Transcript 7-Day Point Prevalence Rates

VA Puget Sound Health Care
System
Deployment Health Clinic
Outreach
Post-Combat Evaluations
Follow-up Care
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Unique OIF/OEF Veterans Treated
VA Puget Sound Health Care System
1800
1600
1400
1200
1000
800
600
400
200
0
Facility
Mental Health
FY02
FY03
FY04
FY05
VA PSHCS Mental Health Services for OIF/OEF Veterans
Organizational Diagram
Vet Centers
Seattle
Tacoma
Bellingham
Yakima
Spokane
VA PTSD Programs
PTSD Clinical Teams
Women’s Trauma Team
PTSD Inpatient Unit
PTSD Domiciliary
Post-Deployment Clinic
Primary medical care
Mental health screening/triage
Brief therapy & meds management
State Dept. Veterans Affairs
29 contract therapists
Affiliated Mental Health
Programs
Addictions Programs
General Mental Health
Integrated Care for Combat Veterans
Common Barriers to Treatment
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•
Lack of information on available services
Perceived/actual problems with access to services
(dropped cases referred to specialty clinics)
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•
•
Stigma against receiving care (mental or physical)
Lack of information on health risks
Low priority of care compared to “getting back to
normal life”
Deployment Health Clinic
Integrated Care for Combat Veterans
“We recommend a comprehensive post-combat
evaluation to establish a baseline snapshot of how you
are functioning now”
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•
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Physical exam and mental health evaluation with attention to
pertinent deployment experiences/environmental risks
Ongoing care to provide necessary treatment and monitoring for
any emerging combat related conditions.
Education regarding available benefits/sources of support for
the veteran and his/her family to ease transition
Deployment Health Clinic
The Deployment Health Clinic is dedicated to the
care of veterans who are experiencing mental or
physical health concerns related to a specific
deployment (Gulf War I, Peace-Keeping
Deployments, OIF/OEF)
A philosophy of mind-body relationships is adopted
in which medical and mental health concerns are
presumed to interrelate
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VA Puget Sound Health Care System
Deployment Health Clinic
The purpose of the Deployment Health Clinic is to:
•
Provide Outreach and Community Educational Services
•
Address and support the veteran in all aspects of life which
have been affected by their combat experience.
•
•
Provide that support in an accessible and integrated format
Provide support in an ongoing way for as long as it is
needed
VA Puget Sound Health Care System
Deployment Health Clinic
The objective of the Deployment Health Clinic is to:
Provide the support necessary for the veteran and
his/her family to readjust, recover and be optimally
functioning in all realms as soon as possible after
return from combat and for the long term.
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VA Puget Sound Health Care System
Deployment Health Clinic
• Staff Members
» Primary Care Physician
» Registered Nurse Practioner
» Clinical Psychologist
» Masters-level mental health counselor
» Psychiatrist
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Integrated Care for Combat Veterans
Primary Treatment Interventions
•
Deployment Health Clinic Services:
» Integrated mental health and medical post combat care
» Preventive/health promotion based care
» Family involvement in care
» Innovative psychiatric medication treatments (i.e., prazosin)
» Innovative Cognitive Behavioral Interventions (Brief
Motivational Interviewing, BA, ACT, Mindfulness)
» Referrals to inpatient/outpatient mental health services
(PTSD, substance abuse, general mental health services)
or specialty medical clinics within the VA Medical System
VA Puget Sound Health Care System
Deployment Health Clinic
Post-combat care:
Using the two years of post-combat priority eligibility
proactively as a period for assessment, monitoring
and utilization of appropriate services directed
towards optimal recovery, rehabilitation and
reintegration into post-combat, non-military life.
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Mental Health Problems and
Clinical Services for OIF/OEF
Veterans
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Common Post-Deployment Readjustment
Reactions
• Problems with finances, employment, and housing
• Preoccupation with news about the war
• Worry about friends still deployed overseas
• Missed excitement of combat with urges to return
• Adjustment to “civilian” norms
• Altered schedule for sleeping and eating
• Marital conflict and family reintegration problems
Integrated Deployment Clinic Care
Presenting Psychosocial Health Concerns
• Redefined familial roles
• Marital/parenting issues
• Public Social Functioning
• Occupational/financial concerns
• Separation from military social support
• Risk of re-deployment
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Common Mental Health Disorders
• Anxiety disorders
» Adjustment Disorder, Generalized Anxiety, Panic
Disorders, PTSD (or PTSD-like syndromes)
• Depressive Disorders
» Adjustment Disorder, Dysthymia, Major Depressive
Disorder
• Substance Misuse, Abuse, and Dependency
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Mental Health Profiles of returning OIF/OEF Veterans
Presenting to the Deployment Health Clinic (N = 128)
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Demographics: Mean age was 32.2 years, 95.3% were
male, 72.2% Caucasian, and 50.8% were married.
Measures
» The PTSD Checklist Military Version (PCL-M) (Weathers, Huska,
and Keane, 1991)
» The PRIME-MD Patient Health Questionnaire (PHQ) (Spitzer,
Kroenke, and Williams, 1999)

depression (major depressive disorder),

anxiety (any anxiety disorder except panic disorder)

alcohol misuse (abuse or dependence)
» Barriers to Mental Health Care (Hoge et al., 2004)
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Combat Exposure
•
Event (Percentage)
» stationed close to enemy lines (87.0%),
» faced an extreme threat to their personal safety (86.9%)
» received incoming fire from mortars, rockets, or artillery (74.2%).
» one or more firefight (59.8%)
» mines or booby traps (55.2%)
» sniper or sapper fire (51.2%).
» witnessed an accidental death (31.7%)
» took care of someone who’s life wasn’t saved (28.8%)
» were responsible for someone else’s death (11.2%)
» observed the death of a close friend (10.1%)
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Rates of Mental Health Disorders
Disorder
Percent (N)
Depression
35.7% (46)
General Anxiety
24.0% (31)
Alcohol Misuse
22.5% (29)
PTSD
20.9% (27)
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Rates of Mental Health Disorders
(continued)
Count
Percent (N)
All 4
3.1% (4)
3 Or More
18.6% (24)
2 Or More
33.3% (43)
1 Or More
48.1% (62)
None
51.9% (67)
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Barriers to Receiving Mental Health Care
• The most frequently cited barriers to
accessing mental health services:
» financial (35.4%)
» fear of being perceived as weak (30.8%)
» fear of being treated differently by unit leadership
or employers (26.2%).
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Deployment Health Clinic
Integrated Care for Combat Veterans
Question: Does routine delivery of mental health
assessment/ treatment in the primary care setting
reduce stigma, improve satisfaction with care,
and/or increase utilization of mental health
services among soldiers returning from
OIF/OEF?
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