Army OneSource Behavioral Health Campaign:Issues of Women Returning

from Combat

Paula McBrideCommunity Support Coordinator Oklahoma &

Arkansas

Objectives

• 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

Behavioral Health Campaign

• 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

A Different War

• 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

Impact on Service Members

Over 1 ½ million have served in Iraq and Afghanistan

• 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

Public Health Issue

• 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

DoD and VA Data

• 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

Women Using the VA

• 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

Veterans: Women vs. Men

• 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%

Mental Health Diagnosis Reported Among OEF/OIF Veterans

Women vs. Men

• 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%

PTSD and Women Veterans

• 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

Other PTSD Risk Factors

• No clear relationship to level of education• Divorced or legally separated veterans at

greater risk than married or single• No significant difference by race

Presentation and Diagnosis

• 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

Focus Group Conducted:Health Concerns

• Disrupted menstrual cycles• Exposure to prisoners and animals• Sexual harassment/assault• Combat-related fear of death

Post-deployment

• Fertility issues/miscarriages• Lack of sexual interest• Overprotective of their children

Barriers to Care

• Surrounded by men• Guilt• Denial

Military Culture

• 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

Boots on the Ground:One Woman’s Point of ViewLT Elizabeth Marks, USNR

Women Enlist Over Time

• 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

Military Culture and Women

Some people:• Believe in the Boy’s Club or Rite of Passage• Consider women’s physical and

psychological characteristics incompatibility leads to lessening of standards

• Believe women are a distraction to the male warrior who wants to protect

• Believe in stereotyping female roles and jobs• Frustrated by accommodating female

presence in barracks

Challenges

• Aggressive vs. emotional• Isolation and lack of camaraderie• Socialization with men• Competition for recognition• “Becoming one of the guys”• Garnering too much attention

Sexual Stigmas

• Sexual assault• Risk working environment, reputation and

promotions• Pregnancy

• No-sex policy• Risk being sent home• Jeopardizing a unit

Issues

• Single mothers• Pre-deployment• Deployment• Reintegration• Wanting to go back• Buying weapons• Getting into trouble• Adrenaline rush• Isolation• Anger

Barriers to Mental Health Care

• 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

Mental Health Care Considerations

• 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

Mental Health Care Considerations

• 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

TRICARE

• 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

TRICARE

• Regions: North, South and West• Options: Prime, Standard, Extra and Reserve

Select• Services: Pharmacy, Inpatient and

Outpatient• Becoming a provider

US Department of Veterans Affairs

• 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

VA Seamless Transition Program Manager

• 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

Additional Information and Resources

• Awareness Campaign Folder• Awareness Campaign Online Course• Awareness Campaign Handouts

Paula McBrideArmy OneSource

Community Support Coordinator

Oklahoma & Arkansas

405.471.7750Paula.McBride@serco-

na.com