Mental Health Veterans Presentation


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Help for Mental Health Counselors Working with OIF and OEF Veterans

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Mental Health Veterans Presentation

  1. 1. Working With U.S. ArmyVeterans Who Have Served in Iraq and AfghanistanJeannette M. Horton, MA, CDP, LMHCA Honorably Discharged Staff Sergeant, U.S. Army South Korea DMZ, OIF2, OEF7 Veteran
  2. 2. Table of ContentsSection One: Help for Mental Health Counselors Working With OIF/OEF VeteransSection Two: An “On The Go” Special Population Consult for OIF/OEF VeteransSection Three: Referral Information, Community Resources and Help
  3. 3. Section One: Help for Mental Health Counselors Working With OIF/OEF Veterans
  4. 4. PTSD – A Soldier’s Perspective• Bullshit! I was always this angry before! I always drank this much before! You don’t know what its like, so get out of my head and quit telling me that you do know!• SHH! Don’t say that out loud! My unit will think I’m crazy and then I won’t get promoted. My people won’t respect me. Its hard enough being in the military without some damn label following me around.• Me? No way! Guys actually saw other guys get killed! Guys killed people! I didn’t do any of that! I never got off the base! How can I have PTSD? I’m fine! Don’t say that I have PTSD when other people had it so much harder than I did. Focus on them, not on me.• PTSD is for those crazy Vietnam vets.
  5. 5. PTSD – A Soldier’s Perspective• Do I have PTSD? Ok, I hear that word a lot, but what does it really mean? I feel crazy and weird and unhappy all the time, but what am I supposed to do about it!? PTSD is those guys who come home and shoot their wives and kids, right? So how can that be me? I had a good time over there, and I’m doing okay now! (…am I doing okay?)• Yeah, maybe I got that PTSD thing. So what? I still gotta live my life and do my job. Everyone has nightmares. Whatever! I don’t have time to deal with all that crap, I’ve got stuff to do. I don’t want to think about all that bad stuff, and I don’t want to deal with it. Oh, and I resent the hell out of you for thinking that dealing with this stuff is a good idea, too. Why open the can of worms when its fine sitting in the cupboard where it is?
  6. 6. PTSD Triggers for a Soldier• The firing ranges on nearby military bases and firing ranges. Booming in general can trigger hypervigilence.• Hypervigilence = easily spooked! Coming up behind them unexpectedly? Waking them up by shaking them? Please don’t do this.• Seeing convoys of military vehicles on the highway, etc• 21-gun salute, Taps, etc (either in real life or in movies). Graphic war games• Burning fuel/burning garbage smell• Overpasses, heavy/slow traffic, getting into a fender bender.• Certain dates, holidays, anniversaries• “Harissa” is a flavoring/spice combination that is common in Middle Eastern cooking. Its popping up in restaurants here as a savory flavor that can really “take you back.” (savory blend of garlic, hot peppers, thyme, and cloves)• Seeing the U.S. flag waving people on overpasses and being all “yay soldier” or hearing this kind of thing on the radio or television (if you don’t feel proud of your service, this is just annoying and makes you feel bad. Even if you ARE proud, this can bring back memories).
  7. 7. Special Situations To Understand - Age• A soldier can enlist when they are 17YO. If they leave for basic training right away and pick a job with a short training time (i.e. Infantry, Artillery, etc) they can potentially be deployed and experiencing high risk situations before their 18th birthday!• Soldiers that join young and do well will move up in rank. This means increased responsibility at young ages. A 20YO can make Sergeant/E-5 and be in charge of people older and younger than him, have to make intense decisions that impact people’s lives, and have way more responsibility on their shoulders than a civilian 20YO would likely experience.
  8. 8. Special Situations To Understand - Age• Being older doesn’t mean not experiencing hazardous duties and deployments. 55YO+ soldiers still only get around the deployment zone by convoy (all soldiers on a convoy are expected to participate in convoy defense), still guard front gates (which are big targets for suicide bombers), and more and more these older soldiers are being relied upon to train local Iraq and Afghan people to take over security operations due to their experience (which means greater exposure to hazards from infiltrators, not to mention grueling difficult work!).• Older soldiers have also more likely experienced the Gulf War (chemical weapons were commonly used), Bosnia (many soldiers witnessed the after effects of genocide), and other conflicts. This means they have learned different tactics for different conflicts in different political climates – adjusting to OIF/OEF after deployments like this is difficult. Every conflict has different rules and a different environment.
