert Chester, 25, who served in the National Guard for six years and became a student at the Massachusetts School of Professional Psychology.

"That's why we want to get more veterans into mental health, both to break down the stigma and get more clinicians out there."

Chester is now an admissions assistant at Train Vets to Treat Vets.

Starting the program was a joint effort between the Massachusetts Department of Veterans' Services and veterans (Chester and colleagues Greg Matos and Norman Tippens) who are also students at at the school.

"We, as the veteran students, wanted to see that we could create more of a military cohort at our school," Chester said. "We really wanted to put something together where we can help our fellow veterans by providing mental health services in that specific way."

Since the program's start, Chester has fielded e-mails every day from veterans who want to get involved. Six will enroll in the school's fall class.

Massachusetts School of Professional Psychology President Nick Covino says the idea for the program came from a Latino mental health program the school began about eight years ago.

"It was clear that folks who wanted to talk about emotional issues ... want to talk about emotional issues with somebody that understands their culture and probably want to do it with somebody that's from their culture," Covino said. "It was a natural extension to think about returning veterans."

Having student veterans in the program has been beneficial not only to the veterans it has helped but to non-veteran graduate students who want to specialize in veteran care.

From casual conversations to exchanging papers and working on doctoral projects together, a collaboration between veteran and non-veteran students is "radically changing the academic culture of our learning community," Covino said.

                                                            Laptop battlefield

Leaning over an occasionally beeping laptop in a downtown Chicago office building, Robert Kyle rolls up the sleeves of a blue button-down shirt to reveal heavily tattooed forearms. On one, a drawing that looks like the Grim Reaper. On the other, columns of initials. There are so many, his arm is more ink than skin. He explains that they're the initials of friends who died alongside him while deployed in Afghanistan and Iraq. There are 53, he says. But there are more to add he hasn't gotten around to yet.

Kyle, who goes by his first and middle name online for security reasons, has his own set of challenges. At 26, he has survived three deployments and sustained a traumatic brain injury. He enlisted in the Army when he was 17 and served from 2003 to 2009.

Although he still carries burdens from his deployment, since his return, he hasn't forgotten about his military family. Some, he knows personally; others, he's only met through that beeping laptop. He has dedicated his life to helping veterans connect to one another and improve their mental health.

Kyle works as a peer coach at Vets Prevail, a free online forum and multistep mental health program. It was founded in 2009 by a small group of professionals, almost all of them veterans.

While working as a peer coach, Kyle is pursuing a graduate degree in psychology from DePaul University.

Six salaried professionals work at Vets Prevail, as well as three peer coaches who directly interact with veterans online. Although the peer coaches are not doctors, they complete a training process, and most important, Kyle says, they have all served on active duty.

"When they hear that you have done what they've done, (veterans) tend to open up more than someone that has never been in a combat zone. That opens a little more trust," Kyle says. "Veterans are doing this for veterans."

Kyle retired from service in 2009 after his injury and went back to school, earning a degree in psychology from Lees-McRae College in North Carolina.

Since that time, he has worked to develop Vets Prevail. Now, more than 8,000 veterans from about 5,000 ZIP codes turn to the site to chat and learn coping mechanisms, and membership is rapidly increasing.

Justin Savage, a 32-year-old Army veteran who works as the head of program development for Vets Prevail, says a large part of that success is the users' assurance that the experts on the other side of the computer screen are speaking their language.

"We live and breathe accountability," said Savage, who returned from Iraq in 2005. "Having vets do it really brings a new level."

                                                                         "A really good fit"

It makes sense that veterans would want to become mental health professionals, psychologist Joe Troiani says. In a military culture built on camaraderie, the desire to help a fellow veteran is natural and powerful.

Troiani, an associate professor at the Adler School of Professional Psychology, where Schilling is a student, is also a retired Navy commander and is determined to ensure that veterans get the help they need.

"If I was in trouble, I could pick up the phone and call some of my veteran friends," Troiani said. "You and I could have served together, and I have your back, you have my back. If something happens to you, I'm going to make sure that your family is taken care of."

The Adler School offers training for a new post-doctorate specialty called "military clinical psychology" and since the program's start two years ago has trained about 20 students per class. The need is greater, but 20 is the cutoff to ensure the best training, Troiani says.

Entering the mental health field can be "a really good fit personality-wise" for veterans, says Bret Moore, a former active-duty Army psychologist who completed two tours in Iraq.

"(Service members) want to protect and help people get through difficult times," Moore said. "That's really what a psychologist does: helps people who are more vulnerable, or not as strong in a certain sense, get through difficult times."

