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The effect on military returning home and PTSD. CHCCS426B Provide support and care relating to loss and grief

The effect on military returning home and PTSD. CHCCS426B Provide support and care relating to loss and grief

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    The Loss and Grief of Military Returning Home.. The Loss and Grief of Military Returning Home.. Presentation Transcript

    • The Loss and Grief of Military returning home. CHCCS426B Provide support and care relating to loss and grief. Rebecca (Beccy) Dixon
    • Effects of impact of specific loss and features of grief (including complex grief), bereavement and trauma at the individual, family and community level. Whilst many personnel leaving the military may initially experience some uncertainty and a loss of confidence, most make the adjustment successfully. At other times, the problems may not go away – and for some, become worse. Some of the reasons why making the transition can be challenging include: The military has a unique culture, one that is very different to civilian culture. Some discharged members may experience ‘culture shock’ as they try to adjust to civilian life and a civilian workplace. These ones have strong links to PTSD (Post Traumatic Stress Disorder)
    • Effects of impact of specific loss and features of grief (including complex grief), bereavement and trauma at the individual, family and community level. Some of the social issues for military personnel making the transition to civilian life? • Have trouble readjusting to family they have not lived with for a long period, this can include parenting responsibilities. • Feel cut off from people or feel unable to connect with anyone. • Find it hard to accept the difference between civilian life and experiences in military service. • Have concerns about supporting the family, possibly on a lower wage. • Have financial problems.
    • Effects of impact of specific loss and features of grief (including complex grief), bereavement and trauma at the individual, family and community level. Some more of the social issues for military personnel making the transition to civilian life. • Feel less valued or appreciated with a sense of diminished status in life. • Find it challenging making new friends, and coping without old friends. • Find civilian life chaotic due to perceived lack of structure, order, and direction. • Not knowing what to do with free time. • Feel ashamed, angry or humiliated if they left the military involuntarily. • Experience a loss of role, identity or purpose. • Find it difficult getting a new job. Further, a new job can be challenging if they have to readapt or learn new skills.
    • Things commonly recognised with having difficulty fitting back into civilian life & PTSD. • Re-experiencing the event (visual images when either awake or asleep). • Intrusive thoughts about the event. • A desire to avoid anything associated to the event. • Feelings of panic or being highly anxious. • Feeling sad, tearful, hopeless or down. • Feeling disorientated or that you have changed as a person.
    • Things commonly recognised with having difficulty fitting back into civilian life & PTSD. • Increase alcohol intake or misuse of other substances such as nicotine. • Feelings of guilt or anger. • Trouble concentrating or poor memory. • Sleep disturbance, excessive alertness or being easily startled. • Feeling unable to control your moods, especially anger. • Having difficulties managing relationships with others.
    • What is PTSD (Posttraumatic Stress Disorder)? PTSD, or Posttraumatic Stress Disorder, is a Mental Health disorder that can occur following the experience or witnessing of a life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, or physical or sexual assault in adult or childhood. Most survivors of trauma return to normal given a little time. However, some people will have stress reactions that do not go away on their own, or may even get worse over time. These individuals may develop PTSD. People who suffer from PTSD often relive the experience through nightmares and flashbacks, have difficulty sleeping, and feel detached or estranged, and these symptoms can be severe enough and last long enough to significantly impair the person’s daily life.
