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Veteran Mental Health Challenges and Solutions
Table of Contents
Acknowledgments
A Special Message to the Creative Community
Letter from Brian Dyak, President, CEO, and Co-Founder, Entertainment Industries Council Inc.
Letter from Sonja Batten, Deputy Chief Consultant for Specialty Mental Health, U.S. Department of Veterans Affairs
Veterans’ Experiences: Powerful American Drama
The Reality
Make the Connection: An Authentic Resource for Storytellers
Real Character Studies: Overcoming Challenges, In Veterans’ Own Voices
Bryan’s Story, U.S. Marine Corps, 2003–2008, a Recent Combat Veteran
Nicole’s Story, U.S. Army, U.S. Air Force Reserve, 1990–1993, 1996–Present, a Desert-Era Combat Veteran
Chaunte’s Story, U.S. Air Force, U.S. Air Force Reserve, 2000–Present, a Recent Combat Veteran
Jack’s Story, U.S. Marine Corps, 1963–1967, a Vietnam-Era Combat Veteran
Tiffany’s Story, Fiancée of a U.S. Marine Corps Veteran
Mental Health Care for Veterans
Signs and Symptoms of Veterans Experiencing Mental Health Challenges
Barriers to Treatment
Treatment Works
Treatment Settings
Depiction Priorities
Questions to Ask of Your Characters and Storylines Involving Veteran
Mental Health
Sample Characters: Symptoms and Treatments
Appendix
About Picture This: Veteran Mental Health Challenges and Solutions
A Commitment to the Nation’s Veterans: About the U.S. Department of Veterans Affairs and Its Advances in Mental Health Services
U.S. Veterans: Did You Know?
Additional Information and Resources
Language and Terminology
End Notes
ii
Special thanks to our collaborator and sponsor, the U.S. Department of
Veterans Affairs.
Entertainment Industries Council Picture This Team:
Brian Dyak, President, CEO, and Co-Founder
Marie Gallo Dyak, Executive Vice President, Program, Services and
Government Relations
Larry Deutchman, Executive Vice President, Marketing and Industry Relations
Shawn King, Administration and Executive Assistant to the President and CEO
Skylar Zwick, External Communications and Program Director
Ashley Jupin, Program Manager
Anthony Perez, Program Manager
Shana Baiz, Assistant Program Manager
Jeff Coppola, Program Assistant
Rebecca Jackson, Assistant Program Manager
Picture This Associates:
Aaron Dowler
Bridget Phelan
Daniel Menist
Jose Mata Jr.
Kayla Begg
Malika Vastare
Michelle Cheoung
Rebecca M. Kreps
Ryan Badin
iv
At the heart of the Make the Connection campaign are many individual testimonials
from Veterans and their family members. As you will see on the website
(www.MakeTheConnection.net), these stories of successful recovery offer compelling
reasons for others, especially Veterans, to seek treatment. We need your help in
overcoming the national stigma associated with mental health conditions and mental
health treatment. We also need your help in combatting preconceived notions with
facts: Not all Veterans are challenged by these conditions after leaving the service, and
for those who are, treatment is available and effective.
This publication includes written accounts of Veterans who have faced and successfully
overcome hurdles in order to live healthier lives, which we hope will assist you in
creating accurate and compelling depictions of Veteran mental health challenges. As
powerful as these testimonials are on the page, however, written accounts cannot
compare to hearing firsthand from the Veterans themselves. I encourage you to visit
MakeTheConnection.net and watch the true stories of our Veterans. You will meet their
families, see them in their homes and communities, and hear the emotion in their voices
as they talk of positive changes treatment and other sources of connection can bring.
By sharing their stories, these Veterans have done a tremendous public service. It is
now up to you to answer the same call.
With deep gratitude,
Sonja V. Batten, Ph.D.
Deputy Chief Consultant for Specialty Mental Health
U.S. Department of Veterans Affairs
vii Picture This: Veteran Mental Health Challenges and Solutions
Today is a unique time in our nation’s history, ripe
for telling compelling stories of authentic Veteran
experiences. Hundreds of thousands of Service members
are returning from deployment to face arguably the
most challenging economic environment of the last 60
years. Larger numbers than ever are women who have
experienced the rigors and stress of combat situations and
environments—as well as extended separation from young
children. At the same time, Vietnam Veterans are going
through life transitions, including becoming grandparents,
retiring, and aging.