  9. 9. Special Situations To Understand - Homecoming• Coming Home usually is fantastic for most troops…for the first month or two. You come home, there’s lots of ceremonies and awards, soldiers get leave and reintegrate with their families. This is the “honeymoon” period. Soldiers get briefed on PTSD, what that means, are given information on accessing VA services and on what to expect upon returning home (problems with kids, spouses, figuring out what parental/spouse roles to play, old arguments coming back up, infidelity, alcohol/drug use, DV, etc). This happens the first week after soldiers return home.• Month 3 or 4 or 5…honeymoon is over. Now what? Lame job on base, or getting ready for yet another deployment? Maybe you decide to get out of the military? Then what? Spend time with your deployment buddies drinking or be at home with the spouse and kids? Memories memories memories! Running into the families of people that got hurt or killed. Deployment “families” break up as units that bled together get broken up and moved to different units, etc.
  10. 10. Special Situations To Understand - Homecoming• “I’m supposed to be living it up and I don’t know what that is supposed to mean anymore. I used to wear a flak vest and carry a loaded gun and when I spoke people listened because of that. Now I’m just some guy working some job and nobody gives a damn. I’d rather be over there than here, because over there makes sense. Speed limits, lunch breaks, Saturdays, grocery stores, what the hell?” These things DON’T make sense.• Overseas soldiers learned how to get complacent with the idea that they could die at any time. “You can spend all your time worrying about it or you just learn to not care so you can do your job.” This means getting numb, getting tough, working hard and doing your best not to think about it all too much. Trying to NOT live your life this way when you get home is really hard!
  11. 11. Special Situations – Unfinished Business• REGRET. Did you kill someone you weren’t supposed to? Were you not as helpful/on the mark as you were supposed to be, and someone got hurt because of it? Did you use tactics to keep yourself safe that you’re not proud of? (i.e. aiming your .50 cal at innocent civilians so they keep their vehicles away from your convoy and watching little kids start to cry). Did you lose out on the rank you were entitled to because of politics, paperwork issues, etc? Did a fellow soldier mess with you and you didn’t say anything about it? Did you get intimate with a fellow soldier and you shouldn’t have? Were you a good leader to your soldiers, or did you just say ‘yes’ to whatever stupid task your command gave you without sticking up for them?• Returning home can mean a lot of unfinished business that doesn’t ever really get finished.
  12. 12. Understanding The Deployment Family• Even if you really don’t like the people you deploy with, you bond with them. (I hated my shop Lieutenant but I made a baby blanket for his new son anyway. That’s what you do, that’s the ‘rules’.) Platoon sergeants are like fathers and mothers. Your buddies are your brothers and sisters. Your commander may be a dork but he’s a decent guy and he remembers that you’re from Upstate New York, which means a lot. Somebody getting a divorce? We all know about it! Someone have a baby, a cheating spouse, their mom died? We all know about it! Go home on R&R and you married the person you were dating! Wow!• Where are you going to go for Christmas? Why, to work of course! Every day is Monday! That means going to the holiday dinner with your team (assuming a holiday meal is available), because who the heck else are you going to spend it with? Lots of soldiers throw parties, get stuff shipped from overseas and celebrate together intentionally. ITS FUN. This can mean some problems at homecoming too – yeah, its nice being with the spouse and kids, but man, it can’t compare to making s’mores on the exhaust of a HMMVVV and drinking Near-Beer while singing silent night with the crew! Memories, guilt over rather being with them than your family, etc are particularly tough at holiday time for the soldier who comes home.
  13. 13. Understanding The Deployment Family This kind of thing is NORMAL. What ISN’T normal? The soldier that DOESN’T bond with their people, that isolates (its hard to do but it can be done), that doesn’t get mail,that doesn’t BS, that gets ignored as a result. These soldiershave a tougher time coming home than the others – at least the others had buddies to tough it out with. These lonersoldiers had nobody and had to get even more tough, evenmore numb. That makes it harder to reintegrate when they get home.
  14. 14. For Mental Health Counselors• Didn’t deploy? Say so. Its hard seeing a non-veteran counselor when you are a veteran for obvious reasons, but it also can be a good thing – your perspective is not blurred, there’s no semblance of “military rank” hanging around the session, you are a clean slate who is eager to learn. Many people don’t think about this perspective! Remember that you have a kind of advantage by not personally knowing, and remind your soldier-client of this too. It can put your client in a position of power as a teacher of their experience just as you are a teacher/healer, and bringing this idea up to them can be very empowering.• Don’t understand? Ask. Want to go somewhere but you aren’t sure? Ask. Be transparent in your therapy/intervention intentions, regardless of your orientation. Soldiers have a lot of stigma, suspicions and cultural ideas of therapy – tell a soldier what your point is, why you’re asking the questions you’re asking, what your perspective on people is. Be up front and honest about what you’re doing from the very beginning.• KNOW YOUR BIASES. Just like any other population, working with veterans will likely bring up things in you, given all the news, politics, etc. surrounding it.
