Enhancing Resilience and Recovery of Reservists

By Paul A. Finch, LCSW, Program Manager, Reserve Psychological Health Program and Director, Psychological Health for Navy and Marine Forces Reserves, and Dr. Mark Long, Health Promotion and Wellness Department, NMCPHC

CHARLOTTE, N.C. (Sept. 18, 2010) El-Brenda Wiley, a psychological health outreach program counselor(left), advises Ensign Chris Love, a member of the reserve component assigned to Cargo Handling Battalion (CHB) 4, and his wife during a pre-deployment family readiness conference. The Psychological Health Outreach Program is geared toward providing mental health care to service members who have served in support of Operation Iraqi Freedom and Operation Enduring Freedom. (U.S. Navy photo by Mass Communication Specialist 2nd Class Maddelin Angebrand/Released) http://www.navy.mil/view_image.asp?id=91996

CHARLOTTE, N.C. (Sept. 18, 2010) El-Brenda Wiley, a psychological health outreach program counselor(left), advises Ensign Chris Love, a member of the reserve component assigned to Cargo Handling Battalion (CHB) 4, and his wife during a pre-deployment family readiness conference. The Psychological Health Outreach Program is geared toward providing mental health care to service members who have served in support of Operation Iraqi Freedom and Operation Enduring Freedom. (U.S. Navy photo by Mass Communication Specialist 2nd Class Maddelin Angebrand/Released) http://www.navy.mil/view_image.asp?id=91996

It is well known that extended and repeat deployments can impact the readiness and psychological health of Sailors and Marines who put on their uniform every day in defense of freedom, but what about the Sailors and Marines who temporarily set aside civilian and family responsibilities and lace up their boots in support of the same cause? They receive the same pre-deployment training and experience the same potentially traumatic events, such as injury and loss, during deployment. Yet, studies indicate that Reserve and National Guard members may be at greater risk for developing psychological health conditions than their active duty counterparts. How can we bridge the gap?

Know the Facts

About 40 percent of Reserve and National Guard members returning from deployment report experiencing psychological health conditions (Hoge, Auchterlonie, & Milliken, 2006; Seal, Metzler, Gima, Bertenthal, Maguen, & Marmar, 2009). In addition, rates of post-traumatic stress disorder (PTSD) and depression actually increase in these service members during the period following a return from deployment, with some reports more than doubling in the first six months post-deployment (Milliken et al., 2007). This is substantially greater than that observed in active duty service members with similar combat experiences and suggests that post-deployment reintegration issues may pose a significant obstacle for Reserve and National Guard members (Milliken et al., 2007; Thomas, Wilk, Riviere, McGurk, Castro, & Hoge, 2010).

Identify the Challenges

Significant differences in occupations and social and military support structures likely contribute to the additional stress experienced by Reserve service members following their demobilization. Reservists are rarely employed in the military full time and frequently hold jobs in the civilian sector that may be disrupted by prolonged absences during deployments. When they return home, some Reservists may be out of uniform and back at their civilian jobs within weeks or even days, which can isolate them from the military community and its support systems. Many Reservists live and work in rural locations away from military bases, which can impede access to Medical Treatment Facilities (MTFs). This geographical limitation can delay treatment and further isolate a service member in need. In addition, families of Reservists may be less accustomed to the frequent and extended absences of their service member and are less likely to be integrated into a military community and culture that can offer support before, during, and after deployments (Erbes, Kaler, Schult, Polusny, & Arbisi, 2011).

Overcome the Barriers

Although Reservists face unique challenges when it comes to serving in the military and living in the civilian population, they may share the same negative perception of seeking support for a psychological condition as their active duty counterparts. Research suggests that only 23 to 40 percent of service members who were thought to have a moderate or severe psychological health condition following a recent deployment received professional assistance. Service members cite a variety of perceived barriers to psychological health services, including lack of trust toward professionals, the expense of seeking treatment, and the negative attitudes toward receiving psychological health support (Hoge et al., 2004; House Armed Services Committee 111-491, Report to Congress on Barriers to Seeking Treatment, 2012).

