By Hilda R. Heady, MSW 2005 NRHA President Associate Vice President for Rural Health West Virginia...
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Transcript of By Hilda R. Heady, MSW 2005 NRHA President Associate Vice President for Rural Health West Virginia...
By Hilda R. Heady, MSW2005 NRHA President
Associate Vice President for Rural HealthWest Virginia University
Our Invisible Heroes-Rural Veterans: A Special Concern for
Rural Health Advocates
The Message
1. There is a never-changing role of rural people in the military and rural people are disproportionately represented among veterans.
2. Community based services vary across the country for these rural veterans and there are training implications for the healthcare workforce to serve these veterans.
3. We need to be concerned about the availability and quality of community based services
“To care for him who shall have borne the battle, and for his
widow, and his orphan.”
Abraham LincolnSecond Inaugural Address
March 4, 1865
“Let those West Virginian hillbillies go get shot, they
won’t take me.”
Unidentified college studentThe Washington
Monthly/April 1972
“PTSD is the price of war. Its cost to everyone involved is chronic in
nature. At the least, those affected deserve intensive therapy without
fear of reprisal.”
Mike Magee, Health Politics,
September 1, 2004
Rural people value service to others and military
service is just another way to serve
So who are our
Veterans?
States with % of Veterans > the National Average of 12.7%, 1990 - 2000
14.1%Colorado15%Arizona*
14.2%South Carolina15.1%Virginia
14.2%Arkansas15.1%Washington
14.4%West Virginia15.1%Oregon
14.5%South Dakota15.3%Florida
14.7%New Mexico15.9%Maine
14.8%Oklahoma16%Wyoming
14.8%Idaho16.1%Nevada
15%New Hampshire16.2%Montana
SF-36: Physical and Mental Health of Veterans, Rural VS Urban
5045.644.5Mental Health
503733Physical Health
All U.S.Adults
UrbanVeterans
RuralVeterans
Average Score for 8 Measurements of Physical and Mental Health
Veterans and Signature Damage (Source: Craig Hyams, Veterans Health Administration)
• Each war has a signature wound
• Military physicians note signature wounds and researcher study them
• Many veterans suffer these wounds
Signature Damage or Wounds
• Medical science learns and benefits from treating such wounds over time
• The longer veterans live with such wounds, the greater the contribution to the medical science knowledge base
World War I “doughboys” in the infirmary line after being gassed
Traumatic Brain Injury
Traumatic Brain Injury
High tech body armor is saving lives and resulting in TBI and possibly PTSD
TBI can present life-long impairments and disabilities: physical, cognitive, behavioral, emotional, and social
TBI Complications
• Cognitive issues may impact treatment of other diseases and injuries
• Cumulative effect as the veteran may experience additional TBI or emotional trauma
• TBI and PTSD can go hand in hand
• Potential increased risk of Alzheimer’s due to interaction of the susceptibility gene (ApOE 4) and TBI
TBI Services
• Defense and Veterans Brain Injury Center
• TBI care network to augment VA services
• 10 national centers (9 VA and 1 civilian)
• VHA TBI Case managers network
Defense and Veterans Brain Injury Center Network
The Face of the New
American MilitaryFamily
“IT’S NOT YOUR FATHER’S VA”
• Currently, women make up approximately 15 percent of the active force, are serving in all branches of the military, and are eligible for assignment in most military occupational specialties except for direct combat roles.
• By the year 2010, the women veteran population is projected to be over 10 percent of the total veteran population.
(Source: Center for Women Veterans - http://www1.va.gov/womenvet/ )
Community Based ApproachesNeed to include self-helporganizations for veterans and their families
www.woundedwarriorproject.org
Who provides their care?
