Community Based Services:

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Community Based Services Helping The Warrior
After The War Presented by Doug Leonardo,
Executive Director The Harbor Behavioral Health
Care Institute, Inc. BayCare Health System
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Overview of the Problem
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More Vietnam veterans have now died from suicide
than the 55,000 who were killed directly during
the war in the 1960s and 70s. Representative Bob
Filner, Chairman, Veterans Affairs Committee of
the U.S. House of Representatives at The
National Alliance on Mental Illness (NAMI) 2007
Annual Convention
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Population Basics

• National Veteran Population
• Projected Number of Living WW II Veterans (as of
  9/30/2007) 2,795
• Percentage of Veteran Population 65 or Older 39
• Estimated Resident Veteran Population by Local
  County
• Hillsborough 98,605
• Hernando 23,896
• Pasco 50,532
• Pinellas 109,300
• Low Estimate, does not include part-time
  residents

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Operation Iraqi/Enduring Freedom

• There are over 170,000 US troops in Iraq.
• There have been
• Nearly 4,000 fatalities
• 90 of the casualties are males
• 51 of the casualties are under 25 yrs old
• Over 27,700 wounded
• 20 have brain and spinal injuries.
• 30 develop mental health problems three to four
  months after returning home.

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PTSD Basics

• Factors that may contribute to Post Traumatic
  Stress Disorder (PTSD) and other mental health
  problems.
• These factors include
• Role in the war
• The politics around the war
• Where it's fought
• The type of combat (jungle, urban, etc.)

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PTSD has been identified in

• Approximately 30 of Vietnam veterans
• Approximately 10 of Gulf War (Desert Storm)
  veterans
• Approximately 6 to 11 of veterans of the
  Afghanistan war (Enduring Freedom)
• Approximately 12 to 20 of veterans of the Iraq
  war (Iraqi Freedom)
• As PTSD is characterized by long-term, ongoing
  patterns of symptoms, the lower rates observed
  for recent conflicts will increase.
• Today, Vietnam veterans are receiving 92 of PTSD
  care provided within VA health care.

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PTSD Basics

• PTSD affects 15-30 of our returning men and
  women.
• Additionally, veterans using VA health care
  indicate
• 23 out of 100 women (23) reported sexual assault
  when in the military
• 55 out of 100 women (55) and 38 out of 100 men
  (38) have experienced sexual harassment when in
  the military
• 3 out of 10 (30) suffer from depressive
  symptoms, two to three times the rate of the
  general population

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Substance Abuse Basics

• Approximately 324,000 VA patients have a
  substance-related diagnoses. (NSDUH, 2003)
• In 2000,
• Approximately two million veterans reported using
  illicit drugs. (6 of the U.S. veteran
  population.)
• the number of veterans admitted to addiction
  treatment exceeded 55,000 admissions. (TEDS,
  2000)
• Substance abuse disorders remain one of the top
  three diagnoses in the VA system.
• Dr. Richard T. Suchinsky, Department of Veterans
  Affairs (DVA), Associate Chief for Addictive
  Disorders.

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Homelessness Facts

• Among Americas estimated 750,000 homeless,
  approximately one-third are veterans. (194,000 -
  270,000 individuals, depending on survey)
• Veterans who are at greatest risk for
  homelessness today served during the Vietnam and
  post-Vietnam eras.
• Of those veterans, approximately
• 45 percent suffer with mental illness.
• Over 70 percent suffer from chronic substance use
  disorders. (Cooney, 2003)
• Approximately 57 of this group are African
  American or Hispanic veterans.

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Suicide Facts

• In 2006, the suicide rate in the Army reached its
  highest level in 26 years.
• Families of soldiers deployed in Afghanistan
  or Iraq face increasing pressures from repeated
  and longer tours of duty.
• Almost a third of veterans returning
  from Afghanistan and Iraq confront mental health
  problems.
• Unlike civilian suicide rates, greater numbers of
  young soldiers are taking their own lives, with
  broken relationships or marriages considered to
  be factors.