Bridge the Gap

The U.S. Bureau of Medicine and Surgery (BUMED) created the Psychological Health Outreach Program (PHOP) to serve as a psychological “safety net” for Reservists and their families who are in need of support services. Licensed mental health clinicians work to address and overcome the unique challenges that Reservists face and reduce barriers to seeking help. They provide assistance with issues related to PTSD, Traumatic Brain Injury (TBI), depression, substance abuse, and relationship issues. Services are available at six Navy and six Marine regional offices, which offer behavioral health care screenings, referrals, and 24/7 phone and email support. The PHOP staff also provides command support in the form of briefings and consultations. If you or someone you know is a Reservist in need of support reintegrating or transitioning back to civilian life, don’t hesitate to reach out for help.

If you or someone you know is contemplating suicide, seek immediate assistance. Do not leave the person alone. Call 911, seek help from a healthcare professional and/or call the Military Crisis Line. Chaplains, corpsmen, health care professionals at your MTF or branch clinic, and your local Fleet and Family Support Center can also provide assistance.

Available Resources

Psychological Health Outreach Program (PHOP)
Military OneSource
Military Crisis Line
Marine DSTRESS Line
Vets4Warriors
Moving Forward

Your Navy Chaplain: Focused on “Every Sailor, Every Day”

By: Rear Adm. Margaret Grun Kibben, Chief of Navy Chaplains

Like a family, shipmates have an obligation to look out for each other, to look out for Every Sailor, Every Day.” While September is identified as Suicide chapPrevention Month, every day, day in and day out, we must direct our efforts to prevent the deaths of our Sailors, Civilians and all our family members.

Often when people think about suicide, it’s because they feel isolated and alone, as if no one will listen to them. I ask each of you to break the silence and start the conversation if you notice someone going through a difficult time. By engaging with your shipmates with the simple question, “Are you doing ok?” you are giving that person permission to reach out and ask for help. You are helping that person realize they are not alone. By really listening to their response, you also remind them that people do care about them and will care if something happens to them.

But it isn’t just about other people. Frankly, all of us have heard that message loud and clear and most of us are on the lookout for people who seem to be at their wit’s end. I’m more concerned about those of you who aren’t letting anyone in on your feelings of despair, isolation, or crushing pain. Please hear this message: it should never be a matter of taking your life but taking control of your life. All of us, no matter where we are in our lives, will encounter stress that can feel incredibly overwhelming. I encourage each of you to consider your own self-care and to take the steps now to build your own resilience to help navigate the stress that will inevitably come your way. And that means things like staying connected to your family, your shipmates, and the resources available to you. Knowing that we are not facing life’s challenges alone can help reduce stress levels before they ever develop into a personal crisis. But when it does, it means having the courage to say something to someone – to break YOUR silence – when you’ve lost control of your life and you need help.

As chaplains, we are committed to being where it matters, when it matters, with what matters. We help people reconnect with their sources for hope. That’s really our whole reason for being. We are here to make sure you have some place safe to go where you have absolute confidentiality to share your concerns or fears when things seem out of your control. You talk, and we’ll listen. If you just want to sit and not say anything, we’ll remain by your side. Chaplains will help you tap into your spiritual foundation or whatever keeps you grounded. And when you’re ready, chaplains will help you connect with the right resources and get you the help you need. Remember, our commitment is to you.

We are a team, the Navy Team. Together, we can make a difference in someone’s life – your life.

Contact your command chaplain to learn more about your right to absolute confidentiality with a chaplain. Don’t know who your nearest chaplain is? Call 1-855-NAVY-311 to be connected with a chaplain.

If you or someone you know is in immediate danger, call 911. If you or someone you know is in crisis, help is just a call or click away. Call the Military Crisis Line at 1-800-273-TALK (option 1) or visit www.veteranscrisisline.net.

For more information on the Navy’s ongoing efforts for suicide prevention, visit www.suicide.navy.mil.

An Intensely Personal Issue

By: Lt. Mark Peugeot, Ph.D., Clinical Psychologist, U.S. Naval Hospital Guam

September is Suicide Prevention Month, but what does that mean for us? 