As entertainers and creators, you can tell these stories in a
way that is respectful, interesting, and faithful to the truth.
You can dig into the topic of Veteran mental health in ways
that transcend stereotypes and present a more honest,
compelling, and powerful product. And you can do it by
letting Veterans’ own voices guide you. So many of them
are eager to share their realities with the world. You can
make their experiences resonate with viewers throughout
the country. You can provide a service that is good for your
industry, our Veterans, and our nation.
Veterans have done their part. Now you can do yours. By
taking the time to better understand Veterans’ strengths
and challenges, you can help drive the evolution of a more
positive and accurate social narrative around Veterans’
experiences—as well as the value and benefits of seeking
support and treatment. So take advantage of the resources
available to help you improve your product, build your
audience, and inspire your stories.
The Reality
To begin increasing awareness and understanding of mental
health challenges and dispelling myths about our nation’s
Veterans, it is important to have facts about the realities of
being a Veteran.
Most Veterans honorably serve their country, complete military service, and successfully transition into civilian life. They have the ability to lead in the workplace, in their communities, and at home by using the skills they have learned and perfected during their service.
Just like those who never served in the military, Veterans may experience mental health issues and difficult life events that are unrelated to their service. However, the difficulties of service, such as combat, noncombat training exercises, other traumatic military experiences, and repeated deployments, may complicate their efforts to deal with those issues.
Many currently returning Service members have been deployed multiple times and exposed to more combat than were Veterans of previous generations. They include Service members of all-volunteer Armed Forces, approximately half of whom were Reservists and members of the National Guard who left behind their civilian lives to tackle incredibly difficult tasks.
Older Veterans, such as those who served in Vietnam, comprise one-third of American Veterans. They have transitioned or soon will be transitioning into retirement. When they returned to civilian life years ago, they were busy raising families and working, during an age when mental health issues were not a priority for discussion. Now, at the same time they are facing new life changes, many of these Veterans are confronted with issues they may have tried to bury—for the good of their families and themselves—long ago.
Veterans and others who see the benefit of using mental health services may be unaware of resources tailored specifically to Veterans’ needs. Because of their unique experiences, Veterans often can benefit more from services designed for them and others in the Veteran community.
Veterans’ loved ones also face unique challenges and can benefit from making the connection with others who have had similar experiences. Military service can temporarily separate families, and readjustment can be tough. Family members can explore treatment and support options for themselves and the Veterans in their lives that build resilience and strengthen their families. VA and other community-based resources offer options for loved ones of Veterans seeking assistance and the means to help those they care about.
Many Veterans seek help and support for mental health challenges. In fact, more than 1.3 million Veterans received mental health care at VA in 2011.
Veterans are often willing to offer assistance to others. Many Veterans are involved in peer-to-peer support for their fellow Veterans and their families, and in their communities.
3
Signs and Symptoms of Veterans
Experiencing Mental Health Challenges
Identifying mental health issues can often be difficult.
Accurately portraying these challenges in fiction can also be
tough. The following signs and symptoms are among early
warning signs of mental or emotional issues. Writers and
actors looking to depict Veterans dealing with such challenges
should be aware of some of these possible indicators:
Changes in sleep, appetite, or weight
Decreased energy, motivation, or interests
Problems with attention, concentration, or memory
Uncharacteristic irritability, anger, or “short temper”
Feelings of guilt, worthlessness, helplessness, or hopelessness
Unhealthy behaviors, such as reckless behavior and problems with alcohol or drugs
Thoughts of suicide
Problems functioning at home, work, or school
Some Veterans face challenges that can contribute to
mental health issues, such as stress caused by transitioning
from service to civilian life; reintegrating back into family,
relationships, and routine; or other significant life events,
such as:
Loss of a loved one
Major life changes, such as retirement
Job loss
Exposure to another traumatic event, such as an accident or criminal act
Specific mental health conditions may include:
Anxiety disorders, including post-traumatic stress disorder (PTSD)
Depression or bipolar disorder
Alcohol or drug problems
Schizophrenia
Barriers to Treatment
Veterans may not access mental health treatment because
of a variety of real or perceived barriers to care. Although
Veterans often cite physical barriers such as clinic hours and
distance as reasons for not seeking mental health treatment,
perceived barriers such as negative beliefs about mental
health care also have a significant impact.