  15. 15. For Mental Health Counselors - MI• Motivational Interviewing is particularly good, because of its strong adherence to “rolling with resistance.” Just like any client who engages in negative/unhelpful behaviors, soldiers don’t want to hear a lecture. They may even have been lectured more than the average client as a result of their time in the military. Don’t be “The Man.” (Some research is being done which indicates MI is not only a useful ‘pretreatment’ to get reluctant clients involved in regular therapy, but that it can be particularly helpful in helping individual veterans get an idea of what a ‘normal’ person experiences compared to what they are currently experiencing as a means of motivation). (1) (1) Arkowitz, H.; Westra, H.A.; Miller, W.R.; & Rollnick, S. (2008). Motivational interviewing in the treatment of psychological problems. New York: Guilford Press.
  16. 16. For Mental Health Counselors - MI***Elicit-Provide-Elicit (EPE): “Can I tell you a little bit about whatI’ve heard other soldiers’ experiences are like? (Elicit)” “Yeah, Iguess.” “Soldiers tend to think that all this therapy stuff is bullshit(Provide).” “Duh, doc!” “What do you think, knowing that most ofthe people who are doing what you’re doing feel like an idiotsitting in that chair? (Elicit).” (1) - Soldiers just get TOLD, they don’t get a choice most of the time. EPE and asking permission, providing your information and then asking for feedback lets the soldier feel autonomous and empowered.(1) Arkowitz, H.; Westra, H.A.; Miller, W.R.; & Rollnick, S. (2008). Motivational interviewing in the treatment of psychological problems. New York: Guilford Press.
  17. 17. Normalization Helps• “Maybe you didn’t see combat. But you saw photos of dead civilians, you were privy to conversations about intense things, you witnessed extreme poverty and horrific conditions, saw abuse of women and children as a part of everyday culture. THIS HAS AN IMPACT ON A PERSON AFTER A YEAR. You have to become tough in the face of all of this as well. You don’t have to have killed someone point blank for you to not feel good in your head.”• “Feeling like crap after a deployment is actually pretty normal. Its your brain trying to wrap itself around the craziness you experienced. You are not crazy, you are doing the best you can with what you’ve got. If you DIDN’T feel a little funny now that you’re home, that might actually be crazy!”
  18. 18. The Idea of Tool Maintenance• Soldiers are VERY familiar with the idea of taking care of their tools (weapons, vehicles, etc). Leadership takes a very active role in making sure that PMCS (Preventative Maintenance Checks and Services) occurs regularly. Broken/damaged/poorly maintained tools will not hold up to the rigors of a deployment.• Are soldiers not ‘tools’? How can they operate effectively and serve the mission if there is damage somewhere? Experiencing symptoms of PTSD is a sign that not everything is going well, much the same as a dirty rifle at jams all the time. Seeking mental health services can be looked at as a mental PMCS to help a soldier become the best functioning ‘tool’ they can be. (1)• This is not my idea, but came from a colleague - this is a neat way to broach the subject of mental health care to individual soldiers while also serving to break down some of the stigma about mental health that pervades the military. (1) P. D. Fitzgerald (personal communication, June 2011)
  19. 19. Things To Help Your Client Move Forward• The idea of Atonement. Maybe you did some things you aren’t proud of over there, but you can’t go back. What can you do today to “pay it forward”? Can you volunteer, pray, make a commitment to be a better parent and set goals within that commitment, etc? It can be helpful for a soldier that did bad things or has regrets to do something ACTIVE in the present as a way of making amends. (NOT necessarily military oriented. Sometimes breaking a sweat in a food bank can be really healing)• Join military organizations like the VFW, etc to regain that sense of camaraderie and deployment family. This can provide respect from other veterans who have been there (this is a special kind of respect. Even if I’m an OIF vet and he’s a Korean War vet, we understand one another)
  20. 20. Myths – Please Help Stop The Spread of These!• You are a veteran, and so you must be – A hero – Willing to work extremely hard and be self sacrificing all the time (“Well, weren’t you in the army? Doesn’t that mean you never say no?”) – Evil, or at least more likely to respond with violence (You don’t hear baby killer much, but people can be wary of you when they find out where you’ve served) – A natural leader (Soldiers always know what to do) – Struggling with PTSD (“Oh, you were in Afghanistan? You aren’t gonna go ballistic when I make this popcorn are you?”) – Lying (“You’re too young”) – Ultra patriotic (“Ah man, you must really love your country!”)