Taking responsibility for another human life is a familiar duty for veterans, Covino says.

"To have been in situations where they've needed to rely on judgment and develop a capacity for reflection, an ability to act autonomously and courageously. ... Those are qualities of character you can't teach," Covino said.
                                                               "They haven't experienced it"

Jon Neely, a 45-year-old living in Springfield, Illinois, has been using Vets Prevail for several months and says he logs on for about an hour every week, though when he first began using it, he logged on every day. Neely served in Kosovo from 1999 to 2000 and retired from the military in 2005.

"All too often, you go seek help from somebody that is book-learned, but they don't understand," he said. "They don't know. To me, getting help or seeking help from a non-veteran is like going to a marriage counselor that has never been married. They know all the book knowledge, but they haven't experienced it."

Sarah Bonner, 31, an Air Force veteran who was medically discharged from Ramstein Air Base in Germany in 2006, is an active user of Vets Prevail. She says that talking to a "like-minded" person is what has kept her coming back to the site.

She has bonded with the peer coaches, to whom she refers by their first names like friends, in a way she did not expect.

"There were a couple times recently, I was at a really low point," she said. "I was angry, and I wasn't holding back with what I said. They don't care. If I want to cuss out and threaten to punch something, they might say, 'Let's think of softer things than the wall to punch.' ... They let you talk about the stuff that's ugly."

                                                              "Why did all of us serve?"

Training veterans to treat other veterans does involve some risk, Chester says. If veterans are not stable themselves, they should not treat others as mental health professionals. For that reason, it can be a good idea for them to work with a psychologist even while they administer care to others.

There is so much training and hands-on experience involved in a post-doctorate program that it is highly unlikely a veteran who is still feeling unstable would make it all the way through, Troiani says. Rarely, but occasionally, a veteran will say, "This program is not a good fit for me," he says.

But if it is a good fit, the results can be rewarding.

"Why did all of us serve if not for each other?" Kyle asked. "Just because we're not in the military any more, it doesn't mean we are no longer brother and sister. It's a bond we'll have for the rest of our lives."

Military Suicide: Help for Families Worried About Their Service Member

By Alexandra Sifferlin

In this week’s TIME cover story, “One a Day” (available to subscribers here), journalists Mark Thompson and Nancy Gibbs explore why suicides among the U.S. military have reached crisis levels. Every day, one active-duty service member dies by his own hand, the authors note: “The U.S. military seldom meets an enemy it cannot target, cannot crush, cannot put a fence around or drive a tank across. But it has not been ale to defeat or contain the epidemic of suicides among its troops.”

The specific triggers for suicide are unique to each soldier. Each person deals differently with the stresses of war, frequent deployments, separation from family, death of comrades. Many contend with depression and post-traumatic stress upon returning home. There are several programs and support lines for these soldiers, but it also helps for their immediate families to remain vigilant and to monitor their behavior. Even still, many service members fall through the cracks.

Below is what we hope is helpful advice for military spouses, who want to know what warning signs to look for in their service member and how best to handle severe situations. One immediate sign, say experts, is a pervasive sense of uselessness, a feeling that they no longer belong. “What we learn from our families [who lost service family members to suicide] and what they saw in their loved ones, is behavior [in which they] pulled back and felt they were not able to be a useful part of unit that relied on them,” says Bonnie Carroll, founder and chairman of the Tragedy Assistance Program for Survivors, or TAPS, a non-profit that supports those who have lost a loved one in the military. “These men and women need to know they are still a part of a unit at home and overseas.”

Here, experts offer more answers to common questions that military families face when a loved one shows signs of trouble:

What are the signs of suicide risk to look out for?
There are many signs of suicide, says Kim Ruocco, director of the suicide prevention programs at TAPS. Some key warning signs to look out for:

• Hopelessness and saying things like “This will never get better”
• Helplessness and saying things like “I can’t do anything about this”
• No longer finding joy in things they once enjoyed
• Angry outbursts and increased agitation
• Sleeplessness or oversleeping
• Lack of appetite or increased appetite
• Withdrawal from friends and family, or suggestions that family would be better off without them
• History of suicide attempt and history of depression
• Post-traumatic injury

Warning signs of suicide that call for immediate attention:

• Talking about or making plans to take his or her own life
• Putting personal affairs in order
• Giving away personal possessions
• Obsessing about death
• Abusing drugs or alcohol
• Acquiring or obtaining access to lethal means (prescription drugs, weapons, etc.)
• Engaging in out-of-the-ordinary or risky behaviors

“You should always ask someone if they are thinking of killing themselves and if they are, do not leave them alone, escort them to help, take them to a doctor at primary care, behavioral health or the emergency room,” says Ruocco. “Sometimes a person will deny thinking of suicide despite warning signs. These people should also be considered high risk and be taken for immediate evaluation.”