    • What is PTSD (Posttraumatic Stress Disorder)? PTSD is complicated by the fact that people with PTSD often may develop additional disorders such as depression, substance abuse, problems of memory and cognition, and other problems of physical and mental health. The disorder is also associated with impairment of the person’s ability to function in social or family life, including occupational instability, marital problems and divorces and difficulties in parenting. Unfortunately, many people do not know that they have PTSD or do not seek treatment. With PTSD flashbacks can happen with the most simple tasks that most people take for granted each day. Warning the following clip –could generate emotional reactions in someone experiencing PTSD • Flashback RUN this is a clip of how easy it is for someone to have a flashback. http://www.youtube.com/watch?v=O9kvgEMQWeM
    • PTSD Affects Men and Women Differently Researchers now realize that there are important differences in the way Post Traumatic Stress Disorder affects men and women. They have found that women with PTSD are more likely to suffer from the following symptoms and health conditions than men with PTSD: • Anxiety disorders • Avoidance and numbness • Gastrointestinal effects • Arthritis • Cardiovascular disease • Reproductive effects • Cancer • Low blood pressure • Fatigue Men with PTSD are more likely to experience the following symptoms more than women: • Anger • Irritability • Substance abuse http://www.militarymentalhealth.org/blog/2012/06/ptsd-affects-men-and-women-differently
    • Statistics of PTSD of Australian Military. 6.4% 56.0% 31.0% Percentage of ages,Vietnam War and Gulf War Ages 16 to 85 Vietnam War Gulf War 43 70 79 62 81 85 123 123 128 174 0 20 40 60 80 100 120 140 160 180 200 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Statistics of returning Military with PTSD between 2002-2011 http://pickingupthepeaces.org.au/post-traumatic-stress-disorder-statistics/ http://www.abc.net.au/news/2012-04-11/aussie-soldiers-struggling-with-combat-stress/3944270
    • You will notice the figures from the Vietnam War are higher as the return home was only the beginning of a long period of readjustment. For a long time after the war large numbers of Vietnam veterans felt that many in Australia blamed them, rather than politicians, for the war and the way it had been conducted. Some veterans recall being abused as baby killers, rapists and murderers on their return. Images of the war, many still familiar, like this one of children burned by napalm had an effect on public opinion and public understanding.
    • Effects and impact of loss, grief and bereavement on social and emotional health and well-being. Loss and the resulting grief response can impact a person’s mental and behavioural wellness. Repressed, unrecognized or unresolved grief can cause personal anguish, increased anxiety, multiple physical complaints, functional impairment, strained relationships, marital issues, disrupted sleep, increased substance abuse—tobacco, alcohol, drugs, tranquilizers; clinical depression, and an increased mortality from heart disease and suicide. http://www.youtube.com/watch?v=Ld8yOgfaWJI The effects of combat stress on soldiers. Screening for mental health.
    • Suicide with PTSD • MORE Australian Defence Force employees have died by suicide over the past decade than have died on the front line.. • According to the ADF, 61 members have died by suicide since 2003, while there were 37 deaths of members on the front line in Afghanistan in the same period. http://www.heraldsun.com.au/news/victoria/at-least-15-ex-servicemen-have-committed-suicide-since- christmas-in-the-terrible-hidden-toll-of-war/story-e6frf7kx-1226598932503
    • A military person can suffer from grief and loss before returning home. These are because of what they have seen and or have done while serving. Some of these can be and not limited to the following: • Injuries sustained while serving vision, hearing, wounds, missing of limb/limbs or mental capacity, chronic pain or illness; political torture. • Losing a job or role redefinition, • Getting ready for re-entry adjustment to home culture after serving.
    • A military person can suffer from grief and loss before returning home. These are because of what they have seen and or have done while serving. Some of these can be and not limited to the following: • Socioeconomics circumstances of the military. • Loss of fellow soldier/s • If leaving forces was not of their decision. • Knowing they are losing the structure/routine of military life.
    • Engaging with individuals experiencing loss grief trauma and bereavement with empathy, sensitivity, professionalism and courtesy. • Identifying and affirming the grieving person’s strengths and opportunities. • Empathetic Listening. • Using questions and concreteness to focus on identifying immediate needs and concerns. • Helping manage overwhelming feelings to facilitate coping.
    • Engaging with individuals experiencing loss grief trauma and bereavement with empathy, sensitivity, professionalism and courtesy. • Unconditional positive regard for the client. • Facilitating informed choices by the client. • Non-judgemental approach. • Genuineness of response.
    • Responding appropriately including culturally appropriate boundaries, appropriate communication techniques and skills, verbal and non- verbal approaches and responses to loss grief and trauma. This can be obtained by: • Verbal approaches that support empathy, sensitivity, professionalism and courtesy. • Facial expressions, gestures, eye contact, and personal space that support empathy, sensitivity, professionalism and courtesy. • Being respectful and understanding of one’s culture and beliefs.