  21. 21. Myths – Please Help Stop The Spread of These!• You are a veteran, and so you must be – Proud of your service (“Thank you, young man! You must be so proud!”) – More knowledgeable about politics than the average person, or that your personal opinion is somehow more special (“I’ll bet you voted for McCain! What do you think about Libya? Gays in the military sure is a crock, isn’t it?”) – Constantly aware of what is going on ‘over there right now’ even if you have been home for years and refuse to watch the news (“I heard a bad bomb went off somewhere in Iraq last week. Did you hear about it?”) – Willing to answer inappropriate questions in public (“Did you kill anyone? Did you see anyone get killed? Can my four year old son ask you questions while we wait in this line at Safeway?”) – Grateful for all the random strangers that approach you to say thank you, hug you, buy you things (Yes, its kind! Its also really awkward!) – Were DEFINITELY exposed to combat/seeing bad stuff/etc. (Most soldiers see some stuff, but not many see really hardcore stuff.)
  22. 22. Please Don’t Ask• At least, don’t ask us unless you know us really well, we’re somewhere quiet, and you actually are ready to hear the response (this means no asking questions because the story sounds fascinating! I hear more stories from buddies who get asked these questions because the other person thought it would be entertaining) – Did you ever kill anyone? – Did you ever see anyone get killed? – Were you ever shot at? – Do you miss it? – Were you scared? – Why do you think the U.S. went to those countries? – Were you ever ‘messed with’? (i.e. sexually assaulted) (NOTE: This is not to say that counselors can’t ask these questions! This information is intended to enforce the idea of delicacy when approachingthese topics and to help spread the word that asking veterans these questions in the wrong circumstances is not okay.)
  23. 23. Section Two: An “On The Go” SpecialPopulation Consult for OIF/OEF Veterans
  24. 24. Why Does This Matter?• Serving in the military means joining a culture that is just as multifaceted as Hispanic, Asian, Native American, etc.• This culture is highly publicized in news, movies, popular television series and more importantly – locally! But most of it is twisted, stereotyped, opinionated, and dead wrong! The result is that cultural ignorance is alive and well!• Its frustrating. Its pervasive. It impacts the kind of mental health treatment veterans receive. Most importantly, it can impact a veterans’ decision to seek treatment!
  25. 25. Army Rank for Dummies• Enlisted soldiers = everyone who isn’t an officer. Ranked from E1 (Private) through E9 (Sergeant Major).• E1 – E4 will happen automatically if you don’t get in trouble. Anything higher means getting special training and earning rank through a points system.• NCO = NonCommissioned Officer. These are the upper enlisted (Sergeants).• NCOs “Work For A Living.” There is a natural disdain from enlisted soldiers in general towards officers.
  26. 26. Enlisted Rank
  27. 27. Army Rank for Dummies• Officers – the ones in charge of pretty much everything. Ranked from O1 through O10.• 01 – 03 will happen automatically if you don’t get in trouble. You need to have a college degree in order to become an officer and attend special training. Anything higher means getting more special training and earning rank through a political system.• Officers hold command posts.
  28. 28. Officer Rank
  29. 29. Don’t Forget The Other Branches!• Its not only the Army serving in the middle east these days. The Air Force, Marines and Navy all have a very active presence there and quite frequently serve right alongside Army soldiers. They generally have their own branch commands represented where they are stationed, but they also serve and report to the commands of the other branches with whom they are serving.• I had the great opportunity to have two navy personnel and an airman working under me in Afghanistan. They had their own things going with their own commands, but they reported to my shift, obeyed my orders, and went through me for permission for various things. It continues to be a learning experience for all involved.
  30. 30. Rank in the Other Branches• Navy Rates (this is not a typo – the Navy uses the term ‘Rate’)• Marine Corps Rank Structure nks.htm• Air Force Rank Structure nks.asp
  31. 31. Some Basic Understanding• OIF – Operation Iraqi Freedom• OEF – Operation Enduring Freedom – These conflicts are broken down into numbers according to when the conflict began. Most soldiers will refer to their deployments this way (i.e. “I was in OIF2 and OIF6”). • If you went to Iraq between March 2003 and March 2004, you are a veteran of OIF1. If you went to Iraq between March 2006 and March 2007, you are a veteran of OIF4. • There are very distinct periods of time within these conflicts (more to follow). Understanding this will give you a better idea of what your client specifically experienced.
