Presented by: Deloria R. Wilson, Ph.D. Warrior Resiliency Program

1. Military Culture, Mental Health and Law Enforcement Crisis Intervention Team International Conference 1 June 2010 Deloria R. Wilson, Ph.D. Warrior Resiliency Program San Antonio Texas 210-424-8946

2. Disclaimer Many slides were derived from staff at the Center for Deployment Psychology (CDP) and other Experts. The views and opinions expressed in this presentation are solely those of the author and do not reflect an endorsement by the U.S. Government, DoD, Department of the Army or the Warrior Resiliency Program.

3. Military Culture Some similarities with Law Enforcement

4. Military and Law Enforcement

5. Culture-Similarities Service often before self Seeking challenge Emotional regulation Multiple exposure to high stress situations

8. Military Culture-Uniqueness Variation across services Variation with AFSC, MOS, etc. (jobs) Variation in combat exposure Subcultures

9. Combat Stress and PTSD

10. A Continuum of Combat Reactions Mission Event Combat Stress Acute Stress PTSD Combat Ready Adjustment Adjustment

11. A Continuum of Combat Reactions Mission Event Combat Stress Acute Stress PTSD Combat Ready Adjustment Adjustment

12. Typical Post Deployment Adjustment Issues Problems sleeping Irritability/Anger More (assertive) driving? Disturbing dreams/images Feeling out of place Physical/Emotional/Cognitive Fatigue Range of emotions including numbness

13. Yellow Flags Increased drinking More withdrawn Some family difficulties Reduced work performance Occasionally late to work/appointments Hyper-vigilance / arousal Discipline Problems

14. Red Flags Alcohol Abuse/Dependence Behavior requiring paperwork Signs for Depression/Anxiety Psychotic Behavior Signs of suicidal ideation Consistently unable to control anger Increasing withdrawal and isolation

15. PTSD Symptoms Impact onSocial Support PTSD and associated problems can reduce available social support Emotional numbing Detachment Hostility and aggression Distrust of others Social problem solving deficits As symptoms persist, individuals may tire of providing support or exhaust resources CDP

16. Relation between PTSD and Social Support One of the strongest predictors of recovery following trauma is social support Deterioration of perceived social support over time may contribute to increased symptoms In general, families provide a primary source of social support, with intimate partners typically the chief source

17. Other Types of Deployment Stress

18. Deployment Cycle and Family Considerations

19. Why is the family important? Each gear impacts the ability of the service member to complete the Mission.

20. Stressors in the Deployment Cycle Pre-deployment Notification Preparation Training Return from Deployment Reunion Reintegration Deployment Departure Sustainment Combat and conflict

21. Pre-Deployment Stressors Preparedness Shifting expectations Changes in family dynamics Anticipation of threats Perception of Mission Lack of information/Rumors Briefing by David Riggs, June 2007

22. Pre-Deployment Stressors - Spouses Confusion Denial Resentment Arguing Worrying Planning Briefing by Doug Lehman, May 2008

24. Regression

25. Anger Outbursts

26. Sadness

27. Surprise

28. Guilt

29. Behavioral problemsBriefing by Doug Lehman, May 2008

30. Pre-Deployment Stressors - Adolescents “I don’t care” Fear of rejection Denial of feelings Anger Higher value on friends Briefing by Doug Lehman, May 2008

31. Stressors in the Deployment Cycle Pre-deployment Notification Preparation Training Return from Deployment Reunion Reintegration Deployment Departure Sustainment Combat and conflict

32. Stressors in the Deployment Cycle Pre-deployment Notification Preparation Training Return from Deployment Reunion Reintegration Deployment Departure Sustainment Combat and conflict

33. Common Stressors SM CDP Editors Charles Figley and William Nash, Combat Stress Injury (2007)

34. Change in Mindset: SM CDP

35. Family Re-Adjustmentcan be like driving in San Antonio

36. It can be hard to figure out how to merge safely

37. Many times families will confuse normal adjustment issues for serious problems or vice versa.

38. Most service members and families expect that the service member or the family will remain unchanged.

39. Knowing the difference between expected adjustment issues and mental health problems often depends on time.

40. “IF YOU WENT TO WAR AND WEREN’T CHANGED, YOU WERE CRAZY BEFORE YOU LEFT.” Ch. Morris, Minnesotata

41. Changes for Family Family has… Service Member’s Return can… • New routines • New responsibilities • More independence and confidence • Made many sacrifices • Worried, felt lonely • Gone through milestones that were missed • Interrupt routine • Disrupt space • Throw off decision making • Cause family to walk on tip toes • Not make everything perfect • Not replace the sacrifices and missed milestones CDP

42. Community Partnering to Maximize Positive Outcome

43. Common Issues during Crises Not necessarily dissimilar than general civilian population Domestic issues/ Relationship issues Financial problems Legal Issues Circumstances may be different May not have family nearby Possible exposure to violence in theater Injured/Wounded Service Member

44. Get to know Military Leadership Military Police Military Mental Health/Medical VA and other veteran’s resources On Line and Community Resources

45. They May Be Able to Help With Information about service member and or family Information about what member’s unit has gone through Links to family and other resources Possibly medical and personal history Resources to collaborate with training Follow-through after an event

46. Discussion and Questions