    • Distinctive social, cultural, ethnic and spiritual differences in loss, grief and bereavement. Some of these are: • Cultural expressions of grief and bereavement. • Reactions to loss. • Individual expressions of grief and bereavement. • Coping strategies. • Spiritual and religious beliefs relating to loss, grief and bereavement.
    • Potential reactions to loss associated expressions of grief and bereavement. • Symptoms of traumatic distress/stress • Complex grieving. • Possibilities of substance abuse. • Possibilities of gambling. • Symptoms of separation distress. • Suicidal ideation.
    • Strategies for formal and informal support for grief bereavement support. • Aboriginal health services. • Emergency services. • Empathic listening. • General practitioners. • Group grief counselling. • Health services.
    • Strategies for formal and informal support for grief bereavement support. • Individual grief counselling. • Palliative care services and teams. • Psychological services. • Spiritual and faith care services. • Support groups in person and online. • Telephone counselling services.
    • Types of treatment for post-traumatic stress disorder (PTSD) • Trauma-focused cognitive-behavioural therapy. Cognitive-behavioural therapy for PTSD and trauma involves carefully and gradually “exposing” yourself to thoughts, feelings, and situations that remind you of the trauma. Therapy also involves identifying upsetting thoughts about the traumatic event–particularly thoughts that are distorted and irrational—and replacing them with more balanced picture.
    • Types of treatment for post-traumatic stress disorder (PTSD) • Medication is sometimes prescribed to people with PTSD to relieve secondary symptoms of depression or anxiety. Antidepressants such as Prozac and Zoloft are the medications most commonly used for PTSD. While antidepressants may help you feel less sad, worried, or on edge, they do not treat the causes of PTSD.
    • Types of treatment for post-traumatic stress disorder (PTSD) • EMDR (Eye Movement Desensitization and Reprocessing) incorporates elements of cognitive-behavioural therapy with eye movements or other forms of rhythmic, left-right stimulation, such as hand taps or sounds. Eye movements and other bilateral forms of stimulation are thought to work by “unfreezing” the brain’s information processing system, which is interrupted in times of extreme stress.
    • Types of treatment for post-traumatic stress disorder (PTSD) • Family therapy. Since PTSD affects both you and those close to you, family therapy can be especially productive. Family therapy can help your loved ones understand what you’re going through. It can also help everyone in the family communicate better and work through relationship problems caused by PTSD symptoms.
    • Available grief and bereavement care service and information resources. • Internet resources. • Fact sheets. • Information packs. • Government Agencies. • Health Care Providers.
    • Available grief and bereavement care service and information resources. • http://www.rslqld.org/community-initiatives/soldier-recovery-centres/ • http://www.dva.gov.au/health_and_wellbeing/health_programs/vvcs/services/Pages/group.aspx • https://www.facebook.com/pages/Australian-Veterans-PTSD-Network/137276826365412 • http://qldtpi.org.au/
    • Available grief and bereavement care service and information resources. • Department of Veterans Affairs ~ Level 5/12 Short Street, Southport Ph: 1800555254 or 56300203 • Australian Federation of Totally and Permanently Incapacitated Ex Servicemen and Women Ex- Serviceman Ph: 5571 2680 • Southport RSL ~ 5552 4200 • Veterans & Veterans Family Counselling Service ~ 12 Short St, Southport Ph: 5630 0204 • Men's Shed: http://www.countryparadiseparkland.com/#!mens-shed/cir1/c1tsl/i41znf Nerang
    • Issues related to difficulties in dealing with loss and grief including suicide risk, stress vulnerability factors, referring individuals with mental illness. • Alcohol and drug use. • Medication use. • Coping skills. • Social support. • Meaningful activities. • Suicidal intentions as not being able to fit back into civilian life.
