we hope to see you on the third wednesday of every month. sometimes we do leches with guests in our studio. please join us, and you can get more information that sfgov.org. it is a wonderful day, and i'm going to go get a burrito.

(music) hello, i'm ivette torres and welcome to another edition of the road to recovery . today we'll be talking about behavioral health issues among military families. joining us in our panel today are kathryn power,

director, center for mental health services, substance abuse and mental health services administration, u.s. department of health and human services, rockville, md; captain joan hunter, director of psychological health, u.s. public health service, detailed with the national guard bureau, arlington, va; hector zayas, recovery coach and consultant, orlando, fl; dr. bradley karlin, national mental health director for psychotherapy and psychogeriatrics, office of mental health services, department of veterans affairs headquarters, washington, dc. kathryn, more than 2 million troops deployed to afghanistan and iraq. what are some of the behavioral health issues related to the returning vets that are there, the vets that are there, and the returning vets? i think all of us are paying great attention to

the behavioral health issues of anyone who has been in combat. and, first of all, when we use the term "behavioral health," we generally are talking about a broad range of mental and emotional and substance abuse disorders and/or problems. we know that anyone who has been in combat will probably suffer from trauma and anyone who has been in a combat situation will have effects of that trauma. so, the first thing we really want to pay attention to is: how have the individuals who have served in combat absorbed that trauma and become resilient to that trauma? in addition, we are seeing a variety of behavioral adjustments having to do with post-traumatic stress, having to do with depression, having to do with suicide ideation. and of course, the reintegration issues when people come back from combat and move back into their families and try to sustain some normality of family life; we see behavioral issues going on within the families. so, there's a host of issues that are happening for these individuals. and, dr. karlin, exactly what types of symptoms

are associated with some of these disorders? let's take ptsd, for example. so with ptsd, post-traumatic stress disorder, there are certain clusters of symptoms that we typically see, including what we first call avoidance symptoms. so, individuals with post-traumatic stress disorder may avoid places or circumstances that may remind them of the traumatic event that they experienced during war time or other situations that might have been the precursor, if you will, to the post-traumatic stress disorder. individuals with ptsd also often experience numbing symptoms, if you will, to block the pain associated with the post-traumatic stress disorder and so, sometimes individuals will engage in certain behaviors to block that numbing. they'll not confront the emotional experiences that they may have, try to stuff it down. sometimes alcohol or substance use is a way to try to block

those emotional pain symptoms. and another common type of symptom that individuals experience with ptsd is hyper-vigilant symptoms, where individuals might be sometimes easily startled, for example, especially in circumstances that might serve as a reminder of the traumatic event. and, lastly, i should mention that individuals often also experience what are known as re-experiencing symptoms. re-experiencing symptoms can include nightmares, intrusive thoughts that are essentially flashbacks, if you will, to that traumatic event that precipitated the ptsd. and so, one of the things that i want to say that it is just not the person that is on active military, but there's also the vets, there's national guard, there's reserves; so, we're talking about a whole host and spectrum of categories within the military of men and women that are affected, correct?

i think it's very important, ivette, that we stress that the populations that we really are concerned about, is that whole gamut, as you've indicated. it is individuals who have served on active duty and may still be on active duty. it is individuals who are in the national guard, who are a special group of people who actually belong to a state militia. we have individuals who have served in reserve components of each of the individual services who may or may not be in active status. and then we have a whole host of the family members who come into relationships and have relationships with those individuals who may be attached to an active-duty military base, who may not have any connection. and then we have veterans, and we have veterans who are disbursed all across the united states and may or may not have access to va services. so it is a very important definitional issue. and, captain hunter, let's talk a little bit. kathryn just mentioned the families. how does the family, then, approach an individual who may have a problem?

what are some of the issues that they need to be aware of? my experience in the national guard has been that ptsd and mild traumatic brain injuries affect the whole family. one person may be the person who has the disorder or the stress symptoms, but it goes throughout the whole family. you can't not address ptsd without affecting the whole family in that, so to speak, the work that you do, and taking care of someone with ptsd, the family benefits from that. we see that in the national guard all the time, and we see family programs that are dedicated specifically to deal with service members who have ptsd, mild traumatic brain injuries, but a whole host of other reintegration issues. especially now, in the national guard, we're seeing a population who's never deployed, who is experiencing stress and stress-related concerns.