• VA hospitals and medical centers
• Vet Outreach Centers
• Community Health Centers
• CBOCs
• Private Providers
Number of Vet Centers, CBOCs, VAMCs by States with Highest Veteran Populations
State Vet Pop CBOCs Vet Ctrs VAMCs
Montana 16.2% 10 2 1
Nevada 16.1% 4 3 2
Wyoming 16% 7 2 2
Maine 15.9% 5 5 1
Florida 15.3% 31 13 6
Oregon 15.1% 9 4 2
Wash. 15.1% 8 5 5
Virginia 15.1% 5 4 3
Arizona 15% 15 5 3
Number of Vet Centers, CBOCs, VAMCs by States with Highest Veteran Populations
State Vet Pop CBOCs Vet Ctrs VAMCs
N Hampshire 15% 5 1 1
Idaho 14.8% 3 3 1
Oklahoma 14.8% 2 3 2
New Mexico 14.7% 13 3 1
So Dakota 14.5% 8 3 3
W Virginia 14.4% 5 9 4
Arkansas 14.2% 9 1 3
So Carolina 14.2% 9 3 2
Colorado 14.1% 11 6 2
Budget Considerations
• Baby Boomer veterans are aging and putting pressure on all systems of care
• We are continuing to create veterans
• From 1996 to 2004 the VA experienced an increase of vets seeking care by 134%
• The VA’s budget from 1996 to 2004 increased by 44%
Iraq KIA Disproportionately from Non-metro counties
• Between March 2003, and March 2004, 29% of the 600 soldiers killed in action in Iraq were from non-metro counties
• By contrast, 19% of the population 18-55 years of age live in 2,396 non-metro counties and 81% live in 836 metro counties
Killed in Iraq as of 2/2/04
519TOTAL
156> 100,0002040,000 – 50,000
690,000 – 100,0002330,000 – 40,000
1580,000 – 90,0003620,000 – 30,000
1070,000 – 80,0006310,000 – 20,000
960,000 – 70,0001241,000 – 10,000
2050,000 – 60,000430 – 1,000
Total Killed
Hometown Population Range
Total Killed
Hometown Population Range
PTSD Study, 1988
• Vietnam Veterans with PTSD– 15.2% of male Vietnam Veterans– 8.5% of female Vietnam Veterans
• Estimated number of Vietnam Veterans with full or partial PTSD = 1.5M
VA Commissioned PTSD Study by the Institute of Medicine
June 16, 2006
“The committee wrote that because all veterans deployed to a war zone are at risk for the development of PTSD, it would be prudent for health professionals to query veterans about their wartime experiences and their symptoms, when presenting at primary care and other health facilities (inpatient or outpatient).”
U.S. Army has begun to Study Mental Health Issues
21.5Suicide rate, U.S., persons 18-34, 2001
10.7Suicide rate, U.S. civilian population, 2001
11.9Suicide rate for whole U.S. army, 1995-2002
12.8Suicide rate for whole U.S. army, 2003
17.3Suicide rate for soldiers in Iraq and Kuwait, 2003
Rate per 100,000
Suicide
Pre and Post Deployment Studies of Iraq Soldiers
Exposure to combat:
• Doubles the rate of PTSD
• Increases major depression
• Substance Abuse
• Impairment in social functioning (family)
• Impairment in ability to work
• Increases use of health care services
Pre and Post Deployment Studies
• Pre and Post studies showed increase rate of mental disorders from 9.3% to 16%
• Rate of PTSD directly correlates to intensity of wartime experience
• Rates are likely to be understated
Veterans with Active Mental Health Issues
• 38% lack trust in mental health professionals
• 41% are embarrassed to seek help
• 50% felt seeking help would damaged their careers
• 65% feared being labeled as weak
Males with Active Mental Health Issues
• 30% male civilians seek treatment
• Less than 20% servicemen seek treatment
Implications for Families of Vietnam Veterans
• War related PTSD impairs parenting (long distant parenting, emotional distancing, abuse, etc.
• Rates of suicide of children of PTSD war veterans increases (Australian study showed 3 times civilian rates)
• Divorce rates four times average rate for civilian population
The Bottom line….
• VA services are not enough…there are too many to serve and too many are hidden
• “The sticking point is skepticism among military personnel that the use of mental health services can remain confidential.”
And they are aging
Vietnam era veterans represent the largest veteran population at 8.4 million or 31.7% of the total veteran population
Veterans Integrated Service Networks
NRHA is working to bring this issue to the American
conscience
NRHA Efforts
• NRHA now over 10, 000 members, was the first on March 29, 2001 US Senate Special Committee on Aging, “Healthy Aging in Rural America” testimony to include concerns for aging rural veterans
• April 19, 2004 Congressional staff hearing Congressional Rural Caucus
• July 2004 Rural Health Policy passes policy paper on rural veterans
NRHA Efforts
• November 11, 2004 NRHA press campaign regarding rural veterans in observance of Veterans Day
• NRHA leadership delivers national speeches on rural veterans’ issues
• January 31, 2006 Press release on TBI and rural veterans
NRHA Efforts
• Technical Assistance to non-VA health care providers responding to VA requests for proposals
• Currently producing a manual on contracting with the VA
• Staff and leadership maintain contact with congressional staff and other organizations on this issue.
So what can I do?
• If you have a veteran in your family, thank him or her.
• If you don’t know, find out if you do, and then thank him or her.
• Help spread the word and knowledge about the needs of rural veterans
So What Can I Do?
• Contact your congressional delegation asking for a congressional hearing on the needs of rural veterans
• Contact local veteran organizations and let them know that NRHA cares about rural veterans
• Include workshops at your conferences on rural vets’ needs and issues.
So What Can I Do?
• Join NRHA or a veterans group and get involved
• Don’t forget the rural vet’s family members who need support and knowledge, as they may be his or her only system of support and care.