  32. 32. Lingo• Hajji/raghead – derogatory term for Muslim people• Man jammies – the long loose tunic and loose fitting pants that are common dress in the Middle East• Burqua – the head to toe enveloping fabric that some Muslim women are forced to wear (note: color denotes tribal affiliation)• Hijab/Jilbab – the headscarf or full body cloak most Muslim women are required to wear• A’zan – a publicly broadcast call to prayer that happens five times a day on loudspeakers from multiple mosques at once (it has a very distinct sound and can be a trigger for soldiers and PTSD symptoms.)• DFAC – chow hall• Connex – the big metal containers you see on tractor trailers. Soldiers ship these overseas on boats and it’s the main way that stuff gets from the U.S. to the deployed soldiers. It gets trucked from the port in Kuwait to Iraq and Afghanistan, and A LOT OF STUFF GETS STOLEN BY LOCALS ON THE WAY.• Chocolate Chips – the uniforms the soldiers wore in Desert Storm (the black dots on the camouflage look like chocolate chips)
  33. 33. Lingo• DCUs – Desert Combat Uniform, looks like the old school green camouflage but its all desert colors• ACUs – what soldiers wear now. The bluish/greenish/tannish colored uniform that has camouflage-like smudging on it, but the camouflage is made up of tiny pixels• Combat Patch vs. Unit Patch – The unit patch is something you wear on your left sleeve, and its just the insignia of the current unit you belong to. The Combat Patch is also a unit patch, but it belongs to the unit you deployed with and goes on your right sleeve. (i.e. You’re in the 201st Brigade, so you wear their patch on the left sleeve. But you went over with the 1st Infantry Division, and so you wear that patch on your right sleeve as a way of telling other people that you’ve deployed and who you went with. This is a big point of honor among troops and the root of lots of frustration between commands and the lower ranking soldiers about which Combat Patch they choose to wear, and discussions about where loyalty lies and who is the tougher soldier).• Stripe Wearer – A soldier who is promoted to Sergeant but doesn’t deserve it, or behaves inappropriately once promoted. Lazy. Incompetent.
  34. 34. Lingo• IED – Improvised Explosive Device (roadside bomb)• SIED – Suicide Bomber (walk up in a vest)• SVIED/VBIED – Suicide Bomber (drives up and blows the car)• FOB – Forward Operating Base (usually smaller, more primitive)• Camp – More like headquarters, better amenities• Flagpole – Wherever command is located (“Man, Camp Victory is way too close to the Flagpole for me!”)• Dog and Pony Show – doing pointless activities to impress VIPs• FOBit – A soldier that never gets off the FOB or Camp. Are usually considered soft, lazy, and are reviled by the guys who “actually go outside the wire and do something” (note: Medics are always highly respected, even if they are a FOBit)• Outside the Wire – anything outside of a secure area
  35. 35. Lingo• Queen for a Year – a female soldier who is not very attractive, but due to the lack of other females gets a lot of attention anyways with the understanding that this will end once she returns stateside• Rear D –Most units leave a small group of soldiers back at the main base in the U.S. as a ‘rear detachment’ to help with paperwork issues, ship specialty things to the deployed soldiers, and work as liaisons between overseas and stateside commands• CENTCOM – the big brass in charge of operations in the Middle East• GIF – Good Idea Fairy (usually means lower ranking soldiers are doing a stupid task that someone with more rank decided was a Good Idea)• MOS – Military Occupational Specialty. This is the soldier’s job. Its usually a mix of numbers and letters (i.e. 95B is an MP, a 33W is a Military Intelligence computer specialist, etc. 11B is infantry, anything in the 13’s is artillery related)• Butter Bar – A new 2nd Lieutenant. Generally regarded as inexperienced, headstrong, “bright eyed, bushy tailed and stupid.”
  36. 36. OIF – Things That Impact The Soldier• Soldiers fly to Kuwait first and for a week or two get briefings, training, and plan for upcoming convoys. Any gear that was shipped via boat is now accessible. Everyone lives in transient tents. Sand storms are a reality. Bases are safe.• Iraq has roads! Real, paved highways. This means that most soldiers convoy, and convoy frequently to get around the country. Convoying from Kuwait to all points north in Iraq means driving through some traditional ‘hot spots.’• Iraq is flat except for the very northern part of the country. This means easy access for snipers, etc as convoys move on these highways regularly. The very northern part of the country is Kurdish country, and to this day U.S. forces are still well liked up there in the less populated areas, although Mosul remains a significant hotspot.• Supply is fairly regular due to good highway routes and airports that were in good repair when we got there that have only gotten better since.• Most soldiers aren’t living in tents anymore in country. Trailer parks are the norm, as are old buildings and palaces that have been converted to living and working quarters.
