Philadelphia Medicine Summer 2019 - 11

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They are red flags that veterans often don't recognize in
themselves. In a documentary
shown at the summit, a veteran
who had post traumatic stress
disorder, but didn't know it, described what happened when he
finally decided to visit a doctor.
"I was at the doctor's office, and
I was starting to read about post
traumatic stress in the waiting
room. And I went down the list. And I thought to myself, 'son of
a bitch, I have every one of these! Maybe there's something to it. I
have every one of these.'" A recognition by veterans that they need
help is an essential piece of the puzzle.
In his talk, Dr. Machiavelli touched on a number of the danger
signs for a veteran who is suicidal. He said someone downing six
drinks or more a day is six times more likely to commit suicide. "No
one should have more than two drinks a day, period. Not for any
other medical reason than for suicide."
Retired Major Paula Smith-Benson is executive director of
the Women's Command Center in Philadelphia. She said one of
the main causes for women veterans committing suicide is sexual
trauma they suffered while in the service. Smith-Benson said when
many of these victims of sexual assault seek help at the Philadelphia
Veterans Hospital, they often end up going through a gauntlet of
men harassing them on their way to the doctor's office.
"In what other context would a victim of violence have to
essentially go for help to the place where the perpetrator committed
the act?"
It's also a challenge for them to seek help, because like their
male counterparts they are saddled with the belief that it is a sign of
weakness to ask for help. They also have the fear that revealing their
emotional or psychological crisis will result in a medical discharge.
Sometimes they fear the opposite - that revealing their problems,
including substance abuse, will delay their separation.
Many of them also say that like Andrew Einstein they come
home and lack a sense of purpose or responsibility.
Smith-Benson said there is also a spiritual component to the
pain they suffer. She called it a moral injury. "The moral injury
happens when a person's soul is wounded. There's no prescription
for a wounded soul. It has to be handled holistically. Often, their
trust has been betrayed. As a result, they won't ask for help."
What we can do to Help
The summit was organized to be not simply a problem describer,
but a problem solver. Group exercises in the afternoon came up with
a list of ways for the VA and other veterans and community services
to reach those in need. The following is a partial list:

1) Help with the transition
to civilian life. Veterans should
be made aware of their medical
benefits. Every veteran should have
counseling on affordable housing
and job opportunities. Seek veterans
out, don't wait for them to come to
you. Listen carefully to them. The
intimate family that the military
turned out to be for many veterans
is gone. That intense love is gone.
Veterans often need help finding their new normal. It's important
to keep them from isolating themselves and engaging in high-risk
behaviors alone, such as drinking and drugs.
2) Reducing the stigma attached to needing help. Health
care should integrate physical and mental health and offer a
holistic approach to care. Don't make assumptions about who
is and isn't a substance user. Treat each of them like a human
being deserving of respect. The Dalai Lama said, "my religion
is kindness." Those taking care of veterans should embrace such
a philosophy. Break the myth that "you are not weak, you are
strong." Allow military personnel to state their injuries.
3) Emergency care. It must be timely. Veterans must have 24/7
access to mental health services. They should know that when
they are in crisis they should call 9-1-1. Ensure a safe place/warm
handoff. Narcan should be made even more widely available.
The assessment of the individual is crucial. Veterans considering
suicide tend to not seek help, so health care and peer resources
need to proactively engage with veterans.
4) Drug and Alcohol Counseling. Many veterans in physical
pain need alternatives to the opioids on the market. Drugs should
be removed from the marketplace that cause more harm than
good. Pills are not always the answer. Veterans need counseling
on the dangers of excessive drinking. They need to be helped to
find alternatives to self-medication. Offer integrative approaches,
such as yoga and equine therapy.
5) Veterans programs need to be better coordinated.
Doctors should be able to know what drugs a patient is receiving
from all sources - the VA and private physicians.
6) Recovery is a lifelong process. Need to look at issues
that cause relapses. Recovery starts when there is a platform for
people to be open and have conversations.
7) Need more accurate research to get a better understanding of the current causes of veteran suicides. Need
algorithms to identify people who are most vulnerable and try
to offer the best programs for their needs during the timeframe
when they are seeking services.
8) Need more funding for veterans' programs on both a
national and state level. *

Summer 2019 : Philadelphia Medicine 11

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Philadelphia Medicine Summer 2019

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