hector, let's get an idea. you were military, you served in the military, and now you're working with some of the individuals that are experiencing some of these behavioral health issues. you want to talk a little bit about your own experience? sure. i've spent quite an extensive amount of time in the military and recently discharged last year. and i've made it a commitment -being long-term recovery myself- made it a commitment to go ahead and reach out to these folks that are suffering from these issues, that are relying on substance use as an escape mechanism, if you will. and, obviously, that is a wrong path to take, if you will, so i try to help them out. were you involved while you were in the military, and how did it happen? i was in full-blown alcoholism while i was in the military and had extensive, obviously, experience in treatment through that end. i got to a point where now

my time is to pay back by giving back to that community, especially military and veterans that we had discussed across the board. and i just don't want anybody to experience what i had, and there was a personal collapse, so i take great pride and honor in helping those, to let them know that there are things to actually do about it and not have a fear-based type of attitude at all times, to go ahead and pursue help at all costs. i was just going to mention, hector, that one of the things that we've discovered in talking with various members of the military, that peer support services seem to be an area that is getting more and more attention, about the fact that they are very effective. i know the va uses some peer support services, and what is your experience in terms of why is the value of peer support services so important? the most important part in there is because, being a veteran, you can understand another veteran, because you've been there, you're going through these things as well:

the operations, deployment tempos, and that sort of thing, the operational picture of everything. you've been there, done that, so to speak, as we always know. so by providing myself and making myself available to veteran organizations, anybody that deals with veterans -either active or reserve or haven't, you know, under the va system- then that helps out. it just supplements the help that they are already getting, you know, through treatment and so forth, to go ahead and relate, to bring that component of compassion and understanding, let them know that there's something we can do, there's hope. i want to go back and talk about a little bit on the issue of homelessness. now, we see post-traumatic stress disorder, we see alcoholism, we see other substance use disorders, and then you also see depression and other mental health problems. dr. karlin, how acute is the issue of homelessness within the military?

so, certainly among veterans, there is a sizeable homeless population, and this has actually been a priority of the department of veterans affairs to reduce homelessness. in fact, secretary shinseki has declared that va will eliminate homelessness, or end homelessness, and so there has been a 5-year plan in place to end homelessness among veterans, which includes a comprehensive constellation of programs and services for individuals that are homeless. to address homelessness, though, it's not just a matter, of course, of providing housing. that is one important aspect to make sure the individuals are in comfortable, secure surroundings. but it's also critical to address the mental health problems that a lot of homeless individuals have, as you noted. and so we have, in va, a variety of programs that address both aspects and oftentimes very much together, where we have residential treatment programs that specialize in providing individuals

with that secure and safe surrounding, while they're initially receiving intensive care that they may need. and then following that, there is a range of additional services for homeless individuals so that they can get their lives back. and that doesn't only include shelter and emotional health; it's an important part, but also, work. and so there are a number of employment-related programs within va to support them getting back to work. and i want to continue, when we come back, i want to continue on the topic of homelessness, because i really want to get to the issue of when the vet comes back. i mean, how does the family, there are issues, you know, we talked a lot about the family a little bit already, but i want to see that intersect of what can a family member do to, you know, prevent a vet or a member of the military from becoming homeless. we'll be right back. (music)

post-traumatic stress disorder is a clear issue for a lot of people, especially deployed troops coming home. and when they come home, they come home to communities and to families that are going to experience the effects of that, and there's pretty good evidence that people with post-traumatic stress, whether it's from a military interaction or from some other traumatic event, have more difficulty with mental illness, with depression, anxiety, with substance use, with having difficulties with family relationships, with just interactions in their community. so, we know that we can prevent some of that if we acknowledge that and deal with it ahead of time, before it begins to manifest. samhsa's efforts, because we address essentially what we call the civilian aspect of it, the department of defense and the veteran's administration

are responsible for the major component, but we find that military families often are not eligible for va services, or that military members themselves don't present to a military services, so they show up in the civilian communities. so, we're trying to educate community practitioners about post-traumatic stress disorder, we're trying to partner with the va and the department of defense, so that the safety net is created so we can address issues like suicide. in fact, we have a partnership with the va, with a suicide hotline, so that an individual who is on active duty or is eligible for va services can call that hotline and they will be referred to the va, so that we keep that safety net intact. and if the person who is a veteran or active-duty member or his or her family presents to a community-based organization,

