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Healing Hidden Wounds

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  1. Healing Hidden Wounds Antonette Zeiss, Ph.D. Chief Consultant, Office of Mental Health Services

  2. One “Hidden” Wound: Post Traumatic Stress Disorder • What is PTSD? • Defined in the American Psychiatric Association Diagnostic & Statistical Manual (DSM) – IV • NOT any mental health problem occurring after trauma or severe stress • Very specific diagnostic criteria: • Criterion A: Exposure to a severely stressful, life-threatening situation • Symptoms in each of the following clusters: • Persistent re-experiencing • Persistent avoidance and emotional numbing • Persistent symptoms of increased arousal not present before • Duration of symptoms for more than 1 month • Significant impairment

  3. Diagnoses of Veterans Who Come to VA for Health Care

  4. Mental Health Diagnoses of Veterans Who Come to VA for Health Care

  5. What Are The Treatments For PTSD? • Most effective treatments, likely to result in greatest recovery, are psychotherapies • Medications can be helpful, particularly anti-depressant SSRIs and prazosin for nightmares • Positive symptoms (re-experiencing, hypervigilance, increased arousal) generally respond better to medication than negative symptoms (avoidance, withdrawal) • Some medications are contra-indicated, e.g., benzodiazepines (Xanax, Librium, Ativan)

  6. What is VA’s Commitment to Veterans? • Our nation’s commitment to a new generation of Veterans, for their lifetime: • Treat returning Veterans early in the course of mental heath problems • Provide holistic, integrated care for physical and mental health problems: Mental health is an essential component of overall health care • Being there for their lifetime and for the lifetime of all Veterans we are serving, from all eras

  7. How Are We Doing? • VHA Comprehensive MH Strategic Plan, evolving to Uniform Mental Health Services Handbook • Defines mental health services to be provided to all enrolled veterans • Completes implementation of Strategic Plan for patient services • Emphasizes Psychosocial Rehabilitation and the Recovery model for mental illness • Current hiring for expansion • 1,600 mental health staff • 300 support staff • Approximately 300 peer support staff • RAND/Altarum independent review of VA mental health services – conclusions: • VA provides care superior to private sector on almost all measured criteria • VA does not always meet its own high aspirational standards

  8. Context - All Mental Health Staff:Core Mental Health Staff, All VISNs

  9. Context: Increase in Veterans Seen for Mental Health

  10. Discussion • Questions? • Your thoughts about next steps for VA with current returning Veterans and generally