Whom should I contact if I’m concerned about my loved one?
The first person to speak with is your loved one. Ask your he or she is feeling, says Eileen M. Lainez, a spokeswoman for the U.S. Department of Defense. For example: Do you feel as if you could harm yourself? How often are you having those kinds of thoughts? Do you have a plan to harm yourself?

“Keep track of all conversations with a service member who expresses any indication that he or she could harm him or herself, or is experiencing unique or intense stressors,” says Lainez.

There are several 24/7 service lines open to family members who have immediate concerns:

• Military Crisis Line: Dial 800-273-8255 (press 1 for military) or visit the crisis line online, which provides a chat and text service for veterans (see below) and active duty members
• Veterans Crisis Line: Visit Veterans Live Chat or call 800-273-TALK to talk with a crisis counselor
• DCoE Outreach Center: Visit Real Warriors Live Chat or call 866-966-1020 to talk with a health resource consultant
• Military OneSource: Call 800-342-9647 for one-on-one counseling or visit online
• Do not hesitate to call 911 in an emergency

Should I alert the military if my loved one is showing signs of suicide at home?
Anyone concerned about a service member for any reason should not hesitate to contact that service member’s supervisor, commander, any health-care provider or a chaplain. “If the family member is looking for behavioral health support, information or resources, they should contact [these individuals]. The earlier an adjustment or behavioral health issue is identified and addressed, the more likely a positive outcome will result,” says Lainez.

Is there anything I shouldn’t do?
Don’t be afraid to be proactive: Ask your loved one questions about suicidal thoughts or plans, and do not hesitate to get help. “Suicidal thoughts can be a medical emergency. Someone who has been thinking about suicide over time can lose the ability to control the impulse. Put aside fears of betraying your loved one or ruining his [or her] career and chose to save his [or her] life,” says Ruocco.

Should I be more concerned if my loved one has been overseas for several tours, or less concerned if he or she hasn’t?
There are many factors associated with suicide, which make it difficult to point to any one factor as a root cause. Currently, there is no evidence directly linking the number of deployments to an increased risk of suicide. Any warning signs of suicide should be taken seriously, regardless of the number of times the service member has been deployed overseas.

“Combat exposure can increase risk for suicide, especially if the service member was exposed to trauma or suffered a concussive injury,” says Ruocco. “However, about half of our service members who die by suicide have never deployed, so the fact that they have not deployed should not be a reason to not seek treatment.” The 2010 Department of Defense Suicide Event Report found that indeed half of all service members who died by suicide during 2010 had never been deployed to Iraq or Afghanistan.

What can I do to support my soldier and help prevent suicide risk?
Real Warriors, a campaign started by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) to promote recovery and resilience among returning service members, suggests that you encourage and help your loved one do the following:

• Cut back on obligations when possible and set reasonable schedules for goals
• Consider keeping a journal to express pain, anger, fear or other emotions
• Avoid isolation — get together with buddies, commanding officers, family, friends or other members of the community regularly
• Stay physically fit by eating healthy foods and getting enough sleep
• Stay motivated by keeping personal and career goals in mind
• Use relaxation techniques to help manage stress
• Stay organized by keeping a daily schedule of tasks and activities

There are plenty of mental-health resources out there, but here are a few we highly recommended for service members and their families:

• U.S. National Suicide & Crisis Hotlines: http://suicidehotlines.com/national.html
• U.S. Army Suicide Prevention: http://www.armyg1.army.mil/hr/suicide/
• Real Warriors suicide prevention: http://www.realwarriors.net/family/support/preventsuicide.php
• U.S. Department of Veterans Affairs suicide prevention: http://www.mentalhealth.va.gov/suicide_prevention/
• Tragedy Assistance Program for Survivors, for families who have lost a loved one in uniform to suicide: http://www.taps.org/survivors/survivor.aspx?id=6320

Read the full TIME cover story, available to subscribers here.

WRAP for Veterans and People in the Military

The process of recovery begins with you, but you don't have to do it alone!!!

I am currently attending a program that will certify me to conduct the Wellness Recovery Action Plan (WRAP) for veterans I serve.