Common barriers to seeking mental health treatment include:
Lack of understanding about the signs and
symptoms of mental illness. Some Veterans may write off the signs and symptoms of mental health challenges as an inevitable and unchangeable result of their military service.
Perceptions of weakness or failure. Veterans experiencing mental health conditions often express feelings of embarrassment or fear of being viewed by their peers as weak or having failed, which may prevent them from seeking appropriate treatment.
Misconceptions about the necessity and efficacy of
treatment. Because some mental health challenges, such as PTSD, have only recently become fully understood and defined, many Veterans do not realize they are experiencing real problems that can be successfully treated.
Lack of familiarity with treatment regimens and
resources. Treatment for mental health issues has advanced over the years, encompassing evidence-based psychotherapies that successfully treat various conditions and do not necessarily involve taking medications. However, many older Veterans view treatment as unending, and younger Veterans may believe all treatment involves pharmaceuticals—causing them to avoid seeking treatment.
Belief that treatment is not available to them, or
they don’t deserve support. Service members are trained to look out for their buddies and put the good of the unit before themselves. Veterans retain these attitudes about caring for others first and themselves second, and therefore may believe treatment should be reserved for those who may need it more than they do. They also may think that because they did not see combat—or because their fellow Service members saw more intense action—they are not deserving of the resources available to them.
17
Treatment Works
Showing signs of mental health challenges does not
mean a Veteran has to live with these issues forever. VA
and other resources offer support for confronting and
overcoming whatever holds Veterans back from leading
fulfilling lives. The entertainment industry can present
stories that resonate with audiences and directly impact
the lives of Veterans and their loved ones when characters
and storylines include seeking treatment for emotional
and mental health symptoms and portraying the positive
outcomes of treatment.
The type of mental health treatment to be provided is
highly dependent on the individual and the condition
being treated. There is no one-size-fits-all treatment and
there are no magic pills. For almost every condition, there
are various effective treatments that can help Veterans
cope with symptoms and greatly improve their quality of
life. Treatments can involve counseling, medication, or a
combination of both.
It is important to remember that treatment is often a finite
process: Veterans and others who seek assistance with
mental health-related issues, as with other health issues,
need not remain in treatment forever. They can get help,
get well, and return to their normal routines.
Treatment Settings
The setting for treatment usually depends on both the
Veteran and his or her specific condition. Some settings
available to Veterans include:
Outpatient Care: Most treatment is offered through visits to local primary care offices, psychiatrists, psychologists, mental health clinics, or community centers, and is designed to help Veterans during a difficult time. Telemedicine may be used in specific cases.
Intensive Outpatient Care: This option involves several hours per week of treatment to help address more significant symptoms of mental health conditions.
Supported Work Settings: These settings provide resources, services, and assignments to assist Veterans who are re-entering or integrating into the workforce.
Residential Care: This can be used to support treatment for a wide range of mental health conditions and is designed for people who may benefit from living in a structured environment for a limited period of time.
Inpatient Care: 24-hour care may be initiated as the result of a severe or life-threatening mental health condition. Just as with mental health treatment for civilians, this level of care is not necessary for most Veterans who seek treatment.
18 Picture This: Veteran Mental Health Challenges and Solutions
The effort to share real stories from Veterans is a
collaboration that began with a national Picture This forum
held at the National Association of Broadcasters (NAB)
in Washington, D.C. A group of 43 nationally recognized
experts engaged a panel of entertainment industry
professionals about Veteran mental health communication
priorities. Building on the D.C. forum, leaders in the
entertainment industry gathered in Los Angeles with
VA leaders and Veteran participants in the Make the
Connection campaign to discuss how writers, actors,
directors, producers, and executives can learn from real
Veteran stories and use them to inform their characters
and storylines.
The following statements, made by participants at both
events, reflect a range of familiarity with and reflection on
the challenges our Veterans face and the strengths with
which they can tackle them.
Sen. Gordon Smith, President, National
Association of Broadcasters (NAB)
“I am confident that our work today will greatly advance the
cause of paying our military the respect it deserves. Every
day, soldiers, sailors, airmen, guardsmen and women,
and Marines go out and risk their lives to protect the
freedom that creators, moviemakers, and television
broadcasters especially enjoy: our freedom of speech.
Your focus on accurately portraying our servicemen and
women through fiction is a wonderful thing. There are no
greater contributors to our society than our Veterans, who
give so much so that we can enjoy the freedoms we do. We
at NAB are anxious to help put into people’s ears and eyes
the content that you will produce.”
