Veterans: Challenges to Transition & the Legal System
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Stephen N. Xenakis, M.D., Brigadier General (Ret) U.S. Army presented at the 2016 Hidden Wounds of War Conference.
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Veterans: Challenges to Transition & the Legal System
- 1. Stephen N. Xenakis, M.D. Brigadier General (Ret) U.S. Army
- 2. Slide 2 of 16
- 3. • Shook Over Hell: unprecedented violence after Civil War • SMI: 3X more in jail than hospitals • Military: ‘Chapter’ discharges for ‘character disorders’ • Military demographics – older adolescents & young adults • Impulsive, action-oriented, seeking gratification, etc. • Self-medication – drugs & alcohol • Suicide, accidents, PTSD, mTBI, troubling relationships, etc. Slide 3 of 16
- 4. • David Phillips: Lethal Warriors • At-risk cluster of risk factors • One BCT & IN battalion • Higher levels of intense combat exposure • High op tempo • Stigma • Peer & personal pressure • Low referral rates to Mental Health • Increasing trend of ‘moral waivers’ Slide 4 of 16
- 5. Slide 5 of 16 Once an army is involved in war, there is a beast in every fighting man, which begins tugging at its chains, and a good officer must learn early on how to keep the beast under control, both in his men and himself (1942).
- 6. Slide 6 of 16
- 7. • Suicide • Child pornography • Rape • Murder Slide 7 of 16
- 8. • ALI Guidelines • Diagnosed with a relevant mental condition or defect • Unable to appreciate the criminality of his conduct • Conform his conduct to the requirements of the law • M’Naghten Rule • “laboring under such a defect of reason, or disease of the mind…” • Did not know the nature or quality of the act • If he did not, did not know that the act was wrong Slide 8 of 16
- 9. Slide 9 of 16
- 10. • 29 y/o former SGT – 2 tours in Iraq & Afghanistan • Convicted for rape – sentence for 37 years • h/o childhood sexual abuse & trauma • Multiples concussions while in the Army • PTSD, depression, ETOHism, etc. • Illnesses aggravated as commercial diver Slide 10 of 16
- 11. • Plea for murder – LWOP • NGRI – for TBI & PTSD • Troubled childhood • 2 tours in Iraq & Afghanistan • Suicidal, PTSD, depressed • TBI – paralyzed & blind • Rehab, RTD, & disabled • No recall for events Slide 11 of 16 Nicholas Kristof: When War Comes Home, New York Times, Nov 2012
- 12. Overall prevalence: Pain 81.5% TBI 68.2% PTSD 66.8% PTSD P3 Multi-symptom Disorder TBI/Pain Lew, Otis,Tun, Kerns, Clark, & Cifu, in review Sample = 340 OEF/OIF outpatients at Boston VA 42.1% 5.3% 2.9% 16.5% 10.3% 12.6% 6.8% 12CLARK- 2009
- 15. 15
- 16. • Patient-centered and integrative care • Developments in neuroscience • Findings in related areas of endocrinology, sleep medicine, pain management, and physiology • Information technology and predictive analysis • Mental health parity and related legislation • Political and social concerns over violence and suicide • Growing frustration among patients and families in need of comprehensive effective care Slide 16 of 16
Editor's Notes
- Trends over the next 10 years Patrick Kennedy – leading changes in mental health – predicts ‘chaos’ If we don’t lead – then we will be dragged along – military hat of when in charge, take charge’ Not a far cry from Guantanamo to legislation: Focus the right spotlight on mental health Our state of mind anchors or well-being, & anchors or personal & collective security Torture is wrong & dehumanizing Ignoring the less fortunate & marginalizing in our society is dehumanizing We have a collective & community responsibility to uphold the fundamental principles of this democracy – founded in human rights – linking torture & securing our communities in a humane way – and speaking up against the violations of human rights.
- Trends over the next 10 years Patrick Kennedy – leading changes in mental health – predicts ‘chaos’ If we don’t lead – then we will be dragged along – military hat of when in charge, take charge’ Not a far cry from Guantanamo to legislation: Focus the right spotlight on mental health Our state of mind anchors or well-being, & anchors or personal & collective security Torture is wrong & dehumanizing Ignoring the less fortunate & marginalizing in our society is dehumanizing We have a collective & community responsibility to uphold the fundamental principles of this democracy – founded in human rights – linking torture & securing our communities in a humane way – and speaking up against the violations of human rights.