they too will try to make sure that they ask about whether you are in the military or you have a loved one in the military and it's affecting you, so that we can address those issues. (music) while i will equally encourage spouses and family members to be able to come forth, there are programs there as well that listen to them; their presence in the family and their relation to a military member is equally important to the armed services and they are never forgotten. they need to also know, at all times that they can come forth and, through family advocacy programs, chaplains, any kind of counseling or any kind help that they need, even some of the individuals units have members

and spouse groups that get together. the ombudsman program in the navy, in particular, is very important, so there are sources for them to reach out and say, and let them know that they do need help, the help is there if they ask. kathryn, let's continue on the thought of homelessness and, when a member returns, what can the family do to really support that member and to be vigilant about some of the signs? well, i think that when dr. karlin was mentioning the va's efforts in homelessness, i was reminded that the va has really developed a program that is new in many ways for the va that's picking up some of the strategies and some of the outreach and some of the connection of some of the programs that the department of health and human services and hud have used for several years, and it's wonderful that we really actually have a partnership now between the department of veterans affairs and hhs and housing and urban development.

and one of those engagement strategies is trying to make sure there is outreach to the individual military member and their family member in some ways to make sure that they are employed, as dr. karlin indicated, and that they have the kind of support services around them that they need. many of the family members don't really know what to do. in other words, someone comes back into the house, they feel ... everyone's, you know, maybe angry, there's a lot of adjustment going through, they're not quite sure how to approach the discussion. what happens is that they may have some financial problems, they might not be able to get a job, so all of these homelessness programs, as dr. karlin indicated, are looking at not only housing issues, but also supported employment opportunities and also family support opportunities. and so we recommend that, if family members need that kind of support, that they look into some of the local homelessness service providers, as well as what the va has available

and make sure that they seek those local services so that the individual is supported and housed and employed. so, that helps create more stability in the family. and within va, to facilitate this process, va has recently established a national center for homelessness among veterans. and as part of that center, there's an 800 number that individuals can call, individuals who might be homeless, at risk for homelessness; family members may call this and immediately get connected to a counselor that can help them to chart the right path for that individual. this is important for the national guard, but there's another population in the national guard that i think needs to be highlighted here. and that is, not all of the national guard are considered veterans. so, they may not be able to participate in some of the va programs. that's why our relationship with samhsa and kathryn's group,

the memorandum of understanding that we have between the national guard and samhsa is so important because it connects with the community. and the communities, through samhsa and our relationship, that's where the national guard is. it's the governor in the state and it's the militias, as kathryn mentioned, so a vast majority of folks that we're seeing in the psychological health program, they've never been deployed. so, it's very important for us to look at community resources, as kathryn mentioned. absolutely, and hector, you're in the thick of it in the community. take us through a cycle of some of the folks that you counsel and that you work with. the most important part, when we think about these veterans and when it comes to homelessness, for me, the key is how do we get the information to them? it's hard for them to get to a phone or seek, because the level of hopelessness, it is just completely eroded. so i try to get to them in a way that they will go ahead

and seek and lead them to the local va facility. now, some va facilities in local places, they may not have a facility to take these people. i mean, this is what they talk about at certain times; we don't have a place nearby and transportation, a lot of factors that fall into this. and what i try to do is get involved at a level that they don't get left by the wayside because the assets are there, the programs are there, but we need to get them involved and bring them forward so they can go ahead and have access to all these. so, what i'm hearing is that veterans affairs and other services associated with the military has some programs but also that everyone can avail other programs, correct, kathryn? absolutely, ivette, and i think one of the most important things that i think we represent here today in talking with you about this issue is that we are beginning to see that the military-civilian relationship has to change.

and it is significant that it is changing and it is significant that the department of defense, the department of veteran affairs, are no longer closed systems. and, in fact, those systems have, i think, appropriately acknowledged that there may be people in the community and we need to work together to make sure that we are reaching out together with communities, and that means talking to the civilian population and the civilian providers, and the civilians have to feel the same way. that they can have conversations with the military treatment facility providers with the va, and that whole dialogue, i think, is emblematic of a new way of thinking, and i think it's extremely important and very, very favorable for the behavioral health world to understand that. and dr. karlin, let's talk about utopia. people would have memorandums of understanding, they work together, but in reality, if that system wasn't yet perfected, do families need to know they need to be persistent?