If you are on active duty, in the reserves, or have been in the military, you may be having a hard time coping with the hardship, trauma, and loss related to military service and being involved in war-related activities. You may have feelings and experiences that are extremely upsetting, feelings that keep you from being the way you want to be and doing the things you want to do. In addition, things may be happening in your life that are difficult to deal with. Family members and friends, who don’t understand what you are experiencing and why you are behaving the way you are, may not know how to respond or how to help. Some may try to help and others may turn away. You may feel like the situation is hopeless - that you will never feel well and enjoy life again.
The Wellness Recovery Action Plan can help you in the process of recovery, of getting well and staying well, and of assisting you in becoming who you want to be and making your life the way you want it. It will also be helpful to you in adapting to any challenges you have in your life like chronic illness, serious disability, being on active duty, or dealing with extreme loss or grief.

This online version of the Wellness Recovery Action Plan (WRAP) is specifically oriented for people who are in the military or have been in the military. There are video clips with Mary Ellen Copeland talking to veterans as they are developing their WRAPs. This WRAP is private and can be accessed at any time. You can make changes to it whenever you want and e-mail it to anyone you choose. WRAP can help with coordinating daily living as well as larger issued like depression and PTSD. This version of WRAP is very convenient for military personnel and is friendly, easy, and empowering. https://wrap.essentiallearning.com/Default.aspx?ReturnUrl=%2f

After my certification I hope to begin providing classes specifically for veterans in Idaho that will help them develop a personal WRAP as well help them start down the road of recovery.

Call me at Riverside Rehab, Inc. (208) 853-8536 and I will help you with your WRAP in my veteran services department.

Did you know that:

• More than 42 million American men and women have served in a time of war
• Current Projected U.S. Veterans Population: 23,442,000
• There are between 529,000 and 840,000 veterans who are homeless at some time during the year, that’s 23% of the homeless population
• 89% of homeless veterans received Honorable Discharges
• 33% of homeless veterans served in a war zone
• Each year between 375,000 – 600,000 homeless veterans receive no assistance
• 6 million veterans are living with a disability
• 45% of veterans need help finding a job
• 37% of veterans need help finding housing
• Number of Veterans with for Post Traumatic Stress Disorder (as of 09/30/08): 342,624

I have PTSD...so what?

I really like what he says and how he says it, don't agree completly with carry weapons around but nonetheless the message is great.....

"For those who are like me, there is help. Seek it out. You were strong enough to make it this far, don’t give up. Dig a little deeper and make that final push. If you do not know where to go or have fallen astray, contact me. I will help. We are all brothers and sisters in this battle that will rage invariably for eternity and the one constant is that we have each other."
 By RU Rob
I have PTSD. We all know what it is, Post Traumatic Stress Disorder. I am one of millions who are affected by it each and every day. Millions of men and women who have varying symptoms yet manage to maintain a normal lifestyle. I, along with my cohorts, have been classified as a potential powder keg just waiting on that spark to set us off into a murderous explosion of ire. This is not the case as I am just as normal as you.
At the end of every day I lay my head down in an attempt to sleep. That in itself is no different than you. But when my eyes close and I should be drifting off into a peaceful bliss, my mind takes over and I am tormented in my dreams with a vivid and exaggerated version of every combat encounter witnessed. There has been nary a night that I do not have this, and have not had an uninterrupted night of sleep for years. Yet in the morning, I rise with the consistency of the sun, roll out of my sweat soaked bed, and shake off the remnants of the nightly battles and start my day…just like you.
I am functional in society, but I am a little more vigilant than you, always on the look-out for danger, avoiding large crowds and loud places. But somehow, I can still manage to go out to eat, shop for my clothes and drive my car. I pay close attention to those around me, see the drug deal that just took place on my right and notice the people who just don’t belong in a certain situation. You may not have evil intentions, but I will notice nonetheless.
I have guns. As a matter of fact I just about always have one on me. You see, even though I have PTSD, I am still a Sheepdog watching out for my flock. I don’t brandish my weapon and most of the time you won’t even know I have it on my body, but it is there. I also carry a large knife in my pocket, one that could cause serious injury or death if used improperly. I have never used any of my weapons in a malicious manner and never will, but in my duties as a Sheepdog I will not hesitate to draw down on you should the circumstance warrant it. I am armed, but I am not dangerous.
There are times that I am medicated. My PTSD comes in cycles and when things get bad I need that extra chemical push to regulate me. I accept this and because of it I do not drink. I have other physical problems that could easily warrant an addiction to pain killers, but just like most of us with PTSD, I avoid it.
I have never committed violence in the workplace, just like the vast majority of those who suffer with me. My co-workers know I spent time in the military but they do not know of my daily struggles, and they won’t. I can still communicate with my subordinates and supervisors in a clear manner. I have never physically assaulted anyone out of anger or rage.
It pains me when I listen to the news and every time a veteran commits a crime (or commits suicide); it is automatically linked to and blamed on PTSD. Yes, there are some who cannot control their actions due to this imbalance in our heads, but don’t put a label on us that we are all incorrigible. Very few of us are bad. There are more of us out there that are trying harder to do good than the lesser alternative.
Do not pity me. I know who I am and recognize the journey that has shaped me into what I am. I have no regrets about anything that I have done in the past and look forward to many wonderful years in the future. I freely take every step of life during the day knowing that there is something that will haunt me at night.
For those who are like me, there is help. Seek it out. You were strong enough to make it this far, don’t give up. Dig a little deeper and make that final push. If you do not know where to go or have fallen astray, contact me. I will help. We are all brothers and sisters in this battle that will rage invariably for eternity and the one constant is that we have each other.
To the rest of society and particularly the media: I have PTSD!