- Memorable quote from GEN Marshall Burden of senior leadership – containing the violence. Medics speak “truth to power.”
- Trends over the next 10 years Patrick Kennedy – leading changes in mental health – predicts ‘chaos’ If we don’t lead – then we will be dragged along – military hat of when in charge, take charge’ Not a far cry from Guantanamo to legislation: Focus the right spotlight on mental health Our state of mind anchors or well-being, & anchors or personal & collective security Torture is wrong & dehumanizing Ignoring the less fortunate & marginalizing in our society is dehumanizing We have a collective & community responsibility to uphold the fundamental principles of this democracy – founded in human rights – linking torture & securing our communities in a humane way – and speaking up against the violations of human rights.
- Trends over the next 10 years Patrick Kennedy – leading changes in mental health – predicts ‘chaos’ If we don’t lead – then we will be dragged along – military hat of when in charge, take charge’ Not a far cry from Guantanamo to legislation: Focus the right spotlight on mental health Our state of mind anchors or well-being, & anchors or personal & collective security Torture is wrong & dehumanizing Ignoring the less fortunate & marginalizing in our society is dehumanizing We have a collective & community responsibility to uphold the fundamental principles of this democracy – founded in human rights – linking torture & securing our communities in a humane way – and speaking up against the violations of human rights.
- Avoided suicide by joining the French Foreign Legion Support setting up Veterans Courts Educating defense attorneys about PTSD/TBI/moral injury.
- Trends over the next 10 years Patrick Kennedy – leading changes in mental health – predicts ‘chaos’ If we don’t lead – then we will be dragged along – military hat of when in charge, take charge’ Not a far cry from Guantanamo to legislation: Focus the right spotlight on mental health Our state of mind anchors or well-being, & anchors or personal & collective security Torture is wrong & dehumanizing Ignoring the less fortunate & marginalizing in our society is dehumanizing We have a collective & community responsibility to uphold the fundamental principles of this democracy – founded in human rights – linking torture & securing our communities in a humane way – and speaking up against the violations of human rights.
- Trends over the next 10 years Patrick Kennedy – leading changes in mental health – predicts ‘chaos’ If we don’t lead – then we will be dragged along – military hat of when in charge, take charge’ Not a far cry from Guantanamo to legislation: Focus the right spotlight on mental health Our state of mind anchors or well-being, & anchors or personal & collective security Torture is wrong & dehumanizing Ignoring the less fortunate & marginalizing in our society is dehumanizing We have a collective & community responsibility to uphold the fundamental principles of this democracy – founded in human rights – linking torture & securing our communities in a humane way – and speaking up against the violations of human rights.
- Lew, et. al. Prevalence of chronic pain, PTSD, &persistent postconcussive symptoms in OIF/OEF veterans. Nov 2009.
- Treated according to the “door you walk through.” Observations of 25 years ago – motivated to set up service lines & primary care clinics at BACH & EAMC. Challenges of implementing models for integrated care – legacy barriers of specialties, separate departments, & academic medicine.
- Focus on age & stage – goals & objectives – natural orientation of veterans – imprint of military experience. Goals & objectives – set the “mission” for the stage of life. Application of GST – homeostasis & end state.
- Guns & dangerousness 30,000 deaths annually – a public health problem 20,000 deaths – suicide >300,000 over past 10 years – 6X the combat deaths in Vietnam Advocate for care for soldiers & veterans Support for the Murphy Bill
- Trends over the next 10 years Patrick Kennedy – leading changes in mental health – predicts ‘chaos’ If we don’t lead – then we will be dragged along – military hat of when in charge, take charge’ Not a far cry from Guantanamo to legislation: Focus the right spotlight on mental health Our state of mind anchors or well-being, & anchors or personal & collective security Torture is wrong & dehumanizing Ignoring the less fortunate & marginalizing in our society is dehumanizing We have a collective & community responsibility to uphold the fundamental principles of this democracy – founded in human rights – linking torture & securing our communities in a humane way – and speaking up against the violations of human rights.