  37. 37. OIF – Shifts In Conflict: 2003• March: The conflict begins. Fighting is more like what people imagine it to be – tanks, airstrikes, one army vs. another army. – The U.S. is greeted as heroes. Joy in the streets. Saddam Hussein was hated by all but the few elite (although he was pretty liberal – women could drive, own property, seek divorces). – What little there is of the Iraqi Army collapses with little resistance. Naysayers who think the West is evil don’t have much power and are mainly ignored. – The U.S. Army is not very prepared! NO uparmored hmmvv’s, flak vests without armored plates in them, supply issues rampant, and orders on what to do from here are very unclear.
  38. 38. OIF – Shifts In Conflict: 2004• April: Street fighting is limited. LOTS of road checkpoints that locals are forced to wait at for hours before being allowed to drive on. Frustration starts to mount, and then the abuse photos from Abu Ghraib prison are released. Promised infrastructure repairs don’t happen. Areas of the country that were used to having regular electricity still don’t have it. Access to clean water remains an issue. – The mood of the country shifts. Soldiers are greeted with distrust or outright hostility. Naysayers that say the West is evil start to be taken more seriously and get organized. IED attacks increase significantly. Bases start getting mortared regularly. The army is still not prepared! Uparmored hmmvv’s are RARE, people still don’t have properly outfitted flak vests, while soldiers are on the roads and dealing with the uprising in the country more than ever. Soldiers on the bases are starting to be killed in mortar attacks. No place is ‘safe.’
  39. 39. OIF – Shifts In Conflict: 2004• Orders on what to do remain unclear. Soldiers at all ranks are frustrated and nervous. Things start to get out of hand as the “cowboy mentality” kicks in (“The top leadership doesn’t get it and isn’t going to, Iraqis hate us, the U.S. doesn’t support us, we have no clue why we’re here anymore, supply sucks, and now we’re starting to get killed in high numbers by nasty means. Its time to look out for our own selves and do whatever we gotta do to not get killed because nobody else is looking out for us”). NATO forces start pulling out.
  40. 40. OIF – Shifts In Conflict: 2005 - 2007• Anti-American sentiment is high. Resistance forces are organized. Religious leaders openly speak out against the presence of U.S. forces. Iraq has had its first election and voting process since the invasion, and Iraqi foreign policy towards the U.S. was a major point for electoral candidates. “Vote for me and I’ll kick the infidels out.” – Supply is better. Bases are well established, mortar attacks become more rare although the IED problem is still rampant. The “cowboy” mentality continues and only serves to make national feeling towards the U.S. more negative as collateral damage increases. Street patrols are invading houses and not making amends when they get things wrong. People at home in America are starting to pay less attention. Infrastructure is slowly improving but not as quickly as the Iraqi people would like. Thousands of soldiers are on the ground, and orders from above are starting to get a little more concrete “avoid collateral damage wherever possible, be friendly with the locals” but this seems like too little, too late for most people. Part of the mission shifts to seriously training the Iraqi Army (IA) and Iraqi Police (IP) in anticipation of having Iraqi forces take over operations so the U.S. can gradually step back.
  41. 41. OIF – Shifts In Conflict: 2008 - 2009• Anti-American sentiment is still high, although many Iraqi people seem to think that our presence is now inevitable. Elected officials who promised to get Americans out of Iraq don’t follow through on promises, talk of civil war is going on, Iraqi parliament issues/corruption/inability to restore infrastructure any better than the U.S. leads to Iraqi’s being skeptical of both the U.S., IA and IP forces (corruption is RAMPANT), and religious leaders gain even more power as a result. Resistance forces are still organized, many are operating with the backing of major religious leaders. Religious leaders openly speak out against the presence of U.S. forces and Iraqi government.• Mortar attacks still rare although the IED problem is still rampant. The “cowboy” mentality starts to diminish as Iraqi’s don’t just hate the U.S. but are skeptical of everyone in power. Collateral damage remains an issue, but COIN (Counter- Insurgency Operations) are starting to really take off. Concentrated efforts to make infrastructure improvements and financial donations to areas that have been traditionally hostile towards the U.S. really get under way. Rules of Engagement are enforced more tightly than ever, resulting in less ability for the “cowboy” mentality. This frustrates soldiers, who are still nervous and unsure of what they’re supposed to be doing in Iraq, and are now more limited in the ways they can protect themselves.