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Community Treatment

• Community based treatment providers have been the
  safety net, serving thousands of veterans and
  their families annually, Why?
• Within the military MH/SA problems can be viewed
  as a "career-buster", which may cause veterans to
  wait longer to get help or not at all.
• Veterans may end up being Baker Acted or getting
  treatment through Crisis Stabilization Units.
• Lack of transportation - those in rural areas may
  have to travel long distances to get help which
  is not always affordable/feasible.
• VA Hospitals do not have adequate capacity
  especially for Acute care and detoxification.
• Treatment benefits from the VA do not extend to
  family members.

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DCF Survey Data

• As many as 6,419 veterans receive SA and MH
  services from CMHCs annually.
• Mental Health currently serves 3,752 unduplicated
  veterans.
• The predominant MH diagnosis relates to
  depression.
• Mental Health Services most typically accessed
  include
• Medical Services (psychiatric and medications)
• Case Management
• Outpatient
• Crisis/Emergency Services

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DCF Survey Data, cont.

• Substance Abuse Health currently serves 2,667
  unduplicated veterans.
• Substance Abuse Services most typically accessed
  include traditional services
• Case Management
• Crisis/Emergency Services
• Crisis Intervention
• Medical Services
• Outpatient Counseling
• Residential

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Lessons learned from previous wars have prepared
us to understand the psychological aftermath
faced by our armed service members. Were
concerned that there are some people from Vietnam
who have had chronic or persistent illness,
because it was years before we had effective
treatments available to them, Dr. Ira
KatzDeputy Chief of Patient Care Services for
Mental Health for VA in Washington
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Progress

• The VHAs effort to systemically identify, admit,
  and treat its troubled population of homeless,
  mentally ill, and/or addicted Veterans has been a
  priority with increasing attention and advocacy.
• Initiatives to increase access to treatment, and
  options for care are vital to protect todays
  service men and women from the issues that have
  troubled previous generations.
• By supporting their entire family unit, Veterans
  obtain the support needed to heal, and maintain
  active, productive lives.

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Local Survey Results
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Preliminary Results

• Surveys were returned by Discharged Veterans,
  Retirees, Active Reservists and Spouses.
• Surveys represented respondents from the Air
  Force, Army, Navy and Marine Corp. service
  members from Traditional, National Guard, Special
  Forces and Reserves.
• Service periods from 1940s to 2000s are
  represented, with a third of respondents serving
  over two or more decades.
• One third expressed interest in counseling
  services for themselves over 40 indicated
  multiple needs for the respondent their family.
  
• Access to Mental Health Counseling, Readjustment
  Counseling, Adjusting to Physical Limitations and
  Prescription Medications topped the Most
  Important needs.

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Self-Identified Service Needs of Veterans and
Family Members
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Self-Identified Service Needs of Veterans and
their Family Members
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The willingness with which our young people are
likely to serve in any war, no matter how
justified, shall be directly proportional as to
how they perceive the veterans of earlier wars
were treated and appreciated by their
country. President George Washington Statement
to Congress, 1789
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A man who is good enough to shed his blood for
his country is good enough to be given a square
deal afterwards. Theodore Roosevelt Speech in
Springfield, Illinois July 4, 1903
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• The challenges facing all federal and state
  agencies that deal with veterans are substantial
  but not insurmountable. Providing good health
  care to the Americans who have volunteered and
  deployed to risk everything in the service of
  this nation is a debt we must pay. Our goal is to
  perform these tasks with quality and a level of
  honor befitting Floridas veterans. We will
  continue to strive to improve the Departments
  delivery of advocacy for and services to
  Floridas veterans.
• (RADM LeRoy Collins, Executive Director,
  FDVA, Making Good on our Debt to Veterans Will
  Pay Unexpected Dividends, James Madison
  Institute, July 2007)

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Questions/Comments