Transcript Issues of Women Returning from Combat

Army OneSource
Behavioral Health Campaign:
Issues of Women Returning from
Combat
Paula McBride
Community Support Coordinator Oklahoma & Arkansas
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Provide background on the Army OneSource
Behavioral Health Campaign, the war and its
impact
Explain the history of women in combat and the
scope of the problem
Describe the importance of military culture
Identify psychological issues unique to women
returning from combat
Discuss gender-specific treatment
Provide information on mental health care
resources including TRICARE insurance
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Raise awareness of the challenges of Military life
before, during and after deployment
Engage health professionals and others in
providing specialized services to Service Members
and their Families
Fill gaps in health services available to Service
Members, especially those who live far from
Military installations
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Already lasted longer than WWII
Improvised Explosive Devices (IEDs) / no front line
No down time / constant vigilance
All volunteer force
Multiple and longer deployments
90% of wounded surviving their injuries
Over 1 ½ million have served in Iraq and Afghanistan
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75% experienced situations where they could be
seriously injured or killed
62% know someone who was seriously injured or
killed
33% described an event that caused intense fear,
helplessness or horror
Greater percentage coming home with Traumatic
Brain Injury (TBI), post traumatic stress, and
depression
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Demands for services outpace the capacity of the
Military
Over 1 million veterans eligible for VA services
45% actually seek services from the VA
Half of all Service Members experience multiple
deployments
Family Members are more likely to experience
stress, anxiety and depression
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Analyzed data on 54,000 and 398,000 male
OEF/OIF veterans-who accessed care- for PTSD
risk
Considered: Gender, age, rank, brand, component,
marital status, race
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45,152 female OEF/OIF VA users
12% total OEF/OIF VA users are women
Mirrors the 11% of OEF/OIF women veterans
eligible to use the VA
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More African-American, 28.8% vs. 15%
Ratio for Hispanic is comparable, 11%
Both enlisted rank higher
Younger, 29 years or less
Higher ratio on Air Force, 17% vs. 11%
Lower in marines, 3% vs. 14%
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PTSD: 19% vs. 23%
Non-Dependent Sub. Abuse: 13% vs.19%
Depressive Disorder: 20% vs. 15%
Affective Psychosis: 12% vs. 8%
Neurotic Disorder: 15% vs. 12%
Alcohol Dependence 2% vs. 4%
Drug Dependence: 1% vs. 2%
Personality Disorder: 2% vs. 1%
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Reserves at greater risk than Active Duty
Enlisted at greater risk than Officers
Army at greater risk than other branches
Women older than 30 at a greater risk
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No clear relationship to level of education
Divorced or legally separated veterans at greater
risk than married or single
No significant difference by race
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Women may have less exposure to combat or may
be exposed to a different range of situations
Race, ethnicity, age or rank difference and/or
differences in early life trauma may account for
differing rates of diagnosis
Women may be more likely to receive diagnosis of
personality disorder rather than PTSD
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Disrupted menstrual cycles
Exposure to prisoners and animals
Sexual harassment/assault
Combat-related fear of death
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Fertility issues/miscarriages
Lack of sexual interest
Overprotective of their children
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Surrounded by men
Guilt
Denial
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Distinct culture with its own order, norms, chain of
command, ethical codes and language
Rules counterbalance the chaos of war ensuring
missions are completed no matter how hard or
uncertain
Group bonding
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Women participated in large numbers in WWII
1993 Congress opened combat ships to women
1993-95 first female pilots placed in all branches
2005 first female awarded Silver Star in combat
2008 first female promoted to 4-Star General
Some specialties are still restricted to women
Some people:
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Believe in the Boy’s Club or Rite of Passage
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Consider women’s physical and psychological
characteristics incompatibility leads to lessening of
standards
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Believe women are a distraction to the male
warrior who wants to protect
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Believe in stereotyping female roles and jobs
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Frustrated by accommodating female presence in
barracks
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Aggressive vs. emotional
Isolation and lack of camaraderie
Socialization with men
Competition for recognition
“Becoming one of the guys”
Garnering too much attention
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Sexual assault
• Risk working environment, reputation and
promotions
Pregnancy
• No-sex policy
• Risk being sent home
• Jeopardizing a unit
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Single mothers
Pre-deployment
Deployment
Reintegration
Wanting to go back
Buying weapons
Getting into trouble
Adrenaline rush
Isolation
Anger
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System set up for men
• Woman seeking care for sexual trauma or PTSD
in waiting room with men
• Primary and specialty care were not available
until recently
Fragmentation of Care
Stigmatization of PTSD leading to abuse
Denial
Pride
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Women typically decide who receives care in the
family, putting herself last
If it is paired with something they think is valuable
for the family they are more likely to get the
treatment
Support groups can be helpful for developing
social support, detrimental if a woman cannot
stand being in a closed room or in groups
Integrate short interventions with primary care
such as cutting back on drinking
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Smoking problems are much higher in veteran
women than civilian women
• Proportion of women prescribed NRT is lower
for women
• Encourage phone counseling or cessation
treatment if they are concerned about weight
management or mood changes
Veterans want more education but not all at once
or right after they come home
• Incorporate subsequent contact and Web-based
information
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DoD integrated health care delivery system
Provides health care benefits/services to active
duty, retired, families, survivors and their eligible
beneficiaries
Combines access to military hospitals and clinics
with a network of civilian health care providers
Supports readiness, ensures health of forces and
cares for them when ill or injured
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Regions: North, South and West
Options: Prime, Standard, Extra and Reserve Select
Services: Pharmacy, Inpatient and Outpatient
Becoming a provider
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Includes the Veterans Health Administration and
Veterans Benefits Administration
23.4 million veterans currently alive
25% of US population is eligible for benefits
Each veteran is eligible for 5 years upon returning
from each deployment
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Located at each VA medical Center
Ensures OEF/OIF veterans quickly find their way
to the right VA services and benefits
Begins with contacts at Post Deployment Health
Assessments, walks veterans through the VA
system
Direct any veteran or family member seeking
assistance in connecting with VA services
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Awareness Campaign Folder
Awareness Campaign Online Course
Awareness Campaign Handouts