  42. 42. OIF – Shifts In Conflict: 2008 - 2009• The mission shifts more and more to seriously training the Iraqi Army (IA) and Iraqi Police (IP) in anticipation of having Iraqi forces take over operations so the U.S. can gradually step back. This is a solid mission, but its hard to do – the Iraqi culture is very different than U.S. culture, and training people who are suspicious of America anyways is not easy. Tension rises between IP, IA and U.S. forces who are responsible for training, who are also under immense pressure from above to “get the IA and IP ready, operational, and non-corrupt ASAP so this can become their problem.” More NATO troops pull out.
  43. 43. OIF – Shifts In Conflict: 2009 - Now• Iraqis are still suspicious, but are grateful for the IA/IP as the U.S. takes a less prominent presence. (more IP patrols instead of Army patrols, or blended patrols of both forces). Things get more calm as Obama takes the presidency and starts to talk loudly about his plans to draw down American forces in Iraq.• COIN (Counter-Insurgency Operations) is going strong as the army figures out the best way to make that happen. Iraqi communities are pleased by the significant financial contributions to their needs (although the corruption is still a major problem, the local people are more frustrated by their own leadership and their inability to follow through on their promises to use this money for the common good than they are by the presence of U.S. forces, although there is a lot of talk that the U.S. is in collaboration with local political leaders and the money is just bribes, etc)• U.S. forces start to take a large step back, numbers start to draw down. Soldiers are happy because they’re not in harm’s way for Iraq as much, although there is ongoing frustration with the IA/IP inability to be effective right away.
  44. 44. OEF – Things That Impact The Soldier• Soldiers fly to Kuwait first and for a week or two get briefings, training, and then catch flights to Afghanistan from here. Afghanistan has a few major airports that soldiers fly to – once they get there, its either a long convoy or a helicopter ride to their actual camp.• Afghanistan has ONE HIGHWAY. Its called “Highway One” or “Ring Road” and it goes around the exterior loop of the country connecting Herat, Kandahar, Kabul and Mazar-e Sharif. Most of it is NOT paved. Roads are mostly dirt, can involve driving along cliffs and narrow mountain passes, and in general are terrible. Afghanistan gets snow, which complicates these issues.• Afghanistan is MOUNTAINS. Kandahar and southern regions of the country are flatter, but this country is home to some of the tallest mountains in the world. Most soldiers get around by helicopter, as convoys are dangerous – mountains make great places for enemy forces to hide.
  45. 45. OEF – Things That Impact The Soldier• Supply is hit or miss. There are many camps that are small and highly isolated. Supply is worse in the winter as the country shuts down (you can’t land a helicopter in a snowfield). The good news is winter means less combat as the enemy holes up in Pakistan and regroups in preparation for the spring attacks.• The south has traditionally been the “worst” part of the country for combat operations. East is second worst. The far west and far northern parts of the country are very isolated and while the U.S. hasn’t always been popular, there hasn’t been as many problems there.• Afghanistan is TRIBAL. Pashto are the leading tribe, but there are at least a dozen other major tribes. Afghan people will die for their tribe. Civil war between factions has been the norm since the beginning of time – U.S. presence has not done anything to stop this behavior. Elections are just escalated points of these civil wars.
  46. 46. OEF – Shifts in Conflict: 2001 - 2003• The U.S. goes to war with Afghanistan. Americans are very happy about this. Most Afghan citizens are happy with this too – the Taliban was increasingly cruel to Afghan citizens and we are welcomed. Taking out the main Taliban forces and restoring some basic order in the big cities happens quickly, and control starts to be restored in outlying areas as well.• Supply is bad as the country has very little infrastructure. Airports and what roads there are, are in bad shape. Getting ammunition, vehicles, etc takes a long time. Things get shipped by boat to Kuwait, but are then DRIVEN to Afghanistan by locals.
  47. 47. OEF – Shifts in Conflict: 2004 - 2005• OIF gets going and the mood in America shifts. OEF gets more and more forgotten but still is generally supported. Local Afghans are still supportive of U.S. presence, but collateral damage is hurting our reputation and the sheer difficulty of getting around the country makes it hard to follow up on promises to provide better infrastructure. Taliban starts to regroup and regains control in outlying areas, as the country is vast and U.S. forces can’t be everywhere at once. Taliban also use the failure of U.S. forces to build infrastructure and collateral damage as part of a particularly vicious anti-U.S. propaganda campaign (still alive and well to this date)• The mood starts to shift among the soldiers. “If I’m not stuck here, I’ll be stuck in Iraq.” The mission remains clear but difficult – the Taliban look like everyone else and have an advantage that the U.S. doesn’t have – they know the land, the lingo, the culture, and have been rooted in this country for years.