Dr. Sonja Batten, Deputy Chief Consultant for
Specialty Mental Health, Department of
Veterans Affairs
“Our mission at the U.S. Department of Veterans Affairs
is to serve those who have served our country. There has
never been a time in history when so many Veterans were
eligible for care and have come to VA so soon after they
have left the service.
It is important to realize that not all Veterans require mental
health services. But for those who do, excellent care is
available. Improving Veterans’ mental health is one of the
highest priorities at VA. Last year, about a quarter of the
Veterans who came to a VA Medical Center were seen,
among other things, for mental health conditions. But
there is still more to be done in service to those who served
our country. We need to be careful about balancing our
messages: Most Veterans honorably serve their country,
complete military service, effectively transition into civilian
life, and are able to successfully work through any mental
health or readjustment challenges that they may have. And
those who do have mental health challenges should not be
defined solely by that aspect of their lives.
For us to responsibly depict mental health issues and
the Veterans who face them, we also need to depict
the strengths and unique abilities of our Veterans with
respect to discipline, team focus, ability to carry out a
mission, adaptability, and perseverance. Veterans have
amazing stories. We owe it to them to tell their stories in
a fuller context, and show the positive steps they take to
improve their own lives, as well as what they do for their
own families and communities.”
25
A Commitment to the Nation’s Veterans:
About the U.S. Department of Veterans
Affairs and Its Advances in Mental
Health Services
The United States has the most comprehensive system of
assistance for Veterans of any nation in the world.
In 1930, the VA health care system totaled 54 hospitals.
Today, it includes more than 150 medical centers; more
than 350 outpatient, community, and outreach clinics;
and 300 Vet Centers. VA health care facilities provide a
broad spectrum of medical, surgical, and rehabilitative
care. Through treatment and accessible resources, VA
provides Veterans with the tools necessary to lead fulfilling
lives following their selfless service to our country. These
tools are geared specifically toward Veterans and are
delivered in a way that makes them and their loved ones
most comfortable. VA has experience working with all
Veterans—from the oldest to those from recent conflicts—
and has several services and programs geared toward
specific groups, including women and recent Veterans.
A Commitment to Treatment
VA specializes in the care and treatment of Veterans.
In recent years, research from around the world has
dramatically increased our understanding of mental health
conditions and how to treat them. Several million Veterans
have received treatment for mental health conditions
and found solutions for improving their lives. They have
learned what all Veterans should know: Treatment works
and recovery is possible.
A Commitment to Resource Awareness
VA is at the forefront of creating new ways to help Veterans
and their families identify resources and treatment options
that are tailored for them. But it is not enough to offer
these resources: VA is committed to performing local and
national outreach so all Veterans realize the support that
is available to them. Many Veterans are affiliated with a
VA Medical Center, a Veterans Service Organization, or
other community organizations and may be well aware
of their options for health care, including mental health
services and support. For those who do not, VA is taking
the message of treatment availability and effectiveness to
the public sphere.
VA’s Make the Connection public awareness campaign
highlights candid, personal testimonials from Veterans and
their families and provides resources to help them discover
ways to improve their lives. MakeTheConnection.net
helps Veterans recognize that they are not alone—
there are people out there like them who are going
through similar experiences, overcoming challenges,
reaching positive outcomes for treatment and recovery,
and finding paths to fulfilling lives. These messages
are conveyed through the most credible source
of all—the voices of other Veterans. The Make the
Connection campaign encourages Veterans and their
families to “make the connection”—with information and
resources, with the strength and resilience of Veterans
like themselves, with other people, and with available
sources of support, including mental health treatment.
30 Picture This: Veteran Mental Health Challenges and Solutions
Additional Information and Resources:
U.S. Department of Veterans Affairs
Make the Connection
National Center for PTSD
Veterans Crisis Line
Defense and Veterans Brain Injury Center
Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury
National Resource Directory
National Suicide Prevention Lifeline
Substance Abuse and Mental Health Services Administration
33
Language and Terminology:
Adapted from MakeTheConnection.net,
NLM.NIH.gov, Medicinenet.com
ACT: Acceptance and Commitment Therapy. An effective type of talk therapy for depression, anxiety, and substance use problems. ACT helps people move beyond their struggles with emotional pain and worries. It teaches them to recognize, commit to, and achieve what’s important to them, rather than making choices due to avoidance of painful or uncomfortable experiences.