family members are so key to everything we're talking about because, oftentimes, it's the family member that is the first and sometimes the only individual to begin to identify that something's wrong. and so family members in so many cases, i think, are the unrecognized assets, if you will, in terms of getting the treatment that individuals may need to those individuals. so it is critical that professionals within the department of veterans affairs, within samhsa and other agencies, are engaging with family members to provide the education, to provide the information that those family members might need to first identify that there is a problem and then to know what to do. what do you do when you notice that your family member has a problem? and it's critical that these partnerships that kathryn talked about are available between agencies and with communities so that we can interface with family members, we can make those connections to ensure that family members are empowered with the information they need

and with information about how to engage resources so that help can be received, both for the individual and for the family members. and kathryn, with the new health care reform legislation, i suspect that there are going to be some changes to facilitate more access? well, i think the health care reform law is certainly going to have an impact at the community and local and the state level because the law basically encourages an increase in the number of people who will become available for insurance, and so we're predicting that there will be 13 million more people that will be coming under and eligible for medicaid so that those individuals will probably have some behavioral health issues, and approximately a third of those individuals will probably have a serious mental illness or substance abuse disorders. so, under the state exchanges and under the way in which the community providers will work, we think there will be some significant changes.

and we also, again, continue to look at the fact that, as these facilities, the department of defense has to depend more and more on community-based agencies for their delivery service because they are not necessarily investing in active-duty military treatment facilities, but working through their tricare contracts. and so that means that tricare has to go into the community and have relationships with those community providers. that's all continuing to move, ivette, and shift dramatically, as each state then has to make its own health exchange and health insurance plans. so, yes, you're correct, it is dramatic. well when we come back, i want to continue on the thought of the cost to society of not meeting the needs of all of these individuals as well as some of the programs that are available to...have families continue to access treatment. we'll be right back. for more information on national recovery month , to find out how to get involved, or to locate an event near you,

visit the recovery month web site at recoverymonth.gov. i had no idea it was going to be so hard. i didn't know what to expect. you hear the stories, but i never took any of it seriously until i found myself here. and then i realized i was going to have to work hard for my recovery. if you or someone you know has a drug or alcohol problem, you are not alone. call 1-800-662-help. recovery was the hardest job i ever had... and the most important. brought to you by the u.s. department of health and human services.

(music) the mission of grace after fire is women veterans reaching out to other women veterans and supporting those women veterans. a quarter of a million women have served in both iraq and afghanistan. that's a large population of women who now have seen combat, but to think that you're going to go over to places like iraq, afghanistan, and now libya and come back and be the same person, is not realistic. we're here to make sure that woman veteran knows how to get to the va, how to find a professional

who can help her with whatever issues she has, whether it's needing counseling, or therapy, or to take care of her physical ailments. we're an organization is made up of female veterans, we understand what they're going through, what they've been through, and who better to help you than that type of organization? the way we provide assistance to women veterans is, foremost, is ourselves. so as women veterans, we're connecting with the other female veteran and trying to help them figure out which is the best approach to solve their problem. and then, when you pick up the phone, if you've been to afghanistan ... i've got somebody who's been to afghanistan. you want to talk about iraq? i've got three iraqi veterans. you want to talk about the vietnam era? i've got one of those. you want to talk about desert storm? i've got a gal that's done that. a couple of us were at kosovo. we actually have online support that's available 24/7. anyone can become a friend or family member of grace; you do not have to be the veteran.

it's anonymous registration, so that you are able to blog. there are some phenomenal, fascinating, heart-wrenching stories that have been posted on our web site, where women are for the first time feeling safe to talk about something that happened to them years ago. we don't know where they live, we don't know what their name is, but we can give them the answer to hopefully find the path that they're looking for. because we all served in the military, in different capacities, we do have a sense of sisterhood and, because we have that sisterhood, when we approach or a veteran approaches us who needs assistance, they can feel that. these individuals need to be treated because some of the lasting effects that come from this, if it just festers and does go untreated, we have had an increase in the suicide rate. and so we need to try to reach in and intervene

before it gets to that stage. as the veteran comes back in, if they can get involved in their community and do something tangible, his and her recovery will be a whole lot quicker. so, one of the things grace after fire is doing right now, it's with my staff, it is my staff that's doing the build this weekend in a habitat for humanity house. it is an all-woman build; it was all funded by women raising money and is a woman that is receiving this house. grace after fire has been a great organization to partner with. they refer women veterans to my organization, operation healthy reunions, and help provide needed resource. veterans can still serve their country and their community even after they've taken the uniform off. so, here's a perfect example of how women vets have stepped up: they're building a home in a small community for a woman who needs a house. we're here to help them. we've been in that same situation. our country really needs to realize the differences