Chicago, IL, USA
In the aftermath of the terrorist attacks on September 11th, 2001 that destroyed the World Trade Center in New York and severely damaged the Pentagon in Washington, the United States has been engaged in armed conflict in Iraq and Afghanistan, the longest war in our country’s history. Over 2.5 million servicemen and women have served in the war zones of Iraq and Afghanistan, more than half with multiple deployments. Over 6,800 service members have died in these conflicts and about a third of troops return with a so-called “invisible wound of war”, post-traumatic stress disorder (PTSD) and/or traumatic brain injury (TBI). These invisible wounds of war are complex and highly individualized in their presentation, and can impede the ability of the returning veteran to reintegrate at home or work. Those with PTSD may exhibit irritability, isolation, or a lack of interest in their usual activities; along with the behavioral changes and impediments associated with TBI such as impulsivity and
memory and concentration difficulties, these conditions can put
enormous strain on the families of affected individuals. Rates of marital
discord and divorce are elevated among couples in which one or both partners
have served, and repeated deployments are associated with higher levels of depression
and anxiety in their children,
persisting even after the deployed parent returns. Reservists called to deploy may
return to communities where few or none of their neighbors share their
experiences, and where their sons and daughters are the only military children
among their peers, increasing their sense of isolation. Every day, over twenty
veterans kill themselves, a rate of suicide that is orders of magnitude higher
than in the general population – this grim finding dramatically underscoring our
failure to address the profound unaddressed aversive experience of many of our
servicemen and women.
|Mark H. Pollack, M.D.|
Socioeconomic factors can compound the problem for the veteran who may return from their time in service years behind their peers in degree of educational attainment and civilian job experience. They may return home to a stagnant job market and encounter employers that do not understand how military experience translates into civilian skills.
Though a “sea of goodwill” for returning veterans has proliferated, resources are fragmented, and veterans and their families often find the process of identifying and navigating the systems of care and support to which they are entitled confusing and overwhelming. Only about half of returning veterans needing care receive it and for many of those, the care is inadequate. The VA system and other military facilities, despite some well-publicized difficulties, have worked hard to take care of the returning veterans but the need is great, and it has been increasingly clear that these institutions can’t do it alone. It is apparent that a void exists in providing veterans and their families with help in accessing and navigating the care, support, and services that they have earned and need and that the non-military health care system has to take on a role in providing veteran-sensitive care to our returning servicemen and women. While many veterans benefit from their care at the VA, a significant number may be uncomfortable accessing VA programs because of its association with their military, or have had previous frustrating or negative experiences; others may be ineligible for VA services. Further, the Veterans Administration (VA) is specifically not commissioned to provide care for spouses and children who thus may have difficulty accessing the treatment that they need.
In the spring of 2014 with the help of anchor funding from the McCormick Foundation and the Major League Baseball’s Welcome Back Veterans Initiative, as well as other private and foundation philanthropic support and in-kind resources from Rush University Medical Center, we opened the doors of the Road Home Program – The Center for Veterans and their Families at Rush. This program, representing a collaboration of departments and services across the institution, provides care not only for the veterans who are dealing with the invisible wounds of war, but also support and treatment for their families, spouses, parents, children and other loved ones, who are often not able to get care in traditional military settings. In 2015, with substantial support from the Wounded Warrior Project, we and colleagues at three other leading academic medical centers across the country, Harvard’s Massachusetts General Hospital in the Northeast, Emory University in the South and UCLA in the West, established the Warrior Care Network. As part of this initiative, we have expanded our outpatient services for veterans and their families and developed an innovative intensive outpatient program in which we bring veterans in from all over the country to receive focused care over a three week period for their PTSD and related mental health conditions as well as TBI. To date, our network has treated over a thousand individuals and the requests for services from veterans and their families continue to escalate.
In addition to evidence-based and innovative treatments for the invisible wounds of war, our program’s veteran outreach workers, help veterans and their families navigate the breadth of available social service resources available to them including those related to education and job training. With the recognition that as many as 20 to 25% of service women as well as a significant number of service men have experienced military sexual trauma we have also developed specific treatment programs to meet the needs of this population. We collaborate with colleagues at the VA and other military medical facilities – connecting patients to resources in these settings for which they are eligible and that are likely to be helpful – and receiving referrals from these institutions for veterans and family members who may benefit from our services.
In addition to directly providing services at our own program, we are committed to expanding the pool of providers able to effectively treat veterans throughout the general medical system. We therefore provide educational programs for medical and mental health personnel to enhance their understanding of veteran culture and challenges, as well as to develop their expertise in evidence based treatments to improve outcomes for veterans with a range of mental health issues consequent to their service.
The growth and success of our program and network to date, as well as the nascent development of other veteran related initiatives in the general medical health care system, demonstrates the potential for the private sector to be an important contributor to the health care of the veteran population. Going forward, private-public partnerships with the VA and other military medical institutions and supported through a range of government and private sources may become an increasingly important factor in meeting the mental health and other medical needs of our servicemen and women and their families.
Mark H. Pollack, M.D. is the Grainger Professor and Chairman – Department of Psychiatry, Rush University Medical Center; Director – Road Home Program: The Center for Veterans and their Families at Rush.