Acute: Of abrupt onset, in reference to a disease. Acute often also describes an illness that is of short duration, rapidly progressive, and in need of urgent care.
Antidepressant: A medication used to treat depression. The available antidepressant drugs include SSRIs, or selective serotonin reuptake inhibitors, MAOIs, or monoamine oxidase inhibitors, tricyclic antidepressants, tetracyclic antidepressants, and others.
Anxiety: An experience characterized by episodes of intense fear or exaggerated worry and tension most of the time or in everyday social situations. Experiences of anxiety may be accompanied by physical symptoms like heart pounding, trouble breathing, trembling, sweating, or being easily startled.
Bipolar disorder: A mood disorder in which an individual may experience extreme shifts in mood, energy, and activity levels. The individual can go from feeling almost supercharged with tremendous energy to feeling so down that it may be hard for him or her to find the energy to do much of anything. These extreme mood swings can happen over a short period of time or over several months, and there may be periods of “normal” moods in between. Bipolar disorder can make it very difficult to function at work or in social settings. It can also lead to strain on family and personal relationships.
CBT: Cognitive-Behavioral Therapy. A type of talk therapy effective for depression, anxiety, and PTSD. CBT helps people learn new patterns of thinking and practice new positive behaviors.
Chronic pain: A condition characterized by the experience of pain in one or more areas of the body for a prolonged period of time. The pain may be nagging or severe and often seems worse than short-term pain because of its duration. General wear and tear from aging as well as different types of illnesses and injuries can cause chronic pain.
CPT: Cognitive Processing Therapy. A type of cognitive behavioral talk therapy effective for PTSD. CPT helps people learn new patterns of thinking so their memories of trauma do not interfere with their daily lives. CPT uses some exposure therapy (see definition of “PE: Prolonged Exposure Therapy” ).
Dementia: Loss of memory and intellectual capacity that is severe enough to limit a person’s ability to function. Alzheimer’s disease is one common type of dementia.
Deployment: The movement of Armed Forces and their logistical support infrastructure around the world. During deployments, men and women leave their families and homes with other Service members and travel to another location for a set period of time.
Depression: Feelings of sadness or hopelessness that last for more than a few weeks or seriously impact one’s life. Depression is a common problem that affects people in different ways. It not only affects a person’s mood, but also affects a person’s body, actions, and thoughts. Depression can interfere with daily life and normal functioning.
Dissociation: A feeling of detachment from one’s immediate experiences, surroundings, or even from the body. Dissociation is characterized by a sense of the world as a dreamlike or unreal place and may be accompanied by memory problems.
Domiciliary or Residential Rehabilitation
Treatment Program: A safe, homelike facility where Veterans live for a short time while they “get back on their feet.” Such programs provide state-of-the-art, high-quality residential rehabilitation and treatment. Here, Veterans can receive services that help them get a job, return to school, improve social skills, and address physical and mental health problems.
34 Picture This: Veteran Mental Health Challenges and Solutions
Fatigue: Fatigue can result in a lessened capacity for work and reduced efficiency of accomplishment. Fatigue is usually accompanied by a feeling of weariness and tiredness. It can be acute and come on suddenly or be chronic and persistent.
Flashback: The feeling of re-experiencing a traumatic event. Individuals might remember everything about the event as if they were going through it again—vividly recalling the sights, sounds, smells, and other details while losing contact with their current surroundings. They might even have the same feelings or physical sensations that they had at the time of the event.
GAD: Generalized Anxiety Disorder. GAD is characterized by six months or more of chronic, exaggerated worry and tension that is unfounded or much more severe than the normal anxiety most people experience. People with this disorder usually expect the worst; they worry excessively about money, health, family, or work, even when there are no signs of trouble. They are unable to relax and often experience insomnia. Many people with GAD also have physical symptoms, such as fatigue, muscle tension, headaches, or stomach pain.
Insomnia: A common sleep disorder characterized by trouble falling asleep, staying asleep, or both. It can be acute (short term) or chronic (ongoing). Acute insomnia is common and often is brought on by situations such as stress at work, family pressures, or a traumatic event. Acute insomnia lasts for days or weeks, while chronic insomnia lasts for a month or longer. Most cases of chronic insomnia are secondary, meaning they arise as a symptom or side effect of a medication or another mental or physical illness.