SP Month CartoonWill it mean more training on suicide prevention? For some suicide prevention is a very sensitive issue. Others, who have not been impacted by suicide, please don’t roll your eyes just yet. Suicide prevention is an intensely personal issue for those who believe that barriers to care are what led to the loss of their loved one, friend, battle buddy, or member of their unit. It is entirely possible that if someone had realized the distress the person was experiencing and acted on it that death was preventable. This is where you are needed! You can help prevent death from suicide and you are the front line in the battle against suicide.

Some may not be convinced to read further, but I challenge you to continue reading and understand the importance of the problem we face as service members together. According to the Veterans Administration, in 2010 we lost 105 people each day to suicide, making suicide the third largest cause of death in the United States for persons under the age of 25. Of the suicides in the United States, roughly 1 in 5 persons who complete suicide is a veteran. This means we lose nearly 18- 22 veterans a day to suicide or as many as 8,000 of our brothers and sisters who have served this country each year. In the past, active duty military service members were significantly less likely to complete suicide and exhibited rates far below that of the general population (VA/DoD, 2013). Department of Defense data from 2012 however indicates that active duty member suicide rates have peaked significantly above the general population (DoD, 2013). If this doesn’t show that the fight against suicide is at our front door, I don’t know what will.

As a clinical psychologist, I know that psychologists, psychiatrists, and other allied health care providers can make a difference when caring for an actively suicidal person. Unfortunately, many times health care providers do not ever get the opportunity to intervene because we were not aware of the need. As a clinical psychologist, one of the greatest hurdles to preventing suicide I see is getting the person to walk through our door. The perceived stigma associated with seeking mental health care is one of the most often cited reasons by my patients when I ask why they have delayed seeking treatment. Often times, after seeking and receiving care, my patients adopt a radically different view of mental health treatment, mental health stigma, and what mental health care means to them.

Many of my patients express concern during our initial meetings regarding the long term impact of seeking mental health care. I have heard people tell me that if they go to mental health that it will be the “end of my career”, “limit my ability to pursue specific jobs/assignments”, and “will prevent me from attaining future success.” Frankly, there is always the possibility that mental illness or a specific mental condition might result in any of those outcomes. In practice, however, that is not often the case for the majority of patients. In my experience, many of the patients that are seen in mental health are able to achieve symptom resolution/management and are able to continue their careers without significant adverse impact. This includes depression, anxiety, and a wide variety of other conditions. In other cases, mental health care has prevented the premature ending of careers by providing the support and treatment needed to return service members to full duty. So, while it is true that some conditions are service disqualifying or limiting, many can be successfully treated with the final result being the return of the service member to full duty.

Accurately identifying those who are suicidal can often be more difficult than identifying persons who are experiencing psychological or emotional distress. Should you be aware of a person experiencing emotional or psychological distress, share your concern with them and encourage them to seek professional care. Ask if they are feeling suicidal or have a desire to harm themselves or others, and if they do, stay with them until you can get additional help. There are three direct warning signs that should never be ignored regarding suicide:

  1. Suicidal communications (talking, writing, etc.)
  2. Preparations (divesting of responsibility or assets)
  3. Seeking access to lethal means (firearms, medications, or dangerous/isolated areas)

If you observe any of these warning signs: Don’t think; ACT to ensure the safety of the individual.

In closing, I hope to have achieved two goals in this article. First provide information about how to identify and protect those in need of care. Second, to dispel misinformation surrounding mental health care and reduce the stigma that serves as a boundary to seeking care. Both issues are critical to preventing suicide amongst service members. Seeking help for emotional or psychological problems is important. Seeking help for suicidal thoughts, plans, intent, or behavior is critical! Simply seeking help for emotional or psychological problems will not automatically end your career. Seeking help is not a sign of weakness, but a sign of strength and resilience. Take care of yourself and the sailors around you and don’t let stigma get in the way of your health.

Together we can prevent suicide.