    • Referring to appropriate grief and bereavement care services and resources. When identify the situations that may indicate that you need to refer your client. • If the client is perceived as a challenge. It can be a chance to further the development of new skills and knowledge. This can be done with supervisory assistance. • If you are clear and certain that you cannot work with a particular client for a strongly personal reason: (e.g.: triggers, lack of knowledge) referral is the ethical thing to do. • It should be done respectfully, promptly and clearly
    • Referring to appropriate grief and bereavement care services and resources. When identify the situations that may indicate that you need to refer your client. Referral procedures • When considering referral, you will need to consider your organisation’s procedures for referring clients to other agencies or individual service providers. You also need to be aware of the other agency’s referral procedures and guidelines for maintaining confidentiality.
    • Referring to appropriate grief and bereavement care services and resources. When identify the situations that may indicate that you need to refer your client. Involving clients in the process • Clients have a right to be involved in assessing the suitability of services to which they are referred, just as they have a right to be involved in identifying their needs, setting their goals and participating in decision-making on issues impacting on their lives. • Clients may like to know more about the service to which you would like to refer them, so they can decide on the type and amount of information to be disclosed about them to the service. They may like to see information on the organisation’s role, responsibilities and expectations of service users, as well as the way this service will fit into their support network. • Active participation by clients in decision-making regarding referral to other services may influence how comfortable clients will feel about accessing this service.
    • Documentation requirements, sharing and accessing client information with appropriate services. • Counsellors should ensure that records of the client’s identity are kept separately from any case notes. • Arrangements must be made for the safe disposal of client’s records, especially in the event of the counsellor’s incapacity or death. • Care must be taken to ensure that personally identifiable information is not transmitted through overlapping networks of confidential relationships.
    • Documentation requirements, sharing and accessing client information with appropriate services. • Practitioners should take into account their responsibilities and their clients “rights under data protection legislation and other legal requirements. • Any discussion of their counselling work with other professionals should be purposeful and not trivialising. • When case materials is used for studies, reports or publications the clients informed consent must be obtained wherever possible and their identity must be effectively disguised.
    • Documentation requirements, sharing and accessing client information with appropriate services. • Counsellors must pay particular attention to protecting the identity of clients. • Practitioners are required to keep appropriate records of their work with clients. • Records include client notes, emails, and transcripts of SMS communication. • All records should be accurate, respectful of clients and colleagues and protected from unauthorised disclosure.
    • Risks associated with grief and bereavement support work. Some of the risks may include: • Compassion fatigue. • Vicarious traumatisation. • Burnout. • Lack of adequate supervision. • Lack of access to external expertise.
    • Accessing appropriate supervision and debriefing in line of work. • Develop a case management plan and review it from time to time. • Obtain internal professional supervision. • Obtain external professional supervision. • Debrief. • Seek colleague support. • Self-reflect.
    • Reviewing and evaluating grief and bereavement support provided. • Duty of care to client. • Self-care.
    • References • https://www.facebook.com/PTSDaware • https://www.facebook.com/pages/Australian-Veterans-PTSD-Network/137276826365412?ref=br_tf • http://pickingupthepeaces.org.au/post-traumatic-stress-disorder-statistics/ • http://www.abc.net.au/news/2012-04-11/aussie-soldiers-struggling-with-combat-stress/3944270 • http://www.militarymentalhealth.org/blog/2012/06/ptsd-affects-men-and-women- differently/#sthash.5nohQ8Ro.dpuf • http://www.youngdiggers.com.au/transition-and-adjustment-civilian-life • http://www.helpguide.org/mental/post_traumatic_stress_disorder_symptoms_treatment.htm • http://www.ptsd.ne.gov/what-is-ptsd.html • http://www.militarymentalhealth.org/blog/2012/06/ptsd-affects-men-and-women-differently/ • http://www.northernstar.com.au/news/defence-loses-more-to-suicide-than-to-enemy/1894959/ • http://www.heraldsun.com.au/news/victoria/at-least-15-ex-servicemen-have-committed-suicide-since- christmas-in-the-terrible-hidden-toll-of-war/story-e6frf7kx-1226598932503