MST: Military Sexual Trauma. MST is sexual assault or sexual harassment during military service. It includes uninvited sexual advances or contact or forced sex while in the military and happens to men and women. MST can be associated with mental and physical problems. Every VA facility provides free MST-related care and has a designated MST Coordinator who serves as a contact person for MST-related issues.
OEF/OIF/OND: Acronyms for Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn.
Panic attack: A sudden onset of intense fear or terror, often associated with feelings of impending doom. During these attacks, there are symptoms such as shortness of breath or smothering sensations; palpitations, pounding heart, or accelerated heart rate; chest pain or discomfort; choking; and fear of losing control.
PE: Prolonged Exposure Therapy. An effective treatment for PTSD, PE therapy helps people slowly become more comfortable with sights, sounds, and smells that remind them of the trauma. The therapist helps the individual relive traumatic memories in a safe environment. The memories become less troubling and interfere less with the person’s daily life as the person repeatedly contacts the difficult memory. Other approaches to exposure therapy may use methods such as writing about the traumatic event.
PTSD: Posttraumatic Stress Disorder. An anxiety disorder that may sometimes result when a person experiences a potentially traumatic event. PTSD symptoms can disrupt daily life. They include re-experiencing the trauma through intrusive thoughts or nightmares and distancing from other people or feeling emotionally numb. Other symptoms include being irritable or quick to anger and having trouble sleeping or feelings of anxiety.
Schizophrenia: A mental health disorder characterized by feelings of fear and paranoia that make it very hard to trust others, having a significant effect on personal relationships. Schizophrenia may get in the way of one’s ability to make good decisions. Research shows many people with schizophrenia can recover when correctly diagnosed and treated. Note that schizophrenia is not the same as dissociative identity disorder or multiple personality disorder.
35
Substance use disorders: The excessive use of a substance, especially alcohol or a drug. Substance use problems can impair an individual’s ability to function and can lead to complications including, but not limited to, liver disease, harm to unborn children, high blood pressure, mood swings, and neglect of personal responsibilities and appearance.
TBI: Traumatic Brain Injury. TBI can occur when something outside the body hits the head with significant force, and can cause changes in a person’s ability to think, control emotions, walk, or speak. It can also affect sense of sight or hearing. TBI can be mild to severe. Mild traumatic brain injury or concussion refers to brief changes in or loss of consciousness. Severe traumatic brain injury or concussion refers to longer periods of unconsciousness and memory loss around the event. Note that TBI is not a mental health condition.
Telemedicine, or telemental health: A cutting-edge technology that allows a clinical provider to care for a patient from a remote location, using a camera and special TV that allow the patient and provider to see and hear each other. Telemental health can be used to perform assessments and conduct individual or group psychotherapy and medication management.
Traumatic experience: A traumatic experience is an event that causes physical, emotional, or psychological distress or harm. It is an event that is perceived and experienced as a threat to one’s safety or to the stability of one’s world. At the time of a traumatic event, the person experiencing the event might feel numb and, therefore, not know how to respond. Later on, memories of the trauma can bring out feelings of helplessness, fear, and even horror—as if the person were reliving the trauma all over again.
36 Picture This: Veteran Mental Health Challenges and Solutions
End Notes:
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Use Mass Approaches to Challenge the Stigma of Mental
Illness,” Psychiatric Services 57 (2006): 393 – 398.
Corrigan, Patrick W., and Janessa R. Shapiro, “Measuring the
Impact of Programs That Challenge the Public Stigma of
Mental Illness,” Clinical Psychology Review 30 (2010): 907 – 922.
Dickstein, Benjamin D., Dawne S. Vogt, Sonia Handa,
and Brett T. Litz, “Targeting Self-Stigma in Returning
Military Personnel and Veterans: A Review of Intervention
Strategies,” Military Psychology 22 (2010): 224 – 236.
Edlund, Mark J., John C. Fortney, Christina M. Reaves,
Jeffrey M. Pyne, and Dinesh Mittal, “Beliefs About
Depression and Depression Treatment Among Depressed
Veterans,” Medical Care 46 (2008): 581 – 589.
Gallup, “Listening to the Voices of Veterans, Focus Group
Report for the Substance Abuse and Mental Health
Services Administration” (March 2010).