Bibliography

  1. DoD. (2013, 12 20). Department of Defense SuicideEvent Report. Retrieved August 17, 2014, from National Center for Telehealth and Technology: http://www.t2.health.mil/sites/default/files/dodser_ar2012_20140306-2.pdf
  2. VA/DoD. (2013, June). Assessment andManagement of Patients at Risk for Suicide (2013). Retrieved August 17, 2014, from U.S. Department of Veterans Affairs: http:// www.healthquality.va.gov/guidelines/MH/srb/VADODCP_SuicideRisk_Full.pdf

About the Author
LT Mark Peugeot is a licensed clinical psychologist at U.S. Naval Hospital Guam. He graduated from Uniformed Services University of the Health Sciences with a Ph.D. in clinical psychology in February of 2014. LT Peugeot completed a clinical internship at Portsmouth NMC in 2012 before being assigned to U.S. Naval Hospital Guam in October 2012. Prior to being selected to attend USUHS LT Peugeot served 9 years on active duty with the United States Air Force.

Bonus: Check out the September issue of Pacific Pulse, USNH Guam’s monthly newsletter, featuring additional health promotion resources.

Upcoming Webinar to Recognize Mental Health and Suicide Prevention Month

Recognizing and understanding the factors that place Sailors and Marines at risk for suicide and communicating with one another to connect the dots and take 120604-N-KS651-015action play important roles in suicide prevention and intervention efforts, from the deckplate to leadership levels. The Department of the Navy recognizes September as Suicide Prevention Month, and in 2014, the theme for this observance is “Every Sailor, Every Day.” This month serves as a launch pad to promote suicide prevention resources, continuous engagement in suicide prevention efforts, and overall psychological and emotional well-being throughout the year.

In observance of Mental Health and Suicide Prevention Month, Navy and Marine Corps Public Health Center’s Health Promotion and Wellness Department will co-host a webinar with Navy Suicide Prevention Branch (OPNAV N171). Learn more from psychological health experts about the public health approach to suicide prevention. OPNAV N171 will discuss strategies for enhancing your command’s suicide prevention program as well as evidence-based suicide prevention tools.

Participate in the upcoming webinar on September 15, 2014 from 1200-1300 ET. To view the webinar on the day of the event, click on or copy and paste the following link:

https://connect.dco.dod.mil/r5gqvevou2a/

The webinar is intended for command suicide prevention coordinators, transient personnel unit staff, chaplains, first responders, primary care and behavioral health providers, and Navy and Marine Corps health professionals and health educators who can share their resources with the Sailors, Marines, and beneficiaries they support. The webinar is designated for Certified Health Education Specialists (CHES) to receive up to 1 Category 1 CECH. To register, visit http://www.med.navy.mil/sites/nmcphc/health-promotion/Pages/webinars.aspx.

Pledge to ACT – It’s about being there for Every Sailor, Every Day

Shipmates,

As many of you know, life can get challenging when trying to balance mission demands in a changing environment and our family and personal lives. As a part of the Navy family, we’re never alone when trying to navigate these challenges. ESEDOur connections with each other can help us build resilience and protect us from the negative effects of stress when times get tough. Every day actions to build trust and encourage open and ongoing conversation can make a difference—and may save a life. It starts with each one of us having the courage to break the silence and reach out to our shipmates and friends when we notice them struggling, setting the stage for open communication and support. It’s about being there for Every Sailor, Every Day, by every Sailor, every day.

As we join in global recognition of September as Suicide Prevention Month, I ask that you take a moment to Pledge to ACT (Ask, Care, Treat) if you notice things that seem out of the norm for a shipmate, possibly indicating signs of distress. This confidential, quick and voluntary pledge is available to all Sailors and families online at https://survey.max.gov/index.php/437524/lang-en from Sept. 1 – 30. The pledge not only emphasizes ongoing support and bystander intervention, but encourages personal and proactive stress navigation practices that empower you to lead by example.

Pledge to ACT today… we are all in this together, and together we will make a difference.

Respectfully,

Capt. Mike Smith
Navy Resilience Chief

For more information on Navy Suicide Prevention Month and additional ways to be there for “Every Sailor, Every Day” visit www.suicide.navy.mil.

“I Pledge to ACT” is not a survey and is for personal use only. Your decision to take part is voluntary and you may choose to take part, or choose to stop taking part, at any time. All responses are anonymous.