Army suicide rates decline for first time in 4 years

This is a topic that always needs to be discussed and should never fall out of the spotlight. The most important thing service members and veterans need to remember is there are people who can help and by making the step to talk to someone is the bravest thing anyone can do.

Army suicide rates decline for first time in 4 years
By Gregg Zoroya, USA TODAY

Army suicide rates declined for the first time in four years in 2011, the result of a complex effort to identify soldiers engaged in risky or self-destructive behavior, according to the outgoing vice chief of staff, Gen. Peter Chiarelli.

"I think we've at least arrested this problem and hopefully will start to push it down," Chiarelli said Thursday, citing additional numbers showing an increase in hospitalizations for soldiers who talk of suicide. "For all practical purposes … it has leveled off."

But he said there also remain second- and third-order effects from a decade of war and multiple deployments, including a sharp rise in sexual assaults and child and domestic abuse in the Army.

"We see these problems, we see where we've had successes. And we're attacking those areas where we've got problems," Chiarelli said. "After 10 years of war … we had problems that no one could have forecast."

Suicides among active duty soldiers and those in the National Guard and Reserve who are not on active duty fell by 9% last year from from 305 deaths in 2010 to 278 in 2011.

It is the first good news on suicide for the Army since those deaths began a steady increase among active-duty soldiers in 2004.

Still, the suicide rate in the Army, estimated at 24 per 100,000 last year, remains far higher than a similar demographic among civilians, estimated at 19 per 100,000. The rate among soldiers who have served in Iraq and Afghanistan ranges even higher, up to 38 per 100,000, the Army says.

As the increase continued, Chiarelli was appointed in 2009 to look at underlying causes and began a campaign of targeting risky behavior across the service, demanding more accountability from commanders.

He said Thursday that the efforts have been successful.

According to a trend analysis released Thursday, the number of soldiers kicked out of the service for misconduct increased by 57% since 2006, and the Army did away with accepting convicted felons on special waivers.

The result was to bar from enlistment or muster out about 40,000 potential people in that time, according to the report. Overall crime is down. The number of soldiers committing multiple felonies has dropped.

But with alcohol abuse in the Army at record levels, sexual assault and domestic violence have increased.

The percentage of soldiers committing sex crimes has increased 32% since 1006.

The number of domestic abusers in the Army grew by 50% from 4,827 in 2008 to 7,228 last year. During that same, the number of child-abuse offenders is up 62% from 3,172 to 5,149, according to the report released Thursday.

Other findings:

— Years of combat, along with more aggressive efforts to screen for mental illness and brain injury, have had an impact. More than 15,000 concussion cases were identified in the Army in 2010, five times as many as diagnosed in 2000. The nearly 11,000 PTSD cases in 2010 were 15 times higher than in 2003.

— The Army estimates that the total number of servicemembers from all branches of service afflicted with PTSD may be nearing a half million, half of them soldiers.

— More complex wounds have led to longer periods of rehabilitation before soldiers return to duty or leave the Army. Nearly 7,000 have been convalescing for one to two years, and nearly 1,300 for two to three years.