Hoge, Charles W., Carl A. Castro, Stephen C. Messer, Dennis
McGurk, Dave I. Cotting, and Robert L. Koffman, “Combat
Duty in Iraq and Afghanistan, Mental Health Problems,
and Barriers to Care,” New England Journal of Medicine 351
(2004): 13 – 22.
Institute of Medicine (IOM), Returning Home from Iraq and
Afghanistan: Preliminary Assessment of Readjustment Needs
of Veterans, Service Members, and Their Families (Washington,
D.C.: The National Academies Press, 2010), 19 – 20.
Kerfoot, Karin E., Ismene L. Petrakis, and Robert A.
Rosenheck, “Dual Diagnosis in an Aging Population:
Prevalence of Psychiatric Disorders, Co-morbid Substance
Abuse, and Mental Health Service Utilization in the
Department of Veterans Affairs” (December 2010).
Lindley, Steven, Holly Cacciapaglia, Delilah Noronha, Eve
Carlson, and Alan Schatzberg, “Monitoring Mental Health
Treatment Acceptance and Initial Treatment Adherence in
Veterans,” Annals of the New York Academy of Sciences 1208
(2010): 104 – 113.
Maguen, Shira, Li Ren, Jeane O. Bosch, Charles R. Marmar,
and Karen H. Seal, “Gender Differences in Mental Health
Diagnoses Among Iraq and Afghanistan Veterans Enrolled
in Veterans Affairs Health Care,” American Journal of Public
Health 100 (2010): 2450 – 2456.
Maguen, Shira, Jeremiah A. Schumm, Rebecca L. Norris,
Casey Taft, Lynda A. King, Daniel W. King, and Brett T.
Litz, “Predictors of Mental and Physical Health Service
Utilization Among Vietnam Veterans,” Psychological Services
4 (2007): 168 – 180.
McFall, Miles, Carol Malte, Alan Fontana, and Robert A.
Rosenheck, “Effects of an Outreach Intervention on Use of
Mental Health Services by Veterans With Posttraumatic Stress
Disorder,” Psychiatric Services 5 (March 2000): 369 – 374.
Pietrzak, Robert H., Douglas C. Johnson, Marc B. Goldstein,
James C. Malley, and Steven M. Southwick, “Perceived
Stigma and Barriers to Mental Health Care Utilization Among
OEF-OIF Veterans,” Psychiatric Services 60 (2009): 1118 – 1122.
Ramchaud, Rajeev, Terry L. Schell, Benjamin R. Karney,
Karen Chan Osilla, Rachel M. Burns, and Leah Barnes
Caldarone, “Disparate Prevalence Estimates of PTSD
Among Service Members Who Served in Iraq and
Afghanistan: Possible Explanations,” Journal of Traumatic
Stress 23 (2010): 55 – 68.
Seal, Karen H., Thomas J. Metzler, Kristian S. Gima, Daniel
Bertenthal, Shira Maguen, and Charles R. Marmar, “Trends
and Risk Factors for Mental Health Diagnoses Among Iraq
and Afghanistan Veterans Using Department of Veterans
Affairs Health Care, 2002–2008,” American Journal of Public
Health 99 (2009): 1 – 8.
37
Seal, Karen H., Shira Maguen, Beth Cohen, Kristian S. Gima,
Thomas J. Metzler, Li Ren, Daniel Bertenthal, and Charles R.
Marmar, “VA Mental Health Services Utilization in Iraq and
Afghanistan Veterans in the First Year of Receiving New
Mental Health Diagnoses,” Journal of Traumatic Stress 23
(2010): 5 – 16.
Stecker, Tracy, John C. Fortney, Francis Hamilton, and Icek
Ajzen, “An Assessment of Beliefs About Mental Health Care
Among Veterans Who Served in Iraq,” Psychiatric Services,
58 (October 2007): 45 – 49.
Stecker, Tracy, John Fortney, Francis Hamilton, Cathy D.
Sherbourne, and Icek Ajzen, “Engagement in Mental Health
Treatment Among Veterans Returning from Iraq,” Patient
Preference and Adherence 4 (2010): 45 – 49.
Swords to Plowshares, “Combat to Community: Facts
and Figures of Post-9/11 Veterans and Their Families”
(January 2011).
Tanielian, T., and L. H. Jaycox, Invisible Wounds of War:
Psychological and Cognitive Injuries, Their Consequences,
and Services to Assist Recovery (Arlington, VA: RAND Corp.,
2008).
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38 Picture This: Veteran Mental Health Challenges and Solutions
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