  48. 48. OEF – Shifts in Conflict: 2006 - 2007• OEF isn’t even getting big news coverage anymore, unless a big IED goes off. Elections in the country have been held and civil wars increase, with lots of civilian deaths as the result. Local opinion of the U.S. starts to get bad “the Taliban is still here, the tribes are killing each other and killing us, and the U.S. hasn’t done anything to make this better. All they’ve done is kill innocent people and make our lives harder.”• Soldiers are well aware that the people at home aren’t paying attention anymore. The mission shifts in two directions – fight the Taliban by playing their own game (strategically placed humanitarian aid campaigns, anti-Taliban propaganda, etc. Remember COIN?) and train the Afghan Army (ANA) and Afghan Police (ANP) to take over security
  49. 49. OEF – Shifts in Conflict: 2008 - 2009• ANA and ANP training gets tougher as Taliban fighters infiltrate the ranks (i.e. an “ANP” gets on base wearing a suicide vest and kills a bunch of people). U.S. soldiers are wary – the ANA and ANP are particularly hard to train, and not being able to trust them when their back is turned only adds to the problems.• COIN is going strong, but so is Taliban operations and propaganda. U.S. forces are spread thin in the push to support Iraq, and soldiers are experiencing multiple long deployments (18 months). Soldiers are tired, the mission seems unwinnable, and they get frustrated “why the hell are we still here? We bombed them after the 9/11 attacks, what other point was there?”
  50. 50. OEF – Shifts in Conflict: 2009 - Now• President Obama sends more troops to Afghanistan to help as things start to deteriorate. COIN is going strong, but so is Taliban operations and propaganda.• ANA and ANP take to the streets, but corruption is as bad as (if not worse than) Iraq. Reports of ANA/ANP attacks on the local populace increase. Afghans are fed up “the ANA and ANP are as bad as the Taliban ever were, and the U.S. is still here. Screw everybody.”
  51. 51. Section Three: Referral Information, Community Resources and Help
  52. 52. Resources• *MY FAVORITE* Veterans of Foreign Wars – help with VA paperwork, access to VA services, appealing VA decisions and fighting for veterans issues. I highly recommend that you utilize these guys when trying to do case management with your veteran clients! They know who to talk to and understand the VA system.• There are veterans’ service offices that are specifically dedicated to helping veterans with obtaining benefits. Local VFW halls also generally offer access to these offices and are knowledgeable.
  53. 53. Resources• IAVA – Iraq and Afghanistan Veterans of America. They lobby heavily in Washington D.C. and intervene for individual soldiers who need help. They are fabulous and a great starting point for access to resources.• Coffee Strong – local group in Lakewood, WA that provides support, referrals, etc in a coffee shop that is veteran owned and veteran run. It also is a really good website that offers some insight into the OIF/OEF veteran culture.• Up to date information on what is going on in Congress regarding Veteran’s benefits, etc. Also a great spot for jobs that have veteran preference in hiring and a good site for general information. You can sign up for email updates as well.
  54. 54. Resources••• NAMI supports veterans too! _Resources&Template=/ContentManagement/Content Display.cfm&ContentID=53242&lstid=877• Substance Abuse/Veteran Info• The American Legion, another service organization.• Disabled American Veterans
  55. 55. Resources• VA Forms• Main VA Information Page• General military assistance and information forms/military-forms-and-veterans-forms• National Center for PTSD• Veterans Only Employment• Federal Employment, Veteran Preference
  56. 56. Resources• Give an Hour is a nonprofit organization that has established a national network of more than 5,300 licensed mental health professionals who provide free mental health services to U.S. troops, their families and communities affected by the current military conflicts in Afghanistan and Iraq. Each one gives an hour each week to provide free mental health services to military personnel and their families. In addition, these volunteers work to educate the public and the military community to reduce the stigma so often associated with mental health issues.
  57. 57. Resources• WACVA – Women’s Army Corps Veterans Association. You must be a female veteran to join, but they don’t turn away male veterans who need help. They are nowhere near as active as the VFW and IAVA, but they are a resource and a great way to connect with other veterans (I have attended their yearly conventions before and that is an amazing experience. Their newsletter is great too).• American Lake VA Homepage (Tacoma, WA)
  58. 58. Resources• Confidential PTSD screening tools and referral information• Washington State VA Website• Nationwide VA Facility Locator =1• National Coalition for Homeless Veterans, Washington State• Yakima County Veteran Assistance ult.htm
  59. 59. Resources• Spokane County Veterans Services• King County Veterans Services x• Pierce County Veterans Services /default.htm• Transportation for Veterans to and from medical appointments (nationwide service)
  60. 60. Questions