The biggest problem the Army and service members face is the stigma that is associated with a PTSD diagnosis. If we can beat this we will get those who need help the help they need. In being true to my preaching I have decided to speak with a counselor even if it just for a wellness check and to ensure that there is something I am not seeing. Do the same.....
"A study published in the Archives of General Psychiatry in October found that soldiers were two to four times more willing to report PTSD, depression, and suicidal thoughts if they were allowed to answer a survey anonymously, rather than put their names on a routine post-deployment screening form."

Idea to take the 'D' out of PTSD being studied

By Lindsay Wise

Houston Chronicle

Published: January 16, 2012

 

The president of the American Psychiatric Association says he is "very open" to a request from the Army to come up with an alternative name for post-traumatic stress disorder so that troops returning from combat will feel less stigmatized and more encouraged to seek treatment.
Dr. John Oldham, who serves as senior vice president and chief of staff at the Houston-based Menninger Clinic, said he is looking into the possibility of updating the association's diagnostic manual with a new subcategory for PTSD. The subcategory could be "combat post-traumatic stress injury," or a similar term, he said.
"It would link it clearly to the impact and the injury of the combat situation and the deployment experience, rather than what people somewhat inaccurately but often assume, which is that you got it because you weren't strong enough," Oldham said.
The potential change was prompted by a request from Gen. Peter Chiarelli, the Army's vice chief of staff, who wrote to Oldham last year, suggesting APA drop the world "disorder" from PTSD.
"Calling it a disorder contributes to the stigma and makes it so some folks -- not all, but some folks -- don't get the help they need," Chiarelli said.
The general doesn't like to use the word disorder. "It's not a dirty word, but I think it's misused here," he said. "I don't think that the post-traumatic stress that soldiers experience is a disorder. It's not something that happens just to weak people or people that are somehow inclined to be affected by horrible things that they see or are required to do. I think it causes an actual injury to the brain and how the brain works."
Early discussions
After receiving Chiarelli's letter, Oldham wrote back to say he appreciated his concern, but dropping the word disorder might not be the best way to go. He said he was eager to work with Chiarelli to see what APA could do.
The general invited Oldham to the Pentagon to discuss the situation. They met for about an hour and a half on Dec. 9. Oldham agreed to bring the general's suggestion to the APA work group tasked with reviewing PTSD for the next version of the association's Diagnostic and Statistical Manual of Mental Disorders, the classification book used by psychiatrists in America. APA is finalizing the fifth edition of the manual, due in May 2013.
Oldham cautioned the discussion is very preliminary but speculated that a new subcategory like "combat post-traumatic stress injury" might work.
Although Chiarelli still would prefer to lose "disorder" entirely, he said a new subcategory would be a start. "I'm frustrated with how long this is taking to be honest," he said.
The general pointed out that PTSD has had many names over the years, from shell shock to battle fatigue. "It's been called all kinds of different things and somehow we decided to go with PTSD and I think that's just wrong," he said.
Chiarelli's campaign to change the name of PTSD is part of the Army's effort to reduce alarming suicide rates among soldiers. Statistics released last month identified 260 potential suicides in 2011. Of that total, 154 were active-duty soldiers, 73 were National Guard troops and 33 were reservists.
Silence over stigma
Stigma is a major problem. A study published in the Archives of General Psychiatry in October found that soldiers were two to four times more willing to report PTSD, depression, and suicidal thoughts if they were allowed to answer a survey anonymously, rather than put their names on a routine post-deployment screening form.
Of the soldiers who screened positive for PTSD or depression, 20 percent said they weren't comfortable answering honestly on the routine form. The study concluded that the Army's screening process misses most soldiers with significant mental health problems.
Dr. Harry Croft, a psychiatrist in San Antonio, said the findings jibe with what he hears from veterans he treats for PTSD.
"Even though the rules, as I understand them, say you don't get kicked out if you get diagnosed with PTSD, depression or any other issues, a lot of veterans say, 'I knew damn well if I answered the questions right my chance to get promoted was gone,' " Croft said.
Croft has mixed feelings about changing the name of PTSD. He understands the concern about stigmatizing troops but thinks whether the condition is called PTSD or something else will have little effect on the suicide rate.
"Rather than concentrate on what we call it, we need to concentrate more on how to help warriors coming back from the combat zone, because I don't think the name we give it will have much of an impact on the 18 suicides a day and all the other problems that we see," Croft said. "That's putting a Band-Aid on a much bigger wound."
Chiarelli says his main concern is getting soldiers into treatment, so if calling post-traumatic stress a disorder keeps them from seeking help, then the wording needs to change, the sooner the better.
"You can have the very, very best treatments in the world, but if you can't get people take advantage of them, they don't do any good," he said.